Anaphylaxis in pregnancy

adrenaline in anaphylaxis pregnancy May 11, 2026

Anaphylaxis in pregnancy is rare, but when it occurs, it carries a dual urgency. The mother’s physiology shapes how anaphylaxis presents and progresses, while the fetus relies entirely on maternal circulation for oxygenation.

In the perioperative setting, this creates a time-critical balance.

The pathophysiology remains centred on vasodilation, capillary leak, and airway compromise. In pregnancy, reduced venous return from aortocaval compression and increased oxygen demand can accelerate instability. Even brief maternal hypotension can significantly reduce uteroplacental perfusion, placing the fetus at risk.

Management remains maternal-focused.

⚡ Adrenaline is first-line and should never be withheld
⚡ Left lateral tilt reduces aortocaval compression and improves venous return
⚡ Early airway management is essential due to increased airway oedema risk
⚡ High-flow oxygen supports both maternal and fetal oxygenation
⚡ Continuous fetal monitoring should be considered once stable
⚡ Early obstetric and neonatal team involvement is critical
⚡ Perimortem caesarean birth should be considered if maternal cardiac arrest persists beyond 4 minutes

Perimortem lower uterine segment caesarean section is not only a fetal intervention. It can improve maternal resuscitation by relieving aortocaval compression and enhancing venous return and cardiac output.

In practice, this requires rapid, coordinated decision-making. Preparation often begins alongside resuscitation, not after it.

For perianaesthesia nurses, clarity of roles becomes essential. While resuscitation continues, ensuring equipment readiness, facilitating team communication, and anticipating escalation can support both maternal and fetal outcomes.

When time is critical, coordinated action across teams is what makes the difference.

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References:

McCall, S.J., Kurinczuk, J.J., Knight, M. (2021). Anaphylaxis in pregnancy: a population-based study. BMC Pregnancy and Childbirth.
Mulla, Z.D., Ebrahim, M.S., Gonzalez, J.L. (2013). Anaphylaxis in the obstetric patient: analysis and management considerations. Obstetrics and Gynecology.

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