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

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.