Severe Antepartum Eclampsia Complicated by Intrauterine Fetal Demise and Pulmonary Edema: A Case Report.

BACKGROUND

Eclampsia remains a leading cause of maternal mortality in low-resource settings, particularly among adolescent primigravida with limited antenatal care. This report describes the management of severe eclampsia complicated by intrauterine fetal demise (IUFD) and multiorgan dysfunction in a 17-year-old primigravida at 35 weeks gestation in Mogadishu, Somalia.

CASE PRESENTATION: A 17-year-old primigravida presented with generalized tonic-clonic seizures, Oxygen saturation of 78% (SPO2), blood glucose of 47 mg/dL, and elevated blood pressure of 140/90 mmHg. Initial findings included generalized edema, absent fetal heart rate, proteinuria (+++), acute kidney injury (creatinine 1.76 mg/dL), borderline thrombocytopenia (platelets 152 ×109/L at admission, declining to 113 ×109/L by Day 2), and transaminitis (AST 527 U/L, ALT 370.2 U/L). Obstetric ultrasound confirmed IUFD. Following resuscitation, magnesium sulfate seizure prophylaxis, intubation, and mechanical ventilation, she underwent emergency cesarean section delivering a macerated stillborn fetus weighing 2.13 kg. Chest radiography showed bilateral pulmonary opacities consistent with pulmonary edema. Postoperative intensive care included broad-spectrum antibiotics, furosemide and gradual ventilatory weaning. She was extubated on day 5 and discharged in stable condition on day 7.

CONCLUSION

Multidisciplinary critical care enabled maternal survival despite severe physiological derangements, highlighting the need for enhanced emergency obstetric and ICU capacity in Somalia.