What are the potential complications and contraindications in a parturient (patient in labor) with a history of Hashimoto's disease, asthma, Rh (Rhesus) negative blood type, class 2 obesity, and urticaria (hives) due to unknown environmental triggers?

From the Guidelines

Potential Complications and Contraindications

Patients with a history of Hashimoto's disease, asthma, and class 2 obesity are at increased risk for complications during labor and delivery, including postpartum hemorrhage, respiratory distress, and thromboembolic events 1. The presence of urticaria to unknown environmental triggers warrants caution with medication administration, particularly with opioids such as morphine and codeine, which may exacerbate allergic reactions 1.

Rh Negative Status and Isoimmunization

RH negative status requires administration of Rh immune globulin (300 mcg IM) within 72 hours of delivery to prevent isoimmunization, as supported by studies demonstrating the effectiveness of anti-D immunoglobulin in preventing seroconversion in Rh-negative patients 1.

Medication Administration and Asthma

Additionally, caution is advised with the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and ketorolac, which may exacerbate asthma and are contraindicated in patients with active peptic ulcer disease or renal impairment 1.

Key Considerations

• Asthma management: careful consideration of asthma exacerbation risk with medication administration and labor management strategies 1
• Allergic reactions: caution with medication administration due to urticaria and potential for anaphylaxis 1
• Rh isoimmunization prevention: administration of Rh immune globulin to prevent isoimmunization in Rh-negative patients 1
• Obesity and thromboembolic risk: increased risk of thromboembolic events due to class 2 obesity, requiring careful management and prophylaxis as needed 1

From the FDA Drug Label

CLINICAL PHARMACOLOGY HyperRHO S/D Full Dose is used to prevent isoimmunization in the Rho(D) negative individual exposed to Rho(D) positive blood as a result of a fetomaternal hemorrhage occurring during a delivery of an Rho(D) positive infant, abortion (either spontaneous or induced), or following amniocentesis or abdominal trauma INDICATIONS AND USAGE Pregnancy and Other Obstetric Conditions HyperRHO S/D Full Dose is recommended for the prevention of Rh hemolytic disease of the newborn by its administration to the Rho(D) negative mother within 72 hours after birth of an Rho(D) positive infant,

The potential complications in a parturient with a history of Hashimoto's disease, asthma, Rh (Rhesus) negative blood type, class 2 obesity, and urticaria due to unknown environmental triggers are not directly addressed in the provided drug labels. However, for the Rh negative blood type, the labels suggest that Rh immune globulin (IM) can be used to prevent isoimmunization in Rho(D) negative individuals.

• The labels do not provide information on the management of Hashimoto's disease, asthma, class 2 obesity, or urticaria in the context of Rh immune globulin administration.
• The labels do not discuss potential interactions between Rh immune globulin and other conditions or medications that may be relevant to the patient's history 2, 2. The FDA drug label does not answer the question.

From the Research

Potential Complications

• A parturient with a history of Hashimoto's disease may experience complications due to the autoimmune nature of the disease, which can affect the thyroid gland and potentially lead to hypothyroidism 3
• The presence of Hashimoto's disease may also increase the risk of other autoimmune disorders, such as chronic spontaneous urticaria, although the exact relationship between the two conditions is not fully understood 4
• The patient's history of asthma may also pose a risk for complications during labor, particularly if the asthma is not well-controlled 5
• The patient's Rh negative blood type may require special consideration during labor, particularly if the baby is Rh positive, to prevent the risk of Rh incompatibility 5
• The patient's class 2 obesity may increase the risk of complications during labor, including gestational diabetes, hypertension, and cesarean delivery 5
• The patient's history of urticaria due to unknown environmental triggers may pose a risk for anaphylaxis during labor, particularly if the triggers are not identified and avoided 4

Contraindications

• There are no specific contraindications for labor in a patient with Hashimoto's disease, although the patient's thyroid function should be closely monitored to ensure that it is within a normal range 3
• The patient's asthma may require special consideration during labor, particularly if the asthma is not well-controlled, and may necessitate the use of asthma medications during labor 5
• The patient's Rh negative blood type may require the use of Rh immune globulin during labor to prevent the risk of Rh incompatibility 5
• The patient's class 2 obesity may increase the risk of complications during labor, and may necessitate closer monitoring and more frequent interventions during labor 5
• The patient's history of urticaria due to unknown environmental triggers may require special consideration during labor, particularly if the triggers are not identified and avoided, and may necessitate the use of medications to prevent anaphylaxis 4

Immunological Considerations

• Hashimoto's disease is an autoimmune disorder, and the patient's immune system may be more prone to inflammation and immune responses during labor 6
• The patient's history of urticaria due to unknown environmental triggers may also be related to an immune system dysfunction, and may require special consideration during labor 4
• The use of intravenous immunoglobulin (IVIG) has been shown to be effective in the treatment of Hashimoto's encephalopathy, a rare but serious complication of Hashimoto's disease, although its use during labor is not well-established 7