Asthma pregnancy healthy baby gives birth. Bronchial asthma during pregnancy: is there any reason for confusion? Glucocorticosteroids for systemic use

Bronchial asthma is one of the most common lung diseases in pregnant women. Due to the increase in the number of people prone to allergies, cases of bronchial asthma have become more frequent in recent years (from 3 to 8% in different countries; with each decade the number of such patients increases by 1-2%).
This disease is characterized by inflammation and temporary obstruction of the airways and occurs against a background of increased excitability of the airways in response to various influences. Bronchial asthma can be of non-allergic origin - for example, after brain injury or due to endocrine disorders. However, in the vast majority of cases, bronchial asthma is an allergic disease, when in response to exposure to an allergen, bronchospasm occurs, manifested by suffocation.

VARIETIES

There are infectious-allergic and non-infectious-allergic forms of bronchial asthma.
Infectious-allergic bronchial asthma develops against the background of previous infectious diseases of the respiratory tract (pneumonia, pharyngitis, bronchitis, tonsillitis); in this case, the allergen is microorganisms. Infectious-allergic bronchial asthma is the most common form, accounting for more than 2/3 of all cases of the disease.
In the non-infectious-allergic form of bronchial asthma, the allergen can be various substances of both organic and inorganic origin: pollen, street or house dust, feathers, animal and human hair and dander, food allergens (citrus fruits, strawberries, strawberries, etc.), medicinal substances (antibiotics, especially penicillin, vitamin B1, aspirin, pyramidon, etc.), industrial chemicals (most often formalin, pesticides, cyanamides, inorganic salts of heavy metals, etc.). When non-infectious allergic bronchial asthma occurs, hereditary predisposition plays a role.

SYMPTOMS

Regardless of the form of bronchial asthma, three stages of its development are distinguished: pre-asthma, asthma attacks and status asthmaticus.
All forms and stages of the disease occur during pregnancy.
minorities.
Pre-asthma includes chronic asthmatic bronchitis and chronic pneumonia with elements of bronchospasm. There are no pronounced attacks of suffocation at this stage yet.
In the initial stage of asthma, asthma attacks develop periodically. In the infectious-allergic form of asthma, they appear against the background of some chronic disease of the bronchi or lungs.
Choking attacks are usually easy to recognize. They begin more often at night and last from several minutes to several hours. Choking is preceded by a scratching sensation in the throat, sneezing, runny nose, and tightness in the chest. The attack begins with a persistent paroxysmal cough, no sputum. There is a sharp difficulty in exhaling, tightness in the chest, and nasal congestion. The woman sits down, strains all the muscles of the chest, neck, and shoulder girdle to exhale air. Breathing becomes noisy, whistling, hoarse, audible at a distance. At first, breathing is rapid, then becomes less frequent - up to 10 respiratory movements per minute. The face takes on a bluish tint. The skin is covered with perspiration. Towards the end of the attack, sputum begins to separate, which becomes more and more liquid and abundant.
Status asthmaticus is a condition in which a severe attack of breathlessness does not stop for many hours or several days. In this case, the medications that the patient usually takes are ineffective.

FEATURES OF BRONCHIAL ASTHMA DURING PREGNANCY AND BIRTH

As pregnancy progresses, women with bronchial asthma experience pathological changes in the immune system, which have a negative impact on both the course of the disease and the course of pregnancy.
Bronchial asthma usually begins before pregnancy, but may first appear during pregnancy. Some of these women also had mothers with asthma. In some patients, asthma attacks develop at the beginning of pregnancy, in others - in the second half. Asthma that occurs at the beginning of pregnancy, like early toxicosis, may disappear by the end of the first half. In these cases, the prognosis for the mother and fetus is usually quite favorable.
Bronchial asthma, which began before pregnancy, can occur in different ways during pregnancy. According to some data, during pregnancy, 20% of patients maintain the same condition as before pregnancy, 10% experience improvement, and in most women (70%) the disease is more severe, with moderate and severe forms of exacerbation predominating with daily repeated attacks suffocation, periodic asthmatic conditions, unstable treatment effect.
The course of asthma usually worsens already in the first trimester of pregnancy. In the second half, the disease progresses more easily. If a deterioration or improvement of the condition occurred during a previous pregnancy, then it can be expected in subsequent ones.
Attacks of bronchial asthma during childbirth are rare, especially with the prophylactic use of glucocorticoid drugs (prednisolone, hydrocortisone) or bronchodilators (aminophylline, ephedrine) during this period.
After childbirth, the course of bronchial asthma improves in 25% of women (these are patients with a mild form of the disease). In 50% of women, the condition does not change, in 25% it worsens, they are forced to constantly take prednisolone, and the dose has to be increased.
Patients with bronchial asthma more often than healthy women develop early toxicosis (in 37%), threatened miscarriage (in 26%), labor disturbances (in 19%), rapid and rapid labor, which results in high birth traumatism ( in 23%), premature and low birth weight babies may be born. Pregnant women with severe bronchial asthma experience a high percentage of spontaneous miscarriages, premature births and cesarean sections. Cases of fetal death before and during childbirth are observed only in severe cases of the disease and inadequate treatment of asthmatic conditions.
The mother's illness can affect the baby's health. 5% of children develop asthma in the first year of life, and 58% develop asthma in subsequent years. Newborns in the first year of life often develop upper respiratory tract diseases.
The postpartum period in 15% of postpartum women with bronchial asthma is accompanied by an exacerbation of the underlying disease.
Patients with bronchial asthma during full-term pregnancy usually give birth through the birth canal, since attacks of suffocation during childbirth are not difficult to prevent. Frequent attacks of suffocation and asthmatic conditions observed during pregnancy, the ineffectiveness of the treatment provided are indications for early delivery at 37-38 weeks of pregnancy.

TREATMENT OF BRONCHIAL ASTHMA DURING PREGNANCY

When treating bronchial asthma in pregnant women, it should be borne in mind that all drugs used for this purpose pass through the placenta and can cause harm to the fetus, and since the fetus is often in a state of hypoxia (oxygen starvation), a minimum amount of drugs should be administered. If asthma does not worsen during pregnancy, there is no need for drug therapy. With a mild exacerbation of the disease, you can limit yourself to mustard plasters, cupping, and inhalation of saline solution. However, it should be borne in mind that severe and poorly treated asthma poses a much greater danger to the fetus than the drug therapy used to treat it. But in all cases, a pregnant woman suffering from bronchial asthma should use medications only as prescribed by a doctor.
The main treatment of bronchial asthma includes bronchodilators (sympathomimetics, xanthine derivatives) and anti-inflammatory drugs (intal and glucocorticoids).
The most widely used drugs are from the group of sympathomimetics. These include isadrin, euspiran, novodrin. Their side effect is increased heart rate. It is better to use so-called selective sympathomimetics; they cause relaxation of the bronchi, but this is not accompanied by palpitations. These are drugs such as salbutamol, bricanil, salmeterol, berotec, alupent (asthmopent). When used inhalation, sympathomimetics act faster and stronger, so during an attack of suffocation, take 1-2 breaths from the inhaler. But these medications can also be used as prophylactics.
Adrenaline also belongs to sympathomimetics. Its injection can quickly eliminate an attack of suffocation, but it can cause spasm of peripheral vessels in the woman and fetus and worsen uteroplacental blood flow. Ephedrine is not contraindicated during pregnancy, but it is ineffective.
It is interesting that sympathomimetics have found wide use in obstetrics for the treatment of miscarriage. An additional beneficial effect of these drugs is the prevention of distress syndrome - breathing problems in newborns.
Methylxanthines are the most preferred treatment for asthma during pregnancy. Eufillin is administered intravenously for severe asthma attacks. Eufillin tablets are used as a prophylactic agent. Recently, extended-release xanthines - theophylline derivatives, such as Teopec - have become increasingly widespread. Theophylline preparations have a beneficial effect on the body of a pregnant woman. They improve uteroplacental circulation and can be used to prevent distress syndrome in newborns. These drugs increase renal and coronary blood flow and reduce pulmonary artery pressure.
Intal is used after 3 months of pregnancy for non-infectious allergic forms of the disease. In severe cases of the disease and asthmatic conditions, this drug is not prescribed. Intal is used only for the prevention of bronchospasm, but not for the treatment of already developed asthma attacks: this can lead to increased suffocation. Intal is taken in the form of inhalations.
Among pregnant women, more and more often there are patients with severe forms of bronchial asthma who are forced to receive hormone therapy. They usually have a negative attitude towards taking glucocorticoid hormones. However, during pregnancy, the danger associated with the administration of glucocorticoids is less than the risk of developing hypoxemia - a lack of oxygen in the blood, from which the fetus suffers very seriously.
Treatment with prednisolone must be carried out under the supervision of a physician, who sets an initial dose sufficient to eliminate an exacerbation of asthma in a short period of time (1-2 days), and then prescribes a lower maintenance dose. In the last two days of treatment, inhalations of becotide (beclamide), a glucocorticoid that has a local effect on the respiratory tract, are added to prednisolone tablets. This drug is harmless. It does not stop the developing attack of suffocation, but serves as a preventive measure. Inhaled glucocorticoids are currently the most effective anti-inflammatory drugs for the treatment and prevention of bronchial asthma. During exacerbations of asthma, without waiting for the development of severe attacks, the dose of glucocorticoids should be increased. The doses used are not dangerous for the fetus.
Anticholinergics are drugs that reduce the narrowing of the bronchi. Atropine is administered subcutaneously during an attack of suffocation. Platyphylline is prescribed in powders prophylactically or to stop an attack of bronchial asthma - subcutaneously. Atrovent is a derivative of atropine, but with a less pronounced effect on other organs (heart, eyes, intestines, salivary glands), which is associated with its better tolerability. Berodual contains Atrovent and Berotec, which was mentioned above. It is used to suppress acute attacks of asthma and to treat chronic bronchial asthma.
The well-known antispasmodics papaverine and no-spa have a moderate bronchodilator effect and can be used to suppress mild attacks of suffocation.
In case of infectious-allergic bronchial asthma, it is necessary to stimulate the removal of sputum from the bronchi. Regular breathing exercises, toileting of the nasal cavity and oral mucosa are important. Expectorants serve to thin sputum and promote the removal of bronchial contents; they moisturize the mucous membrane and stimulate coughing. For this purpose the following can be used:
1) inhalation of water (tap or sea), saline solution, soda solution, heated to 37°C;
2) bromhexine (bisolvon), mucosolvin (in the form of inhalations),
3) ambroxol.
3% solution of potassium iodide and solutan (containing iodine) are contraindicated for pregnant women. An expectorant mixture with marshmallow root and terpin hydrate in tablets can be used.
It is useful to drink medicinal mixtures (if you are not intolerant to the components of the collection), for example, from wild rosemary herb (200 g), oregano herb (100 g), nettle leaves (50 g), birch buds (50 g). They need to be crushed and mixed. Pour 2 tablespoons of the mixture into 500 ml of boiling water, boil for 10 minutes, then leave for 30 minutes. Drink 1/2 glass 3 times a day.
Recipe for another collection: plantain leaves (200 g), St. John's wort leaves (200 g), linden flowers (200 g), chop and mix. Pour 2 tablespoons of the collection into 500 ml of boiling water, leave for 5-6 hours. Drink 1/2 cup 3 times a day before meals, warm.
Antihistamines (diphenhydramine, pipolfen, suprastin, etc.) are indicated only for mild forms of non-infectious allergic asthma; in the infectious-allergic form of asthma, they are harmful because they contribute to the thickening of the secretions of the bronchial glands.
In the treatment of bronchial asthma in pregnant women, it is possible to use physical methods: physical therapy, a set of gymnastic exercises that facilitate coughing, swimming, inductothermy (warming) of the adrenal gland area, acupuncture.
During childbirth, treatment for bronchial asthma does not stop. The woman is given humidified oxygen and drug therapy continues.
Treatment of status asthmaticus must be carried out in a hospital in the intensive care unit.

PREVENTION OF PREGNANCY COMPLICATIONS

It is necessary for the patient to eliminate risk factors for exacerbation of the disease. In this case, removing the allergen is very important. This is achieved by wet cleaning of the room, excluding from food foods that cause allergies (oranges, grapefruits, eggs, nuts, etc.) and nonspecific food irritants (pepper, mustard, spicy and salty foods).
In some cases, the patient needs to change jobs if it involves chemicals that act as allergens (chemicals, antibiotics, etc.).
Pregnant women with bronchial asthma should be registered with a antenatal clinic physician. Each “cold” disease is an indication for treatment with antibiotics, physiotherapeutic procedures, expectorants, for the prophylactic administration of drugs that dilate the bronchi, or for increasing their dose. In case of exacerbation of asthma at any stage of pregnancy, hospitalization is carried out, preferably in a therapeutic hospital, and in case of symptoms of a threat of miscarriage and two weeks before the due date, in a maternity hospital to prepare for childbirth.
Bronchial asthma, even its hormone-dependent form, is not a contraindication for pregnancy, as it is amenable to drug and hormonal therapy. Only with recurring asthmatic conditions may the question of abortion in the early stages of pregnancy or early delivery of the patient arise.

Pregnant women with bronchial asthma should be regularly monitored by an obstetrician and a antenatal clinic physician. Treatment of asthma is complex and must be managed by a doctor.

Bronchial asthma is becoming an increasingly common disease affecting different segments of the population. This disease does not pose a serious threat to human life, so it is quite possible to live a full life with it if modern pharmaceuticals are used.

However, the period of motherhood sooner or later occurs for almost every woman, but here she is faced with the question - how dangerous are pregnancy and bronchial asthma? Let's figure out whether it is possible for an asthmatic mother to carry and give birth to a baby normally, and also consider all the other nuances.

One of the main risk factors influencing the development of the disease is the poor ecology in the region of residence, as well as difficult working conditions. Statistics show that residents of megacities and industrial centers suffer from bronchial asthma many times more often than residents of villages or villages. For pregnant women, this risk is also very high.

In general, a variety of factors can provoke this disease, so it is not always possible to determine the cause in any particular case. These include household chemicals, allergens found in everyday life, insufficient nutrition, etc.

For a newborn, the risk is poor heredity. In other words, if one of the two parents had this disease, then the probability of its occurrence in the child is extremely high. According to statistics, a hereditary factor occurs in one third of all patients. Moreover, if only one parent has asthma, then the probability of the child developing this disease is 30 percent. But if both parents are sick, then this probability increases significantly - up to 75 percent. There is even a special definition for this type of asthma - atopic bronchial asthma.

The effect of bronchial asthma on pregnancy

Many doctors agree that treating bronchial asthma in pregnant women is a very important task. A woman’s body already endures various changes and increased stress during pregnancy, which are also complicated by the course of the disease. During this period, women experience weakened immunity, which is a natural phenomenon during pregnancy, and this also includes changes in hormones.

Asthma can cause a mother to experience a lack of air and oxygen starvation, which already poses a danger to the normal development of the fetus. In general, bronchial asthma in pregnant women occurs only in 2% of cases, so it is impossible to talk about any connection between these circumstances. But this does not mean that the doctor should not respond to this disease, because it can really harm the unborn baby.

The tidal volume of a pregnant woman increases, but the expiratory volume decreases, which leads to the following changes:

• Bronchial collapse.
• Inconsistency between the amount of incoming oxygen and blood in the breathing apparatus.
• Against this background, hypoxia also begins to develop.

Fetal hypoxia is a common occurrence if asthma occurs during pregnancy. A lack of carbon dioxide in a woman’s blood can lead to spasms of the umbilical vessels.

Medical practice shows that pregnancy caused by bronchial asthma does not develop as smoothly as in healthy women. With this disease, there is a real risk of premature birth, as well as death of the fetus or mother. Naturally, these risks increase if a woman is negligent about her health without being observed by a treating specialist. At the same time, the patient becomes progressively worse at about 24-36 weeks. If we talk about the most likely complications that arise in pregnant women, the picture looks like this:

• Preeclampsia, which is one of the most common causes of death in women, develops in 47 percent of cases.
• Fetal hypoxia and asphyxia during childbirth - in 33 percent of cases.
• Hypotrophy - 28 percent.
• Insufficient development of the baby - 21 percent.
• Threat of miscarriage - in 26 percent of cases.
• The risk of premature birth is 14 percent.

It is also worth talking about those cases when a woman takes special anti-asthmatic drugs to relieve attacks. Let's consider their main groups, as well as the effect they have on the fetus.

Effect of drugs

Adrenergic agonists

During pregnancy, adrenaline, which is often used to relieve asthma attacks, is strictly prohibited. The fact is that it provokes spasm of the uterine vessels, which can lead to hypoxia. Therefore, the doctor selects more gentle drugs from this group, such as salbutamol or fenoterol, but their use is only possible according to the indications of a specialist.

Theophylline

The use of theophylline preparations can lead to the development of rapid heartbeat in the unborn baby, because they are able to be absorbed through the placenta, remaining in the child’s blood. Theophedrine and antastaman are also prohibited for use, because they contain belladonna extract and barbiturates. It is recommended to use ipratropinum bromide instead.

Mucolytic drugs

This group contains drugs that are contraindicated for pregnant women:

• Triamcinolone, which negatively affects the baby's muscle tissue.
• Betamethasone with dexamethasone.
• Delomedrol, Diprospan and Kenalog-40.

Treatment of asthma in pregnant women should be carried out according to a special scheme. It includes constant monitoring of the condition of the mother’s lungs, as well as the choice of method of birth. The fact is that in most cases he decides to perform a caesarean section, because excess tension can provoke an attack. But such decisions are made individually, based on the specific condition of the patient.

As for how exactly asthma is treated, several points can be highlighted:

• Getting rid of allergens. The idea is quite simple: you need to remove all kinds of household allergens from the room where the woman is. Fortunately, there are various hypoallergenic underwear, air purifying filters, etc.
• Taking special medications. The doctor collects a thorough medical history, finding out about the presence of other diseases, allergies to certain drugs, i.e. conducts a complete analysis to prescribe appropriate treatment. In particular, a very important point is intolerance to acetylsalicylic acid, because if it is present, then non-steroidal analgesics cannot be used.

The main point in treatment is, first of all, the absence of risk for the unborn child, on the basis of which all drugs are selected.

Treatment of pregnancy complications

If a woman is in the first trimester, then treatment for possible pregnancy complications is carried out in the same way as in normal cases. But if there is a risk of miscarriage in the second and third trimester, then it is necessary to treat the pulmonary disease, and it is also necessary to normalize the mother’s breathing.

The following drugs are used for these purposes:

• Phospholipids, which are taken as a course, along with multivitamins.
• Actovegin.
• Vitamin E

Childbirth and postpartum period

At the hour of labor, special therapy is used to improve blood circulation in the mother and her baby. Thus, drugs are introduced that improve the functioning of the circulatory systems, which is very important for the health of the unborn baby.

To prevent possible suffocation, glucocorticosteroids are prescribed by inhalation. The administration of prednisolone during labor is also indicated.

It is very important that a woman strictly follows the doctor’s recommendations, not stopping therapy until the birth itself. For example, if a woman takes glucocorticosteroids on an ongoing basis, then she should continue taking them after the birth of the baby during the first 24 hours. The dose should be taken every eight hours.

If a caesarean section is used, epidural anesthesia is preferred. If general anesthesia is advisable, the doctor must carefully select the drugs to administer, because carelessness in this matter can lead to attacks of suffocation in the child.

After childbirth, many suffer from various bronchitis and bronchospasms, which is a completely natural reaction of the body to labor. To avoid this, you must take ergometrine or any other similar drugs. You should also be especially careful when taking antipyretics that contain aspirin.

Breast-feeding

It is no secret that many medications pass into mother's breast milk. This also applies to asthma medications, but they pass into milk in small quantities, so this cannot be a contraindication for breastfeeding. In any case, the doctor himself prescribes medications for the patient, keeping in mind the fact that she will have to breastfeed the baby, so he does not prescribe medications that could harm the baby.

How does childbirth occur in patients with bronchial asthma? Labor during bronchial asthma can proceed quite normally, without visible complications. But there are times when childbirth is not so easy:

• The water may break before labor occurs.
• Childbirth may happen too quickly.
• Abnormal labor may occur.

If the doctor decides on spontaneous childbirth, then he must perform a puncture of the epidural space. Then bupivacaine is injected there, which promotes the expansion of the bronchi. Labor pain relief for bronchial asthma is carried out in a similar way, by administering drugs through a catheter.

If a patient experiences an asthma attack during childbirth, the doctor may decide to perform a cesarean section to reduce the risks for mother and baby.

Conclusion

In conclusion, I would like to say that pregnancy at different stages and bronchial asthma can completely coexist if a woman receives proper treatment. Of course, this complicates the process of childbirth and the postpartum period a little, but if you follow the basic recommendations of your doctor, then asthma is not as dangerous during pregnancy as it might seem at first glance.

Maintaining normal indicators of external respiration function (ERF) during gestation (bearing a child) is necessary to maintain the woman’s well-being and the proper development of the fetus. Otherwise, hypoxia occurs - oxygen starvation, which entails many adverse consequences. Let's figure out what features bronchial asthma has during pregnancy and what are the basic principles of treating the disease and preventing exacerbations.

Causes

Although the development of asthma may coincide with the period of pregnancy, a woman usually suffers from this disease even before conception, often from childhood. There is no single cause of the inflammatory process in the respiratory system, but there are a fairly large number of provoking factors (triggers):

1. Genetic predisposition.
2. Taking medications.
3. Infections (viral, bacterial, fungal).
4. Smoking (active, passive).
5. Frequent contact with allergens (household dust, mold, professional triggers - latex, chemicals).
6. Unfavorable environmental conditions.
7. Poor nutrition.
8. Stress.

Patients suffer from asthma throughout their lives, and the course of the disease usually worsens in the first trimester and stabilizes (with adequate therapy) in the second half of pregnancy. Between periods of remission (no symptoms), exacerbations occur due to a number of triggers:

• contact with allergens;
• unfavorable weather conditions;
• excessive physical activity;
• a sharp change in the temperature of inhaled air;
• dustiness of premises;
• stressful situations.

Asthma that develops in the initial trimester of pregnancy may spontaneously disappear by the end of the first half of gestation.

This phenomenon is observed in women whose mothers suffered episodes of bronchial obstruction (narrowing of the airways as a result of spasm) during their own pregnancy. However, it does not occur often. Attacks of suffocation can not only disappear without a trace, but also transform into the so-called true, already chronic asthma.

Although the disease is not always associated with allergies, immune disorders underlie the pathogenesis (mechanism of development) of most episodes. The key link in the formation of the reaction is hyperreactivity, or increased, heightened sensitivity of the bronchi to irritants of various natures.

Why is asthma dangerous during pregnancy?

In addition to the usual risks associated with suffocation and hypoxia (oxygen starvation), bronchial asthma during pregnancy increases the likelihood of such conditions and consequences as:

• early toxicosis;
• formation of a threat of termination of pregnancy;
• development of labor disorders;
• spontaneous abortion.

In addition, the mother’s illness can affect the health of the fetus (during exacerbations, it suffers from hypoxia) and the newborn child. Symptoms of asthma may appear in the first year of life, although most episodes of hereditary asthma are still recorded in children older than this age. There is also a tendency to diseases of the respiratory system - including infectious pathologies.

Symptoms

During the period of asthma remission, a pregnant woman feels well, but in the event of a relapse, an attack of suffocation develops. An exacerbation usually begins at night and lasts from several minutes to hours. First, “harbingers” appear:

• runny nose;
• sore throat;
• sneezing;
• discomfort in the chest.

Soon you can observe a combination of characteristic signs:

1. Shortness of breath with difficulty in exhaling.
2. Paroxysmal cough.
3. Noisy breathing that can be heard at a distance from the patient.
4. Whistling dry rales in the lungs.

The woman takes a sitting position and tenses the muscles of the chest, shoulder girdle and neck to ease difficulty breathing. She has to rest her hands on a hard surface. The face takes on a bluish tint, and cold sweat breaks out on the skin. The separation of viscous, “glassy” sputum indicates the end of the attack.

During pregnancy, there is also a risk of status asthmaticus - a severe attack in which conventional medications do not work, and airway patency decreases sharply, leading to suffocation (asphyxia). In this case, the patient limits physical activity, taking a forced position with support on her hands, is silent, breathes quickly or, on the contrary, rarely, superficially. There may be no wheezing (“silent lung”), consciousness is depressed to the point of coma.

Diagnostics

The examination program is based on such methods as:

• survey;
• inspection;
• laboratory tests;
• functional tests to assess respiratory function.

When talking with the patient, you need to determine what causes the attack and understand whether there is a hereditary predisposition to asthma. The examination allows you to find out the characteristics of the current objective condition. As for laboratory tests, they can have a general or specific focus:

1. Blood test (erythrocytes, leukocytes, formula calculation, gas composition).
2. Determination of the concentration of class E immunoglobulins (IgE), or antibodies - protein complexes responsible for the development of allergic reactions.
3. Sputum analysis (search for an increased number of eosinophil cells, Kurshman spirals, Charcot-Leyden crystals).

The “gold standard” of functional tests is spirography and peak flowmetry - measurement using special devices of such parameters of respiratory function as:

• forced expiratory volume in the first second (FEV1);
• vital capacity of the lungs (VC);
• peak expiratory flow (PEF).

Skin tests with allergens are prohibited during pregnancy.

They are not performed regardless of the duration and condition of the patient, since there is a high risk of developing anaphylactic shock.

Treatment

Therapy for asthma during pregnancy is not much different from standard regimens. Although during gestation it is recommended to stop taking drugs from the group of H1-histamine receptor blockers (Suprastin, Tavegil, etc.), the woman should continue and, if necessary, plan or supplement the course of treatment.

Modern medications used for basic therapy do not have a negative effect on the fetus. If the course of the disease is controllable (stable), patients use topical (local) forms of medications - this allows the drug to be concentrated in the area of ​​inflammation and eliminate or significantly reduce the systemic (on the entire body as a whole) effect.

Principles of pregnancy management

It is necessary to determine the severity of asthma and the level of risk for mother and child. Regular examinations by a pulmonologist are recommended - for controlled BA three times: at 18-20, 28-30 weeks and before birth, for unstable forms - as needed. Also required:

Drug therapy

Since uncontrolled asthma is dangerous for both the mother and the fetus, pharmacological drugs occupy an important place in the treatment algorithms for asthma during pregnancy. They are assigned, selected in accordance with the safety category:

• no side effects for mother/fetus when taken in standard therapeutic dosages (B);
• toxic effects have been documented in humans and animals, but the risk of discontinuing the drug is higher than the likelihood of side effects (C).

There are no Category A medications available to treat asthma (meaning studies have shown no risk to the fetus). However, the correct use of level B and, if necessary, level C products usually does not entail negative consequences. For basic or basic therapy the following are used:

The therapy is stepwise: for mild asthma, medications are used as required (usually Salbutamol, Ipratropium bromide), and then other medications are added (depending on the severity of the condition). If a woman was taking leukotriene receptor antagonists before pregnancy, it is advisable to continue therapy with them.

Help with exacerbations

If a pregnant woman has an asthma attack, you must:

• stop the trigger (if it can be identified - food, cosmetics, etc.);
• open a window or window if the situation occurs indoors;
• unbutton or remove clothing that interferes with breathing (shirt buttons, heavy coat);
• help use a medicine inhaler - for example, Salbutamol;
• Call an ambulance.

If possible, they resort to administering drugs through a nebulizer - this is a device that creates a medicinal aerosol from small particles that penetrate even into areas of the respiratory tract that are difficult to reach with conventional means. However, only a mild attack can be stopped on your own; a severe exacerbation requires emergency hospitalization of the pregnant woman in the hospital - sometimes immediately to the intensive care ward.

Management of childbirth

It is carried out against the background of basic therapy for asthma, which the patient received during gestation. In the absence of attacks, respiratory function indicators are assessed every 12 hours, in case of exacerbation - as needed. If a woman was prescribed systemic glucocorticosteroids during pregnancy, she is switched from Prednisolone to Hydrocortisone - for the period of labor and for 24 hours after the birth of the child.

The presence of bronchial asthma in a pregnant woman does not mean the impossibility of natural childbirth.

On the contrary, surgery is seen as a last resort as it entails additional risks. It is used when there is a direct threat to the life of the mother/child, and the need for surgery is determined by obstetric indications (placenta previa, abnormal fetal position, etc.).

To prevent exacerbation of bronchial asthma, it is necessary:

1. Avoid contact with allergens and other attack triggers.
2. Follow your doctor's recommendations regarding basic therapy.
3. Do not refuse treatment or reduce the dosage of medications on your own.
4. Keep a diary of external respiratory function indicators and, if there are significant fluctuations, visit a doctor.
5. Remember about scheduled consultations with specialists (therapist, pulmonologist, obstetrician-gynecologist) and do not miss visits.
6. Avoid excessive physical activity and stress.

A woman suffering from bronchial asthma is recommended to get vaccinated against influenza at the stage of pregnancy planning, since this variant of acute respiratory infection can significantly worsen the course of the underlying disease. Vaccination is also allowed during the gestation period, taking into account the patient’s health status.

In the modern world, more and more women suffer from bronchial asthma. However, every woman sooner or later faces the question of motherhood. Lack of control of bronchial asthma during pregnancy can lead to various complications not only for the mother’s body, but also for the fetus.

Modern medicine claims that bronchial asthma and pregnancy are completely compatible things.

Because the right therapy and regular medical monitoring increase the chance of maintaining the health of the mother and giving birth to a healthy baby.

Course of the disease during pregnancy

It is very difficult to predict how pregnancy will progress with bronchial asthma. It was noticed that women suffering from mild or moderate asthma did not notice a deterioration in their health while carrying a child. There are cases when, on the contrary, it improved. In patients with severe disease, exacerbation of asthma was quite often observed, the number of attacks and their severity increased. To avoid such manifestations, it is necessary to be under regular supervision not only by a gynecologist, but also by a pulmonologist.

Important! If the disease begins to worsen, then hospitalization in a hospital is necessary, where the medications taken are replaced with safer ones that will not have a negative effect not only on the fetus, but also on the mother’s body.

There is also a tendency that bronchial asthma in pregnant women in the first trimester is much more severe than in subsequent weeks.

The following are the complications that may develop in the expectant mother:

• more frequent attacks;
• risk of premature birth;
• risk of miscarriage;
• the appearance of toxicosis.

A pregnant woman with asthma receives insufficient oxygen, as a result of which the placental blood flow is also less enriched with it. In addition, asthmatic bronchitis, along with asthma, can cause hypoxia in the fetus, which is fraught with the following possible complications:

• low fetal weight;
• developmental delay;
• possible disorders of the cardiovascular and muscular systems;
• the risk of injury during childbirth increases;
• suffocation.

All of the above consequences develop exclusively with incorrectly chosen therapy. With adequate treatment, pregnancy with asthma often ends in the birth of a healthy baby with normal weight. The only common consequence is the baby’s predisposition to allergic manifestations. Therefore, during breastfeeding, the mother must strictly adhere to an antiallergic diet.

Most often, a deterioration in a woman’s well-being is observed from 28-40 weeks, when a period of active fetal growth occurs, which leads to a limitation in the motor function of the lungs. However, before the birth process, when the baby descends into the pelvic area, the mother’s well-being improves.

Usually, if the disease is not out of control and the woman is not in danger, then natural childbirth is recommended.

To do this, 2 weeks before the upcoming birth, the woman is hospitalized, where she and the baby are monitored around the clock. During delivery, she is given drugs that prevent the development of an attack and do not have a negative effect on the fetus.

On the day of birth, the woman is administered hormonal drugs every 8 hours, 100 mg, and the next day - every 8 hours, 50 mg intravenously. Then there is a gradual withdrawal of hormonal drugs or a transition to oral administration of the usual dosage.

If a woman notices a deterioration in her health, her attacks become more frequent, then at 38 weeks delivery is carried out by cesarean section. By this time, the baby becomes mature enough to live outside the mother's body. If surgical intervention is not performed, then both the mother and the child increase the risk of developing the above complications. During a caesarean section, it is advisable to carry out epidural anesthesia, as general anesthesia can aggravate the situation. In the case of general anesthesia, the doctor is more careful in selecting the drug.

Treatment of the disease during pregnancy

Treatment of bronchial asthma in pregnant women is somewhat different from conventional therapy. Since some drugs are contraindicated for use, others require a significant reduction in dosage. Therapeutic actions are based on preventing exacerbation of bronchial asthma.

The main therapeutic objectives are presented below:

1. Improved respiratory function.
2. Prevention of asthma attacks.
3. Relieving an attack of suffocation.
4. Preventing the influence of side effects of medications on the fetus.

In order for asthma and ongoing pregnancy to be completely compatible with each other, a woman must follow the following recommendations:

Medicines not recommended during pregnancy

The following are drugs that require careful use or are prohibited for use during pregnancy:

Important! During pregnancy, immunotherapy using allergens is prohibited, since this procedure provides a 100% guarantee that the baby will be predisposed to developing asthma.

How to stop an asthma attack in a pregnant woman?

Unfortunately, during pregnancy, patients also experience asthma attacks, which must be quickly stopped. First of all, you should calm down, open the window for better air flow, unfasten your collar and call an ambulance.

It is better for a woman to sit on a chair facing the back, with her hands on her sides. In such a way that the chest has an expanded position. This way you can take a relaxing position and use the auxiliary pectoral muscles. You can stop asthma attacks in the following ways:

Important! It is forbidden to use Intal aerosol to relieve an attack, as it can significantly worsen the situation. This drug is used to prevent the development of asthma attacks.