Massive ascites following spontaneous vaginal delivery in a woman with preeclampsia-a diagnostic and management challenges in a low resource country: A case report

Introduction and importance: Hypertensive disorders of pregnancy, including preeclampsia, causes major pregnancy associated morbidity and mortality. Massive ascites is a rare complication in a severe preeclampsia. This case report high lights the importance of obstetrician being aware of such complications of severe preeclampsia, and avoid non-therapeutic interventions such as exploratory laparotomy. Case presentation: A 39-year-old woman from remote village of Bhutan with severe preeclampsia had spontaneous vaginal delivery in the ambulance at 34+6 weeks of gestation enroute to a tertiary care hospital. In the postpartum period, she had a massive ascites, and she underwent exploratory laparotomy. Discussion: Ascites in severe preeclampsia is a rare complication. Diagnosis and management of such a rare condition is challenging in a resource constraint setting. In addition, prevalence of tuberculosis and gynecological malignancies in our setting prompts obstetricians to perform an invasive procedure such as exploratory laparotomy in view of excluding these conditions. Conclusion: This case report highlights the importance of obstetricians to be aware of the possibility of ascites in preeclampsia which may be managed medically, without the need for surgical interventions.