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      The incidence, characteristics, management and outcomes of anaphylaxis in pregnancy: a population‐based descriptive study

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          Abstract

          Objective

          The aim of this study was to estimate the incidence of anaphylaxis in pregnancy and describe the management and outcomes in the UK.

          Design

          A population‐based descriptive study using the UK Obstetric Surveillance System ( UKOSS).

          Setting

          All consultant‐led maternity units in the UK.

          Population

          All pregnant women who had anaphylaxis between 1 October 2012 and 30 September 2015. Anaphylaxis was defined as a severe, life‐threatening generalised or systemic hypersensitivity reaction.

          Methods

          Prospective case notification using UKOSS.

          Main outcome measures

          Maternal mortality, severe maternal morbidity, neonatal mortality and severe neonatal morbidity.

          Results

          There were 37 confirmed cases of anaphylaxis in pregnancy, giving an estimated incidence of 1.6 (95% CI: 1.1–2.2) per 100 000 maternities. Four cases of anaphylaxis were in women with known penicillin allergies: two received co‐amoxiclav and two cephalosporins. Twelve women had anaphylaxis following prophylactic use of antibiotics at the time of a caesarean delivery. Prophylactic use of antibiotics for Group B streptococcal infection accounted for anaphylaxis in one woman. Two women died (5%), 14 (38%) women were admitted to intensive care and seven women (19%) had one or more additional severe maternal morbidities, which included three haemorrhagic events, two cardiac arrests, one thrombotic event and one pneumonia. No infants died; however, in those infants whose mother had anaphylaxis before delivery ( n = 18) there were seven (41%) neonatal intensive care unit admissions, three preterm births and one baby was cooled for neonatal encephalopathy.

          Conclusions

          Anaphylaxis is a rare severe complication of pregnancy and frequently the result of a reaction to antibiotic administration. This study highlights the seriousness of the outcomes of this condition for the mother. The low incidence is reassuring given the large proportion of the pregnant population that receive prophylactic antibiotics during delivery.

          Tweetable abstract

          Anaphylaxis is a rare severe complication of pregnancy and frequently the result of a reaction to antibiotic administration.

          Tweetable abstract

          Anaphylaxis is a rare severe complication of pregnancy and frequently the result of a reaction to antibiotic administration.

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          Most cited references 18

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          Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

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            2012 Update: World Allergy Organization Guidelines for the assessment and management of anaphylaxis.

             Ledit Ardusso,  ,  F Simons (2012)
            The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis published in early 2011 provide a global perspective on patient risk factors, triggers, clinical diagnosis, treatment, and prevention of anaphylaxis. In this 2012 Update, subsequently published, clinically relevant research in these areas is reviewed. Patient risk factors and co-factors that amplify anaphylaxis have been documented in prospective studies. The global perspective on the triggers of anaphylaxis has expanded. The clinical criteria for the diagnosis of anaphylaxis that are promulgated in the Guidelines have been validated. Some aspects of anaphylaxis treatment have been prospectively studied. Novel investigations of self-injectable epinephrine for treatment of anaphylaxis recurrences in the community have been performed. Progress has been made with regard to measurement of specific IgE to allergen components (component-resolved testing) that might help to distinguish clinical risk of future anaphylactic episodes to an allergen from asymptomatic sensitization to the allergen. New strategies for immune modulation to prevent food-induced anaphylaxis and new insights into subcutaneous immunotherapy to prevent venom-induced anaphylaxis have been described. Research highlighted in this Update strengthens the evidence-based recommendations for assessment, management, and prevention of anaphylaxis made in the WAO Anaphylaxis Guidelines.
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              The UK Obstetric Surveillance System for rare disorders of pregnancy.

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                Author and article information

                Contributors
                stephen.mccall@npeu.ox.ac.uk
                Journal
                BJOG
                BJOG
                10.1111/(ISSN)1471-0528
                BJO
                Bjog
                John Wiley and Sons Inc. (Hoboken )
                1470-0328
                1471-0528
                03 January 2018
                July 2018
                : 125
                : 8 ( doiID: 10.1111/bjo.2018.125.issue-8 )
                : 965-971
                Affiliations
                [ 1 ] Policy Research Unit in Maternal Health and Care National Perinatal Epidemiology Unit (NPEU) Nuffield Department of Population Health University of Oxford Oxford UK
                [ 2 ] Birmingham Clinical Trials Unit University of Birmingham Birmingham UK
                [ 3 ] Nuffield Department of Obstetrics and Gynaecology John Radcliffe Hospital University of Oxford Oxford UK
                [ 4 ] Department of Obstetrics and Gynaecology Sunderland Royal Hospital Sunderland UK
                [ 5 ] Department of Anaesthetics Northwick Park Hospital London UK
                [ 6 ] Neonatal Unit Royal Infirmary of Edinburgh Edinburgh UK
                [ 7 ] Teaching Hospitals Foundation NHS Trust Bradford UK
                Author notes
                [* ] Correspondence: S McCall, Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK. Email stephen.mccall@ 123456npeu.ox.ac.uk
                Article
                BJO15041
                10.1111/1471-0528.15041
                6033185
                29193647
                © 2017 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 1, Tables: 3, Pages: 7, Words: 5095
                Product
                Funding
                Funded by: Department of Health
                Funded by: NIHR Research Professorship
                Funded by: Nuffield Department of Population Health and Medical Research Council (MRC)
                Award ID: MR/K501256/1
                Categories
                Epidemiology
                Epidemiology
                Custom metadata
                2.0
                bjo15041
                July 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.4.3 mode:remove_FC converted:05.07.2018

                Obstetrics & Gynecology

                outcomes, anaphylaxis in pregnancy, causal agents, management

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