Massive Vulvar Edema in a Patient with Preeclampsia with Severe Features Managed with Needle Fenestration: A Case Report

Sisay Beyazn; Awoke Belete

doi:doi:10.11648/j.mhs.20260201.12

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Massive Vulvar Edema in a Patient with Preeclampsia with Severe Features Managed with Needle Fenestration: A Case Report

Sisay Beyazn^*

, Awoke Belete

Published in Medicine and Health Sciences (Volume 2, Issue 1)

Received: 18 November 2025 Accepted: 27 November 2025 Published: 29 December 2025

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Abstract

Massive vulvar edema is an uncommon but distressing complication during pregnancy, most frequently associated with preeclampsia with severe features, and can result in significant maternal discomfort, functional impairment, urinary obstruction, and difficulty with obstetric assessment. Although conservative management-such as pelvic elevation, cold compresses, and analgesia-is typically the first-line approach, severe cases may necessitate alternative interventions. We report the case of a 30-year-old primigravida at 33+1 weeks’ gestation who presented with sudden-onset, rapidly progressive vulvar swelling over two days, accompanied by severe pain, inability to abduct the thighs, difficulty walking, urinary retention, persistent headache, and blurred vision. On examination, her blood pressure was 170/110 mmHg with significant proteinuria, fulfilling criteria for preeclampsia with severe features. Initial management included antihypertensive therapy, magnesium sulfate for seizure prophylaxis, and dexamethasone for fetal lung maturation. Conservative measures failed to relieve the swelling, and urinary catheterization was impossible due to extreme edema. Multiple superficial needle fenestrations (“needle prickering”) were performed under sterile conditions, resulting in immediate decompression of the vulvar tissue, enabling catheter placement, and providing rapid relief of pain and improved mobility. The patient was managed expectantly until spontaneous labor at 34 weeks, delivering a 1700 g female neonate with good Apgar scores, and both mother and newborn were discharged in stable condition. This case demonstrates that needle fenestration is a simple, minimally invasive, and effective intervention for rapid decompression in severe vulvar edema associated with preeclampsia when conservative measures fail, and highlights its potential value as a supportive measure in selected patients.

Published in	Medicine and Health Sciences (Volume 2, Issue 1)
DOI	10.11648/j.mhs.20260201.12
Page(s)	10-14
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Vulvar Edema, Massive Edema, Preeclampsia, Pregnancy, Needle Fenestration, Obstetric Complication

References

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[2]	Ngowa JDK, Kasia JM, Damtheou S, Ashuntantang G, Toukam M, Mawamba YN, Vlastos AT. Massive vulvar edema in a woman with severe preeclampsia: a case report and review of literature. Clinics in Mother Child Health. 2010; 7. https://doi.org/10.4303/CMCH/C102047
[3]	El Fazazi H, Benabdejlil Y, Achenani M, Kouach J, Moussaoui D, Dehayni M. Isolated massive vulval edema in pregnancy: a case report. Int J Innov Appl Stud. 2014; 7(2): 631–3. https://doi.org/10.11604/pamj.2014.19.338.5572
[4]	Baidada A, Chater S, Laaboub K, Kharbach A, Lakhdar A, Douraidi N. Vulvar edema with severe preeclampsia: case report. Asian Res J Gynaecol Obstet. 2022; 5(1): 195–7.
[5]	Bracero LA, Didomenico A. Massive vulvar edema complicating preeclampsia: a management dilemma. J Perinatol. 1991; 11(2): 122–5. https://doi.org/10.1038/jp.1991.24
[6]	Ihssane et al. Pathophysiology of vulvar edema in pregnancy, renin-angiotensin, oncotic pressure, and tissue characteristics. World J Pharm Res. 2020.
[7]	Le QA, Akhter R, Coulton K, et al. Periodontitis and preeclampsia in pregnancy: systematic review and meta-analysis. arXiv. https://doi.org/10.1007/s10995-022-03556-6
[8]	Bermejo Martín JF, Martín Fernández M, López Mestanza C, Duque P, Almansa R. Shared features of endothelial dysfunction in sepsis and chronic disease: relevance to preeclampsia (vascular leakage, permeability). https://doi.org/10.3390/jcm7110400
[9]	Denis A, Merviel P, Janky E. Management of vulvar edema associated with severe preeclampsia: case series and literature review. J Obstet Gynaecol Res. 2020; 46(4): 620–5. https://doi.org/10.1111/jog.14191
[10]	Adkins K, Thomas L, Rivera S. Pathophysiologic mechanisms of fluid overload in hypertensive disorders of pregnancy. Hypertens Pregnancy. 2018; 37(3): 133–40. https://doi.org/10.1080/10641955.2018.1468329
[11]	Patel H, Wong K, Lee J. Needle fenestration for refractory vulvar edema: a minimally invasive approach. Case Rep Obstet Gynecol. 2021; 2021: 1–4. https://doi.org/10.1155/2021/8894523
[12]	Gebremariam A, Teshome T, Yimer T. Severe preeclampsia and its atypical manifestations in low-resource settings. Ethiop Med J. 2022; 60(1): 31–8. https://doi.org/10.2147/emj202206
[13]	Brown MA, Magee LA, Kenny LC, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations. Pregnancy Hypertens. 2018; 13: 291–310. https://doi.org/10.1016/j.preghy.2018.05.004
[14]	Santos P, Oliveira L, Ferreira A. Localized edema in pregnancy: differential diagnosis and management strategies. Clin Obstet Gynecol. 2020; 63(4): 821–9. https://doi.org/10.1097/GRF.0000000000000585
[15]	Patel A, Singh R, Sharma P. Management of severe vulvar edema in pregnancy: a systematic review of conservative and interventional approaches. Int J Womens Health. 2021; 13: 789–797. https://doi.org/10.2147/IJWH.S321456

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APA Style

Beyazn, S., Belete, A. (2025). Massive Vulvar Edema in a Patient with Preeclampsia with Severe Features Managed with Needle Fenestration: A Case Report. Medicine and Health Sciences, 2(1), 10-14. https://doi.org/10.11648/j.mhs.20260201.12

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ACS Style

Beyazn, S.; Belete, A. Massive Vulvar Edema in a Patient with Preeclampsia with Severe Features Managed with Needle Fenestration: A Case Report. Med. Health Sci. 2025, 2(1), 10-14. doi: 10.11648/j.mhs.20260201.12

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AMA Style

Beyazn S, Belete A. Massive Vulvar Edema in a Patient with Preeclampsia with Severe Features Managed with Needle Fenestration: A Case Report. Med Health Sci. 2025;2(1):10-14. doi: 10.11648/j.mhs.20260201.12

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@article{10.11648/j.mhs.20260201.12,
  author = {Sisay Beyazn and Awoke Belete},
  title = {Massive Vulvar Edema in a Patient with Preeclampsia with Severe Features Managed with Needle Fenestration: A Case Report},
  journal = {Medicine and Health Sciences},
  volume = {2},
  number = {1},
  pages = {10-14},
  doi = {10.11648/j.mhs.20260201.12},
  url = {https://doi.org/10.11648/j.mhs.20260201.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.mhs.20260201.12},
  abstract = {Massive vulvar edema is an uncommon but distressing complication during pregnancy, most frequently associated with preeclampsia with severe features, and can result in significant maternal discomfort, functional impairment, urinary obstruction, and difficulty with obstetric assessment. Although conservative management-such as pelvic elevation, cold compresses, and analgesia-is typically the first-line approach, severe cases may necessitate alternative interventions. We report the case of a 30-year-old primigravida at 33+1 weeks’ gestation who presented with sudden-onset, rapidly progressive vulvar swelling over two days, accompanied by severe pain, inability to abduct the thighs, difficulty walking, urinary retention, persistent headache, and blurred vision. On examination, her blood pressure was 170/110 mmHg with significant proteinuria, fulfilling criteria for preeclampsia with severe features. Initial management included antihypertensive therapy, magnesium sulfate for seizure prophylaxis, and dexamethasone for fetal lung maturation. Conservative measures failed to relieve the swelling, and urinary catheterization was impossible due to extreme edema. Multiple superficial needle fenestrations (“needle prickering”) were performed under sterile conditions, resulting in immediate decompression of the vulvar tissue, enabling catheter placement, and providing rapid relief of pain and improved mobility. The patient was managed expectantly until spontaneous labor at 34 weeks, delivering a 1700 g female neonate with good Apgar scores, and both mother and newborn were discharged in stable condition. This case demonstrates that needle fenestration is a simple, minimally invasive, and effective intervention for rapid decompression in severe vulvar edema associated with preeclampsia when conservative measures fail, and highlights its potential value as a supportive measure in selected patients.},
 year = {2025}
}

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TY  - JOUR
T1  - Massive Vulvar Edema in a Patient with Preeclampsia with Severe Features Managed with Needle Fenestration: A Case Report
AU  - Sisay Beyazn
AU  - Awoke Belete
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T2  - Medicine and Health Sciences
JF  - Medicine and Health Sciences
JO  - Medicine and Health Sciences
SP  - 10
EP  - 14
PB  - Science Publishing Group
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AB  - Massive vulvar edema is an uncommon but distressing complication during pregnancy, most frequently associated with preeclampsia with severe features, and can result in significant maternal discomfort, functional impairment, urinary obstruction, and difficulty with obstetric assessment. Although conservative management-such as pelvic elevation, cold compresses, and analgesia-is typically the first-line approach, severe cases may necessitate alternative interventions. We report the case of a 30-year-old primigravida at 33+1 weeks’ gestation who presented with sudden-onset, rapidly progressive vulvar swelling over two days, accompanied by severe pain, inability to abduct the thighs, difficulty walking, urinary retention, persistent headache, and blurred vision. On examination, her blood pressure was 170/110 mmHg with significant proteinuria, fulfilling criteria for preeclampsia with severe features. Initial management included antihypertensive therapy, magnesium sulfate for seizure prophylaxis, and dexamethasone for fetal lung maturation. Conservative measures failed to relieve the swelling, and urinary catheterization was impossible due to extreme edema. Multiple superficial needle fenestrations (“needle prickering”) were performed under sterile conditions, resulting in immediate decompression of the vulvar tissue, enabling catheter placement, and providing rapid relief of pain and improved mobility. The patient was managed expectantly until spontaneous labor at 34 weeks, delivering a 1700 g female neonate with good Apgar scores, and both mother and newborn were discharged in stable condition. This case demonstrates that needle fenestration is a simple, minimally invasive, and effective intervention for rapid decompression in severe vulvar edema associated with preeclampsia when conservative measures fail, and highlights its potential value as a supportive measure in selected patients.
VL  - 2
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Author Information

Sisay Beyazn

Department of Obstetrics and Gynecology, Debre Berhan University, Debre Berhan, Ethiopia

Contact Email

http://orcid.org/0009-0005-1773-7513
Awoke Belete

Department of Obstetrics and Gynecology, Alem Ketema Enat Hospital, Amhara, Ethiopia

Contact Email

http://orcid.org/0009-0007-3804-9570

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APA Style

Beyazn, S., Belete, A. (2025). Massive Vulvar Edema in a Patient with Preeclampsia with Severe Features Managed with Needle Fenestration: A Case Report. Medicine and Health Sciences, 2(1), 10-14. https://doi.org/10.11648/j.mhs.20260201.12

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ACS Style

Beyazn, S.; Belete, A. Massive Vulvar Edema in a Patient with Preeclampsia with Severe Features Managed with Needle Fenestration: A Case Report. Med. Health Sci. 2025, 2(1), 10-14. doi: 10.11648/j.mhs.20260201.12

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AMA Style

Beyazn S, Belete A. Massive Vulvar Edema in a Patient with Preeclampsia with Severe Features Managed with Needle Fenestration: A Case Report. Med Health Sci. 2025;2(1):10-14. doi: 10.11648/j.mhs.20260201.12

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@article{10.11648/j.mhs.20260201.12,
  author = {Sisay Beyazn and Awoke Belete},
  title = {Massive Vulvar Edema in a Patient with Preeclampsia with Severe Features Managed with Needle Fenestration: A Case Report},
  journal = {Medicine and Health Sciences},
  volume = {2},
  number = {1},
  pages = {10-14},
  doi = {10.11648/j.mhs.20260201.12},
  url = {https://doi.org/10.11648/j.mhs.20260201.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.mhs.20260201.12},
  abstract = {Massive vulvar edema is an uncommon but distressing complication during pregnancy, most frequently associated with preeclampsia with severe features, and can result in significant maternal discomfort, functional impairment, urinary obstruction, and difficulty with obstetric assessment. Although conservative management-such as pelvic elevation, cold compresses, and analgesia-is typically the first-line approach, severe cases may necessitate alternative interventions. We report the case of a 30-year-old primigravida at 33+1 weeks’ gestation who presented with sudden-onset, rapidly progressive vulvar swelling over two days, accompanied by severe pain, inability to abduct the thighs, difficulty walking, urinary retention, persistent headache, and blurred vision. On examination, her blood pressure was 170/110 mmHg with significant proteinuria, fulfilling criteria for preeclampsia with severe features. Initial management included antihypertensive therapy, magnesium sulfate for seizure prophylaxis, and dexamethasone for fetal lung maturation. Conservative measures failed to relieve the swelling, and urinary catheterization was impossible due to extreme edema. Multiple superficial needle fenestrations (“needle prickering”) were performed under sterile conditions, resulting in immediate decompression of the vulvar tissue, enabling catheter placement, and providing rapid relief of pain and improved mobility. The patient was managed expectantly until spontaneous labor at 34 weeks, delivering a 1700 g female neonate with good Apgar scores, and both mother and newborn were discharged in stable condition. This case demonstrates that needle fenestration is a simple, minimally invasive, and effective intervention for rapid decompression in severe vulvar edema associated with preeclampsia when conservative measures fail, and highlights its potential value as a supportive measure in selected patients.},
 year = {2025}
}

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TY  - JOUR
T1  - Massive Vulvar Edema in a Patient with Preeclampsia with Severe Features Managed with Needle Fenestration: A Case Report
AU  - Sisay Beyazn
AU  - Awoke Belete
Y1  - 2025/12/29
PY  - 2025
N1  - https://doi.org/10.11648/j.mhs.20260201.12
DO  - 10.11648/j.mhs.20260201.12
T2  - Medicine and Health Sciences
JF  - Medicine and Health Sciences
JO  - Medicine and Health Sciences
SP  - 10
EP  - 14
PB  - Science Publishing Group
UR  - https://doi.org/10.11648/j.mhs.20260201.12
AB  - Massive vulvar edema is an uncommon but distressing complication during pregnancy, most frequently associated with preeclampsia with severe features, and can result in significant maternal discomfort, functional impairment, urinary obstruction, and difficulty with obstetric assessment. Although conservative management-such as pelvic elevation, cold compresses, and analgesia-is typically the first-line approach, severe cases may necessitate alternative interventions. We report the case of a 30-year-old primigravida at 33+1 weeks’ gestation who presented with sudden-onset, rapidly progressive vulvar swelling over two days, accompanied by severe pain, inability to abduct the thighs, difficulty walking, urinary retention, persistent headache, and blurred vision. On examination, her blood pressure was 170/110 mmHg with significant proteinuria, fulfilling criteria for preeclampsia with severe features. Initial management included antihypertensive therapy, magnesium sulfate for seizure prophylaxis, and dexamethasone for fetal lung maturation. Conservative measures failed to relieve the swelling, and urinary catheterization was impossible due to extreme edema. Multiple superficial needle fenestrations (“needle prickering”) were performed under sterile conditions, resulting in immediate decompression of the vulvar tissue, enabling catheter placement, and providing rapid relief of pain and improved mobility. The patient was managed expectantly until spontaneous labor at 34 weeks, delivering a 1700 g female neonate with good Apgar scores, and both mother and newborn were discharged in stable condition. This case demonstrates that needle fenestration is a simple, minimally invasive, and effective intervention for rapid decompression in severe vulvar edema associated with preeclampsia when conservative measures fail, and highlights its potential value as a supportive measure in selected patients.
VL  - 2
IS  - 1
ER  -

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