Pregnancy

How is pregnancy in bronchial asthma - features and hazards

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Usually, the doctor manages to diagnose bronchial asthma by carefully querying the woman, auscultation (listening to respiratory noise through the chest wall) and conducting several additional studies, the decision of which is made in connection with the data collected during the survey. For example, if a patient claims that she suffers from allergies and, against the background of contact with allergens, she has seizures, a test will be conducted that will allow her to assess the status of the organism when in contact with various substances that can cause allergies. Sputum is also examined for Kurshman coils (viscous, long pieces of sputum) and Charcot-Leiden crystals (fragments of destroyed eosinophilic blood cells due to inflammation and allergies in the bronchi). Another laboratory study is general and immunological blood tests for an increase in the blood of all the same eosinophils and immunoglobulin E, which is involved in allergic reactions.

In addition to assessing the allergic status and laboratory studies of sputum and blood, the respiratory function is surely investigated using spirometry and peak flowmetry. These techniques allow us to estimate the main respiratory volumes and capacities of the patient and compare the latter with normal values ​​characteristic of a person of a given age, height, sex, race, and physique. At the same time, the subject breathes in a special apparatus, which registers all the data and demonstrates the results in the form of numerical data and graphing, even the form of which can tell a specialist a lot.

One of the additional instrumental studies may be electrocardiography. It can indicate the formation of heart failure on the background of respiratory failure, which is gradually formed in every patient with bronchial asthma.

The most important step in the diagnosis is to determine whether the treatment is effective in this patient. This is important for determining the so-called stage of the disease and adjusting therapeutic measures in connection with the new physiological state of a woman and its features. It is necessary that the treatment was effective.

How asthma complicates pregnancy

Complications that may occur due to bronchial asthma during pregnancy are primarily related to the severity of the disease in the mother and how often his exacerbations occur, as well as how effective and volumetric treatment was chosen before pregnancy.

The main reasons for the complicated course of pregnancy in this case include the following:

  1. Disorders of the immune system,
  2. Disruption of homeostasis (equilibrium of the internal environment of the body), having a hemostatic nature (associated with adverse changes in blood clotting),
  3. Changes in the external respiration function of the mother, which leads to hypoxia (lack of oxygen in the blood) of both the fetus and herself,
  4. Metabolic disorders (metabolism).

Of all of the above, maternal and fetal hypoxia has a direct connection with the disease, since in asthmatics the respiratory function is almost always impaired, the question is only in the degree of these disorders. In this case, the chosen treatment is most important for the prevention of complications.

Failures associated with the work of the immune system, contribute to the reduction of resistance (resistance) of the patient's body to viral, bacterial and fungal infections. In this regard, intrauterine infection often occurs. In addition, the vascular lesion of the placenta can occur (a “baby seat”, the viability of the fetus is maintained at the expense of the placenta) by immune complexes, and therefore the fetal development is often delayed.

Hemostatic disorders can be expressed in chronic thrombohemorrhagic syndrome (disruption of the coagulation system, when alternately coagulation is dramatically increased, and multiple blood clots occur in the microvessels, they are significantly reduced, leading to hemorrhages in them) of the placental vessels, which also slows the development of the fetus.

It should be noted that the clinical manifestations of bronchial asthma itself do not differ from similar ones outside of pregnancy. They are expressed in wheezing, shortness of breath, dry cough and asthma attacks, usually proceeding with difficulty breathing out.

As a rule, the disease is not a contraindication to pregnancy, but it must be remembered that an uncontrolled, severe course of the disease with frequent, difficult to stop (discontinued) seizures can lead to complications in the mother and fetus, up to preterm delivery, threatened abortion, hypoxia and fetal asphyxia during labor. Often, in such cases it is necessary to carry out operative delivery.

How to choose the right treatment

In addition, the patient will receive medical treatment, the woman must stop smoking and permanent (permanent) exposure of harmful volatile substances to her body. Of course, quitting smoking should be final, for the latter adversely affects not only the course of asthma, but also the fetus during pregnancy.

Treatment of bronchial asthma in a pregnant woman is advisable to carry out, without losing sight of the trimester (a gap of three months, part of the pregnancy, there are three: first, second and third).

In the first trimester, treatment usually does not have characteristic features. Therapy is carried out in accordance with the stage of the disease. The main drugs are various inhalants used during an attack (Salbutamol) and daily to prevent attacks (Beclamethasone). For the prevention of attacks can be used different drugs in pill form, it depends on the severity of the disease.

In the next two trimesters, treatment should consist not only in correcting pulmonary complications, but also maintaining and optimizing the state of the energy processes inside the cells, since during pregnancy, accompanied by bronchial asthma, these processes can suffer. To maintain the latter at the proper level, the following treatment is applied:

  1. Vitamin E (tocopherol),
  2. Phospholipids and multivitamins (to prevent cell damage by active oxygen radicals - its special variants capable of serious tissue damage),
  3. Interferon - alpha 2 (immunotherapy for the prevention of complications in the form of various infections),
  4. Sodium heparin (a drug that normalizes the function of the blood coagulation system and binds immune complexes that can damage the vessels of the placenta).

Whether the chosen treatment is effective can be determined by ultrasound diagnosis of fetal development and hemodynamics (adequacy of the vascular system), as well as by the level of hormones produced (produced) by the placenta.

How are birth in patients with bronchial asthma

Often, childbirth in patients with lung bronchial asthma, pass naturally and without complications. The deterioration of the disease does not occur. However, childbirth can be complicated. The most common complications include:

  1. rupture of amniotic fluid before childbirth comes,
  2. birth too fast
  3. childbirth complicated by abnormal (irregular, non-physiological) labor activity.

It should be remembered that childbirth with frequent exacerbations of the disease in the last trimester can be quite difficult.

If it is decided that labor should take place spontaneously, then the epidural space is punctured before delivery (puncture of the spinal canal to enter the space around the solid membrane of the spinal cord), after which bupivacaine, which causes an additional expansion of the bronchi, is injected. In addition, during childbirth continue the usual, previously selected treatment of bronchial asthma.

If after the childbirth begins, the patient has signs of cardiopulmonary insufficiency or asthmatic status (long-term, not ending with therapy, an attack of bronchial asthma), then this is an indication for operative delivery.

Risks for a newborn

The risk of developing a disease in a newborn is quite high if at least one of the parents is sick. Heredity makes almost fifty percent of the contribution to the overall susceptibility of the individual to the development of asthma. However, the child’s illness may not occur. Much in this case depends on the preventive measures taken by the parents, including constant monitoring by a therapeutic specialist.

If the child was born through caesarean section, the risk of developing the disease increases.

What should remember a woman

Treatment of the disease during pregnancy is mandatory. You can pick up drugs that will not harm the fetus and mother. If the patient's condition is stable and there are no exacerbations, then the pregnancy itself and the birth will proceed without complications.

To understand how bronchial asthma and pregnancy should coexist at the same time, one can attend Asthma schools or independently obtain and read the materials of the educational program for patients.

Changes in the respiratory system in pregnant women

At a time when a woman bears a child, changes occur in the respiratory system. The lungs and bronchi are in constant functional tension.

The need for oxygen consumption increases several times. And if in the first periods due to rapid breathing oxygen demand increases by 10%, by 6-9 months oxygen consumption is already 130-140% compared to the original.

During contractions due to increased breathing and tension of the diaphragm, the woman already needs more oxygen, up to 200%.

Also characterized by the following changes:

  • from 12 weeks inhalation of oxygen per minute ranges from 7.5 to 11 liters,
  • 20% decrease in the functional capacity of the lungs,
  • an increase in respiratory volume is observed, due to which the alveolar ventilation of the lungs increases by 70%,
  • with an increase in the uterus, pressure on the diaphragm and its upward displacement of 4–5 cm occurs. Due to this, the capacity and size of the chest are reduced in the lungs. The muscles of the respiratory system have to work more intensely. There is an increase in pressure in the pulmonary artery. Therefore, women often experience rapid, diaphragmatic breathing,
  • may cause shortness of breath in 70% of pregnant women. This is not due to the rarer breathing of a woman, but to a decrease in respiratory volume in the pulmonary system. Dyspnea can be spontaneous and appears not only after physical exertion, but also at rest,

This symptom is most often observed from 1 to 3 trimester of pregnancy.

  • in arterial blood there is a decrease in the amount of oxygen, Therefore, the respiratory muscles begin to work hard to fully supply the entire body with the required amount,
  • due to hyperventilation of the lungs and an increase in their volume, the partial pressure of carbon dioxide in arterial blood decreases by 20%. This contributes to an increase in partial stress,
  • edema of the mucous bronchi and trachea is often observed.
  • Features of the course of pregnancy

    Women with asthma not contraindicated in having children. For a favorable course of pregnancy, the doctor must constantly monitor the patient so that a healthy and full-fledged child is born. An important component is the correct choice of drugs to prevent attacks.

    If a woman uses inhalation during pregnancy, there is a risk of respiratory failure due to a decrease in oxygen in the blood and an increase in carbon dioxide levels.

    The danger of this condition is that the developing fetus will experience oxygen starvation.

    Also during pregnancy there is a high probability of the following complications:

    • the emergence of early toxicosis,
    • preterm labor,
    • forced abortion,
    • capillary stasis due to changes in the vessels of the respiratory system,
    • Pathological indications of changes in the pulmonary system after an X-ray examination:
    • coughing and wheezing
    • arrhythmia and tachypnea,
    • increase in hemoglobin blood
    • preeclampsia (late toxicosis),
    • placental insufficiency.

    Complications of pregnancy in women are observed in the early stages .

    (The picture is clickable, click to enlarge)

    These complications occur if the patient was wrong treatment regimen or it became necessary to take drugs that had a negative impact on the development of the fetus.

    There is also a high probability that children will have a congenital allergy, low body weight, defects in mental or physical development, asphyxiation, or functional impairment of the nervous system.

    As the fetus develops, improvement in well-being is observed in 70% of women. This is due to the fact that by the beginning of the third trimester in the body of a pregnant woman, progesterone begins to be strongly developed, which contributes to the expansion of the bronchi.

    Also, as the fetus develops, the placenta itself produces glucocorticoids, which reduce inflammation in the body.

    Prevention of complications

    The basis of all preventive measures is to completely limit the contact of a pregnant woman with allergens that cause a choking attack.

    A pregnant woman diagnosed with asthma should also follow these guidelines:

    • adjust the diet and completely eliminate from the diet all foods that can provoke allergies,
    • clothes and bedding should be from natural fibers,
    • give up detergents and creams,
    • take a shower every day
    • eliminate contact with dust and animals,
    • the maximum amount of time to spend in the fresh air
    • daily wet cleaning,
    • eliminate any work with harmful substances
    • eliminate smoking and drinking alcohol,
    • avoid crowded places
    • monitor the temperature and humidity in the living room. Humidity should be no higher than 60%, air temperature - 20-23 degrees.

    During pregnancy, it is necessary to use all medications that the doctor prescribed.

    Drugs that contraindicated:

    1. Adrenalin. It can cause vasospasm and cause miscarriage or hypoxia.
    2. Theophylline. The drug is able to penetrate the placenta, causing arrhythmia in the fetus.
    3. Triamcinolone. It has a negative effect on the formation of muscle mass in the fetus.

    Treatment methods

    Preparations are selected by the doctor, taking into account the extent of the disease of the pregnant woman. Be sure to assign a special scheme and strictly controlled the patient's health throughout the pregnancy:

    • With 1 degree disease medications should be used only if necessary to stop an attack. You can use salbutamol or fenoterol. These drugs quickly stop an attack and have a short duration.
    • In the presence of 2 degrees A woman should always have one of the basic drugs with her. It must be taken on an ongoing basis. These are anti-leukotriene agents, bronchodilators and inhaled ICS, which have an anti-inflammatory effect and reduce the swelling of the bronchial mucosa. These drugs include:
    1. Salmeterol,
    2. Fluticasone,
    3. Salbutamol group
    4. Cromons,
    5. leukotriene modifiers.
    • With 3 degrees in combination with a short-acting blocker, 2 more basic preparations are used. Most often in this case, combining combinations of small doses of GCS with blockers, which have a long-lasting effect. For example, Budesonide, Beclamethasone, or Flixotide are effective. In rare cases, the appointment of Theophylline. It is prescribed if the risk of choking exceeds the risk of complications in the development of the fetus.

      Theophylline is strictly contraindicated if the patient has atrial fibrillation. Large doses can cause cardiac arrest.

    • In the first-aid kit in a pregnant woman with 4 degrees severity of bronchial asthma should constantly be 3 basic drugs from different groups:
    1. inhaled GCS,
    2. durable blockers
    3. anti-leukotriene agents.
    • Fifth degree Asthma requires constant medication. This includes numerous preparations of basic therapy, inhaled GCS, monoclonal antibodies. All drugs in most cases, the doctor prescribes in high dosages.

    Exacerbation of asthma during labor

    During childbirth exacerbations of asthma practically not observed.

    This is due to the fact that by this period, due to the stress before birth, epinephrine and endogenous steroids are released into the body, which do not allow an attack to develop.

    Practically in 87% of cases a woman gives birth on her own. And only in 13% of cases there is a need for cesarean section. Для женщин, у которых диагностирована астма средней и тяжелой степени тяжести, самостоятельное родоразрешение становится серьезной проблемой.Due to impaired respiratory function, there is a high risk of developing heart or respiratory failure.

    therefore for operative delivery resort if:

    • revealed cardiopulmonary insufficiency,
    • with a history of spontaneous pneumothorax,
    • if there are indications related to the physiological characteristics of the structure of the organism.

    Despite the disease, doctors are focusing on carrying out natural childbirth in women with bronchial asthma. Before delivery, the patient is injected with a 0.125% solution of marcaine, which suppresses an attack of asphyxiation. Then using amniotomy, labor induction is performed to activate the woman. An anesthetic is also administered that changes the blood flow.

    Obstetricians conduct episiotomy to shorten the time period of delivery. Having carried out all these activities, a woman alone, even with a severe degree of illness, gives birth without negative consequences for health.

    After giving birth, the patient must continue the prescribed treatment. At the same time it is allowed to breastfeed, since taking the drugs will not have a negative impact on the child.

    Send your good work in the knowledge base is simple. Use the form below.

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    Posted on http://www.allbest.ru/

    GBOU VPO Nizhny Novgorod State Medical Academy of the Ministry of Health of the Russian Federation

    Department of General and Clinical Pharmacology

    on the topic:"Therapy of bronchial asthma during pregnancy, its effect on the fetus"

    Completed: clinical intern of the 1st year of study

    Departments of Faculty and Polyclinic Therapy

    Nizhny Novgorod 2015-2016

    • Introduction
    • 1. Causes of complicated pregnancy and perinatal pathology
    • 2. Used groups of drugs for the treatment of bronchial asthma, the possibility of their use in pregnant women and their influence on the fetus
    • 3. Bronchial asthma and childbirth
    • Conclusion
    • Bibliography

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    Asthma in pregnant women - how dangerous it is

    If the expectant mother ignores the symptoms of the disease and does not seek medical help, the illness adversely affects both her health and the state of health of the fetus. Bronchial asthma is most dangerous in the early stages of gestation. Then the course becomes less aggressive, and the symptoms diminish.

    Can you get pregnant with asthma? Despite its severe course, the disease is compatible with carrying a child. With proper therapy and constant monitoring of the doctor, dangerous complications can be avoided. If a woman is registered, receives medications and is regularly examined by a doctor, the threat of a complicated course of pregnancy and childbirth is minimal.

    However, sometimes the following deviations appear:

    1. Increased seizures.
    2. The addition of viruses or bacteria with the development of the inflammatory process.
    3. The deterioration of the flow of attacks.
    4. The threat of spontaneous abortion.
    5. Severe toxicosis.
    6. Premature delivery.

    In the video, the pulmonologist tells in detail about the disease during childbirth:

    The effect of the disease on the fetus

    Pregnancy alters the work of the respiratory organs. The level of carbon dioxide rises, and the breath of a woman quickens. Ventilation of the lungs is enhanced, causing the expectant mother to notice shortness of breath.

    At a later date, the location of the diaphragm changes: the growing uterus lifts it. Because of this, the pregnant woman feels a sense of lack of air. The condition worsens with the development of bronchial asthma. Placental hypoxia is caused with each attack. This leads to prenatal oxygen deprivation in a baby with the appearance of various disorders.

    The main deviations of the crumbs:

    • lack of weight
    • intrauterine growth retardation
    • the formation of pathologies in the cardiovascular, central nervous system, muscle tissue,
    • with severe oxygen starvation, asphyxia (suffocation) of the baby may develop.

    If the disease takes a severe form, there is a high risk of giving birth to the crumbs with heart defects. In addition, the infant will inherit a predisposition to diseases of the respiratory organs.

    How are childbirth in asthma

    If the childbearing was monitored throughout the pregnancy, independent delivery is quite possible. 2 weeks before the estimated date the patient is hospitalized and prepared for the event. When a pregnant woman receives large doses of Prednisolone, she is given Hydrocortisone injections during the expulsion of the fetus from the uterus.

    The doctor strictly controls all indicators of the future mother and baby. During childbirth, a woman is given medication to prevent an asthma attack. It will not harm the fetus, a positive effect on the patient's well-being.

    When bronchial asthma takes a severe course with more frequent attacks, a planned caesarean section is performed at 38 weeks. By this time the child is fully formed, viable and considered full-term. During the operation, it is better to apply a regional blockade than inhalation anesthesia.

    The most common complications during delivery caused by bronchial asthma:

    • premature rupture of amniotic fluid,
    • rapid delivery, badly affecting the health of the baby,
    • discoordination of labor.

    It happens that the patient gives birth independently, but an asthmatic attack begins, accompanied by cardiopulmonary insufficiency. Then conduct intensive therapy and emergency cesarean section.

    How to deal with asthma during pregnancy - proven methods

    If you have received drugs from the disease, but become pregnant, the course of therapy and medications are replaced by a more benign option. Some medicines are not allowed by doctors during pregnancy, and the dose of others should be adjusted.

    Throughout pregnancy, the doctor monitors the condition of the crumbs, performing an ultrasound. If the aggravation has begun, oxygen therapy is carried out, which prevents the oxygen starvation of the baby. The doctor monitors the patient's condition, paying close attention to changes in the uterine and placental vessels.

    The main principle of treatment is the prevention of asthma attacks and the selection of harmless therapy for mothers and crumbs. The tasks of the attending physician are the restoration of external respiration, elimination of asthma attacks, relief of side effects from drugs and control of the disease.

    Bronchodilators are prescribed for the treatment of mild asthma. They can relieve spasm of smooth muscles in the bronchi.

    During pregnancy, long-acting drugs are used (Salmeterol, Formoterol). They are available in aerosol cans. Apply daily and prevent the development of nighttime attacks of breathlessness.

    Other basic drugs are glucocorticosteroids (budesonide, beclomethasone, flutinazone). They are produced in the form of an inhaler. The doctor calculates the dosage, given the severity of the disease.

    If you have been prescribed hormones, do not be afraid to use them daily. Medicines will not harm the baby and prevent the development of complications.

    When the expectant mother suffers from late gestosis, methylxanthines (Euphyllinum) are used as a bronchodilator. They relax the muscles of the bronchi, stimulate the respiratory center, improve alveolar ventilation.

    Expectorants are used to remove excess mucus from the respiratory tract (Mukaltin). They stimulate the bronchial glands, increase the activity of ciliated epithelium.

    In later periods, the doctor prescribes supportive therapy. It is aimed at restoring intracellular processes.

    Treatments include the following medications:

    • Tocopherol - reduces the tone, relaxes the muscles of the uterus,
    • multivitamins - fill the body with an insufficient amount of vitamins,
    • anticoagulants - normalize blood clotting.

    What drugs can not take pregnant for treatment

    During the period of carrying a child, it is not worth using medicines without medical recommendations, and even more so in bronchial asthma. You need to strictly observe all appointments.

    There are medicines that are contraindicated in women asthmatics. They can adversely affect the prenatal health of the baby and the condition of the mother.

    List of prohibited drugs:

    ethnoscience

    Nontraditional methods of treatment are widely used by patients with bronchial asthma. Such tools do well with attacks of breathlessness and do not harm the body.

    Use traditional recipes only as a supplement to conservative therapy. Do not use them without first consulting with your doctor or if you identify an individual allergic reaction to the components of the product.

    How to deal with asthma recipes of traditional medicine:

    1. Oatmeal decoction. Cook and rinse well with 0.5 kg of oats. Put on the gas 2 liters of milk, add 0.5 ml of water. Bring to a boil, add cereal there. Boil another 2 hours to get 2 liters of broth. Take hot on an empty stomach. In 1 glass of drink, add 1 tsp. honey and butter.
    2. Oatmeal broth on goat milk. Pour 2 liters of water into the pot. Bring to a boil, then add 2 cups of oats. Boil the product on low heat for about 50–60 minutes. Then add 0.5 liters of goat milk and boil for another half hour. Before taking the broth, you can add 1 teaspoon of honey. Drink ½ cup 30 minutes before meals.
    3. Inhalation with propolis and beeswax. Take 20 g of propolis and 100 g of beeswax. Heat the mixture in a water bath. When she gets warm, her head is covered with a towel. After that, inhale the product with your mouth for about 15 minutes. Such procedures are repeated in the morning and evening.
    4. Propolis oil. Mix 10 g of propolis with 200 g of sunflower oil. Put a means of heating in a water bath. Strain it and take 1 tsp. in the morning and in the evening.
    5. Ginger juice. Squeeze the juice from the root of the plant, adding a little salt. The drink is used to combat attacks and as a prophylactic agent. To suffocate, take 30 g. To prevent breathing difficulties, drink 1 tbsp daily. l juice. For flavor add 1 tsp. honey, washing it down with water.

    Disease prevention

    Doctors advise women with asthma to control their illness while planning a pregnancy. At this time, the doctor selects the correct and safe treatment, eliminates the effect of irritating factors. Such activities reduce the risk of developing attacks.

    A pregnant woman herself can also take care of her health. Smoking must be stopped. If relatives living with the expectant mother smoke, you should avoid inhaling the smoke.

    To improve your health and reduce the risk of relapse, try to follow simple rules:

    1. Revise your diet, exclude from the menu foods that cause allergies.
    2. Wear clothes and use bedding made from natural material.
    3. Take a shower every day.
    4. Do not contact with animals.
    5. Use hygiene products that are hypoallergenic.
    6. Use special devices, humidifiers, which maintain the necessary humidity and clean the air from dust and allergens.
    7. Spend long walks in the fresh air.
    8. If you work with chemicals or toxic fumes, go to a safe place of activity.
    9. Beware of crowds of people especially in the autumn and spring season.
    10. Avoid allergens in your daily life. Regularly do wet room cleaning, avoiding inhalation of household chemicals.

    At the planning stage of your baby, try to vaccinate against dangerous microorganisms - hemophilic bacilli, pneumococcus, hepatitis virus, measles, rubella and tetanus, diphtheria. Vaccination is carried out 3 months before the planning of the child under the supervision of the attending doctor.

    Conclusion

    Bronchial asthma and pregnancy do not exclude each other. Often the disease occurs if it becomes acute when an “interesting situation” occurs. Do not ignore the manifestations: asthma can adversely affect the health of the mother and child.

    Do not be afraid that the disease will cause any complications in the crumbs. With proper medical monitoring and adequate therapy, the prognosis is favorable.

    Asthma is ...

    Asthma is an acute reaction of the bronchus to irritant.. In other words, it is an attack of suffocation caused by the action of an allergen. A spasm is a narrowing of the lumen of the bronchus, which is called the bronchial obstruction. During an attack, a person cannot inhale, coughs, a pressing feeling arises in his chest. Often, asthma during pregnancy is accompanied by rhinitis, conjunctivitis and skin reactions, such as dermatitis, urticaria, eczema.

    This disease is chronic. Causes of bronchial asthma can be very different: a reaction to pollen, animal dander, street or household dust, cigarette smoke, household chemicals, etc. It may result from not fully cured bronchitis, or may develop due to endocrine system malfunction or after brain injury. Although the disease is chronic, in some cases it is a completely reversible process.. Some former asthmatics live, forever forgetting about attacks.

    Bronchial asthma is a constantly smoldering inflammatory process, which in itself is already dangerous for the fetus. The baby receives oxygen from the mother’s blood through the placenta throughout the gestational period, so frequent asthma attacks in a pregnant woman can lead to fetal hypoxia. No conscious mother wants her child to suffer, so the control of a pulmonologist and an allergist is a prerequisite in this situation.

    How is the disease

    Any woman asthmatic understands the seriousness of the situation, so the inhaler is always with her. However, it cannot be said that during pregnancy asthma makes itself felt more often:

    • Some future mothers say that the disease has receded and seizures no longer bother. Doctors say that this is a merit of the hormonal adjustment of the body, since the hormone cortisol during pregnancy begins to be produced more actively. This concerns not only asthmatics. Многие женщины замечают, что в этот период жизни хронические заболевания отступают, например, приступы ВСД тоже беспокоят беременных крайне редко – природа подумала и об этом,
    • a third of women in the position claim that bronchospasm visits them no more often than before pregnancy. They have the disease is exactly the same as before, and attacks occur with the same frequency,
    • most women complain of an increase in seizures in the last months, from the 28th to the 40th week. This is due to the fact that the fetus is already large and hampers the broncho-pulmonary system. During this period, you need to be especially on your guard. Shortly before childbirth, the child falls into the small pelvis and the mother’s condition returns to normal.

    Basically, the disease is aggravated in those moms who are afraid to use any medications, citing the fact that this will negatively affect the development of the fetus. This is fundamentally wrong! A competent specialist cannot prescribe a drug that will harm a child. All drugs are tested and the risk to the fetus is assessed based on this. A pulmonologist, an allergist and an obstetrician-gynecologist select the most optimal course of treatment for the expectant mother in order to hold back attacks and at the same time minimize harm to the baby.

    In fact, it is much worse to refuse treatment, since another strong attack can lead to premature labor, and in this case it is necessary to prepare for such problems as low weight of the fetus, underdevelopment of its respiratory system, hypoxia. In addition, modern pharmaceuticals offers a large selection of inhalers to an asthmatic woman. The mechanism of their action is as follows: the maximum benefit for the bronchi and the rapid relief of an attack is the minimum absorption into the blood of a small fraction of the active substance.

    Disease Forms

    Bronchial asthma in pregnant women can occur in two different forms. Their main difference is the causative agent. Attacks while practically do not differ in feelings, regardless of what caused the development of this serious illness. But the severity of the disease depends on its shape:

    1. Allergic. In this case, the pregnant woman has a reaction to animal hair, flowering plants, dust, medicines (antipyretic, antibiotics, vitamins), chemical
      substances, some food products (vegetables and fruits of red color, red fish, fruits of exotic plants). This form is often hereditary and, as a rule, a person suffers from childhood. Ecology is also not in the last place in the list of the causes of asthma manifestations - the residents of polluted industrial cities often suffer from this disease. Asthma can develop as a result of professional activity, in contact with aggressive substances, chemicals, gases.
    2. Infectious-allergic. This form of the disease is caused by another type of irritant - pathogenic bacteria and microbes. Asthma during pregnancy can develop as a result of a postponed respiratory infection, which provoked any complication, for example: pharyngitis, angina, bronchitis or pneumonia. Pathogens can be streptococci, staphylococci, fungi and other pathogens. It is from this form of bronchial asthma that future mothers most often suffer.

    Whatever form of bronchial asthma manifests itself, the patient needs constant monitoring by specialists, especially during pregnancy.. You can be ready for an attack at any moment, so the expectant mother should always have a fast-acting medication in her purse, which will ease the condition and relieve the spasm.

    Symptoms of bronchial asthma

    The main symptom of asthma is suffocation, a sudden attack, but its course and duration depend on the severity of the disease.. The disease has several phases of development:

    • predastmatic This is the easiest manifestation of the disease, occurring against the background of chronic bronchitis or pneumonia. A pregnant woman has mild bronchospasm without pronounced choking attacks. This stage is characterized by periodic manifestations of bronchial obstruction,
    • asthma attacks. From the title it is clear what happens to the future mother when this phase of the disease begins. Bronchospasm does not let a woman go from several minutes to several hours. You need to be especially wary at night - it is during this period of the day that seizures come more often. During bronchial obstruction, the patient has a strong dry cough, loud wheezing, sore throat, sneezing, bluish complexion, excessive sweating. When the bronchospasm recedes, the pregnant woman begins to cough up mucus in large quantities,
    • asthmatic status. This is the most severe stage of the disease, in which the disease passes due to the failure of the expectant mother to receive adequate treatment.. Attacks intensify and last from several hours to days. This can lead to serious complications in both mother and fetus. The fact is that drug treatment of bronchial asthma in pregnant women at this stage is already powerless. Such attacks of bronchial obstruction lead to an increase in blood pressure, premature labor and fetal hypoxia.

    So, in order not to have to resort to the services of a pulmonologist-resuscitator, you need not to start asthma and always monitor its course so that it does not turn into the hardest stage. For this purpose, there are preventive measures and compulsory therapy, shown pregnant women with bronchial asthma.

    Treatment of bronchial asthma

    Therapeutic drugs aimed at alleviating the symptoms of bronchial asthma are selected only by a competent specialist. The expectant mother cannot treat herself at her own discretion and use means that have facilitated seizures before pregnancy without consulting the doctor.. What does the self-cancellation of all drugs and the non-attendance of a pulmonologist and allergist result in is described above:

    1. In the mild stage of the disease, which is accompanied by rare bronchospasms of the pregnant woman, beta 2-adrenomimetics are prescribed, for example, Albuterol. They are used exclusively for the relief of an attack of bronchial obstruction and are not applied according to the scheme. If the attacks become more frequent, but remain light, connect Tayled or Intal,
    2. Stronger choking attacks require the use of glucocorticosteroids. The above drugs are not enough, because this form of asthma requires medication intervention at the hormonal level. Pregnant women better opt for beclomethasone-containing drugs, as they are the most benign. Among them are Beoatid, Beclazon Eco, Klenil.
    3. At the stage bordering the most difficult, specialists are forced to connect Theofillin. This happens when its benefits in all respects exceed the expected risks to the mother and fetus. The fact is that this remedy has a side effect in the form of a heart rhythm disorder in the fetus. For this reason, it is prescribed with the complete ineffectiveness of inhaled corticosteroids.

    These are only recommendations; without the advice of a specialist, none of these drugs can be used by a woman in the position. Experts recommend choosing sprays, which include no freon, in order to prevent improper development of organs and systems in the fetus.

    Preventive measures

    Having survived more than one choking attack, a woman who suffered from bronchial asthma before pregnancy probably knows what irritant can provoke bronchospasm in her. Therefore, its task is to protect itself from all possible contacts with the pathogen. If the disease manifested itself for the first time after conception, then you need to turn to such preventive measures:

    • follow a hypo-allergenic diet. Asthmatics cannot eat anything red and orange. Banned - citrus fruits, berries, tomatoes, melons, watermelons. In no case can not use any unfamiliar products that caught my eye for the first time in my life,
    • Do not use drugs that provoke an allergic reaction. If the pathogen was not previously identified, then one should be wary of penicillin antibiotics, antipyretic, vitamin complexes. A woman in position needs to take folic acid, minerals and vitamins, but only asthmatics can work with this and what not, only a doctor can advise
    • remove soft furnishings, carpets, and extra items that collect dust from your home. In an apartment, asthmatics should reign minimalism - only the most necessary. There is one more way out: to vacuum twice a day and wash (or at least knock out) curtains every week, or even better get a steam cleaner. If there is not enough time, then it is better to get rid of unnecessary “dust collectors”,
    • as often as possible to carry out wet cleaning. An asthmatic woman should wipe floors and surfaces daily to protect her respiratory system from exposure to house dust,
    • avoid communicating with smokers. Tobacco smoke is often one of the triggers that contribute to the development of asthma, so you shouldn't be pregnant next to smokers.,
    • take care of sufficient moisture of the room and cleaning it from dust. To do this, you can fork out for the installation of an air conditioner, which has the function of air purification, and use a humidifier, adding to it disinfecting essential oils, for example, eucalyptus or fir.

    Obviously, asthma and pregnancy are not a sentence for the woman and child she wears under her heart. The main thing is not to self-medicate, not to give up drugs prescribed by the doctor and is under the supervision of specialists. Subject to these important rules of behavior, there is no doubt that a healthy and strong baby will be born!

    Bronchial asthma during pregnancy

    Bronchial asthma (BA) is the most common pathology of the respiratory system during pregnancy, occurs in 2-9% of patients. According to the observations of obstetrician-gynecologists and pulmonologists, the progression of the disease is noted in 33-69% of pregnant women. At the same time, in some women the condition remains stable and even improves. Mild forms of BA are diagnosed in 62% of women, moderate - in 30%, severe - in 8%. Although exacerbation of the disease is possible at any stage of pregnancy, more often it occurs in the second trimester, and during the last 4 weeks spontaneous improvement usually occurs due to an increase in the content of free cortisol. The urgency of timely diagnosis of asthma is associated with the almost complete absence of complications with proper medical control.

    Causes of asthma during pregnancy

    The occurrence of the disease in a pregnant woman is triggered by the same factors as in non-pregnant patients. Significant role in the development of bronchial asthma is played by atopy, a hereditary predisposition to allergic diseases due to hypersensitization of the organism with enhanced immunoglobulin synthesis (IgE). The trigger point of the bronchospastic states in these cases is the action of external triggers - household allergens (dust, paint fumes, building materials), plant pollen, animal hair, food, pharmaceuticals, tobacco smoke, occupational hazards, etc. The appearance of symptoms in predisposed pregnant women can be provoked by respiratory viral infections, chlamydia, mycobacteria tuberculosis, intestinal and other parasites.

    The subject of the effect of changes during gestation on the occurrence and course of asthma is not yet sufficiently studied. According to various authors in the field of obstetrics and gynecology, in some cases the debut of the disease is associated with pregnancy, and its symptoms may persist or disappear completely after birth. A number of neuroendocrine, immune and mechanical factors contributing to the development of bronchospasm during gestation has been identified. They also cause exacerbation of the disease and worsening of its symptoms in pregnant women with bronchial asthma:

    • Enhanced secretion of endogenous bronchoconstrictors. The maternal part of the placenta and uterine tissue synthesize prostaglandin F2α, which stimulates the contraction of smooth muscle. Its concentration rises towards the end of gestation, ensuring a timely onset of labor. The substance also provokes respiratory obstruction due to spasm of the smooth muscle fibers of the bronchi.
    • Increasing the concentration of immunoglobulin E. A high level of IgE is an important link in the pathogenesis of an atopic reaction to the action of sensitizing factors. Immune restructuring in response to continuous exposure to fetal antigens leads to an increase in the content of this immunoglobulin in the blood of a pregnant woman and increases the likelihood of developing bronchospasm and asthma.
    • Increasing the number of α-adrenoreceptors. Hormonal changes that occur by the end of pregnancy, are aimed at ensuring adequate labor activity. Stimulation of α-adrenoreceptors is accompanied by increased contractile activity of the myometrium. The number of such receptors also increases in the bronchi, which facilitates and accelerates the occurrence of bronchospasm.
    • Decreased sensitivity to cortisol. Glucocorticoids have a complex anti-asthma effect, affecting different parts of the pathogenesis of the disease. When pregnant, due to competition with other hormones, the pulmonary receptors become less sensitive to cortisol. As a result, the likelihood of bronchial spasm increases.
    • Changing the mechanics of breathing. The stimulating effect of progesterone contributes to the occurrence of hyperventilation and an increase in the partial pressure of carbon dioxide in the first trimester. The pressure of the growing uterus in the II-III trimesters and the increased resistance of the blood vessels of the pulmonary circulation potentiate the appearance of shortness of breath. In such conditions, bronchospasm develops more easily.

    An additional factor that increases the likelihood of asthma during gestation, is progesterone-induced swelling of the mucous membranes, including lining the airways. In addition, due to the relaxation of the smooth muscles of the esophageal-gastric sphincter, pregnant women more often develop gastroesophageal reflux, which serves as a trigger for the development of bronchospasm. Exacerbation of the disease in a patient with manifestations of asthma can also occur when refusal from supporting treatment with glucocorticoid drugs for fear of causing harm to the child.

    A key element in the development of asthma during pregnancy is increased bronchial tree reactivity, caused by specific changes in the vegetative nervous system, inhibition of cyclic nucleotides (cAMP), mast cell degranulation, and the effect of histamine, leukotrienes, cytokines, chemokines, other inflammatory mediators. The action of the trigger allergens triggers a reversible bronchial obstruction with an increase in airway resistance, overstretching of the alveolar tissue, a discrepancy between the ventilation of the lungs and their perfusion. Hypoxemia, hypoxia, metabolic disorders become the final stage of respiratory failure.

    Classification

    In the management of pregnant women suffering from bronchial asthma, use is made of the clinical systematization of the forms of the disease, taking into account the severity. The classification criteria for this approach are the frequency of asthma attacks, their duration, and changes in external respiration rates. There are the following options for asthma during pregnancy:

    • Episodic (intermittent). Asthma attacks are observed no more than once a week, at night the patient is not more than 2 times a month disturbed. The periods of exacerbations last from several hours to several days. Outside exacerbations, respiratory function is not impaired.
    • Light persistent. Typical symptoms occur several times a week, but not more than once a day. During exacerbations, sleep disturbance and habitual activity may occur. The peak expiratory flow rate and its second volume during forced respiration during the day change by 20-30%.
    • Persistent moderate. Daily attacks are noted. Asphyxiation develops at night more often than once a week. Changed physical activity and sleep. Characterized by a decrease of 20-40% peak expiratory flow rate and its second volume when forcing with a daily variation of more than 30%.
    • Heavy persistent. Pregnant worried about daily attacks with frequent exacerbations and the appearance at night. There are restrictions for physical activity. Basic indicators for assessing respiratory function are reduced by more than 40%, and their daily fluctuations exceed 30%.

    Complications

    In the absence of adequate drug control, a pregnant woman with signs of asthma develop respiratory failure, arterial hypoxemia, and peripheral microcirculation is disturbed. As a result, early toxicosis is noted in 37% of patients, preeclampsia in 43%, the threat of abortion in 26%, and premature labor in 14.2%. The occurrence of hypoxia at the time when the laying of the main organs and systems of the child occurs leads to the formation of congenital developmental anomalies. According to the results of research, heart defects, disorders of the development of the gastrointestinal tract, spine, nervous system are observed in almost 13% of children who were worn by women with exacerbations and asthma attacks in the first trimester.

    Циркулирующие в крови иммунные комплексы повреждают эндотелий маточно-плацентарных сосудов, что приводит к фетоплацентарной недостаточности в 29% случаев беременности при БА. Fetal developmental delay is detected in 27% of patients, hypotrophy - in 28%, hypoxia and neonatal asphyxia - in 33%. Every third child born to a woman with a clinic of bronchial asthma has insufficient body weight. This figure is even higher with the steroid-dependent form of the disease. Constant interaction with antigens of the mother sensitizes the child to allergens. In the future, 45-58% of children have an increased risk of developing allergic diseases, more often they suffer from acute respiratory viral infections, bronchitis, pneumonia.

    Diagnostics

    The occurrence in a pregnant woman of repeated attacks of suffocation and sudden unproductive cough is sufficient reason for a comprehensive examination, which allows to confirm or deny the diagnosis of bronchial asthma. In the gestational period, there are certain limitations on the conduct of diagnostic tests. Because of the possible generalization of the allergic reaction, pregnant women are not prescribed provocative and scarification tests with probable allergens, provocative inhalations of histamine, methacholine, acetylcholine and other mediators. The most informative for making a diagnosis of asthma during pregnancy are:

    • Percussion and auscultation of the lungs. During the attack over the lung fields marked boxed sound. The lower boundaries of the lungs are shifted down, their excursion is practically not defined. Weakened breathing is heard with scattered dry rales. After coughing, mainly wheezing in the back of the lungs, wheezing increases, which in some patients may persist between attacks.
    • Markers of allergic reactions. An increase in the levels of histamine, immunoglobulin E, eosinophilic cationic protein (ECP) is characteristic of bronchial asthma. The content of histamine and IgE is usually increased both in the period of exacerbation, and between asthmatic attacks. The increase in ECP concentration indicates a specific immune response of eosinophils to the "allergen + immunoglobulin E" complex.
    • Spirography and peak flowmetry. Spirographic study allows, based on data on the second volume of forced expiration (OVF1), to confirm functional disorders of external respiration in obstructive or mixed type. During peak flowmetry, latent bronchospasm is detected, its severity and daily variation of peak expiratory flow rate (PSV) are determined.

    Additional diagnostic criteria are increased levels of eosinophils in the general blood test, detection of eosinophilic cells, Charcot-Leiden crystals and Kurshman spirals in the analysis of sputum, the presence of sinus tachycardia and signs of an overload of the right atrium and ventricle on the ECG. Differential diagnostics is performed with chronic obstructive pulmonary diseases, cystic fibrosis, tracheobronchial dyskinesia, constrictive bronchiolitis, fibrosing and allergic alveolitis, bronchial and lung tumors, occupational diseases of the respiratory organs, pathology of the cardiovascular system with heart failure. According to the testimony of the patient advise pulmonologist, allergist, cardiologist, oncologist.

    Prognosis and prevention

    Adequate therapy of asthma at the stage of pregnancy completely eliminates the danger to the fetus and minimizes the threat to the mother. Perinatal prognoses with controlled treatment do not differ from prognoses for children bred by healthy women. As a preventive measure, patients from the risk group who are prone to allergic reactions or suffering from atopic diseases are recommended to quit smoking, to limit contact with household, industrial, food, vegetable, animal exoallergens. Pregnant women with BA to reduce the frequency of exacerbations are shown exercise therapy, therapeutic massage, special breathing exercises, speleotherapy and halotherapy.

    Bronchial asthma: effect on pregnancy

    Uncontrolled asthma during pregnancy can have a negative impact on both the health of the woman and the fetus. Despite all the difficulties, asthma and pregnancy are quite compatible concepts. The main thing is adequate treatment and constant supervision of doctors.

    It is impossible to predict in advance the course of the disease in the period of carrying a baby. It often happens that in pregnant women the condition improves or remains unchanged, but this concerns mild and moderate forms. And with severe asthma, attacks can become more frequent, and their severity increases. In this case, the woman must be under the supervision of doctors during the entire pregnancy.

    Medical statistics suggests that the disease has a severe course for only the first 12 weeks, and then the pregnant woman feels better. At the time of asthma exacerbation, hospitalization is usually suggested.

    In some cases, pregnancy can cause a complicated course of the disease in a woman:

    • increase in the number of attacks
    • more severe course of the attack,
    • the addition of a viral or bacterial infection,
    • giving birth before the deadline
    • risk of miscarriage,
    • toxicosis of the complicated form.

    Bronchial asthma during pregnancy can affect the fetus. An asthma attack causes oxygen starvation of the placenta, which leads to fetal hypoxia and serious impairments in the development of a child:

    • low fruit weight
    • the development of the baby is delayed,
    • pathologies of the cardiovascular system, neurological diseases, development of muscle tissue may develop,
    • when passing a child through the birth canal, difficulties may arise and cause birth trauma,
    • due to oxygen deficiency, there are cases of asphyxiation (suffocation) of the fetus.

    With a complicated pregnancy, the risk of having a child with a heart disease and a predisposition to respiratory diseases increases, such children can significantly lag behind the norms in development.

    All these problems occur if the treatment is not carried out correctly, and the condition of the woman is not controlled. If the pregnant woman is registered and she is prescribed adequate therapy, the birth will take place safely, and the baby will be born healthy. The risk to the child may consist in the propensity for allergic reactions and the inheritance of bronchial asthma. For this reason, the newborn is shown breastfeeding, and mothers are given a hypoallergenic diet.

    Pregnancy planning for asthma

    The condition of a woman - asthmatics should be controlled not only during pregnancy, but also when planning it. Control over the disease should be established before the onset of pregnancy and it must be maintained throughout the first trimester.

    During this time, it is necessary to select an adequate and safe therapy, as well as to eliminate irritating factors in order to minimize the number of attacks. A woman should stop smoking if this addiction has occurred and avoid inhaling tobacco smoke if family members smoke.

    Before the pregnancy, the expectant mother should be vaccinated against pneumococcus, influenza, hemophilus bacilli, hepatitis, measles, rubella, tetanus and diphtheria. All vaccinations are given three months before the onset of pregnancy under the supervision of a physician.

    How pregnancy affects the course of the disease

    With the onset of pregnancy, a woman changes not only hormones, but also the work of the respiratory system. The composition of blood, progesterone and carbon dioxide changes, it becomes more, breathing becomes more frequent, ventilation of the lungs increases, a woman may experience shortness of breath.

    In long periods of pregnancy, shortness of breath is associated with a change in the position of the diaphragm, the growing uterus raises it. The pressure in the pulmonary artery also changes, it increases. This causes a decrease in lung volume and a worsening of spirometry in asthmatics.

    Pregnancy can cause swelling of the nasopharynx and respiratory tract even in a healthy woman, and in a patient with bronchial asthma, an attack of suffocation. Every woman should remember that spontaneous cancellation of certain drugs is as dangerous as self-treatment. You can not stop taking steroids, if this is not ordered by a doctor. Cancellation of drugs can cause an attack that will cause much more harm to the child than the effect of the drug.

    If asthma manifested itself only during pregnancy, it is rarely possible to diagnose it in the first months, therefore, in most cases, treatment begins at a late period, which is bad for pregnancy and labor.

    Drugs that are contraindicated during pregnancy

    Self-medication is not recommended to deal with any diseases, and even more with asthma. A pregnant woman should take medications strictly according to a doctor's prescription and be aware that there are a number of medications that are prescribed for patients with asthma, but are canceled during pregnancy:

    List of contraindicated means:

    • Adrenaline relieves a choking attack well, but is forbidden to use during pregnancy. Acceptance of this drug can lead to fetal hypoxia, it causes uterine vascular spasms.
    • Terbutaline, salbutamol, fenoterol - prescribed for pregnant women, but under the strict supervision of a physician. In the later periods, they are usually not used, they can complicate and delay childbirth, drugs similar to these are used when there is a threat of miscarriage.
    • Theophylline is not used in the last three months of pregnancy, it penetrates the fetal bloodstream through the placenta and causes an increase in the heartbeat of the child.
    • Some glucocorticosteroids are contraindicated - Triamcinolone, Dexamethasone, Betamethasone, these drugs have a negative effect on the muscular system of the fetus.
    • Pregnant women do not use antihistamine drugs 2 generations, side effects are bad for the mother and child.

    Bronchial asthma during pregnancy is not dangerous when properly selected treatment and compliance with all recommendations.

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