Vulval Edema: A rare complication of Preeclampsia

Abstract

Presentation
A 29-year-old primigravida woman (G1P0) with a BMI of 35.2 presented at 38+3 weeks with severe edema extending from lower abdomen to her thighs, and vulval edema predominantly right-sided, and associated with difficulty mobilizing. Her BP was 160/94 mmHg. She had a prior diagnosis of gestational hypertension that progressed to preeclampsia.

Diagnosis
Investigations revealed an elevated urine protein-creatinine ratio (PCR 103 mg/Mmol), elevated serum uric acid (399), and thrombocytosis (platelet count 447). Serial PET screening confirmed a diagnosis of preeclampsia.

Treatment
Labetalol was increased to 200 mg TDS. Due to worsening edema and functional impairment, an elective Caesarean section was performed, resulting in the delivery of a healthy 4 kg baby girl. Postoperatively, the patient developed an enlarging vulval swelling (15×10 cm) and her pain unrelenting to pain relief and impaired mobility hence it was drained under local anaesthesia yielding 250 mL of serous fluid. She was treated with oral antibiotics and discharged with improved condition.

Discussion
Massive vulval edema is a rare but distressing complication of preeclampsia, reported in very few global cases. This is the first documented case in Ireland, highlighting the importance of recognizing atypical presentations in hypertensive disorders of pregnancy. Timely intervention led to favourable maternal and foetal outcomes.