Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report

Background Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. Case presentation A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was pla...
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Autor*in:	Takahashi, Miyuki [verfasserIn] Hotta, Kunihisa Inoue, Soichiro Takazawa, Tomonori Horiuchi, Tatsuo Igarashi, Takashi Takeuchi, Mamoru

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2019

Schlagwörter:	Anaphylaxis Pregnancy Cesarean delivery Spinal anesthesia Local anesthetic Mepivacaine Basophil activation test

Anmerkung:	© The Author(s) 2019

Übergeordnetes Werk:	Enthalten in: JA clinical reports - Berlin : Springer, 2015, 5(2019), 1 vom: 19. Dez.
Übergeordnetes Werk:	volume:5 ; year:2019 ; number:1 ; day:19 ; month:12

Links:	Volltext

DOI / URN:	10.1186/s40981-019-0302-6

Katalog-ID:	SPR038029030

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520			\|a Background Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. Case presentation A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother’s vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. Conclusions This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued.
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allfields	10.1186/s40981-019-0302-6 doi (DE-627)SPR038029030 (SPR)s40981-019-0302-6-e DE-627 ger DE-627 rakwb eng Takahashi, Miyuki verfasserin aut Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2019 Background Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. Case presentation A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother’s vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. Conclusions This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued. Anaphylaxis (dpeaa)DE-He213 Pregnancy (dpeaa)DE-He213 Cesarean delivery (dpeaa)DE-He213 Spinal anesthesia (dpeaa)DE-He213 Local anesthetic (dpeaa)DE-He213 Mepivacaine (dpeaa)DE-He213 Basophil activation test (dpeaa)DE-He213 Hotta, Kunihisa aut Inoue, Soichiro aut Takazawa, Tomonori aut Horiuchi, Tatsuo aut Igarashi, Takashi aut Takeuchi, Mamoru aut Enthalten in JA clinical reports Berlin : Springer, 2015 5(2019), 1 vom: 19. Dez. (DE-627)84410051X (DE-600)2842877-8 2363-9024 nnns volume:5 year:2019 number:1 day:19 month:12 https://dx.doi.org/10.1186/s40981-019-0302-6 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 5 2019 1 19 12
spelling	10.1186/s40981-019-0302-6 doi (DE-627)SPR038029030 (SPR)s40981-019-0302-6-e DE-627 ger DE-627 rakwb eng Takahashi, Miyuki verfasserin aut Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2019 Background Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. Case presentation A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother’s vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. Conclusions This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued. Anaphylaxis (dpeaa)DE-He213 Pregnancy (dpeaa)DE-He213 Cesarean delivery (dpeaa)DE-He213 Spinal anesthesia (dpeaa)DE-He213 Local anesthetic (dpeaa)DE-He213 Mepivacaine (dpeaa)DE-He213 Basophil activation test (dpeaa)DE-He213 Hotta, Kunihisa aut Inoue, Soichiro aut Takazawa, Tomonori aut Horiuchi, Tatsuo aut Igarashi, Takashi aut Takeuchi, Mamoru aut Enthalten in JA clinical reports Berlin : Springer, 2015 5(2019), 1 vom: 19. Dez. (DE-627)84410051X (DE-600)2842877-8 2363-9024 nnns volume:5 year:2019 number:1 day:19 month:12 https://dx.doi.org/10.1186/s40981-019-0302-6 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 5 2019 1 19 12
allfields_unstemmed	10.1186/s40981-019-0302-6 doi (DE-627)SPR038029030 (SPR)s40981-019-0302-6-e DE-627 ger DE-627 rakwb eng Takahashi, Miyuki verfasserin aut Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2019 Background Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. Case presentation A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother’s vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. Conclusions This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued. Anaphylaxis (dpeaa)DE-He213 Pregnancy (dpeaa)DE-He213 Cesarean delivery (dpeaa)DE-He213 Spinal anesthesia (dpeaa)DE-He213 Local anesthetic (dpeaa)DE-He213 Mepivacaine (dpeaa)DE-He213 Basophil activation test (dpeaa)DE-He213 Hotta, Kunihisa aut Inoue, Soichiro aut Takazawa, Tomonori aut Horiuchi, Tatsuo aut Igarashi, Takashi aut Takeuchi, Mamoru aut Enthalten in JA clinical reports Berlin : Springer, 2015 5(2019), 1 vom: 19. Dez. (DE-627)84410051X (DE-600)2842877-8 2363-9024 nnns volume:5 year:2019 number:1 day:19 month:12 https://dx.doi.org/10.1186/s40981-019-0302-6 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 5 2019 1 19 12
allfieldsGer	10.1186/s40981-019-0302-6 doi (DE-627)SPR038029030 (SPR)s40981-019-0302-6-e DE-627 ger DE-627 rakwb eng Takahashi, Miyuki verfasserin aut Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2019 Background Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. Case presentation A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother’s vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. Conclusions This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued. Anaphylaxis (dpeaa)DE-He213 Pregnancy (dpeaa)DE-He213 Cesarean delivery (dpeaa)DE-He213 Spinal anesthesia (dpeaa)DE-He213 Local anesthetic (dpeaa)DE-He213 Mepivacaine (dpeaa)DE-He213 Basophil activation test (dpeaa)DE-He213 Hotta, Kunihisa aut Inoue, Soichiro aut Takazawa, Tomonori aut Horiuchi, Tatsuo aut Igarashi, Takashi aut Takeuchi, Mamoru aut Enthalten in JA clinical reports Berlin : Springer, 2015 5(2019), 1 vom: 19. Dez. (DE-627)84410051X (DE-600)2842877-8 2363-9024 nnns volume:5 year:2019 number:1 day:19 month:12 https://dx.doi.org/10.1186/s40981-019-0302-6 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 5 2019 1 19 12
allfieldsSound	10.1186/s40981-019-0302-6 doi (DE-627)SPR038029030 (SPR)s40981-019-0302-6-e DE-627 ger DE-627 rakwb eng Takahashi, Miyuki verfasserin aut Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2019 Background Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. Case presentation A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother’s vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. Conclusions This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued. Anaphylaxis (dpeaa)DE-He213 Pregnancy (dpeaa)DE-He213 Cesarean delivery (dpeaa)DE-He213 Spinal anesthesia (dpeaa)DE-He213 Local anesthetic (dpeaa)DE-He213 Mepivacaine (dpeaa)DE-He213 Basophil activation test (dpeaa)DE-He213 Hotta, Kunihisa aut Inoue, Soichiro aut Takazawa, Tomonori aut Horiuchi, Tatsuo aut Igarashi, Takashi aut Takeuchi, Mamoru aut Enthalten in JA clinical reports Berlin : Springer, 2015 5(2019), 1 vom: 19. Dez. (DE-627)84410051X (DE-600)2842877-8 2363-9024 nnns volume:5 year:2019 number:1 day:19 month:12 https://dx.doi.org/10.1186/s40981-019-0302-6 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 5 2019 1 19 12
language	English
source	Enthalten in JA clinical reports 5(2019), 1 vom: 19. Dez. volume:5 year:2019 number:1 day:19 month:12
sourceStr	Enthalten in JA clinical reports 5(2019), 1 vom: 19. Dez. volume:5 year:2019 number:1 day:19 month:12
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institution	findex.gbv.de
topic_facet	Anaphylaxis Pregnancy Cesarean delivery Spinal anesthesia Local anesthetic Mepivacaine Basophil activation test
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authorswithroles_txt_mv	Takahashi, Miyuki @@aut@@ Hotta, Kunihisa @@aut@@ Inoue, Soichiro @@aut@@ Takazawa, Tomonori @@aut@@ Horiuchi, Tatsuo @@aut@@ Igarashi, Takashi @@aut@@ Takeuchi, Mamoru @@aut@@
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Case presentation A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother’s vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. Conclusions This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. 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author	Takahashi, Miyuki
spellingShingle	Takahashi, Miyuki misc Anaphylaxis misc Pregnancy misc Cesarean delivery misc Spinal anesthesia misc Local anesthetic misc Mepivacaine misc Basophil activation test Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report
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topic_title	Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report Anaphylaxis (dpeaa)DE-He213 Pregnancy (dpeaa)DE-He213 Cesarean delivery (dpeaa)DE-He213 Spinal anesthesia (dpeaa)DE-He213 Local anesthetic (dpeaa)DE-He213 Mepivacaine (dpeaa)DE-He213 Basophil activation test (dpeaa)DE-He213
topic	misc Anaphylaxis misc Pregnancy misc Cesarean delivery misc Spinal anesthesia misc Local anesthetic misc Mepivacaine misc Basophil activation test
topic_unstemmed	misc Anaphylaxis misc Pregnancy misc Cesarean delivery misc Spinal anesthesia misc Local anesthetic misc Mepivacaine misc Basophil activation test
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title	Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report
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title_full	Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report
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author_browse	Takahashi, Miyuki Hotta, Kunihisa Inoue, Soichiro Takazawa, Tomonori Horiuchi, Tatsuo Igarashi, Takashi Takeuchi, Mamoru
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title_sort	mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report
title_auth	Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report
abstract	Background Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. Case presentation A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother’s vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. Conclusions This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued. © The Author(s) 2019
abstractGer	Background Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. Case presentation A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother’s vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. Conclusions This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued. © The Author(s) 2019
abstract_unstemmed	Background Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. Case presentation A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother’s vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. Conclusions This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued. © The Author(s) 2019
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title_short	Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report
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author2	Hotta, Kunihisa Inoue, Soichiro Takazawa, Tomonori Horiuchi, Tatsuo Igarashi, Takashi Takeuchi, Mamoru
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Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report

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