Following a normal spontaneous vaginal delivery (NSVD), a 28 year old G3 now P3 mother develops sudden onset shortness of breath, hypoxia and cyanosis. The delivery room nurse quickly recognizes these symptoms as possible:
Select one:
A.
Manifestations of uteroplacental insufficiency.
B.
Manifestations of prolapsed cord.
C.
Manifestations of anaphylactoid syndrome of pregnancy.
D.
Manifestations of an acute asthmatic episode.
The Correct answer and Explanation is:
The correct answer is C. Manifestations of anaphylactoid syndrome of pregnancy.
Explanation:
The sudden onset of shortness of breath, hypoxia, and cyanosis in a postpartum woman, especially immediately following a normal spontaneous vaginal delivery (NSVD), is highly suggestive of an anaphylactoid syndrome of pregnancy, also known as amniotic fluid embolism (AFE). This is a rare but catastrophic obstetric emergency that can occur during or shortly after delivery.
Anaphylactoid syndrome of pregnancy occurs when amniotic fluid, fetal cells, hair, or other debris enters the maternal circulation, triggering a severe systemic reaction. The exact pathophysiology is not fully understood, but it is believed to be similar to a severe allergic or anaphylactic reaction. The entry of amniotic fluid into the maternal bloodstream leads to an immune response, causing sudden cardiovascular collapse, respiratory failure, and disseminated intravascular coagulation (DIC).
Key Symptoms:
- Respiratory distress: Sudden shortness of breath, hypoxia, and cyanosis are often the first signs. The respiratory failure results from pulmonary vasospasm, pulmonary hypertension, and acute lung injury.
- Cardiovascular collapse: Hypotension, shock, and cardiac arrest may quickly follow the respiratory symptoms.
- Coagulopathy: DIC is a common complication, leading to uncontrolled bleeding.
These symptoms distinguish anaphylactoid syndrome from other conditions listed in the options:
- Option A (Uteroplacental insufficiency) usually presents as fetal distress, such as abnormal fetal heart rate patterns, rather than acute maternal symptoms.
- Option B (Prolapsed cord) presents with fetal bradycardia or variable decelerations rather than maternal respiratory symptoms.
- Option D (Acute asthmatic episode) involves wheezing and a history of asthma, which are absent in this case.
Anaphylactoid syndrome of pregnancy is an obstetric emergency requiring immediate intervention, including oxygen supplementation, hemodynamic support, and rapid delivery if the fetus is still in utero. Multidisciplinary care involving obstetricians, anesthesiologists, and intensive care specialists is essential for managing this life-threatening condition. The rapid recognition and treatment of AFE are crucial for improving maternal and fetal outcomes.