Pregnancy-Associated Diseases

Anaphylaxis during pregnancy

“…34,35 Hypotension associated with anaphylaxis must be differentiated from more common causes of hypotension during pregnancy, including spinal block, local anesthetic administration, and hemorrhage. 31 Sudden onset of urticaria, itching, angioedema, stridor, or wheezing concomitantly with hypotension strongly supports the diagnosis of anaphylaxis (Table IV).…”

“…Diagnosis is based on a clinical presentation that can include 1 or more of the following: profound hypotension, cardiovascular collapse, arrhythmias, cyanosis, dyspnea, respiratory distress, hemorrhage, disseminated intravascular coagulation, and altered mental status, in the absence of other medical explanations for the clinical course. Bronchospasm, absence of large-volume blood loss, and absence of coagulopathy suggest anaphylaxis rather than AFE 31,[40][41][42][43][44] ; however, activation of the coagulation system can also occur in patients with anaphylaxis. 45 A proposed mechanism in AFE is a non-IgE-mediated immunologic reaction to fetal antigens leading to mast cell degranulation, release of histamine and tryptase, and involvement of the complement and coagulation pathways.…”

“…More than 1 body organ system is typically involved (Table II). 10,30,31 Hypotension and shock are not necessarily present. Anaphylactic and anaphylactoid reactions do not need to be distinguished with regard to diagnosis and acute treatment.…”

“…They are also found in patients with myocardial infarction and amniotic fluid embolism (AFE), both of which need to be considered in the differential diagnosis of anaphylaxis during labor and delivery (Table IV). 1,4,10,31,[33][34][35][36][37][38][39][40][41][42][43][44] Moreover, total tryptase levels within the normal reference range of 1 to 11.4 ng/mL cannot be used to refute the clinical diagnosis of anaphylaxis because tryptase levels are seldom increased in patients with food-induced anaphylaxis or those in whom blood pressure remains normal during anaphylaxis. 10,32 During the first 3 trimesters, before labor and delivery, the differential diagnosis of anaphylaxis in pregnancy is similar to the differential diagnosis of anaphylaxis in nonpregnant patients.…”

“…4,31,[37][38][39][40][41][42][43][44] Laryngeal obstruction, a frequent and potentially life-threatening symptom of anaphylaxis, must be differentiated from laryngopathia gravidarum, particularly the acute form that occurs immediately before parturition in women with preeclampsia. 4 In patients with laryngopathia gravidarum, onset of laryngeal symptoms is typically slower than in those with anaphylaxis, and the correct diagnosis is supported by the presence of hypertension, peripheral edema, urinary abnormalities, or a history of preeclampsia.…”