Parturition and angioneurotic oedema

Angioneurotic oedema is a rare disease caused by C1 esterase inhibitor defi ciency. Hereditary angioneurotic oedema includes type I(quantitative and fu nctional) deficiency and type II (functional) deficiency. Its prophylactic treatment during pregnancy, based on danazol therapy if the fetus is male, may avoid acute attacks of generalized or laryngeal oedema. It must be inst ituted before delivery and carried into the postpartum period. If the fetus is female, epsilon aminocaproic acid may be used. The acquired form of ang ioneurotic oedema can be due to antibodies to C1 esterase inhibitor. A prop hylactic therapy is not well established, but high doses of corticosteroids are recommended. Operative delivery is best avoided when possible. Regiona l analgesia is indicated for labour or caesarean section to prevent pain an d stress and to avoid the difficulties associated with laryngeal oedema and tracheal intubation. In the treatment of an acute attack, C1 esterase inhi bitor concentrates (1500 units) may be given i.v. We present two cases, one of hereditary and one of acquired angioneurotic oedema, both presenting du ring pregnancy and both delivered vaginally under epidural analgesia with s uccessful outcome.