Phản vệ ở sản phụ trước sinh: Báo cáo một trường hợp

Anaphylaxis during pregnancy, though a rare event, represents a critical obstetric emergency with potentially devastating consequences for both the mother and fetus. The profound maternal hypotension and compromised uteroplacental perfusion that often accompany anaphylactic shock can lead to severe adverse outcomes, including fetal hypoxia and increased risk of emergency cesarean delivery. Despite its gravity, current guidelines for managing anaphylaxis specifically in pregnant women, particularly regarding the optimal timing for intervention and delivery, remain limited. This case report aims to highlight the complexities and critical considerations in managing such an acute condition in a full-term pregnant patient.

Obstetricians, anesthesiologists, emergency physicians, intensivists, and allergists/immunologists involved in the care of pregnant women.

This paper presents a detailed case report on the management of anaphylactic shock in a 26-year-old full-term pregnant woman (38 weeks 4 days gestation) scheduled for a repeat cesarean section, who developed an anaphylactic reaction to prophylactic Cefazolin. The patient presented with severe symptoms including dyspnea, rash, facial edema, tachycardia, and hypotension, necessitating immediate and aggressive intervention. Initial treatment involved intramuscular and continuous intravenous Adrenaline infusion, along with oxygen administration, intravenous fluid resuscitation, uterine displacement, and continuous fetal heart rate monitoring. The patient responded well, stabilizing after nine hours, with subsequent drug allergy testing performed before a delayed cesarean section. This case underscores that while the fundamental principles of managing anaphylactic shock in pregnant women are similar to non-pregnant individuals, specific obstetric considerations are paramount. Crucially, early fluid resuscitation, timely Adrenaline administration, uterine displacement for optimal uteroplacental perfusion, and continuous fetal heart rate monitoring are vital. The decision to perform a cesarean section in the context of anaphylaxis should be carefully weighed, prioritizing maternal stabilization and resolution of shock to mitigate significant risks associated with anesthesia during an acute anaphylactic episode, unless fetal distress is imminent.