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Fetal risks with dextrans during delivery.

P Barbier1, A P Jonville, E Autret

  • 1Department of Pharmaco-Toxicovigilance, Hôpital Bretonneau, Tours, France.

Drug Safety
|January 1, 1992
PubMed
Summary
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Dextran administration before caesarean section epidural anesthesia can cause severe neonatal distress and maternal anaphylactoid reactions. Safer alternatives like gelatins or crystalloids are recommended for fluid preloading.

Area of Science:

  • Anesthesiology
  • Pharmacovigilance
  • Neonatal Medicine

Background:

  • Epidural analgesia is increasingly preferred over general anesthesia for cesarean sections.
  • Maternal hypotension is a significant risk, often managed with fluid preloading.
  • Dextran solutions are among the colloids and crystalloids used for preloading.

Observation:

  • A case report details a maternal anaphylactoid reaction and apparent neonatal death following intravenous dextran 40 administration before epidural blockade.
  • The mother experienced fainting, urticaria, and mild respiratory issues, while the neonate required resuscitation.
  • A French pharmacovigilance survey identified 32 similar cases of maternal anaphylactoid reactions linked to severe fetal distress after dextran use.

Findings:

  • Dextran administration for maternal fluid preloading during cesarean delivery is associated with severe neonatal complications and maternal anaphylactoid reactions.

Related Experiment Videos

  • Neonatal disorders, including seizures and apparent death, have been reported following dextran exposure in utero.
  • A significant correlation exists between maternal dextran administration and acute fetal distress.

    • Implications:

    • Avoid dextran for maternal fluid preloading during epidural anesthesia for cesarean delivery due to associated risks.
    • Prefer gelatin or crystalloid solutions for fluid preloading.
    • Prompt administration of vasopressor amines is crucial for managing maternal hypotension during epidural anesthesia.