Monitor uterine contractions and foetal heart rate. Lactating women who have been bitten by snakes should be encouraged to continue breast feeding.

Clues for severe snake envenomation should be sought are:

• Rapid early extension of local swelling from the site of the bite. In Cobra bite on finger, necrosis may start in few minutes.

• Early tender enlargement of local lymph nodes, indicating spread of venom in the lymphatic system

• Visible signs of neurological impairment such as ptosis, muscular weakness, respiratory distress or respiratory arrest.

• Early spontaneous systemic bleeding especially bleeding from the gums, bite site, haematuria, haemoptysis, epistaxis or ecchymoses.

• Unconsciousness either with or without respiratory arrest.

• Passage of dark brown urine

• Snake identified as a very venomous one i.e., Cobra, Russel’s viper.