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妊娠合并毒蛇和蜘蛛咬伤。

Venomous Snake and Spider Bites in Pregnancy.

机构信息

Medical Student, Duke University School of Medicine.

Assistant Professor.

出版信息

Obstet Gynecol Surv. 2021 Dec;76(12):760-767. doi: 10.1097/OGX.0000000000000959.

Abstract

IMPORTANCE

Venomous snake and spider bites are relatively rare in the Unites States and even more so in the pregnant population. However, the impact of a venomous bite, also known as an envenomation, can be serious in a pregnant patient. Thus, providers in endemic and high-risk areas must be familiar with the management of envenomation in the pregnant population.

OBJECTIVE

The purpose of this article is to review the current literature on the most common snake and spider envenomations in the United States, the effects of envenomation on maternal and fetal health, and the management of envenomation in pregnancy.

EVIDENCE ACQUISITION

Original research articles, review articles, and guidelines on snake and spider envenomation were reviewed.

RESULTS

Snake envenomation carries higher risks of maternal morbidity and fetal morbidity and mortality than spider envenomation. Although the data are limited, current literature suggests that both snake and spider antivenom can be used in the pregnant population without significant adverse outcomes. However, the risks of an adverse hypersensitivity reaction with antivenom administration should be weighed carefully with the benefits.

CONCLUSIONS AND RELEVANCE

The use of antivenom therapy in the symptomatic envenomated pregnant population is likely safe with the appropriate monitoring and follow-up. Knowledge of the indications for antivenom therapy and proper escalation of care are vital to optimizing maternal and fetal outcomes. More research is needed to determine the effects of both envenomation and antivenom therapy on the pregnant patient and their fetus.

摘要

重要性

在美国,毒蛇和毒蜘蛛咬伤相对较少,在孕妇中更是如此。然而,毒液咬伤(也称为中毒)对孕妇的影响可能很严重。因此,流行地区和高风险地区的医生必须熟悉孕妇中毒的处理方法。

目的

本文旨在回顾美国最常见的毒蛇和毒蜘蛛咬伤的最新文献,中毒对母婴健康的影响,以及妊娠期间中毒的处理。

证据采集

对毒蛇和毒蜘蛛中毒的原始研究文章、综述文章和指南进行了回顾。

结果

与毒蜘蛛中毒相比,毒蛇中毒对母亲发病率和胎儿发病率及死亡率的风险更高。尽管数据有限,但目前的文献表明,毒蛇和毒蜘蛛抗蛇毒血清均可在孕妇中使用,且无明显不良结局。然而,与抗蛇毒血清治疗的益处相比,抗蛇毒血清治疗引起不良反应的过敏反应风险应仔细权衡。

结论和相关性

在有症状的中毒孕妇中使用抗蛇毒血清治疗可能是安全的,只要进行适当的监测和随访即可。了解抗蛇毒血清治疗的指征和适当的治疗升级对于优化母婴结局至关重要。需要更多的研究来确定中毒和抗蛇毒血清治疗对孕妇及其胎儿的影响。

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