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Severe fetal hemorrhage and maternal coagulopathy following intentional bromadiolone ingestion in late pregnancy: a case report

Year: 2026

Type: article

Abstract: Introduction and importance: Long-acting anticoagulant rodenticide poisoning during pregnancy is extremely rare but potentially catastrophic. Bromadiolone, a highly lipophilic superwarfarin, crosses the placenta and can cause fetal coagulopathy. Case presentation: A 19-year-old primigravida at 37 weeks of gestation presented with abdominal pain and fetal distress. Ultrasound showed mild fetal ventriculomegaly and pleural and pericardial effusions. An emergency cesarean delivery was performed for a Category III fetal heart rate tracing. The neonate died shortly after birth, with copious bright red blood observed in the airway during intubation. Postoperatively, the mother developed profound coagulopathy (PT >150 s, unmeasurable INR, prolonged aPTT) with preserved platelet count and fibrinogen. Repeated history-taking revealed intentional ingestion of bromadiolone bait 12 days earlier. She was treated successfully with fresh frozen plasma and prolonged vitamin K1 therapy. Clinical discussion: Marked PT/aPTT prolongation with normal platelet count and fibrinogen supported acquired vitamin K-dependent factor deficiency rather than obstetric DIC. Although toxicological confirmation and autopsy were unavailable, the exposure history, coagulation pattern, neonatal airway bleeding, and response to vitamin K1 strongly supported bromadiolone-associated coagulopathy with suspected severe perinatal hemorrhage. Conclusion: LAAR poisoning should be considered in pregnant patients with unexplained severe coagulopathy and a preserved platelet count and fibrinogen levels. Delayed fetal compromise may occur even when maternal symptoms are minimal. Early multidisciplinary management, prolonged vitamin K1 therapy, and psychosocial support are important.

Source: International Journal of Surgery Case Reports

DOI: 10.1097/rc9.0000000000001043

Authors: Zhiyan Chen, Meifeng Shen, Chenyang Ma, Huifei Kong

Institution: Hangzhou Xiaoshan Second People's Hospital

Language: English

Topic: Poisoning and overdose treatments

Subfield: Emergency Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,090