Respiratory System Diseases During Pregnancy

During pregnancy, women may face many discomforts. These disorders greatly affect the development of the baby. Generally, not eating regularly, sudden movements and careless behavior cause these diseases. At the beginning of these diseases Respiratory System Diseases During Pregnancy is coming. These diseases may be caused by the mother's genetics or by the mother's careless behavior. Smoking, being in used areas, etc. Situations like this are among the main reasons.

RESPIRATORY SYSTEM DISEASES DURING PREGNANCY PHYSIOLOGICAL PREGNANCY CHANGES

In pregnant women, the diaphragm increases (about 4 cm) and the thorax. Its base widens (about 10 cm) and the subcostal angle widens. In respiration:
1) Residual volume decreases (air remaining after maximal expiration, 200 ml.).
2) Expiratory reserve air decreases (air that can be removed by forced expiration after normal air exhalation, 100 ml.).
3) Inspiratory reserve volume increases (air that can be taken with forced inspiration after normal inspiration, 100 ml.).
4) Vital capacity still remains normal (air that can be expelled with maximal expiration after maximal inspiration).

Respiratory System During Pregnancy If a decrease in vital capacity is detected in pregnant women due to illness, another pathological cause must be sought.

5) With each normal inhalation or exhalation, the air (500-700 ml.) increases (Tidal volume).
6) Minute/respiratory volume increases
7) Minute ventilation is fifty percent higher than before pregnancy. That is, ventilation in the alveoli has increased, generally due to more frequent and deeper breathing. Due to this increase, more CO₂ in the blood is excreted (hypocapnia), partial CO₂ pressure in the blood decreases, and a tendency towards respiratory alkalosis occurs. However, the blood pH value does not change due to the increase in plasma bicarbonates. During pregnancy, there is hyperemia and edema in the upper respiratory tract (nasopharynx, sinuses and larynx). (Changes in voice quality in chanteuses!).

1) Bronchitis – Emphysem:

It has been suggested that severe coughing attacks can sometimes cause abortion. In patients with emphysema, dyspnea may increase in recent months. If these patients with respiratory failure can talk comfortably while walking, a normal pregnancy and birth can be expected. Very rarely, the disability becomes severe. Smoking should be prohibited in pregnant women with chronic bronchitis and emphysema, in order to prevent further respiratory failure. Expectoration is difficult, there is right heart failure. They should be advised to stay away from crowded places to avoid getting an infection in the upper airways. At the slightest suspicion, protective measures with antibiotics should be taken immediately. If analgesics are to be given against pain in the second stage of labor, Pethidine should be preferred. Shortness of breath may increase in the second period. It is helped by making it smell. Birth can be completed as soon as possible with forceps at the exit. If sectio is to be performed, spinal anesthesia should be preferred.

2) Asthma Bronchiale:

Although asthma bronchiale is expected to improve due to the increase in corticosteroid secretion in pregnant women, it has actually been understood that cortisol in the plasma binds to α-globulin called Transcortin and is rendered biologically inactive. Respiratory System During Pregnancy In the majority of cases, the condition of the person with asthma does not change, in a few cases it may get better, and in a few cases it may get worse. The rate of abortion and premature birth in severe asthma cases is no different from normal pregnancies. If seizures become severe during birth, they are assisted with forceps.

There is no change in the treatment of asthma during pregnancy. (Oral antiallergics, tranquilizers and aerosol inhalations to relieve bronchospasm). In very severe cases (intravenous aminophylline 250-300 mg. + 40 ml ACTH intravenously twice a day) can be administered. 10 mg every 8 hours. Prednisone is continued. Corticosteroids should not be stopped suddenly. Resistance in the pituitary-adrenal axis is low, especially against the stresses of birth, bleeding, anesthesia and surgical intervention. Additional prophylaxis with steroids should be given before birth and intervention. If more than a year has passed since the treatment was stopped, additional precautions may be taken only in surgical intervention. In an infection in the upper airways, vigorous antibiotic therapy is necessary preventively, with the idea that it may resolve bronchospasm.

3) Pneumonia:

Pneumonia, high fever, anoxia and toxins can lead to intrauterine child deaths, miscarriage and premature birth. The rate of intra-uterine child mortality and premature birth is very high in the last three months of pregnancy. If labor begins at the peak of the disease, the mother's life may also be in danger. However, complications can be prevented with timely and energetic chemotherapy and antibiotics. High doses of penicillin are sufficient for pneumococcal pneumonia. Those who do not respond are switched to other antibiotics.

Yüksek ateşli dönemde 0₂, gereksinmesi çok artar (her derece artışında %10 artma). Hematoz alanı daralmıştır. Akciğerlerde kan dolaşım zorluğu nedeniyle, kalp yük altındadır. Sağ kalp iflası ve akciğer ödemi beklenebilir. O₂ inhalasyonu ile fetus’ün hipoksisi de önlenmiş olur. Ağrıya Codeine, Pethidine ile yardım edilebilir. Son aylarda, doğumda ve loğusalıkta anne mortalitesi yüksektir. Meningitis komplikasyonu sık görülür.

4) Pneumomediastinum:

With strong strains during dilatation and insufflation, the alveoli may rupture, resulting in pneumomediastinum. Air rises in the mediastinum and can be distributed under the skin of the neck and armpit and into the lung interstitium tissue. Respiratory System Treatment During Pregnancy: 0₂ and antibiotics are started immediately. The 0, gap is closed and time is provided for the resorption of air in the tissue. Secondary infection is prevented. In severe cases, surgical intervention may also be required.

5) Pregnancy and tuberculosis:

Tuberculosis is a treatable disease. Under proper care and treatment, it does not have a negative impact on the course of pregnancy and birth. Respiratory system treatment does not change during pregnancy. However, if serious intervention is required, it should be postponed until after puerperium. The important thing is early diagnosis. Radiological checks performed without waiting for clinical symptoms are the cornerstone of early diagnosis. Care should be taken to protect the pregnant uterus during radiography. It has been determined that the body is exposed to more X-rays in the microfilm method used to screen for the disease. (In children of mothers exposed to X-rays, X-ray checks should be performed mostly after the 4th month due to leukemia, Ca, congenital malformations and genetic anomalies.)

Effect of pregnancy and birth on the course of pulmonary TB:

Under control and treatment, pregnancy and birth It does not have a negative effect on the course of the disease. However, exacerbation of the disease can be expected during puerperium. (Insomnia, fatigue, and the difficulties of child care play a role in reactivation.)
In the past, pneumoperitune was performed after birth to prevent lesions, and pregnancy was allowed at least 2 years after entering the inactive period. With today's chemotherapy, the above drawbacks have been eliminated. The medical indication for abortion, which was used frequently in the past, was only considered in very exceptional cases (poor patients living in very poor conditions). Medical evacuation is very important in patients with severe respiratory failure (shortness of breath with the slightest body movement).
It may be necessary.

Effect of tuberculosis on pregnancy:

The rate of spontaneous abortion does not change. In severe cases, premature labor may begin. Concomitant severe anemia can cause problems. Respiratory System Diseases During Pregnancy Diagnosis: In suspicious cases, bacilli should be searched (in sputum, laryngeal swab in the morning, and even in gastric juice). Culture should not be neglected, and if there is growth, an antibiotic sensitivity test should be performed. Tuberculin test in pregnant women has no diagnostic value. In some cases of active tuberculosis, the tuberculin test becomes negative during pregnancy. In suspects who test negative for bacillus, X-ray checks should be continued every few weeks. The possibility of exacerbation after birth should also be closely monitored with laboratory tests and x-rays. Cases with active tuberculosis should be checked and treated in the chest diseases clinic.

Care and birth assistance for pregnant women with tuberculosis:

The mother should be enlightened in all aspects and her wholehearted cooperation with the physician should be ensured.
Chemotherapy: Chemotherapy is started without waiting for culture and test response, and chemotherapy is continued throughout pregnancy and six months postpartum. Mainly Streptomycine, p-aminosalicylic acid (PAS) and isoniazid (INH) are used.
It is stated.

The most important treatment principles:
1) In active tuberculosis, a combination of at least two drugs is required. However, this method prevents the growth of drug-resistant bacilli.
2) Treatment should be continued uninterruptedly. Again, the emergence of resistant strains is prevented.
3) The treatment period should not be less than 18 months.
4) Regardless of which drug combination is started, a more effective combination should be switched according to the sensitivity test results.
5) In pregnant and postpartum women with inactive tuberculosis, prophylactic chemotherapy (ÌNH) should not be neglected to prevent reactivation.
To date, only PAS + INH or streptomycin + INH combinations have been used in active tuberculosis. They all cross the placenta. Although rare, negative effects of streptomycin on the fetus may occur. Recently, ethambutol (ETH) and finally rifampicin (RM) have started to be used instead of whey.

It has been understood that both of them are more effective and their toxic effects are very mild. Since their teratogenic effects are unknown, there are those who prefer classical combinations and those who recommend applying new drugs to cases with resistance or severe intolerance.

In practice:
-Isoniazid (INH): 300 mg orally one or two times.
– Parasalicylic acid (PAS): 12 g orally one or two times.
-Streptomycin: 1 g parenterally per day.

Initially 6 days a week, later reduced to 2 a week. The most effective is INH. It also has minimal side effects. It should go into every combination. If the daily dose is above 300 mg, Pyridoxine should be added. Whey has been pushed to the background in treatments other than pregnancy (due to its difficulty in taking it and its side effects such as nausea, vomiting, diarrhea, flushing and allergic skin reactions). In severe toxic cases, if corticosteroids (prednisolone) are added to chemotherapy when starting treatment, the disease will be brought under control in a shorter time.

Pregnancy It does not prevent the use of corticosteroids. In addition, severe allergic reactions are prevented. Patients with fever, toxicity, and bacilli in their sputum should be treated in hospital. Chemotherapy has eliminated therapeutic abortions. Medical abortion may be considered in rare cases that cannot tolerate the medication. If thoracoplasty is to be performed, it should be postponed until after birth. If it is absolutely necessary, the 32nd week should be waited. Birth policy is no different from normal birth. Only the exit is assisted with forceps. If the child is large, sectio can be performed without tiring. There are those who use local anesthesia and pudendus block instead of inhalation anesthesia. A mother with inactive tuberculosis can breastfeed her child if she wishes. He should pay attention to more rest. If the inactive state is less than 2 years, breastfeeding may be dangerous.

Children of mothers with active, overt tuberculosis should be separated from the mother immediately after birth, BCG is administered to the child. If the child's weight is low, the vaccine is delayed. Mantoux (tuberculin) test is performed 6 weeks after vaccination. If negative, the test is repeated after 2-4 weeks. In the meantime, INH prophylaxis is administered to protect the child. The vaccine to be administered must be prepared with bacilli from a strain resistant to INH.

disease pregnancy In those diagnosed with disease, breastfeeding cannot be allowed, whether the lesion is inactive or active. If more than 2 years have passed after healing, breastfeeding with a face mask may be allowed until the child has a positive Mantoux (tuberculin) test following BCG vaccination. Before returning to the postpartum home, the family circle should be screened, and if there are active tuberculosis cases, necessary precautions should be taken.

To summarize:
Chemotherapy in pregnant women and postpartum women, whether the disease is active or inactive:
-Severe, bacillus shedding cases are treated in hospital,
-After birth, if the mother is under adequate and continuous treatment and the child is protected with BCG and INH, the mother and child can be sent home.
-In new cases, those that have not been adequately treated, the child should be separated from the mother and the puerperal woman should continue to be treated in the hospital.

Congenital TB:

It is extremely rare for a child to become ill before birth. (Placental dam). However, although rare, it can be infected through the cord veins due to a lesion in the placenta or membranes. The primary complex is in the liver and lungs. A less common way of infection is gastrointestinal infection due to swallowing amniotic fluid. The primary complex is in the intestines. It can be confirmed by autopsy findings. At birth, the child with congenital tuberculosis appears healthy. Loses weight quickly. Exit occurs within 10 days with hepatosplenomegaly and icterus.