Disseminated Intravascular Coagulation, Hemoperitoneum, and Reversible Ischemic Neurological Deficit Complicating Anaphylaxis to Prophylactic Antibiotics during Cesarean Delivery: A Case Report and Review of Literature

Mostafa A. Borahay; Hassan M. Harirah; Gayle Olson; Gokhan S. Kilic; Sinem Karipcin; Gary D.V. Hankins

doi:10.1055/s-0030-1271219

American Journal of Perinatology Reports, Table of Contents

AJP Rep 2011; 01(01): 015-020
DOI: 10.1055/s-0030-1271219

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Disseminated Intravascular Coagulation, Hemoperitoneum, and Reversible Ischemic Neurological Deficit Complicating Anaphylaxis to Prophylactic Antibiotics during Cesarean Delivery: A Case Report and Review of Literature

Authors

Mostafa A. Borahay

¹Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
Hassan M. Harirah

¹Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
Gayle Olson

¹Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
Gokhan S. Kilic

¹Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
Sinem Karipcin
Gary D.V. Hankins

¹Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas

Abstract

Routine use of prophylactic antibiotics reduces the risk of postcesarean fever and infections by over 50% in both nonelective and elective (scheduled) procedures. Although anaphylaxis to prophylactic antibiotics is rare, potentially fatal complications might occur. Herein, we present a case where disseminated intravascular coagulation and reversible ischemic neurological deficit complicated anaphylactic reactions to prophylactic antibiotics administered during cesarean delivery. A 27-year-old gravida 9, para 7 at 39²/₇ weeks underwent elective repeat cesarean delivery and bilateral tubal ligation. Her surgery was complicated by intraoperative hypotension, generalized itching, and urticarial skin rash consistent with anaphylactic reaction upon administering prophylactic cefazolin. In the recovery room, she continued to be hemodynamically unstable despite energetic resuscitation. Hemoperitoneum was suspected, and laboratory evaluation indicated disseminated intravascular coagulation. Abdominal exploration revealed massive hemoperitoneum, but there was no source of active bleeding noted. The postoperative course was complicated by reversible ischemic neurological deficit, which resolved on expectant management. Disseminated intravascular coagulation and reversible ischemic neurological deficit may complicate anaphylactic reaction to prophylactic antibiotics administered during cesarean delivery. Immediate recognition and intervention is crucial for a successful outcome.

Keywords

Disseminated intravascular coagulation - anaphylaxis - anaphylactic reactions - reversible ischemic neurological deficit - cesarean delivery

Full Text

References

References
1 Berg CJ, Chang J, Callaghan WM, Whitehead SJ. Pregnancy-related mortality in the United States, 1991-1997. Obstet Gynecol 2003; 101: 289-296
2 Smaill FM, Gyte GM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev 2010; (1) CD007482-
3 Chelmow D, Ruehli MS, Huang E. Prophylactic use of antibiotics for nonlaboring patients undergoing cesarean delivery with intact membranes: a meta-analysis. Am J Obstet Gynecol 2001; 184: 656-661
4 Sampson HA, Muñoz-Furlong A, Campbell RL , et al. Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol 2006; 117: 391-397
5 Peavy RD, Metcalfe DD. Understanding the mechanisms of anaphylaxis. Curr Opin Allergy Clin Immunol 2008; 8: 310-315
6 Gei AF, Pacheco LD, Vanhook JW, Hankins GD. The use of a continuous infusion of epinephrine for anaphylactic shock during labor. Obstet Gynecol 2003; 102: 1332-1335
7 Mulla ZD, Ebrahim MS, Gonzalez JL. Anaphylaxis in the obstetric patient: analysis of a statewide hospital discharge database. Ann Allergy Asthma Immunol 2010; 104: 55-59
8 Clark SL, Hankins GD, Dudley DA, Dildy GA, Porter TF. Amniotic fluid embolism: analysis of the national registry. Am J Obstet Gynecol 1995; 172 (4 Pt 1) 1158-1167 ; discussion 1167–1169
9 Farrar SC, Gherman RB. Serum tryptase analysis in a woman with amniotic fluid embolism. A case report. J Reprod Med 2001; 46: 926-928
10 Inal MT, Memis D, Top H , et al. Late-onset pulmonary edema and disseminated intravascular coagulation due to latex anaphylaxis. Aesthetic Plast Surg 2010; 34: 394-396
11 Lombardini C, Helia RE, Boehlen F, Merlani P. “Heparinization” and hyperfibrinogenolysis by wasp sting. Am J Emerg Med 2009; 27: 1176-, e1–e3
12 Choi IH, Ha TY, Lee DG , et al. Occurrence of disseminated intravascular coagulation (DIC) in active systemic anaphylaxis: role of platelet-activating factor. Clin Exp Immunol 1995; 100: 390-394
13 Simons FE. Anaphylaxis: recent advances in assessment and treatment. J Allergy Clin Immunol 2009; 124: 625-636 ; quiz 637–638
14 Easton JD, Saver JL, Albers GW , et al; American Heart Association; American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke 2009; 40: 2276-2293