Background: Anaphylaxis is currently defined as a serious allergic reaction that is
rapid in onset and might cause death. Data regarding prevalence among pregnant
women is limited, with an estimated prevalence near or at the time of delivery reported
as 2.7 cases of anaphylaxis per 100.000 deliveries. Furthermore, the risk of cesarean
delivery in anaphylactic patients in pregnancy is high (74%). 1 During the first 3
trimesters, aetiologies are similar to those in non-pregnant women.
Case Report: A 19-year-old pregnant woman (30 weeks’ gestation) presented to the
emergency department complaining of back pain and flank tenderness. She had history
of inadequate prenatal care and multiple urinary tract infections, with hospitalization at
28 weeks of pregnancy for pyelonephritis and treatment achieved with intravenous
cefuroxime. This time hospitalization was also decided for surveillance and treatment
with antibiotic therapy. Within 2 minutes after initiation of ceftriaxone IV, the patient
developed facial swelling, dyspnoea (SpO2 92%) and severe hypotension. Ceftriaxone
was immediately suspended. Hydrocortisone 200 mg IV, clemastine 2 mg IV and
adrenaline 1 mg IM (mid-outer thigh) were administered. She had clinical improvement,
presenting a blood pressure of 92/57 mmHg, heart rate 53 bpm and oxygen saturation
98% (with supplemental oxygen 6 L/min). The patient recovered rapidly without a
biphasic reaction of anaphylaxis. Throughout the whole episode the obstetric
evaluation was unremarkable and fetal sonographic examination was reported as
normal. A caesarean delivery was not undertaken. The patient’s hospital course was
uneventful and she was discharged home 5 days later.
Discussion: Anaphylaxis during pregnancy, labour, and delivery is rare and can be
catastrophic for the mother and, especially, the infant. In cases of anaphylaxis during
pregnancy, both mother and fetus must be treated and ccontinuous vigilance of fetal
well-being for 48–72h after the episode is important in order to identify precocious
signs of fetal distress.
Learning Points: Management of anaphylaxis in pregnant women is similar of that in
non-pregnant ones. Treatment should start immediately to prevent further development
of the anaphylaxis reaction and fetal neurological deficiency.

02 / Anaphylaxis in pregnancy: a case report