Allergic reactions during labour analgesia and caesarean section anaesthesia

Allergic reactions in the parturient are challenging for the anaesthetist who is dealing with both mother and baby, often in circumstances when there is a need for delivery. While most previous reviews have focused on specific substances in individual cases, this review focuses on allergic reactions during the peripartum period, the differential diagnosis and specific treatment options. Immunoregulation and susceptibility to allergic reactions may change during pregnancy. Compared with non-pregnant patients, in whom neuromuscular blocking drugs are the most common triggering substances, allergic reactions in parturients mostly occur following contact with latex, injection of antibiotics and uterotonics, and infusion of colloids. With the exception of latex, where patient history may raise suspicion, allergic reactions may occur without prior exposure to triggering agents. Most drugs used for resuscitation of the non-pregnant patient are suitable for the parturient. Some substances, such as H2-receptor antagonists for aspiration prophylaxis or corticosteroids for prematurity, may have been given before the event. Although fetal outcome is important, the mother is the primary focus of care.