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Maternal anaphylactic shock in pregnancy: A case report.
Medicine (Baltimore). 2018 Sep; 97(37):e12351.M

Abstract

RATIONALE

Anaphylaxis is a very rare event in pregnancy, triggering maternal hypotension leading to intrapartum hypoxic-ischemic encephalopathy in infant. Furthermore, cesarean sections are performed at a high rate in anaphylactic pregnant women.

PATIENT CONCERNS

A 34-year-old pregnant woman presented with maternal anaphylaxis following prophylactic antibiotic injection for cesarean section. Within a few minutes after initiation of intradermal skin test with cefotetan, the pregnant woman developed generalized itchy rash, chest tightness, and dyspnea.

DIAGNOSES

Several minutes after the injection of antibiotics, a diffuse urticarial rash was detected over her face and trunk followed by complaints of chest tightness and dyspnea. She was diagnosed with hypotension and hypoxia. Further, fetal heart tones showed bradycardia. A presumptive diagnosis of anaphylactic reaction induced by cefotetan was made for surgical prophylaxis.

INTERVENTIONS

The patient was managed for anaphylaxis, via administration of epinephrine, glucocorticoid, and antihistamine. Emergency cesarean section performed under general anesthesia resulted in a favorable perinatal outcome for the fetus.

OUTCOMES

Maternal and fetal outcomes were good after prompt treatment for anaphylaxis and emergency cesarean section.

LESSONS

This is the first reported case of anaphylaxis following cefotetan administration in pregnancy. Cefotetan, a second-generation cephalosporin, is a commonly prescribed antibiotic used to treat a wide range of bacterial infections. The case demonstrated life-threatening anaphylactic reaction during pregnancy. Even a skin test using antibiotics alone triggered anaphylaxis.

Authors+Show Affiliations

Departments of Obstetrics and Gynaecology.Departments of Obstetrics and Gynaecology.Departments of Obstetrics and Gynaecology.Anesthesiology and Pain Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30212990

Citation

Jeon, Hye Ji, et al. "Maternal Anaphylactic Shock in Pregnancy: a Case Report." Medicine, vol. 97, no. 37, 2018, pp. e12351.
Jeon HJ, Ryu A, Min J, et al. Maternal anaphylactic shock in pregnancy: A case report. Medicine (Baltimore). 2018;97(37):e12351.
Jeon, H. J., Ryu, A., Min, J., & Kim, N. S. (2018). Maternal anaphylactic shock in pregnancy: A case report. Medicine, 97(37), e12351. https://doi.org/10.1097/MD.0000000000012351
Jeon HJ, et al. Maternal Anaphylactic Shock in Pregnancy: a Case Report. Medicine (Baltimore). 2018;97(37):e12351. PubMed PMID: 30212990.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maternal anaphylactic shock in pregnancy: A case report. AU - Jeon,Hye Ji, AU - Ryu,Aeli, AU - Min,Jiwon, AU - Kim,Nan Seol, PY - 2018/9/15/entrez PY - 2018/9/15/pubmed PY - 2018/9/21/medline SP - e12351 EP - e12351 JF - Medicine JO - Medicine (Baltimore) VL - 97 IS - 37 N2 - RATIONALE: Anaphylaxis is a very rare event in pregnancy, triggering maternal hypotension leading to intrapartum hypoxic-ischemic encephalopathy in infant. Furthermore, cesarean sections are performed at a high rate in anaphylactic pregnant women. PATIENT CONCERNS: A 34-year-old pregnant woman presented with maternal anaphylaxis following prophylactic antibiotic injection for cesarean section. Within a few minutes after initiation of intradermal skin test with cefotetan, the pregnant woman developed generalized itchy rash, chest tightness, and dyspnea. DIAGNOSES: Several minutes after the injection of antibiotics, a diffuse urticarial rash was detected over her face and trunk followed by complaints of chest tightness and dyspnea. She was diagnosed with hypotension and hypoxia. Further, fetal heart tones showed bradycardia. A presumptive diagnosis of anaphylactic reaction induced by cefotetan was made for surgical prophylaxis. INTERVENTIONS: The patient was managed for anaphylaxis, via administration of epinephrine, glucocorticoid, and antihistamine. Emergency cesarean section performed under general anesthesia resulted in a favorable perinatal outcome for the fetus. OUTCOMES: Maternal and fetal outcomes were good after prompt treatment for anaphylaxis and emergency cesarean section. LESSONS: This is the first reported case of anaphylaxis following cefotetan administration in pregnancy. Cefotetan, a second-generation cephalosporin, is a commonly prescribed antibiotic used to treat a wide range of bacterial infections. The case demonstrated life-threatening anaphylactic reaction during pregnancy. Even a skin test using antibiotics alone triggered anaphylaxis. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/30212990/Maternal_anaphylactic_shock_in_pregnancy:_A_case_report L2 - http://dx.doi.org/10.1097/MD.0000000000012351 DB - PRIME DP - Unbound Medicine ER -