Prenatal care of angioedema patient

Abstract

Objective: Discuss an intravenous C1 prophylaxis inhibitor (C1-INH) before induction of anesthesia for childbirth in pregnant women, to avoid attacks of hereditary angioedema (HAE) type III. Case details: Primigravid, 33 years old, reports a history of disfiguring facial edema, recurrent with onset after adolescence. In the first trimester it evolved without crises and, as ultrasounds, the results were morphologically normal until the second trimester. In the third trimester, he presented late restricted intrauterine growth (late IUGR) identifying the 3rd percentile of weight in the fetus and with mean cerebral Doppler at the lower limit of normality. Cesarean section was performed, with C1-INH prescription before anesthetic induction. The delivery went well, one patient and the baby was discharged after 48 hours of hospitalization. No exam identified C4 at the lower limit of normality, with C3 normal and C1 normal. The patient’s classification was HAE type III and she remains in control and remains asymptomatic. Final considerations: The major concern of hereditary type III angioedema is that, in general, complement dosages can be normal in asymptomatic patients and can trigger stress and trauma. Therefore, intravenous prophylaxis with C1-INH, before anesthetic induction, may prove important strategy for crisis control.