Severe Antepartum Eclampsia Complicated by Intrauterine Fetal Demise and Pulmonary Edema: A Case Report

Background: Eclampsia remains a leading cause of maternal mortality in low-resource settings, particularly among adolescent primigravida with limited antenatal care. This report describes the management of severe eclampsia complicated by intrauterine fetal demise (IUFD) and multiorgan dysfunction in a 17-year-old primigravida at 35 weeks gestation in Mogadishu, Somalia. Case Presentation: A 17-year-old primigravida presented with generalized tonic-clonic seizures, Oxygen saturation of 78% (SPO2), blood glucose of 47 mg/dL, and elevated blood pressure of 140/90 mmHg. Initial findings included generalized edema, absent fetal heart rate, proteinuria (+++), acute kidney injury (creatinine 1.76 mg/dL), borderline thrombocytopenia (platelets 152 × 10 9 /L at admission, declining to 113 × 10 9 /L by Day 2), and transaminitis (AST 527 U/L, ALT 370.2 U/L). Obstetric ultrasound confirmed IUFD. Following resuscitation, magnesium sulfate seizure prophylaxis, intubation, and mechanical ventilation, she underwent emergency cesarean section delivering a macerated stillborn fetus weighing 2.13 kg. Chest radiography showed bilateral pulmonary opacities consistent with pulmonary edema. Postoperative intensive care included broad-spectrum antibiotics, furosemide and gradual ventilatory weaning. She was extubated on day 5 and discharged in stable condition on day 7. Conclusion: Multidisciplinary critical care enabled maternal survival despite severe physiological derangements, highlighting the need for enhanced emergency obstetric and ICU capacity in Somalia.