Organophosphate poisoning in pregnancy : is it a cry for help?

Abstract

Organophosphate poisoning seems to be a fairly common cause of mortality in young and teenage mothers. The attending healthcare personnel, especially nursing staff and doctors, should always have a high index of suspicion when attending to teenagers who have never initiated antenatal care or those who request termination of pregnancy (TOP), because often – if these patients are not assisted – they choose unsafe, unauthorised alternatives, which could have dire consequences. A management plan should always include preventive measures, attempts to diagnose, and prompt, directed immediate and maintenance therapies. Preventive measures must include clear decisive plans on how to manage women who request TOP and advocacy for use of long-acting reversible contraception, including the intra-uterine device, for all young women who are at any time in contact with the health system. Early and correct diagnosis is mainly guided by the history, including a collateral history if the woman is unresponsive. Attending health personnel are usually able to establish substance ingestion accompanied by a varying degree of symptoms – from nausea, vomiting, hypersecretions, headache, severe confusion, pinpoint pupils, bradycardia, tachypnoea/bradypnoea, hypertension/hypotension to convulsions, coma and eventually death. The basic concepts of multidisciplinary team resuscitation, including the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach, should always be followed to stabilise the patient, while trying to elicit the cause and thus assist with further management.