Journal
PAIN MEDICINE
Volume 22, Issue 8, Pages 1878-1882Publisher
OXFORD UNIV PRESS
DOI: 10.1093/pm/pnaa457
Keywords
Angioedema; Pregnancy; Epidural; Anesthesia; C1 Esterase Inhibitor Deficiency; Hereditary Angioedema
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Hereditary angioedema (HAE) is characterized by repeated episodes of localized submucosal or subcutaneous edema, potentially triggered by emotional stress, mechanical trauma, or intake of estrogens. Multidisciplinary care is essential for planning and executing the specialized care of these patients. Management includes extensive planning among obstetric, anesthesiology, and allergy and immunology teams.
Hereditary angioedema (HAE) is a disease manifested by repeated episodes of localized submucosal or subcutaneous edematous episodes, potentially triggered by emotional stress, mechanical trauma, or intake of estrogens. We present our experience managing two parturients with HAE. Multidisciplinary care is essential for planning and executing the specialized care of these patients, and management included extensive planning among obstetric, anesthesiology, and allergy and immunology teams. Pregnancy has been shown to have a variable effect on triggering HAE episodes. First-line treatment includes Cl esterase inhibitor concentrate, which can also be used for prophylaxis in high-risk patients. Neuraxial analgesia is recommended to avoid general anesthesia and was established early in both individuals. Vaginal delivery was well tolerated without need for emergent treatment for angioedema symptoms.
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