ANAPHYLACTIC SHOCK DUE TO PROPHYLACTIC ANTIBIOTICS IN PLANNED SECTIO CESAREAN : A CASE REPORT

Authors

  • Hatsari Marintan Porman Surtana Siahaan Dr H Marsidi Judono General Hospital, Bangka Belitung, Indonesia

DOI:

https://doi.org/10.61841/k3k49m97

Keywords:

Antibiotic allergy, anaphylaxis shock, fetal compromise, maternal anaphylactic, section caesarian

Abstract

Introduction: Anaphylactic reactions during pregnancy are complex to diagnose and manage, potentially ranging from mild symptoms to life-threatening situations for both the mother and fetus. With an incidence varying from 1.44 to 2.7 cases per 100,000 births and subtle, overlapping symptoms with other obstetric emergencies, accurate identification remains a challenge. Despite being underdiagnosed, severe anaphylactic events during pregnancy share symptoms with other critical conditions, making differentiation intricate. Prior reviews and recent data underscore the necessity for guidelines and public health actions, emphasizing the importance of vigilance and specific management strategies in obstetrics.

 Case report: This case involves Ny. S, a 33-year-old pregnant woman undergoing an elective C-section, who developed an allergic reaction to Cefazolin, necessitating an emergency procedure and subsequent ICU admission due to anaphylactic complications. Patient at 38 weeks pregnant, encountered an unexpected allergic reaction during a planned C-section, necessitating an emergency procedure. Post-surgery, she experienced severe complications, including pulmonary and laryngeal edema, requiring intensive care. With prompt medical attention and a comprehensive treatment plan, including medications and careful monitoring, her condition stabilized over several days. By October 21, 2023, she showed significant improvement, allowing her discharge with scheduled follow-up care.

Discussion: The discussion encompasses the complexity of diagnosing anaphylaxis during pregnancy, highlighting challenges in laboratory confirmation, management protocols mirroring non-pregnant guidelines, and the importance of coordinated medical care to avert adverse maternal and fetal outcomes. It emphasizes the need for standardized protocols and consensus among healthcare providers to effectively manage maternal anaphylaxis, reflecting on the rarity of this condition and the potential risks it poses to both the mother and fetus.    

Conclusion:  Anaphylactic reaction during an elective C-section, prompting urgent medical intervention involving mechanical ventilator support and meticulous care. Patient’s subsequent recovery and discharge, along with fluctuating lab results indicating an acute immune response, underscore the complexity of diagnosing and managing maternal anaphylaxis, emphasizing the need for standardized protocols and coordinated healthcare approaches.

References

Tacquard, C.; Chassard, D.; Malinovsky, J.M.; Saucedo, M.; Deneux-Tharaux, C.; Mertes, P.M.; National Expert Committee on Maternal Mortality (CNEMM). Anaphylaxis-related mortality in the obstetrical setting: Analysis of the French National Confidential Enquiry into Maternal Deaths from 2001 to 2012. Br. J. Anaesth. 2019, 123, e151–e153. [Google Scholar] [CrossRef] [PubMed]

McCall, S.J.; Bunch, K.J.; Brocklehurst, P.; D’Arcy, R.; Hinshaw, K.; Kurinczuk, J.J.; Lucas, D.N.; Stenson, B.; Tuffnell, D.J.; Knight, M. The incidence, characteristics, management and outcomes of anaphylaxis in pregnancy: A population-based descriptive study. BJOG 2018, 125, 965–971. [Google Scholar] [CrossRef] [PubMed][Green Version]

McCall, S.J.; Bonnet, M.P.; Äyräs, O.; Vandenberghe, G.; Gissler, M.; Zhang, W.H.; Van Leeuw, V.; Deneux-Tharaux, C.; Kurinczuk, J.J.; Knight, M.; et al. Anaphylaxis in pregnancy: A population-based multinational European study. Anaesthesia 2020, 75, 1469–1475. [Google Scholar] [CrossRef] [PubMed]

Panesar, S.S.; Javad, S.; de Silva, D.; Nwaru, B.I.; Hickstein, L.; Muraro, A.; Roberts, G.; Worm, M.; Bilò, M.B.; Cardona, V.; et al. The epidemiology of anaphylaxis in Europe: A systematic review. Allergy 2013, 68, 1353–1361. [Google Scholar] [CrossRef] [PubMed]

D’Astous-Gauthier, K.; Graham, F.; Paradis, L.; Des Roches, A.; Bégin, P. Beta-2 Agonists May be Superior to Epinephrine to Relieve Severe Anaphylactic Uterine Contractions. J. Allergy Clin. Immunol. Pract. 2021, 9, 1232–1241. [Google Scholar] [CrossRef] [PubMed]

Hepner, D.L.; Castells, M.; Mouton-Faivre, C.; Dewachter, P. Anaphylaxis in the clinical setting of obstetric anesthesia: A literature review. Anesth. Analg. 2013, 117, 1357–1367. [Google Scholar] [CrossRef] [PubMed]

Jyotsana, L.; Dinesh, K.; Shashi, G.; Surinder, K. Maternal Mortality in a Tertiary Care Hospital: Three Years Retrospective Study. JK Sci. 2016, 18, 145–149. [Google Scholar]

Carra, S.; Schatz, M.; Mertes, P.M.; Torres, M.J.; Fuchs, F.; Senna, G.; Castells, M.C.; Demoly, P.; Tanno, L.K. Anaphylaxis and Pregnancy: A Systematic Review and Call for Public Health Actions. J. Allergy Clin. Immunol. Pract. 2021. [Google Scholar] [CrossRef] [PubMed]

Simionescu, A.A.; Stanescu, A.M.A.; Popescu, F.-D. State-of-the-Art on Biomarkers for Anaphylaxis in Obstetrics. Life 2021, 11, 870. [Google Scholar] [CrossRef] [PubMed]

Philipson, E.H.; Lang, D.M.; Gordon, S.J.; Burlingame, J.M.; Emery, S.P.; Arroliga, M.E. Management of group B Streptococcus in pregnant women with penicillin allergy. J. Reprod. Med. 2007, 52, 480–484. [Google Scholar] [CrossRef] [PubMed]

Thomas, R.E.; Lorenzetti, D.L.; Spragins, W.; Jackson, D.; Williamson, T. Active and passive surveillance of yellow fever vaccine 17D or 17DD-associated serious adverse events: Systematic review. Vaccine 2011, 29, 4544–4555. [Google Scholar] [CrossRef] [PubMed]

Simons FER, Schatz M. Anaphylaxis during pregnancy. Journal of Allergy and Clinical Immunology 2012; 130(3): 597–606. [PubMed] [Google Scholar]

Levy N, Weiniger CF. Anaphylaxis in pregnancy. In: Einav S, Weiniger CF, Landau R. (eds) Principles and practice of maternal critical care. Cham: Springer, 2020, pp. 577–581. [Google Scholar]

Savic LC, Lucas DN. Anaphylaxis in obstetrics – double the trouble. Anaesthesia 2020; 75(11): 1424–1427. [PubMed] [Google Scholar]

Simon LV, Hashmi MF, Bragg BN. APGAR score. Treasure Island, FL: StatPearls Publishing, 2022. [Google Scholar]

Fox S, Park MA. Penicillin skin testing in the evaluation and management of penicillin allergy. Ann Allergy Asthma Immunol 2011; 106(1): 1–7. [PubMed] [Google Scholar]

Berenguer A, Couto A, Brites V, et al. Anaphylaxis in pregnancy: a rare cause of neonatal mortality. BMJ Case Rep 2013; 2013: bcr2012007055. [PMC free article] [PubMed] [Google Scholar]

Fernando UPM, Dharmawardhane MP, Subramaniam N, et al. Acute respiratory distress syndrome following anaphylactic shock – ‘a deadly duel’ – case report and literature review. Open J Anesthesiol 2021: 11: 33–38. [Google Scholar]

Berenguer A, Couto A, Brites V, et al. BMJ Case Reports Published online: [please include Day Month Year] doi:10.1136/ bcr-2012-007055

MacGinnitie A. In utero anaphylaxis. Med Hypotheses 2011;76:70–2.

Jeon, Hye Ji MDa; Ryu, Aeli MDa, Min, Jiwon MDa; Kim, Nan Seol MDb. Maternal anaphylactic shock in pregnancy: A case report. Medicine 97(37):p e12351, September 2018. | DOI: 10.1097/MD.0000000000012351

Hofmeyr GJ, Smaill FM. Antibiotic prophylaxis for cesarean section. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD000933. DOI: 10.1002/14651858.CD000933. Accessed 14 December 2023.

Downloads

Published

2023-12-18

How to Cite

Porman Surtana Siahaan, H. M. . (2023). ANAPHYLACTIC SHOCK DUE TO PROPHYLACTIC ANTIBIOTICS IN PLANNED SECTIO CESAREAN : A CASE REPORT. Journal of Advanced Research in Medical and Health Science (ISSN 2208-2425), 9(12), 107-114. https://doi.org/10.61841/k3k49m97