Anaphylactic shock after misoprostol in voluntary termination of pregnancy – a case report

Béné, Johana; Alarcon, Philippe; Faucon, Marina; Auffret, Marine; Delfosse, Fleur; Becker, Tobias; Zorzi, Sylvio De; Gautier, Sophie

doi:10.1016/j.ejogrb.2014.09.012

Cited by 6 publications

(5 citation statements)

References 2 publications

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“…It is applied via the oral, sublingual, vaginal, and rectal routes, and compared to misoprostol administered orally, misoprostol administered via the sublingual and vaginal routes persists longer in the plasma [ 5 ]. Although a severe allergic reaction or anaphylactic shock due to misoprostol is very rare, obstetricians and gynecologists warn about the risks [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…She experienced a severe hypersensitivity reaction beginning with symptoms such as shivering, an intense burning sensation, and feeling of warmth over the face, hands, and feet 20 minutes after intravaginal placement of 800 μg misoprostol. Further, when vaginal insert misoprostol was used in patients with early postpartum hemorrhage, symptoms such as tachycardia (heart rate, 120 bpm), high fever (39.8°C), and urticaria were noted [ 7 ]. Anaphylaxis and tachysystole started 4 hours after misoprostol administration in a 21-year-old woman who received oral misoprostol for post-date induction of labor at 41 weeks [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…She initially complained of pruritus and flushing 20 minutes after misoprostol administration. Anaphylactic shock was also reported in a 17-year-old woman who received misoprostol in 2 separate doses for voluntary termination of pregnancy at 9 weeks of gestation in 2014 [ 7 ]. This anaphylactic shock was also noted 4 hours after the second dose of misoprostol.…”

Section: Discussionmentioning

confidence: 99%

“…Although we did not perform skin testing because of the patient's refusal, the patient had no allergies to any of the drugs administered before the anaphylactic shock other than the misoprostol because exactly the same drugs were used at the time of the aneurysm clipping and again at the time of cholecystectomy. A tentative diagnosis of anaphylactic shock to misoprostol was made based on case reports obtained after a PubMed search for unexplained shock performed 20 hours after the event [ 5 6 7 8 ]. The patient was in the intensive care unit for 24 hours until she was hemodynamically stable, and the generalized edema disappeared in 48 hours.…”

Section: Case Reportmentioning

confidence: 99%

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Anaphylactic shock to vaginal misoprostol: a rare adverse reaction to a frequently used drug

et al. 2018

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Misoprostol is widely used in daily practice for induction of labor and cervical dilatation prior to intrauterine procedures, including dilatation and curettage or hysteroscopy. Anaphylactic shock to intravaginal misoprostol can occur not only in pregnant women, as reported in 2 previous cases, but also in a non-pregnant, perimenopausal woman, as in the case described herein. A 49-year-old woman received vaginal misoprostol for cervical ripening prior to hysteroscopic myomectomy and experienced anaphylactic shock. Two 400 μg doses of misoprostol 6 hours apart caused uncontrolled shaking and high fever followed by shock. In conclusion, the possibility of anaphylactic shock should be considered in patients with sudden hypotension following misoprostol administration. Prompt identification and management are crucial to prevent morbidity and mortality following an anaphylactic shock to misoprostol.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

See 2 more Smart Citations

Anaphylactic shock to vaginal misoprostol: a rare adverse reaction to a frequently used drug

et al. 2018

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“…In a report of anaphylactic reaction due to rocuronium-sugammadex complex during elective cesarean section, the serum tryptase level was significantly elevated [ 73 ]. Serum tryptase level was reported increased also in anaphylactic shock after misoprostol in voluntary termination of pregnancy [ 74 ].…”

Section: Biomarkersmentioning

confidence: 99%

State-of-the-Art on Biomarkers for Anaphylaxis in Obstetrics

Simionescu

Stănescu

Popescu

2021

Life

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Anaphylaxis is an unpredictable systemic hypersensitivity reaction and constitutes a high risk of maternal and fetal morbidity and mortality when occurring during pregnancy. Currently, the acute management of anaphylaxis is based on clinical parameters. A total serum tryptase is only used to support an accurate diagnosis. There is a need to detect other biomarkers to further assess high-risk patients in obstetrics. Our objective is to present biomarkers in this complex interdisciplinary approach beyond obstetrician and anaesthetic management. Candidate biomarkers derive either from mediators involved in immunopathogenesis or upcoming molecules from systems biology and proteomics. Serum tryptase is determined by singleplex immunoassay method and is important in the evaluation of anaphylactic mast cell degranulation but also in the assessment of other risk factors for anaphylaxis such as systemic mastocytosis. Another category of biomarkers investigates the IgE-mediated sensitization to triggers potentially involved in the etiology of anaphylaxis in pregnant women, using singleplex or multiplex immunoassays. These in vitro tests with natural extracts from foods, venoms, latex or drugs, as well as with molecular allergen components, are useful because in vivo allergy tests cannot be performed on pregnant women in such a major medical emergency due to their additional potential risk of anaphylaxis.

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Drug Hypersensitivity

Macy¹

2018

Asthma, Allergic and Immunologic Diseases During Pregnancy

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Anaphylactic shock after misoprostol in voluntary termination of pregnancy – a case report

Cited by 6 publications

References 2 publications

Anaphylactic shock to vaginal misoprostol: a rare adverse reaction to a frequently used drug

Anaphylactic shock to vaginal misoprostol: a rare adverse reaction to a frequently used drug

State-of-the-Art on Biomarkers for Anaphylaxis in Obstetrics

Drug Hypersensitivity

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