Anaesthetic Management of a Haemorrhaging Gingival Venous Malformation in Pregnancy

Venous malformation (VM) of the maxilla is rare but potentially fatal, causing massive haemorrhage. Here, we present a case of severe gingival bleed in a pregnant woman. A 35-year-old female patient at 32 weeks gestation, with no comorbidities, presented with profuse left upper gingival bleeding (~800 ml blood loss). She was tachycardic, hypotensive and anaemic with a normal coagulation profile. After initial fluid resuscitation and administration of antifibrinolytics, emergency exploration and suturing were planned immediately. Rapid sequence induction and intubation were performed with pressure applied on the bleeding site. Blood and blood products were transfused, and foetal heart rate was monitored perioperatively. After extubation, the patient was shifted to the intensive care unit. On performing magnetic resonance imaging, gingival fibro-adipose VM was detected. Oral VM in full term pregnancy with a shared airway can be a challenging nightmare to an anaesthesiologist. This can be meticulously managed by careful planning and execution.