Managing obstetric emergencies: Anaphylactoid syndrome of pregnancy (aka AFE)

摘要

Anaphylactoid syndrome of pregnancy (ASP) remains a puzzling and deadly condition despite decades of recognition and research. It is a leading cause of maternal mortality, yet it likely has been overdiagnosed, with many unexplained peripartum maternal deaths historically attributed to ASP. The aim of this discussion is to shed light on more recent research and our current understanding of this life-threatening obstetric emergency. Typical presentation Women with ASP may present with the classic triad of hypoxia, hypotension, and coagulopathy resulting in sudden cardiovascular collapse or cardiac arrest.2 In less typical cases, one or more of these signs may be blunted or absent. ASP usually occurs during labor or within minutes of delivery, either vaginal or cesarean. Patients may experience symptoms of anxiety, a sense of impending doom, confusion, or shortness of breath which are accompanied by abnormal vital signs (Table 1), loss of consciousness, or cardiopulmonary arrest.23 Seizures may also occur with this condition, which may be mistaken for eclampsia. Fetal heart rate (FHR) tracing and uterine contraction monitoring may reveal uterine tachysystole as a direct result of maternal catecholamine release; this initial shock reaction also includes shunting of uterine blood from the uterus and placenta to transiently maintain blood pressure and perfusion of maternal vital organs. Both of these processes result in signs of fetal hypoxia and FHR abnormalities, which often precede maternal cardiopulmonary manifestations.