Allergic reactions during labour analgesia and caesarean section anaesthesia

• Published in: International journal of obstetric anesthesia Vol. 22; no. 3; pp. 231 - 242
• Main Authors: Adriaensens, I, Vercauteren, M, Soetens, F, Janssen, L, Leysen, J, Ebo, D
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.07.2013
• Subjects: Adult; Allergy; Anaesthesia; Analgesia, Obstetrical - adverse effects; Analgesics, Opioid - adverse effects; Anaphylaxis; Anaphylaxis - etiology; Anesthesia & Perioperative Care; Anesthesia, Obstetrical - adverse effects; Anesthetics - adverse effects; Anti-Bacterial Agents - adverse effects; Caesarean section; Cesarean Section; Colloids - adverse effects; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - epidemiology; Drug Hypersensitivity - etiology; Drug Hypersensitivity - physiopathology; Female; Histamine H2 Antagonists - adverse effects; Humans; Intraoperative Care; Labour; Latex Hypersensitivity - epidemiology; Latex Hypersensitivity - etiology; Neuromuscular Blocking Agents - adverse effects; Obstetrics and Gynecology; Oxytocics - adverse effects; Postoperative Care; Pregnancy; Anaesthesia; Allergy; Caesarean section; Labour; Anaphylaxis
• ISSN: 0959-289X; 1532-3374
• DOI: 10.1016/j.ijoa.2013.04.010

Abstract Allergic reactions in the parturient are challenging for the anaesthetist who is dealing with both mother and baby, often in circumstances when there is a need for delivery. While most previous reviews have focused on specific substances in individual cases, this review focuses on allergic reactions during the peripartum period, the differential diagnosis and specific treatment options. Immunoregulation and susceptibility to allergic reactions may change during pregnancy. Compared with non-pregnant patients, in whom neuromuscular blocking drugs are the most common triggering substances, allergic reactions in parturients mostly occur following contact with latex, injection of antibiotics and uterotonics, and infusion of colloids. With the exception of latex, where patient history may raise suspicion, allergic reactions may occur without prior exposure to triggering agents. Most drugs used for resuscitation of the non-pregnant patient are suitable for the parturient. Some substances, such as H2 -receptor antagonists for aspiration prophylaxis or corticosteroids for prematurity, may have been given before the event. Although fetal outcome is important, the mother is the primary focus of care.