Propyphenazone-induced Angioedema in Pregnancy: A Case Report on Therapeutic Intervention and Pharmacogenetic Considerations

REPORTassociated with adverse outcomes such as preterm premature rupture of membranes (PPROM), spontaneous preterm birth, or 2nd-trimester pregnancy loss.The condition may be congenital or acquired, and it disrupts normal cervical remodeling.The diagnosis is based on clinical history, physical examination, or ultrasound findings.Risk factors include previous cervical surgery, miscarriage, or a shortened cervix.Management is individualized, with options such as cervical cerclage and vaginal progesterone. 3Cervical cerclage is a surgical procedure that aims to provide mechanical support to the cervix in IntroductIonAngioedema is a nonpitting swelling that develops in the deeper layers of the skin and subcutaneous tissue due to plasma leakage from the blood vessels.It is thought to be triggered by vasoactive and proinflammatory mediators.Clinically, it most often affects the face and neck, the extremities, and mucosal surfaces such as those lining the gastrointestinal tract.When the airway is involved, the condition can quickly be lethal before any immediate intervention is provided. 1A 24-yearold pregnant patient (G3P2L2), in her second trimester, with a marital history of consanguineous marriage, was admitted for the management of cervical incompetence and underwent a cervical cerclage procedure under regional anesthesia.She developed a postanesthetic headache and neck pain, for which she was prescribed a nonsteroidal anti-inflammatory drug (NSAIDs) tablet, DART (containing paracetamol, propyphenazone, and caffeine), and developed angioedema, raising concerns about drug-induced dermatological reactions.Drug-induced angioedema may occur through histamine-, bradykinin-, or leukotriene-mediated mechanisms.Drugs such as NSAIDs, -lactam antibiotics, and angiotensin-converting enzyme inhibitors (ACE inhibitors) have been associated with angioedema.Nonallergic angioedema can result from genetic variations that alter the metabolism of vasoactive peptides such as bradykinin or leukotrienes. 2Cervical incompetence is defined by painless cervical dilatation during the 2nd or early 3rd trimester due to structural or functional abnormalities.It is