Massive vulvar edema during pregnancy: A case report

INTRODUCTION: Massive vulvar edema is an unusual complication of pregnancy that may be due to underlying systemic pathology but has also been associated with preeclampsia. It is likely to interfere with vaginal delivery. It has been associated with maternal mortality in the postpartum period. OBSERVATION: A 34 years old female patient, having already delivered a child by vaginal route, without any other particular pathological history, admitted for severe pre-eclampsia on an unattended pregnancy estimated at 36 weeks of amenorrhea. The examination on admission showed a blood pressure of 170/110 mmHg, a proteinuria of three crosses on the urine dipstick. Examination of the vulva showed massive vulvar edema. The massive vulvar edema was explained by hypoprotidemia secondary to renal damage in the context of severe pre-eclampsia. The evolution was marked by the rapid normalization of the tentional figures and a spectacular regression of the vulvar edema, and its complete disappearance in fifteen days. DISCUSSION: Edema may be seen in 80 % of pregnant women, but isolated massive vulvar edema is rare in pregnancy. Massive vulvar edema has been reported in the literature after tocolysis, vulvovaginitis, Crohn's disease and pre-eclampsia. Treatment of vulvar edema is necessary because it can be alarming to the patient and may lead to occlusion of the vulvar orifices. The patient with vulvar edema deserves special attention, and identification and treatment of the associated factors are essential to its management. CONCLUSION: Massive vulvar edema is rare in pregnancy but requires special attention because it can be associated with maternal and fetal complications. Treatment is symptomatic and etiologic whenever an underlying cause is found and the evolution is often favorable with proper treatment.