46. PHẢN VỆ Ở SẢN PHỤ TRƯỚC SINH: BÁO CÁO MỘT TRƯỜNG HỢP

Abstract

Case summary: A 26-year-old pregnant woman, gravida 2 para 1, at 38 weeks and 4 days of gestation, with a history of cesarean section, was scheduled for a repeat cesarean delivery on June 13, 2025. She was administered prophylactic antibiotics (Cefazolin) prior to being transferred to the operating room. During the antibiotic infusion, she developed symptoms including dyspnea, generalized rash, diffuse erythema, facial edema, tachycardia (121-125 beats per minute), and hypotension (85/50 mmHg). Auscultation revealed no rales. Her oxygen saturation (SpO₂) was 97%, body temperature was 36.5°C, and fetal heart rate ranged between 128 and 131 beats per minute. Immediate treatment included two intramuscular injections of Adrenaline, followed by a continuous intravenous Adrenaline infusion. Additional interventions included administration of oxygen at 8 liters per minute, intravenous saline infusion, positioning the patient on her right side to tilt the uterus to the left, administration of methylprednisolone, and continuous fetal heart monitoring using an obstetric monitor. Obstetric management was provided by an obstetrician and a midwife.

Results: The mother responded well to treatment. Her skin erythema and facial edema resolved, and the Adrenaline infusion was discontinued after nine hours of resuscitation. The fetal heart rate remained stable at 125-135 beats per minute during the first hour and normalized afterward. No biphasic anaphylactic reaction occurred. After 23 hours, the patient showed signs of labor, and a cesarean section was performed under spinal anesthesia. Prior to anesthesia, an allergist conducted drug allergy testing to guide safe medication selection for surgery. The mother’s condition remained stable during and after the operation. The newborn was delivered in good condition, crying immediately at birth, and weighed 3250 grams.

Conclusion: The management of anaphylaxis in full-term pregnant women is fundamentally similar to that in non-pregnant patients. However, early fluid resuscitation and timely administration of Adrenaline, combined with uterine displacement to the left, are essential to restore hemodynamic stability and ensure adequate oxygenation and uteroplacental perfusion. Continuous fetal heart rate monitoring is also critical. In the absence of fetal distress, cesarean delivery should be postponed until maternal shock has resolved, as proceeding with anesthesia during anaphylactic shock poses significant risks to the mother’s life.