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Autoimmune progesterone dermatitis in a parturient for emergency caesarean section
J O'Rourke1, N Khawaja, J Loughrey
1Department of Anaesthesia, The Rotunda Hospital, Dublin, Ireland. jande@gofree.indigo.ie
International Journal of Obstetric Anesthesia
|October 13, 2004
Summary
This case study highlights a patient with autoimmune progesterone dermatitis who experienced angioedema during labor. Intramuscular epinephrine effectively managed her post-operative hypotension, demonstrating its utility in managing this rare condition.
Area of Science:
- Obstetrics and Gynecology
- Dermatology
- Anesthesiology
Background:
- Autoimmune progesterone dermatitis (APD) is a rare condition causing recurrent angioedema and dermatological symptoms.
- Surgical oophorectomy is often curative for APD, but management during pregnancy and labor presents unique challenges.
- Regional anesthesia is preferred in APD patients to minimize airway manipulation risks.
Observation:
- A pregnant patient with a 14-year history of APD presented in labor at 36 weeks gestation.
- She underwent a scheduled cesarean hysterectomy and bilateral oophorectomy under spinal anesthesia.
- Post-delivery, she experienced angioedema and hypotension, requiring pharmacological intervention.
Findings:
- The patient developed angioedema and hypotension 40 minutes after delivery.
- Intravenous fluids, ephedrine, and phenylephrine were administered for initial stabilization.
- Intramuscular epinephrine was used for sustained normotension, leading to a positive outcome without intubation.
Implications:
- This case supports the use of regional anesthesia for APD patients undergoing obstetric procedures.
- Intramuscular epinephrine proved effective in managing post-operative angioedema and hypotension in APD.
- Careful anesthetic and pharmacologic management is crucial for APD patients during delivery and surgery.
