Acute chlorpyrifos poisoning in pregnancy: a case report.
BACKGROUND
Pesticide exposures and poisoning are common and generally under-reported in poorly resourced countries where women are mainly involved in agricultural work. Cases of organophosphate poisoning in pregnancy are unusual.


METHODS
A 22-year-old woman in her 29th week of pregnancy presented to King Edward VIII Hospital, Durban, South Africa having had multiple generalized tonic-clonic seizures at home. An initial presumptive diagnosis of eclampsia was made and treatment using intravenous MgSO(4) was initiated. Signs of OP toxicity included a garlic odor; vomiting, diarrhea, fecal incontinence; hypersecretions with airway compromise, diffuse rhonchi; pinpoint pupils; and muscle weakness and fasciculations. The patient responded to intravenous doses of atropine; oximes were not available. Although the mother survived, the infant was born prematurely and died two days after birth without showing any OP signs.


CONCLUSIONS
Organophosphate poisoning may mimic acute complications in pregnancy, such as eclampsia and seizures. Immediate management includes general supportive measures and use of specific pharmacological agents such as atropine and oximes. Poisoning during pregnancy may result in serious adverse effects for both mother and the fetus or neonate. Prompt diagnosis and treatment are necessary to avoid adverse outcomes.
Solomon
G M
GM
MRC/UN Pregnancy Hypertension Research Unit and Department of Obstetrics and Gynecology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
Moodley
J
J
D000328:Adult; D001285:Atropine / Q000627:therapeutic use; D004390:Chlorpyrifos / Q000506:poisoning*; D002800:Cholinesterase Inhibitors / Q000506:poisoning*; D003866:Depressive Disorder / Q000150:complications; D017809:Fatal Outcome; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007306:Insecticides / Q000506:poisoning*; D018721:Muscarinic Agonists / Q000627:therapeutic use; D011225:Pre-Eclampsia / Q000139:chemically induced / Q000188:drug therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced*; D012640:Seizures / Q000139:chemically induced; D013406:Suicide, Attempted
D002800:Cholinesterase Inhibitors; D007306:Insecticides; D018721:Muscarinic Agonists; D001285:Atropine; D004390:Chlorpyrifos