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Anaphylaxis in the Clinical Setting of Obstetric Anesthesia: A Literature Review

Hepner, David L. MD, MPH*; Castells, Mariana MD, PhD; Mouton-Faivre, Claudie MD; Dewachter, Pascale MD, PhD

doi: 10.1213/ANE.0b013e3182a706c7
Obstetric Anesthesiology: Review Article
Continuing Medical Education

The prevalence of anaphylaxis occurring during pregnancy is approximately 3 cases per 100,000 deliveries. The management of anaphylaxis occurring during the third trimester of pregnancy may be challenging because of the additive effects of aortocaval compression and cardiovascular disturbances of anaphylaxis. In this review, we identify the clinical signs of anaphylaxis occurring during labor and cesarean delivery, discuss the more common allergens that cause anaphylaxis during this clinical setting, and develop a rational approach to the identification of the offending allergen. We also suggest strategies for the management of anaphylaxis occurring during the third trimester of pregnancy, including the prompt administration of epinephrine and emergency cesarean delivery in cases of severe reactions. Evidence is limited to case reports and extrapolation from nonfatal and fatal cases, interpretation of pathophysiology, and consensus opinion.

From the *Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Pôle d’Anesthésie-Réanimation & Consultation d’Allergo-Anesthésie, Centre Hospitalier Universitaire, Nancy, France; and §Service d’Anesthésie-Réanimation Chirurgicale, Hôpital Européen Georges Pompidou and Université Paris Descartes Sorbonne Paris Cité, Paris, France.

Accepted for publication July 3, 2013.

Funding: Not applicable.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to David L. Hepner, MD, MPH, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115. Address e-mail to dhepner@partners.org.

© 2013 International Anesthesia Research Society