Chronic Diseases during Pregnancy
Tonsillitis is a chronic palatal tonsils inflammation. Disease symptoms include: throat irritation, as well as pain, general weakness and fatigue, slight fever, dry cough. One of risk factors during pregnancy are centers of chronic infection at the mother, the most common of which are usually ENT organs – nose, sinuses and throat with tonsils. Palatal tonsils are bodies taking active part in immunological defense mechanisms formation. However, often repeated inflammation of tonsils due to bacterial infection, inhibit immune system production and cause chronic tonsillitis development.
Any form of chronic tonsillitis may cause sensitization and infection of the whole organism. Located in lacunas (cavities in tonsils) bacteria and viruses under appropriate conditions (cooling, reduced body’s resistance, and other reasons) cause local exacerbation in the form of quinsy and diseases indirectly associated with chronic tonsillitis. These diseases are rheumatism, systemic lupus erythematosus, psoriasis, eczema, glomerulonephritis, thyrotoxicosis. Frequent exacerbations require antibiotic treatment, which in itself not recommended during pregnancy.
Tonsillitis can cause harm not only pregnancy, but also the fetus. Presence of tonsillitis in the first place very often causes toxicosis in later stages, and intrauterine infections. Also, this disease can cause miscarriage and premature labour.
If exacerbations occur during pregnancy – they must be treated because it can threaten with intrauterine infection. Acute tonsillitis treatment is generally carried out at home. Strict bed rest is mandatory. Often there is a need for antibiotics. Only a specialist can correctly choose antibiotics. Be sure to take a course of antibiotic therapy to the end, otherwise surviving bacteria after some time will provoke new exacerbation. At the same time they will be resistant to the drug. All patients with quinsy are indicated to drink plenty of fluids and soft, high-calorie, vitaminized food. Throat is necessary to rinse every two hours with chamomile brew, baking soda or salt solution. You can use candies with lemon and honey, they well relieve pain at swallowing. Surgery during pregnancy is not carried out.
Chronic bronchitis is a long-term bronchial mucosa inflammation. The reason is frequent colds and smoking. Characterized by cough with small amount of mucous or mucopurulent sputum and dyspnea which last for more than three months. At bronchitis exacerbation cough intensifies, sputum amount increases, body temperature rises, there is weakness.
Respiratory system provides both the mother and the fetus with oxygen. During pregnancy period, you will need to take care of exacerbations prevention, trying not to catch a cold, remove from the house all factors that trigger irritation and inflammation of bronchial tubes, for example, aromatic substances, household chemicals, etc.
In case of chronic bronchitis exacerbation during pregnancy it is necessary to create conditions under which the body independently can cope with this condition. It is clean, fresh air in the room, «semi-bed rest» regimen, warm cloths, not abundant diet (small portions of light meal – porridge, soups, vegetables) and drinking at least 2 l of water a day. It is not recommended during pregnancy to take a steam-bath and warm legs – it can lead to uterine contractions and miscarriage. Inhalations can only be with steam and alkaline: in a pot of 2 l of boiling water add 2 – 3 table-spoons of baking soda, roll a tube of paper and slowly inhale the steam. Expectorants and antibiotics are taken only on prescription, many of these drugs are contraindicated during pregnancy. It is prohibited to receive while expecting a baby: preparations based on ipecacuanha, potassium iodide and sodium iodide (they can damage normal development of the fetus). They are replaced by lime tea, Thermopsis potion, thyme oil.
When viscous sputum appears, from which it is difficult to get rid of, it is recommended to take thinning sputum drugs (mucolytics). But during the first three months of pregnancy none of drugs in this group can be used. During 2 – 3 trimester bromhexine and bisolvon are prohibited, ambroxol and acetylcysteine are allowed.
Bronchial asthma is an allergic disease characterized by attacks of breathlessness. Asthma affects about 1 percent of pregnant women. It is impossible to predict in advance how pregnancy will affect asthma. Half of women exposed to this disease during pregnancy do not notice any changes, about 25% feel even slight improvement, while the remaining 25% of the observed – deterioration.
Asthma attack often begins with a long night cough, sputum is not discharged. Sharp difficulties with exhaling appear. You have to sit down, all muscles of chest, neck, shoulders are tensed attempting to breathe the air.
During pregnancy, you should regularly go outside, more often ventilate rooms, do breathing exercises, remove from the house all potential allergens, drink alkaline sodium mineral water, such as borzhomi. It is recommended to sleep on high pillows in a semi-sitting position (in this position lungs work better) in a well-ventilated room. Under feet put a cushion or another pillow. In this position, blood circulation in lower extremities and placenta improves. Clothes and underwear of a pregnant women should be loose, not limiting movement, comfortable and made of natural materials.
Feeling dyspnea, sit down on chair or just on your hunkers. To reduce dyspnea you need to do all movements slowly.
Some inhaled drugs do not increase risk of congenital deformities in fetus, whereas no treatment can adversely affect fetal development. Salmeterol and Atrovent (long-term action drugs) are insufficiently studied to draw conclusions about their teratogenecity to human, they are better to be replaced. Among drugs for maintenance therapy the most studied are Beclomethasone and Budesonide. They are considered the safest. The most studied at pregnancy is Albuterol. It is preferable for acute symptoms relief.
Asthma Teatment with Albuterol
Albuterol is a very potent bronchodilator, which stimulates beta2-adrenergic receptors action located in bronchi, myometrium and blood vessels. The drug has suppressive effect on early and late bronchial reactivity.
The main albuterol effect is effective bronchodilatory effect which prevents and suppresses bronchial spasms and also reduces upper and lower respiratory tract resistance.
- ischemic heart disease;
- cardiac insufficiency;
- renal insufficiency;
- I trimester of pregnancy.
- tachycardia (during pregnancy – at mother and fetus);
- myocardial ischemia;
- cardiac insufficiency;
- pulmonary edema (possibly fatal);
- distal tremor;
- dry mouth;
- loss of appetite;
- difficulties with urinating;
- increased blood glucose, free fatty acids;
- allergic reactions such as:
- facial edema;
- difficulties with breathing;
- physical and psychological drug addiction.
The drug increases central nervous system stimulants activity, thyroid hormones cardiotropic activity. Ephedrine and theophylline potentiate toxic effects. Corticosteroids, prostaglandin synthesis inhibitors, tricyclic antidepressants and MAO blockers increase risk of cardiovascular events, means for inhalation anesthesia and levodopa – severe ventricular arrhythmia. Reduces effectiveness of beta-blockers (including ophthalmic forms), antihypertensive agents, antianginal effect of nitrates. Increases risk of glycoside intoxication.
- ventricular flutter;
- peripheral blood vessels expansion;
- low blood pressure;
- increased cardiac output;
- muscle tremor;
- other psychotic disorders.
Treatment: preparation withdrawal and symptomatic therapy; beta-blockers (selective) appointment, at patients with asthma extreme caution is required because of risk of severe bronchospastic reactions.
Receiving high doses of salbutamol during asthma exacerbation leads to the fact that each subsequent attack becomes more intense than previous. At severe asthma attacks breaks between inhalations should not be less than 20 minutes. In absence of minimal effect from inhalations or appearance of pronounced tremor, tachycardia, cardiac arrhythmia, further uncontrolled inhaler use is contraindicated and you need to consult a doctor. Risk of complications increases with long-term treatment, and at abrupt drug cancellation.