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Old 12-01-2011
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ObGyn Urticaria and angioedema during labor!

A 29-year-old woman, gravida 2, para 1, comes to the labor and delivery ward because of contractions. Her prenatal course was significant for a positive Group B Streptococcus (GBS) perineal culture at 35 weeks’ gestation. She has no medical problems. She had a cholecystectomy at the age of 17. She takes no medications and has no known drug allergies. She is found to be 5 cm dilated with contractions every 2 minutes. She is admitted to the labor and delivery unit in active labor and penicillin is started for GBS prophylaxis. Shortly after admission to labor and delivery the patient complains of warmth and tingling of her face. She notes feeling like her lips and tongue are swollen. Physical examination demonstrates normal vital signs but with generalized urticaria and angioedema. Her abdomen is gravid and there is scant bloody mucous around her genital area. Which of the following is the most likely diagnosis?

A. Eclampsia
B. Penicillin allergy
C. Placental abruption
D. Preeclampsia
E. Thyroid storm
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Old 12-01-2011
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It is penicillin allergy
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Old 12-01-2011
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B. Penicillin allergy
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Old 12-01-2011
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B. Penicillin allergy
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Old 12-02-2011
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pencillin allergy
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Old 12-02-2011
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ans B. penicillin allergy
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Old 12-02-2011
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The correct answer is B. Penicillin is widely used during labor and delivery in modern obstetrics to prevent Group B streptococcal invasive disease in newborns. Numerous studies have shown that Group B Streptococcus (GBS)Ėpositive women who are treated with penicillin in labor and delivery have a significantly decreased risk of having a newborn that develops an invasive infection with GBS. Roughly 20 to 30% of women are colonized with GBS, which means that a large number of women in the United States are treated with penicillin during labor and delivery. Estimates of the rate of anaphylaxis caused by penicillin range from 4/10,000 to 4/100,000 recipients. Additionally, as many as 10% of the adult population will have less severe allergic reactions to penicillin. This patient has symptoms and signs that are consistent with an allergic reaction to penicillin. The first clinical manifestations of anaphylaxis usually involve the skin, with the patient noting warmth and tingling of the face, upper torso, palms, and soles. Pruritus is also a common feature, as are urticaria and angioedema. If the reaction progresses, airway obstruction, hypotension, and circulatory collapse can occur.
Eclampsia (choice A) is the diagnosis given to a woman who develops seizures in the presence of preeclampsia. This patient is not having seizures and does not have preeclampsia.
Placental abruption (choice C) describes the condition in which the placenta separates prematurely from the uterine wall. It is often characterized by vaginal bleeding and uterine contractions. This patientís vaginal bleeding is of an amount and quality that is consistent with labor. Her contractions are also consistent with labor. This patient does not have evidence of abruption and her symptoms are most likely a reaction to the penicillin.
Preeclampsia (choice D) can be diagnosed in a patient when there is a new elevation of blood pressure (to greater than 140 mm Hg systolic or 90 mm Hg diastolic) with proteinuria (greater than 300 mg in 24 hours.) This patient has normal blood pressure and a set of signs and symptoms that are consistent with an allergic reaction to penicillin.
Thyroid storm (choice E) is a rare disorder that affects approximately 1% of patients with hyperthyroidism. It is characterized by tachycardia, fever, and mental status changes. This patientís findings are not consistent with thyroid storm.
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