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MANAGEMENT OF A PREGNANT IN LABOUR WITH HEREDITARY ANGIOEDEMA TYPE II
ESRA Academy. Reis E. Sep 8, 2016; 138400; 0243 Topic: Obstetric Population
Dr. Eduardo Reis
Dr. Eduardo Reis

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Abstract
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Background and Aims:

Hereditary Angioedema (HAE) is a rare autosomal dominant disorder, which causes episodic angioedema precipitated by stress factors, involving different locations, including upper airway.
Pregnancy could in some cases worse the course of the disease, with an high incidence of angioedema episodes.

Methods:

We present a case of a 23 years old primiparous lady, with a known HAE type II, presented at our hospital in active labour. She reported multiples previous episodes of abdominal pain and cutaneous angioedema, without any episode involving upper airway. Pregnant was previously evaluated by a multidisciplinary team to labour plan establishment.
C1 esterase inhibitor concentrate was available in the labour department for administration in case of an angioedema event or in the need for caesarean section. The Otorhinolaryngology team was available in the case of an event involving the airway.
A lumbar epidural catheter was early place at the L3-L4 interspace. During labour we administer Ropivacaine 0,2% and Sufentanil, according to our protocol, with successful pain control.
The labour was uneventfully, with a vaginal delivery.

Results:

Although in the majority of cases the labour occur uneventfully, HAE can cause severe consequences for both the pregnant and the fetus.
The  early establishment of a working epidural catheter is very important to reduce the stress associated with the pain during the labour and as a option to avoid general anaesthesia and airway manipulantion in a need of cesarean section.

Conclusions:

This report demonstrates that a rare life threatening conditions could be effectively managed with adequade perioperative planning and preparation by a multidisciplinary team.

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