TAILIEUCHUNG - Critical Care Obstetrics part 62

Critical Care Obstetrics part 62 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Anaphylactic Shock in Pregnancy Table Continued Class of agent Specific agents Comments Radiocontrast media RCM 48-51 Lower osmolarity RCM presently in use have a very low risk of inducing anaphylactoid reactions as compared to the high osmolality agents used in the past. Iso-osmolar agents make RCM reactions extremely unlikely and can be requested when a patient is felt to be at risk of such a reaction RCM causes anaphylactoid reactions but not true anaphylaxis. The incidence of life-threatening reactions is . Peak incidence is between the ages of 20 and 50 so it does occur in women of childbearing age. Anaphylactoid reactions to RCM are more likely if it has happened before but even with a prior history of reactions to RCM the incidence runs between 16 and 44 with a subsequent exposure. Volume overload from administration of RCM can lead to cardiogenic pulmonary edema that is not a hypersensitivity response and is part of the differential diagnosis of respiratory failure in this setting 52 . There is no relationship between RCM reactions and shellfish allergies which are generally due to reactions to tropomyosin proteins and not iodine . The only association between these two allergies is that persons who have anaphylaxis to any agent are more likely to have anaphylaxis to other agents. Pretreatment with steroids and an H1 atagonist such as diphenhydramine can ameliorate or prevent reactions in patients deemed to be at risk Unusual causes described in obstetric patients Seminal fluid Laminaria Oxytocic agents Administration of syntocinon has been associated with anaphylactoid response but has generally been attributed to preservatives used in specific formulations such as chlorobutanol 55-59 Blood products Latex Methotrexate Anesthetic agents including local anesthetic 53 Colloids such as dextran albumin Exercise 54 Whole blood serum plasma fractionated serum products or immunoglobulins can all provoke an anaphylactoid response Exposure to hard rubbers .

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