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RESPIRATORY PROBLEMS IN PREGNANCY

YVETTE CARMELLE B. GELLANG

3 –F

JULY 2010
OBJECTIVES:

1) Determine the different respiratory diseases commonly

acquired by pregnant women.

2) Define and explain the common respiratory diseases of

pregnant women.

3) Discuss the following respiratory problems and how to

avoid such diseases.

INTRODUCTION:

Women commonly acquire respiratory diseases during

pregnancy. This has been a problem throughout the years.

These diseases are known to hit pregnant women even though

these diseases could be hereditary. Theses respiratory

diseases can endanger the pregnant woman and at the same

time, have a big chance of affecting the development of the

fetus inside the womb. As we go along the different

diseases later on, we will the background of the diseases,

their symptoms, how are they diagnosed and their treatment.


1. TUBERCULOSIS

A. General Information

Tuberculosis (TB) is a contagious disease. Like the

common cold, it spreads through the air. Only people who

are sick with TB in their lungs are infectious. When

infectious people cough, sneeze, talk or spit, they propel

TB germs, known as bacilli, into the air. A person needs

only to inhale a small number of these to be infected. Left

untreated, each person with active TB disease will infect

on average between 10 and 15 people every year. But people

infected with TB bacilli will not necessarily become sick

with the disease.

The immune system "walls off" the TB bacilli which,

protected by a thick waxy coat, can lie dormant for years.

When someone's immune system is weakened, the chances of

becoming sick are greater.

- Tuberculosis is a disease caused by the invasion of

acid fast bacillus Mycobacterium tuberculosis to the

lung tissues.

- Macrophasages and T lymphocytes rather only surround

and confine the bacillus instead of killing it


resulting to the development of fibrosis,

calcification, and final ring of collagenous scar

which is tremendously invading more body organs.

- It is a disease that should have been eradicated in

view of the effective treatment available.

- Suddenly the incidence has increased and become

epidemic in high populated areas making it still

one of the leading causes of death.

B. Assessment Findings

- Chronic cough

- Weight loss

- Hemoptysis(Coughing Blood)

- Night sweats

- Low-grade fever

- Chronic fatigue

C. Diagnostic Tests

- Skin testing (PPD) at first prenatal visit

- Chest X-ray to confirm the positive PPD


D. Therapeutic Management

- Isoniazid (INH) with pyridoxine (Vitamin B) to

counteract INH in causing peripheral neurotis.

- Ethambutol hydrochloride (Myambutol)

2. ASTHMA

A. General Information

Asthma is a chronic inflammation of the bronchial

tubes (airways) that cause swelling and narrowing

(constriction) of the airways. The result is difficulty

breathing. The bronchial narrowing is usually either

totally or at least partially reversible with treatments.

Bronchial tubes that are chronically inflamed may become

overly sensitive to allergens (specific triggers) or

irritants (nonspecific triggers). The airways may become

"twitchy" and remain in a state of heightened sensitivity.

This is called "bronchial hyper reactivity" (BHR). It is

likely that there is a spectrum of bronchial hyper

reactivity in all individuals.

However, it is clear that asthmatics and allergic

individuals (without apparent asthma) have a greater degree

of bronchial hyper reactivity than non-asthmatic and non-

allergic people. In sensitive individuals, the bronchial

tubes are more likely to swell and constrict when exposed


to triggers such as allergens, tobacco smoke, or exercise.

Amongst asthmatics, some may have mild BHR and no symptoms

while others may have severe BHR and chronic symptoms.

Asthma affects people differently. Each individual is

unique in their degree of reactivity to environmental

triggers. This naturally influences the type and dose of

medication prescribed, which may vary from one individual

to another.

Asthma is now the most common chronic illness in

children, affecting one in every 15. In North America, 5%

of adults are also afflicted. In all, there are about 1

million Canadians and 15 million Americans who suffer from

this disease.

The number of new cases and the yearly rate of

hospitalization for asthma have increased about 30% over

the past 20 years. Even with advances in treatment, asthma

deaths among young people have more that doubled.

- Asthma is a disorder marked by reversible airflow

obstruction, airway hyperactivity and airway

inflammation.
- It complicates about 1% of pregnancies and is

associated with an increased risk of prenatal

complications (Redding and Stoloff, 2004).

- Symptoms are often triggered by an irritant e.g.

an inhaled allergen, as pollen or smoke.

- With inhalation of the allergen. There is an

immediate release of bioactive mediators such as

histamine and leikotrienes from an IgE/immunoglobulin

interaction.

B. Assessment Findings

- Constriction of bronchial smooth muscle

- Mucosal inflammation and swelling of bronchioles

- Thick bronchial secretions

- Reduction in the size of lumen of air passages

- Difficulty pulling and releasing of air

- High pitched whistling sound (bronchial wheezing)

EFFECT TO MOTHER/FETUS

- Potential reduction of fetal oxygen

- Preterm birth

- Intrauterine growth restriction


C. Treatment Management

- Corticosteroids Beclomethasome (Beclovent,

Vancenase)

- Budesonide (Pulmicort, Rhinocort)

- Hydrocortisome parenteral administration during

labor

- Terbutaline and albuterol – Beta-adrenergic

agonist

- Montelukast sodium (Singular) or Zafirlukast

(Accolate)

Leukotriene receptor antagonist

3. SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

A. General Information

Severe Acute Respiratory Syndrome — or SARS — is

a mystery virus that that swept across parts of Asia

and the Far East, and moved worldwide. It is thought

that the virus originated in the Guangdong province in

southern China, with neighboring Hong Kong being one

of the main centers of the outbreak. Scientists are

focusing on two different possible viruses as being

the possible cause of the illness: one is from the

Coronavirus family (a virus that is often a cause of

the common cold), and the other from the paramyxovirus


family (which causes measles and mumps). It is

believed that a combination of the two viruses might

cause the more deadly variation that has been exposed.

The spread of the disease prompted Singapore and Hong

Kong and parts of Canada to close certain public

places and invoke a quarantine law affecting people

thought to have had close contact with others who were

infected with the disease.

The main symptoms of SARS are high fever (greater

than 38 C or 100.4 F), combined with a dry cough,

shortness of breath, or breathing difficulties, with

other possible symptoms including headache, muscular

stiffness, loss of appetite, malaise, confusion, rash

and diarrhea. A cocktail of drugs has been shown to be

effective in combating the illness. SARS seems to be

spread through close contact with an infected person,

with the incubation period estimated to be between two

and seven days.

- SARS is a newly emerged infectious disease caused

by a coronavirus which originated in Southern

China and has spread to become a worldwide

pandemic (Hu, et al 2004).


- SARS is spread by close person to person contact

via droplet transmission.

- The incubation period is 2-10 days.

B. Assessment Findings

- Persistent fever

- Chills

- Muscle aches

- Malaise (feeling of general discomfort)

- Dry cough

- Headache

- Dyspnea (shortness of breath)

Effect to Mother/Fetus

- Spontaneous abortion

- Preterm delivery

- Intrauterine growth restriction

C. Laboratory Findings

- Decreased lymphocytes and platelet counts

D. Treatment Management

- Intravenous antibiotics
4. PNEUMONIA

A. General Information

- Pneumonia is the bacterial or viral invasion of

lung pathogens such as S. pneumonia, Haemophilus

influenza and Mycoplasma pneumonia.

- After the invasion, an acute inflammatory response

occurs with exudates of red blood cells, fibrin,

and polymorphonuclear leukocytes into the alveoli.

B. Assessmnet Finding

- Bacteria or virus is confined within segments of

the lobes of the lungs but also fills alveoli with

fluid, blocking the breathing space.

Effect to Mother/Fetus

- Premature labor

C. Treatment Management

Antibiotic and oxygen administration

5. NASOPHARYNGITIS

A. General Information

- Acute nasopharyngitis (common cold) cause by a

virus that tends to be more severe during

pregnancy because estrogen stimulation normally

causes some degree of nasal congestion.


- In minor colds, woman can find difficult to

breathe.

- Aspirin should be avoided because of possible

interference with blood clotting with both mother

and fetus and the possibility of prolonged

pregnancy at term.

- Since it is viral infection, antibiotic is not

recommended but only to prevent secondary

infections.

- Woman should check with her physician before

taking any over-the-counter medications for colds.

6. INFLUENZA with H1N1 (swine)

A. General Information

- Influenza is caused by a virus, identified as type

A,B or C.

- The spreads in epidemic form and is not correlated

with congenital anomalies in children or found to

be a cause of preterm labor (Males, 2004).


B. Assessment Findings recall SHARP CVD

S-ore throat C-hills

H-igh fever V-omiting

A-shortness of breathe/dyspnea D-iarrhea; D-

ypnea

R-unny nose (cold)

P-ain in the back and extremities

C. Treatment

- Acetaminophine (Tylenol)antipyretic

- Oseltamivir (Tamilflu)- antiviral drug of category

- Seasonal Influenza for Vaccines pregnant or

Influenza H1N1 vaccine flu shot (not yet available

in the Philippines).
LESSONS LEARNED:

First of all, I have learned the most common

respiratory diseases among pregnant women. These are not

just ordinary diseases in which it does require a quite

costly medical treatment. Disease like these should be

prevented among pregnant women as not to endanger them and

even affect the development of the fetus inside their womb.

I have also learned that these diseases were not just

acquired by pregnant women, but rather in some cases, are

hereditary. These women must already be prepared for these

diseases to appear from the time they plan to have a child.

Serious disease or not, they should be at least

knowledgeable of the probable effects of these respiratory

diseases and in some way, be prepared about it.


BIBLIOGRAPHY

http://www.who.int/mediacentre/factsheets/fs104/en/

(Retrieved: June 27, 2010)

Fauci, Anthony S., et al. Harrison's Principles of

Internal Medicine. 17th ed. United States: McGraw-Hill

Professional, 2008.) (Retrieved: June 27, 2010)

http://www.medicinenet.com/asthma/page2.htm

(Retrieved: July 14, 2010)

Hoare, Zara, and Wei Shen Lim. "Pneumonia: Update on

Diagnosis and Management." BMJ 332 May 6, 2006: 1077-1079.

(Retrieved: June 27, 2010)

http://www.answers.com/topic/common-cold (Retrieved:

June 27, 2010)

Eccles R (November 2005). "Understanding the symptoms

of the common cold and influenza". Lancet Infect Dis 5

(11): 718–25. doi:10.1016/S1473-3099(05)70270-X. PMID

16253889. (Retrieved: July 14, 2010)


Nordenberg, Tamar (May 1999). "Colds and Flu: Time

Only Sure Cure". Food and Drug Administration.

http://www.fda.gov/fdac/features/896_flu.html. (Retrieved:

June 27, 2010)

http://www.wrongdiagnosis.com/n/nasopharyngitis/treatm

ents.htm (Retrieved: June 27, 2010)

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