# A 25-year-old primigravida at 40 weeks gestation is undergoing labor induction with oxytocin. Suddenly, she develops severe dyspnea, cyanosis, and hypotension. The fetal heart rate shows severe bradycardia. The nurse suspects anaphylactoid syndrome of pregnancy (ASP). What is the priority nursing intervention?

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> subject: Maternal Newborn Health

## 문제

A 25-year-old primigravida at 40 weeks gestation is undergoing labor induction with oxytocin. Suddenly, she develops severe dyspnea, cyanosis, and hypotension. The fetal heart rate shows severe bradycardia. The nurse suspects anaphylactoid syndrome of pregnancy (ASP). What is the priority nursing intervention?

Emergency management of suspected anaphylactoid syndrome of pregnancy during labor

## 보기

1. Increase the oxytocin infusion rate to hasten delivery
2. Position the patient in Trendelenburg position
3. Prepare for immediate cardiopulmonary resuscitation and emergency cesarean delivery **✔ 정답**
4. Administer high-flow oxygen via nasal cannula

**정답: 3**

## 해설

Immediate CPR and emergency cesarean delivery are prioritized to stabilize the mother and rescue the fetus. Other interventions are supportive but secondary in this life-threatening scenario.

## 심화 해설

Understanding Anaphylactoid Syndrome of Pregnancy (ASP)

Anaphylactoid syndrome of pregnancy, historically referred to as amniotic fluid embolism (AFE), is a rare, catastrophic obstetric emergency. The underlying mechanism is not a true embolic event, but rather an anaphylactoid reaction to fetal antigens entering the maternal circulation, triggering a massive systemic inflammatory response. This results in a classic triad of acute respiratory failure, cardiovascular collapse, and disseminated intravascular coagulation (DIC). The case reports provided highlight that this syndrome can occur suddenly during labor induction, as in the scenario, leading to rapid maternal decompensation with cyanosis, dyspnea, and hypotension [3]. The profound maternal hypoxemia and hypotension directly cause uteroplacental insufficiency, manifesting as the severe fetal bradycardia observed on the monitor.

Prioritizing Interventions Using the ABC Framework

In any acute crisis, the nursing priority follows the Airway, Breathing, and Circulation (ABC) framework. The patient’s presentation—severe dyspnea, cyanosis, and hypotension—indicates a simultaneous failure of both respiratory and circulatory systems. Option 3, "Prepare for immediate cardiopulmonary resuscitation and emergency cesarean delivery," is the only intervention that directly addresses the imminent threat of complete cardiorespiratory arrest. The case reports consistently emphasize that prompt recognition and aggressive management, including CPR and emergent delivery, are crucial for improving survival rates [3, 4]. The pathophysiology involves acute right heart failure and left ventricular dysfunction, which can rapidly deteriorate into pulseless electrical activity or asystole . Therefore, the nurse must anticipate the need for high-quality CPR and rapid delivery to relieve aortocaval compression and remove the antigenic source, which is critical for maternal resuscitation.

Analysis of Incorrect Options

- Option 1: Increase the oxytocin infusion rate to hasten delivery. This is contraindicated. Oxytocin is a known risk factor for ASP, as it can increase intrauterine pressure and potentially facilitate the entry of amniotic fluid into the maternal circulation. Increasing the rate would exacerbate the underlying pathophysiology and worsen the patient's condition.

- Option 2: Position the patient in Trendelenburg position. This is an outdated and potentially harmful intervention for a patient in respiratory distress. The Trendelenburg position can worsen pulmonary gas exchange by pushing abdominal contents against the diaphragm and may increase intracranial pressure. The immediate priority is to support circulation with chest compressions if a pulse is lost, not to place the patient head-down. Left lateral uterine displacement is the correct positioning to relieve aortocaval compression during resuscitation.

- Option 4: Administer high-flow oxygen via nasal cannula. While oxygenation is critical, a nasal cannula is grossly insufficient for a patient with severe dyspnea and cyanosis who is in impending respiratory failure. This patient requires immediate positive-pressure ventilation with 100% oxygen via a bag-valve-mask device as part of the resuscitation effort, not passive oxygen delivery. This option delays definitive airway management and circulatory support.

Clinical Reasoning and Nursing Action

The nurse’s immediate action is to recognize that the patient is peri-arrest and mobilize the full resuscitation team, including anesthesia, obstetrics, and neonatology. Preparing for immediate cardiopulmonary resuscitation means having the code cart, defibrillator, and airway equipment at the bedside. Simultaneously, preparing for an emergency cesarean delivery involves calling the surgical team and readying the operating room. This dual preparation is the cornerstone of managing a suspected ASP, as maternal survival often depends on rapid fetal delivery to enhance the effectiveness of CPR. The case reports illustrate that complications like DIC and hepatic rupture can follow the initial event, but the immediate priority is to manage the presenting cardiorespiratory collapse [2, 3].References (research sources)

- [3]Amniotic Fluid Embolism Complicated with Hepatic Rupture: A Case Report.Case reportXu Y, Zhang Y, Zheng J, Chen C, Xu X, Yan J. (2025) · DOI: 10.2147/ijwh.s549171

## 임상 시나리오

Clinical Management of Anaphylactoid Syndrome of Pregnancy

Upon suspecting anaphylactoid syndrome of pregnancy (ASP), the nurse must immediately call for help and activate the facility's obstetric emergency response team. The highest priority is to prepare for maternal cardiopulmonary arrest. Initiate high-quality CPR if the patient loses pulses, ensuring left uterine displacement to relieve aortocaval compression. Simultaneously, the team must prepare for an emergent cesarean delivery, as perimortem delivery within 5 minutes of arrest significantly improves maternal resuscitation outcomes and fetal survival.

While CPR is ongoing, manage the airway with 100% oxygen via bag-valve-mask and prepare for rapid sequence intubation. Establish large-bore intravenous access for fluid resuscitation and administration of emergency medications. Continuous fetal monitoring is secondary to maternal stabilization; the focus is on restoring maternal cardiac output to perfuse the uterus. Transfer to an operating room or prepare the labor room for an immediate bedside cesarean section. Post-resuscitation, anticipate massive transfusion protocol for DIC and transfer to an intensive care unit.

## 핵심 개념

- **Anaphylactoid syndrome of pregnancy** — A rare obstetric emergency, historically called amniotic fluid embolism, characterized by an anaphylactoid reaction to fetal antigens causing acute respiratory failure, cardiovascular collapse, and DIC.
- **ABC framework** — A prioritization model in emergency care standing for Airway, Breathing, and Circulation, used to guide immediate life-saving interventions.
- **Cardiopulmonary resuscitation** — An emergency procedure combining chest compressions and ventilation to manually preserve brain function until further measures are taken in a person in cardiac arrest.
- **Emergency cesarean delivery** — A surgical procedure to deliver a fetus rapidly when maternal or fetal condition deteriorates acutely, aiming to improve resuscitation efforts and fetal outcome.

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