Scorpion envenomation in pregnancy: clinical symptoms, maternal and fetal outcomes and management strategies.

BACKGROUND

Scorpion stings pose a significant public health threat, particularly in developing regions, leading to considerable morbidity and mortality. This systematic review assesses the clinical manifestations, maternal and fetal outcomes, and evaluates the treatment approaches in pregnant women affected by scorpion stings.

METHODS

A systematic search was conducted in multiple databases (Web of Science, PubMed, Scopus, SID, and Magiran) from inception to October 26, 2024. Case reports, case series, and observational studies with accessible full texts were included based on predefined eligibility criteria. Data extraction included study characteristics, maternal and gestational age, scorpion species, symptoms, and pregnancy outcomes. The methodological quality of included studies was assessed independently by two reviewers using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports and NIH (National Institutes of Health) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Disagreements were resolved by consensus or consultation with a third reviewer.

RESULTS

A total of 14 studies were included in the review, comprising case reports and case series from various countries. The average maternal age was 27.14 years, and gestational age averaged 23.94 weeks. Common symptoms reported included localized pain (71.4%), nausea (14.3%), vomiting (14.3%), fever (14.3%), and abnormal vital signs (7.1%) in severe cases. The majority of studies (78.6%) indicated low symptom severity. Maternal and fetal outcomes were generally favorable, although severe outcomes, such as maternal death and intrauterine fetal death, were reported in a few cases. Antivenom was administered in only four cases (28.6%) indicating a potential gap in its use.

CONCLUSIONS

Scorpion envenomation during pregnancy typically presents with localized pain, while severe systemic symptoms are less common. Although most maternal and fetal outcomes are favorable, serious complications such as maternal or intrauterine fetal death can occur. These findings suggest that antivenom may be underutilized in pregnant women. Therefore, we recommend: (1) increased vigilance for severe symptoms, especially abnormal vital signs; (2) timely antivenom administration in moderate-to-severe cases; and (3) standardized reporting of pregnancy-specific outcomes. Large prospective studies are urgently needed to establish evidence-based management guidelines.