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<p>Severe refractory epistaxis during pregnancy is uncommon but may rapidly become a life-threatening emergency involving airway safety, haemodynamic stability, ENT decision-making, and obstetric risk assessment. We report a 32-year-old woman at 32 weeks of gestation who presented with profuse spontaneous epistaxis of more than 12 h’ duration, associated with oropharyngeal pooling of blood and haemodynamic compromise. Initial anterior rhinoscopy suggested a posterior or diffuse mucosal bleeding source, with no visible nasal mass or traumatic lesion. Bilateral anterior and posterior nasal packing failed to control the bleeding, and targeted cautery or endoscopic localization was not feasible because of extensive active haemorrhage and poor visualization. Because of aspiration risk and ongoing maternal instability, airway protection was achieved by modified rapid sequence induction, followed by ventilatory and haemodynamic support. Resuscitation included crystalloid infusion, packed red blood cell transfusion, tranexamic acid, and norepinephrine infusion, guided by clinical response and conventional laboratory parameters in the absence of viscoelastic haemostatic testing. Interventional radiology was unavailable. With continued bleeding despite available ENT measures and supportive resuscitation, emergency caesarean section was considered by a multidisciplinary team as a last-resort intervention after weighing maternal risk against iatrogenic prematurity. Epistaxis ceased completely after placental delivery and did not recur, suggesting a pregnancy-related mucosal or hormonal contribution, although causality cannot be established. Postpartum nasal endoscopy and vascular imaging were not performed because of complete clinical resolution, which remains a diagnostic limitation. Both mother and neonate recovered without further complication. This case highlights the need for early ENT assessment, airway protection, haemodynamic support, multidisciplinary planning, and cautious risk–benefit assessment when refractory epistaxis in preterm pregnancy remains uncontrolled despite available haemostatic measures.</p>

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Refractory Epistaxis in Preterm Pregnancy Requiring Emergency Caesarean Delivery: A Case Report

  • 期刊论文

  • 发表日期：

    2026年6月26日

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  • Arun Kumar Patra,
  • Sanjay Kumar,
  • Mandavi Dwivedi,
  • Kashmira Prem,
  • Devesh Yadav

摘要

Severe refractory epistaxis during pregnancy is uncommon but may rapidly become a life-threatening emergency involving airway safety, haemodynamic stability, ENT decision-making, and obstetric risk assessment. We report a 32-year-old woman at 32 weeks of gestation who presented with profuse spontaneous epistaxis of more than 12 h’ duration, associated with oropharyngeal pooling of blood and haemodynamic compromise. Initial anterior rhinoscopy suggested a posterior or diffuse mucosal bleeding source, with no visible nasal mass or traumatic lesion. Bilateral anterior and posterior nasal packing failed to control the bleeding, and targeted cautery or endoscopic localization was not feasible because of extensive active haemorrhage and poor visualization. Because of aspiration risk and ongoing maternal instability, airway protection was achieved by modified rapid sequence induction, followed by ventilatory and haemodynamic support. Resuscitation included crystalloid infusion, packed red blood cell transfusion, tranexamic acid, and norepinephrine infusion, guided by clinical response and conventional laboratory parameters in the absence of viscoelastic haemostatic testing. Interventional radiology was unavailable. With continued bleeding despite available ENT measures and supportive resuscitation, emergency caesarean section was considered by a multidisciplinary team as a last-resort intervention after weighing maternal risk against iatrogenic prematurity. Epistaxis ceased completely after placental delivery and did not recur, suggesting a pregnancy-related mucosal or hormonal contribution, although causality cannot be established. Postpartum nasal endoscopy and vascular imaging were not performed because of complete clinical resolution, which remains a diagnostic limitation. Both mother and neonate recovered without further complication. This case highlights the need for early ENT assessment, airway protection, haemodynamic support, multidisciplinary planning, and cautious risk–benefit assessment when refractory epistaxis in preterm pregnancy remains uncontrolled despite available haemostatic measures.