Successful management of third-trimester scorpion envenomation (Parabuthus maximus) in a resource-limited setting: A case report.

BACKGROUND: Scorpion envenomation in pregnancy is a rare but potentially fatal obstetric emergency, with limited evidence on optimal management and antivenom safety. Neurotoxic venom induces autonomic storms, threatening maternal cardiovascular stability and uteroplacental perfusion, which can lead to fetal distress or demise. CASE SUMMARY: A 31-year-old gravida 4, para 3 woman at 36 weeks' gestation presented 30 minutes after a confirmed Parabuthus maximus sting to her right foot. She manifested systemic envenomation, including agitation, profuse sweating, tachycardia (142 bpm), and hypertension (168/102 mmHg). Cardiotocography revealed fetal tachycardia (175-180 bpm). A multidisciplinary team initiated intravenous morphine, midazolam, and species-specific antivenom (South African Vaccine Producers Polyvalent Scorpion Antivenom), resulting in the resolution of maternal and fetal symptoms within 12 hours. Critically, antivenom was administered within 40 minutes of the sting, which likely contributed to the rapid reversal of the catecholamine surge. A key factor enabling this rapid and targeted response was the patient's action of capturing the scorpion, allowing for precise species identification. The pregnancy progressed uneventfully to term, culminating in an uncomplicated vaginal delivery of a healthy infant. CONCLUSION: This case illustrates that scorpion envenomation in late pregnancy poses a dual threat to both maternal and fetal well-being. Prompt recognition, continuous fetal monitoring, and the very early administration of antivenom-buttressed by multidisciplinary care-can avert catastrophic outcomes. This case provides supporting evidence that antivenom can be safe and effective during the third trimester, even in resource-constrained environments. Public education on safe first aid, including bringing the scorpion for identification, is essential.