Inflammation of the lungs during pregnancy

Pneumonia in pregnancy

Pneumonia in pregnancy is an acute infectious disease of predominantly bacterial etiology, characterized by focal lesion of the respiratory parts of the lungs with the presence of intra-alveolar exudation.

Pneumonia in pregnant and parturient women - pathology, often found in obstetric practice - poses a serious danger to the mother and child. Even in recent years, this disease is one of the causes of maternal mortality in Ukraine. Carried over during pregnancy, pneumonia leads to an increase in the frequency of premature birth, fetal distress, the birth of children with low body weight.

The emergence, course, outcome of pneumonia is largely determined by two factors - the causative agent of the disease and the state of the macroorganism. However, the possibility of aetiological verification of pneumonia, especially in the early stages of the disease, is significantly limited. At the same time, as a result of large epidemiological studies, it was established that when pneumonia in certain conditions reveals an absolutely concrete and rather limited number pathogens. This made it possible to develop a classification of pneumonias taking into account the condition of infection. Its use allows empirically, before receiving the results of bacteriological studies, to conduct rational initial antibiotic therapy.

Causes of pneumonia in pregnancy

Among the chronic concomitant diseases, the most unfavorable effect on the course of pneumonia during pregnancy is given by chronic obstructive pulmonary diseases, bronchiectasis, kyphoscoliosis, diabetes mellitus, severe heart defects, congestive heart disease deficiency, immunodeficiency diseases / conditions, including iatrogenic (long-term therapy with glucocorticosteroids, immunosuppressants, etc.).

To factors that increase the virulence of microorganisms (which leads to antibiotic resistance), increasing the risk of aspiration, pathological colonization of the upper respiratory tract, negatively affecting the defenses of the body, that is, modifying factors, include: bed rest, especially in the supine position, abortion or childbirth, surgery on the pelvic organs, abdominal cavity, chest, long stay in the intensive care unit (ICU), artificial ventilation, tracheostomy, impaired consciousness, beta-lactam or other broad-spectrum antibiotic therapy, conducted during the last three months, tobacco smoking, alcoholism, psychoemotional stress.

Symptoms of pneumonia in pregnancy

Clinical symptoms of pneumonia in pregnancy include common manifestations (weakness, adynamia, decreased appetite, fever), local respiratory symptoms (cough, sputum, dyspnea, chest pain), physical data (dullness or dull percussion sound, weakened or hard breathing, focus of small bubbling rales and / or crepitus). The severity of these symptoms depends on the condition of the woman at the onset of the disease, the severity of the course of pneumonia, the volume and localization of the lesion of the lung tissue. In almost 20% of patients, pneumonia symptoms may differ from typical or completely absent.

For pneumonia, leukocytosis (more than 10 * 109 / L) and / or stab-shift (more than 10%) is also characteristic. When radiographing chest organs, focal infiltration of the lung tissue is determined.

Pneumonia in pregnant women has no fundamental differences either in the nature of the pathogen, or in clinical manifestations. It can develop in any period of pregnancy and the postpartum period. Pediatric delivery on the background of pneumonia does not reduce the risk to the woman's health, In case of an incomplete pneumonia After delivery, the disease often acquires an extremely unfavorable course and can lead to death puerperas.

Classification of pneumonia in pregnancy

• non-hospital (out-of-hospital, out-patient, home);
• nosocomial (hospital, nosocomial);
• aspiration,
• pneumonia in persons with severe impairment of immunity (congenital
• immunodeficiency, HIV infection, iatrogenic immunosuppression).

In addition to the above forms of pneumonia, the clinical course is characterized by a severe and non-severe disease.

Criteria for severe pneumonia: impaired consciousness; respiratory rate more than 30 per 1 min; hypothermia (up to 35 "C) or hyperthermia (over 40 ° C); tachycardia (more than 125 in 1 min); pronounced leukocytosis (more than 20 * 109 / l) or leukopenia (up to 4 * 109 / l); bilateral or polysegmentary lung injury, cavity decay, pleural effusion (according to X-ray study data); hypoxemia (SaD, < 90% or PaO2. <60 mm. gt; item); acute renal failure.

Diagnosis of pneumonia in pregnancy

Diagnosis of pneumonia in pregnant women requires a detailed history, including epidemiological, physical examination, laboratory examination (a general blood test with leukocyte formula, determination of creatinine, urea, electrolytes, liver enzymes in blood), coagulogram, lung X-ray, bacterioscopic and bacteriological study phlegm. With the symptoms of respiratory failure, it is necessary to carry out a pulse of oximetry or to determine the indices of oxygen saturation with oxygen in another way.

Treatment of pneumonia during pregnancy

Preventive care for pregnant women with pneumonia is usually provided by district therapists. To diagnose the disease in difficult, complex cases, it is necessary to attract the most qualified specialists, including pulmonologists.

Pregnant without chronic diseases and with a mild course of pneumonia, provided that proper care is provided and daily medical supervision can be treated at home. In all other cases, after diagnosis of pneumonia, pregnant women need to be monitored and treated in a hospital setting. In the first half of pregnancy it is advisable to hospitalize a patient in a hospital of a therapeutic profile, after the 22nd week - only in an obstetric hospital. Women with severe pneumonia need admission to the ICU. Regardless of the place of stay, the patient should be monitored by a therapist (pulmonologist) and an obstetrician-gynecologist. In addition to a therapeutic examination aimed at diagnosing pneumonia and assessing the condition of a woman, it is necessary to control the course of pregnancy and fetal status, for which any modern diagnostic methods.

Unfinished pneumonia is not an indication for the termination of pregnancy in either early or late term. On the contrary, interruption of pregnancy is contraindicated, since it can aggravate the condition of a pregnant woman. Severe pneumonia does not require early delivery. Moreover, the severe condition of a woman due to pneumonia is a contraindication to delivery due to the danger of aggravation of the course of pneumonia and generalization of infection.

Births in patients with incomplete pneumonia should, if possible, be conducted through the natural birth canal. In severe disease, the presence of respiratory failure, shortening of attempts is shown by the operation of superimposing obstetric forceps. Caesarean section on the background of pneumonia is potentially dangerous.

During labor, patients need thorough anesthesia, oxygen therapy, continuation of antibacterial treatment, symptomatic therapy.

Babies who are sick with pneumonia need careful observation of the therapist (pulmonologist) and obstetrician-gynecologist, treatment in a hospital,

Breastfeeding is contraindicated at the peak of the disease, which is due to the severity of the mother's condition and the possibility of infection of the child. However, suppress lactation should not be. After the normalization of the puerperal condition against the background of the treatment of pneumonia, breastfeeding is possible, the risk of switching to milk and negative The effects on the child of most antibacterial and other drugs used to treat pneumonia are significantly lower than the benefits of natural feeding.

The basis for the treatment of pneumonia in pregnancy is antibiotics.

Empirical antibacterial therapy of hospital pneumonia in pregnant women

Features of pneumonia	The drug of choice	Alternative drugs
Early or late with a mild course, early with severe course in the absence of concomitant chronic pathology and modifying factors	Ceftriaxone or cefotaxime Protected aminopenicillin	Another cephalosporin III-IV generation + gentamicin Aztreonam + clindamycin
Early or late with a mild course and the presence of concomitant chronic pathology and / or modifying factors	Ceftazidime or cefoperazone, or cefepime or cefoperazone / sulbactam	Protected aminopenicillin + vancomycin Valkominin + clindamycin Cephalosporin III generation + macrolide ± rifampin
Early with severe course and concomitant chronic pathology or presence of modifying factors or late with severe course	Cefoperazone / sulbactam or Iephepim + gentamycin	Karbapenem Azrethra + amikacin

Etiotropic therapy is carried out according to the following principles:

1. the antibiotic is administered empirically immediately after the establishment of the clinical diagnosis, without waiting for the identification of the pathogen;
2. the nature and extent of antibiotic therapy is determined based on the characteristics of infection, the severity of the disease, the presence of concomitant extragenital pathology;
3. the antibiotic is selected taking into account its effect on the embryo, fetus and newborn;
4. the antibiotic is administered in therapeutic doses, with observance of the necessary time intervals;
5. 48 hours after initiation of antibiotic therapy, an assessment of its clinical efficacy is performed: in case of a positive result from the starting therapy it continues without changing the antibiotic, in the absence of the effect, the antibiotic is changed, and in case of a severe condition the patient is prescribed a combination antibiotics;
6. in the case of severe pneumonia, the antibiotic begins to be injected intravenously, after reaching a stable result, after 3-4 days, they switch to oral administration (stepwise therapy).

The most objective and generally recognized in the world reference points that determine the possibility of using medicines, including antibiotics, pregnancy are recommendations developed by the administration of quality control of drugs and food products in the United States (FDA).

According to the FDA classification, all medicines are divided into 5 categories - A, B, C, D, X.

The basis for assigning drugs to a certain group is the results of experimental and clinical observations, establishing safety or harm of a medicinal product in relation to the embryo and / or fetus as in the I trimester, and at a later date pregnancy.

• To category A, that is, safe medicines that can be used without restriction at any time of pregnancy, and to category X - harmful drugs, categorically contraindicated during pregnancy, does not belong to any antibiotic.
• To category B (conditionally safe medicines, can be used according to the corresponding indications) are all penicillins (natural and semisynthetic), cephalosporins I-IV generation, monobactams, macrolides (except clarithromycin), carbapens, phosphomycin trometamol, nifuroxazide.
• To category C (potentially dangerous, limited use when it is impossible to find an adequate substitute) belong to rifamycins, imipenem, gentamycin, clarithromycin, vancomycin, nitrofurans, sulfonamide preparations, trimethroprim, nitroxoline, metronidazole, isoniazid, pyrazinamide, ethambutol.
• To category D (dangerous, used during pregnancy only for vital reasons, can not apply in the I trimester) include aminoglycosides (except gentamicin), tetracyclines, fluoroquinolones, chloramphenicol.

In the period of breastfeeding the most safe is the use of penicillins, cephalosporins, macrolides. If necessary, without refusal of lactation, vancomycin, aminoglycosides, rifamycins and other antimycobacterial agents are prescribed. Although imipenem and meropenem fall into breast milk in a small amount, there is no sufficient evidence of their safety at the present time. Contraindicated during breastfeeding tetracyclines, fluoroquinolones, chloramphenicol, lincosamides, metronidazole, long-acting sulfanilamide preparations, spectinomycins, polymyxins. In case of their use, lactation should be discarded.

With a mild course of the disease without concomitant pathology and presence of modifying factors, the main pathogens of pneumonia are Streptococcus pneumoniae, Haemophilus influenzae, as well as intracellular pathogens - Mycoplasma pneumoniae and Chlamydia pneumoniae (the specific gravity of the latter exceeds 50 %). The preparation of choice is macrolide (spiramycin) or amoxicillin, used orally; an alternative drug is another macrolide or amoxicillin / clavulanate. Along with this microflora in the genesis of the disease acquire a certain value Gram-negative enterobacteria, Staphylococcus aureus, and also such intracellular pathogen, as Legionella spp. The drugs of choice are amoxicillin / clavulanate and / or macrolide (spiramycin) used per os or parenterally. Alternative drugs - macrolide and cephalosporins I-III generation, administered orally or parenterally.

In severe non-hospital pneumonia, the causative agents of the disease can be both extracellular Gram-positive and Gram-negative organisms, as well as intracellular pathogens, especially Legionella spp. Drugs of choice are intravenous amoxicillin / clavulanate and macrolide or cephalosporins of generation II and macrolide. Alternative therapy - intravenous cephalosporin IV generation + macrolide or carbapenem + macrolide.

If suspected of infection with Pseudomonas aeruginosa, therapy is initiated with ceftazidime and gentamycin; an alternative is meropenem and amikacin.

Given that the emergence of small pneumonia is often played by the role of intracellular microflora, especially important in the treatment of pregnant women with this pathology belongs to macrolides. This is the only group of antibiotics that is safe for pregnant women (Category B), which has an antimicrobial effect on both extracellular and intracellular pathogens. Of the macrolides, spiramycin is the drug most safe for pregnant women, which confirms the 50-year experience of its use.

The most frequent pathogens of hospital pneumonia in pregnancy are gram-negative microorganisms.

There is also pneumonia early, which developed up to 5 days in hospital, and pneumonia late, which appeared after 5 days in hospital.

Patients with early and late pneumonia with a mild course, with early pneumonia with severe course and absence of concomitant chronic pathology and modifying factors most likely are infected with Gram-negative bacteria of the Enterobacteriaceae series, as well as Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae (MS).

In patients with early and late pneumonia with a mild course and presence of modifying factors, along with the above pathogens, the probability of infection increases significantly anaerobes, Staphylococcus aureus (MR), Legionella spp., Pseudomonas aeruginosa, which are characterized by high frequency of strains with multiple resistance to antibacterial drugs.

Given the severe course of early pneumonia and the presence of modifying factors or severe course of late pneumonia along with major previously listed microorganisms, probable etiopathogens may be highly resistant and virulent Pseudomonas aeruginosa and Acinetobacter spp.

It should be noted that pneumonia is diagnosed in the case of the appearance of clinical and radiological signs after 48 hours of hospital stay and further.

Timely diagnosis of the disease, rational differentiated use of modern antibacterial agents, the right choice tactics of management of pregnancy, sorts, the postnatal period allow to limit essentially negative consequences of a pneumonia for mother and child.

ilive.com.ua

Symptoms and treatment of pneumonia in pregnancy

Pneumonia during pregnancy often develops when hypothermia or as a consequence of acute respiratory viral infection. On the occurrence of colds, many people try not to pay attention to or be treated by folk methods. Future mothers should be more responsive to any ailments and symptoms of colds. You should consult a doctor at an early stage of the disease.Pneumonia and pregnancy are a threat both to the health of women and to the baby.

Signs and causes of the disease

The clinical picture (symptoms of the disease) is the same for all patients. The disease at first looks like a cold. Typical are cough, shortness of breath, fever, chest pain, weakness, fatigue, sweating. With the development of pneumonia, the temperature increases to 39-40 ° C, pain in the thoracic region increases, cough dry, barking or with sputum separation. Depending on the pathogen of pneumonia, the symptoms may be slightly different. Bacterial pneumonia has pronounced symptoms. Atypical - the disease begins smoothly, the symptomatology is poorly expressed. For pneumonia caused by the virus, the typical body aches, expressed by pain in the muscles and joints.

With weakened immunity, the upper respiratory tract, pulmonary tissue, and the mucous membrane of the lungs are affected. There are complications after colds, such as laryngitis, bronchitis, tracheitis. Further, acute pneumonia may develop.

It is a secondary infectious disease of the lungs, and it can provoke staphylococci, Candida fungi, respiratory viruses. The main factor in the development of pneumonia is pneumococcus, which is part of the conditionally pathogenic microflora of man.

In medical terminology, pneumonia is divided into four groups:

• community-acquired;
• nosocomial;
• atypical;
• against the background of immunodeficiency states.

In obstetric practice, inflammation of the lungs in pregnant women is mainly related to the first group.

Features and types of the disease

The course of diseases in pregnant women can be complicated by physiological changes during the period of gestation. The shape of the chest changes, the location of the diaphragm changes, raised by the enlarged uterus. The respiratory surface of the lungs decreases, the load on the cardiovascular system increases, and as a consequence, the oxygen supply to the pulmonary system deteriorates. Fetal oxygen supply depends on the level of oxygenation of the mother's blood. Often, respiratory failure, resulting from respiratory diseases, leads to fetal hypoxia.

Complications associated with pneumonia in pregnancy in the first trimester (12 weeks) are the most dangerous. During this period, microorganisms can have a detrimental effect on the fetus, cause changes in its development, or to provoke infection of the placenta with the development of placental insufficiency, as well as intrauterine infection the fetus.

Sometimes it is recommended to interrupt pregnancy after the course of antibacterial and detoxification therapy.

Pneumonia in pregnant women is more often observed in the second and third trimesters, when all the organs of the fetus are already formed. Treatment of the disease is not a threat to pregnancy, but it can cause premature birth. With the development of pneumonia shortly before the expected delivery time, doctors try to delay the action of labor and reduce the risk of infection of the fetus. The presence of the disease during childbirth makes it impossible to breast-feed a child, which negatively affects its development.

Indications for hospitalization of pregnant women:

• severe course of the disease;
• complication of the pregnancy itself;
• concomitant somatic diseases.

In the first half of pregnancy (up to 22 weeks) the patient is hospitalized in the department of therapy (or pulmonology). In the second half of the term, they are treated in the obstetric ward under the supervision of a therapist.

Diagnosis of the disease

When prescribing treatment, attention should be paid to chronic lung disease, frequent colds, the presence of foci of infection in the nasopharynx, anemia.

There are laboratory tests of blood (the number of leukocytes, ROE, creatine, urea), microbiological examination of sputum (Gram staining), taken in the morning after coughing in sterile container. With an implicit clinical picture of the disease, x-rays of chest organs are appointed in two projections, which allows to identify focal infiltration of the lung tissue. This method of research is used as a last resort, and the fruit should be covered with a special lead shield. Instrumental examination includes the method of fibrobronchoscopy, which diagnoses tuberculosis, development of intrauterine pathology and infection. Additionally, computer tomography and ultrasound of the lungs are prescribed to specify the localization and structure of pulmonary lesions.

Treatment of the disease

Antibiotic treatment is prescribed after the doctor has established a clinical diagnosis. Antibiotic is selected depending on the minimum negative impact on the fetus. The volume, type of administration and group of the drug depend on the characteristics of infection and associated pathologies. In bacterial pneumonia with a typical clinical picture, antibiotics of the penicillin series (such as amoxicillin) are recommended. With pneumonia caused by atypical microorganisms, modern safe drugs, macrolides (azithromycin), are used. In the complicated course of the disease with additional risk factors, protected aminopenicillins or cephalosporins of the 3rd generation are used. With the required parameters, the attending physician can prescribe expectorant and mucolytic drugs, detoxification therapy, antihistamines.

After receiving all the data, the assignment is refined and corrected. When pneumonia is treated for more than a month with symptoms remaining, it is considered a protracted course of the disease.

There is a possibility of a complicated course of pneumonia. Complications include pulmonary edema, cardiopulmonary insufficiency, sepsis, infectious-toxic shock, exudative pleurisy. Prevention is carried out with the appointment of antibiotic therapy, taking into account the sensitivity of microflora to antibiotics. Along with the treatment of the underlying disease, pregnancy complications are treated and fetoplacental insufficiency is prevented by actovegin and riboxin. The fetoplacental complex is a functional system of mother-placenta-fetus.

The evaluation of the effectiveness of treatment is based on the results of laboratory studies of clinical analysis of blood, radiography, tests to determine the level of hormones in the blood of the fetoplacental complex.

Prevention of diseases

The most effective means of preventing any diseases, including pneumonia, is the maintenance of a healthy lifestyle by a pregnant woman. Proper and rational nutrition should include many fruits, vegetables, herbs, dairy products, protein and complex carbohydrates. Walking in the fresh air is useful for both mom and baby.

Pay attention to the climate in the house. It is common knowledge that dry and polluted air in the room changes the properties of the mucus of the upper respiratory tract.

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It becomes dense and does not fulfill its basic functions: it disrupts the ventilation of the lungs, worsens the blood circulation, microorganisms accumulate in stagnant zones, the inflammatory process begins. It is important to carry out regular wet cleaning, and the temperature in the room should be about 20 ° C.

Remarkable prophylaxis of pneumonia is respiratory gymnastics, which helps enrich the lung tissue of oxygen and eliminates shortness of breath and tachycardia.

Also, breathing exercises have a relaxing and soothing effect.

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The main thing is to give up bad habits, such as smoking and alcohol. First of all, it harms the baby and is an additional risk for the occurrence of diseases in the future mother.

respiratoria.ru

Pneumonia in pregnancy

Pneumonia often has a seasonal character, and the incidence is more often in the cold periods of the year. But future mothers, unfortunately, can not always be protected from this disease.

Pneumonia during pregnancy carries a threat to both the mother's health and fetal health and is a reason for hospitalization and qualified treatment. Pneumonia during pregnancy increases the risk of miscarriage, especially if the disease is feverish.

Causes of pneumonia in pregnant women

The causative agents of the disease are various infections, depending on whether the disease has arisen in a domestic setting or is hospital-based. Predisposing factors are alcoholism, smoking, obstructive bronchial lesions, heart failure, treatment with immunosuppressants, adverse ecology, depletion of the body.

Most cases of pneumonia are caused by microorganisms that do not have a pathological effect on the fetus (with the exception of viruses).

Symptoms of pneumonia in pregnant women

The main signs of pneumonia in pregnancy include cough, pain in the chest, fever, dyspnea, chills, general intoxication - headache, weakness, fatigue, sweating, decreased appetite.

Pneumonia during pregnancy is more severe, which is associated with a decrease in the respiratory surface of the lungs during this period, a high diaphragm position, enlarged and raised by the uterus. All this limits breathing, causes an increase in the load on the cardiovascular system.

Treatment of pneumonia in pregnant women

Treatment of pneumonia in pregnancy is advisable to conduct in a hospital. At the same time antibiotics are appointed, which do not have a detrimental effect on the development of the child. In addition, expectorants, inhalers, mustards can be recommended.

Pneumonia provided timely and correct treatment is not an indication for the termination of pregnancy. However, in certain

cases (such as pneumonia in the early stages of pregnancy, taking place against the background of influenza and in severe form), a doctor may recommend the termination of pregnancy, because there is a risk of perinatal complications or spontaneous abortion.

No less dangerous pneumonia in a pregnant woman, which began shortly before the onset of labor. In this case, the threat is pulmonary edema, difficult circulation in them, inadequacy of the cardiac activity of a woman. In such cases, doctors attempt to delay the onset of labor until the peak of the disease has passed, since the birth process during the pneumonia becomes dangerous for the woman herself.

WomanAdvice.ru

Pneumonia in pregnancy. I really need a professional advice!

Answers:

Alla

than to get sick early... pneumonia... I wonder how you can get pneumonia... I had pneumonia when I was pregnant... pricked synthomycin... Nitsche terrible did not happen... my daughter was born healthy

Olga Kalachanova

Pneumonia is not contagious! This is a complication after the disease. My brother was ill while I was pregnant and my mother, too, and nothing. Just in case let immunity strengthens - vegetables and fruits more (in reasonable quantities).

larusia

Let the grass drink in advance. Pneumonia is not an infectious disease.

Katyusha)

Pneumonia and pregnancy
In pregnant women, acute pneumonia often proceeds more severely due to a decrease in the respiratory surface of the lungs, high diaphragm standing, limiting the excursion of the lungs, an additional load on the cardiovascular system.
The clinical picture of acute pneumonia does not differ from that of nonpregnant pneumonia.
With the development of pneumonia, shortly before birth, it should be possible to delay the development of labor by means of p-mimetics and, if possible, other means, since the birth act is dangerous in connection with the effect of toxic-infectious factors on the nervous and cardiovascular systems. here

Yuliya ***

Pneumonia, as a rule, can be cured, so it is not a contraindication for the continuation of pregnancy. With the development of pneumonia, shortly before birth, doctors try to delay the development of labor as much as possible, since the birth act can be dangerous in connection with the impact of toxic-infectious factors on the nervous and cardiovascular systems women. In the presence of severe respiratory failure, childbirth is conducted according to an individual plan. Childbirth on the background of pneumonia most often proceed without complications.
Treat pneumonia in the hospital. The main thing in this case is the choice of an antibiotic, its dose and the way it is injected into the body. In addition to antibiotics, drugs that dilate the bronchi, vitamins and expectorants are used. It should be borne in mind that the untimely and disorderly administration of antibiotics for pneumonia is dangerous. It leads to the development of dysbacteriosis, suppression of immunity and as a result - to complications.
The disease lasts from 2 weeks to 1 month. But the protracted course of pneumonia (more than 4 weeks), usually ends in recovery.

Julia Kalinina

The presence of pneumonia does not complicate the course of labor. In pregnancy, antibacterial treatment is applied taking into account a variety of microorganism-pathogen. Pneumonia, which is severe and with signs of heart failure, may require disabling attempts with obstetric forceps or caesarean section.

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