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The Use of a Continuous Infusion of Epinephrine for Anaphylactic Shock During Labor

Gei, Alfredo F. MD; Pacheco, Luis D. MD; Vanhook, James W. MD; Hankins, Gary D. V. MD

Obstetrics & Gynecology:
Case Report
Abstract

BACKGROUND: Anaphylaxis is a potentially life threatening, acute, and severe systemic reaction that occurs after the reexposure to a specific antigen. This immunoglobulin E-mediated process is the result of the action of basophils and mast cell mediators, causing severe brochospasm, laringospasm, angioedema, urticaria, and cardiovascular collapse.

CASE: We present a case of anaphylactic shock during labor secondary to administration of ampicillin for group B streptococcus prophylaxis. Generalized itching and hives were soon followed by severe maternal hypotension and tachycardia and prolonged fetal bradycardia. These symptoms responded partially to the administration of fluids and parenteral epinephrine. A continuous infusion of epinephrine was required for persistent maternal symptoms. The infusion did not result in further fetal compromise. The patient delivered a healthy fetus 4 hours after the start of the epinephrine infusion.

CONCLUSION: This case supports the use of parenteral (intravenous) epinephrine for the treatment of anaphylactic reactions during pregnancy.

In Brief

We describe an anaphylactic reaction during labor requiring a continuous infusion of epinephrine and resulting in the vaginal delivery of a healthy fetus.

Author Information

Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas

Address reprint requests to: Alfredo F. Gei, MD, Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, 3.400 John Sealy Annex, 301 University Boulevard, Galveston, TX 77555-0587; E-mail: afgei@utmb.edu.

Received October 22, 2003. Received in revised form January 6, 2003. Accepted January 23, 2003

© 2003 by The American College of Obstetricians and Gynecologists.