Exacerbation of bronchial asthma during pregnancy. Bronchial asthma in pregnant women. Treatment of the disease during pregnancy

This is an atopic bronchospastic disease of the respiratory system that arose during gestation or pre-existing and can affect its course. It manifests itself as attacks of characteristic suffocation, unproductive cough, shortness of breath, noisy wheezing. It is diagnosed using physical examination methods, laboratory determination of markers of allergic reactions, spirography, peak flowmetry. For basic treatment, combinations of inhaled glucocorticoids, antileukotrienes, beta-agonists are used, and short-acting bronchodilators are used to relieve attacks.

ICD-10

O99.5 J45

General information

Diagnostics

The occurrence of repeated attacks of suffocation and sudden unproductive cough in a pregnant woman is sufficient grounds for a comprehensive examination to confirm or refute the diagnosis of bronchial asthma. During the gestational period, there are certain restrictions on diagnostic tests. Due to the possible generalization of an allergic reaction, pregnant women are not prescribed provocative and scarification tests with probable allergens, provocative inhalations of histamine, methacholine, acetylcholine and other mediators. The most informative for diagnosing bronchial asthma during pregnancy are:

Percussion and auscultation of the lungs. During an attack, a box sound is noted over the pulmonary fields. The lower borders of the lungs are shifted downwards, their excursion is practically not determined. Decreased breathing with scattered dry rales is heard. After coughing, wheezing intensifies mainly in the posterior lower parts of the lungs, which in some patients may persist between attacks.
Markers of allergic reactions. Bronchial asthma is characterized by increased levels of histamine, immunoglobulin E, and eosinophilic cationic protein (ECP). The content of histamine and IgE is usually increased both during exacerbation and between asthmatic attacks. An increase in ECP concentration indicates a specific immune response of eosinophils to the “allergen + immunoglobulin E” complex.
Spirography and peak flowmetry. A spirographic study allows, based on data on the second volume of forced expiration (FES1), to confirm functional disorders of external respiration of an obstructive or mixed type. During peak flowmetry, latent bronchospasm is detected, the degree of its severity and daily variability of peak expiratory flow (PEF) are determined.

Additional diagnostic criteria are an increase in the content of eosinophils in a general blood test, identification of eosinophilic cells, Charcot-Leyden crystals and Courshman spirals in sputum analysis, the presence of sinus tachycardia and signs of overload of the right atrium and ventricle on the ECG. Differential diagnosis is carried out with chronic obstructive pulmonary diseases, cystic fibrosis, tracheobronchial dyskinesia, fetometry and Dopplerography of placental blood flow. When choosing a pharmacotherapy regimen, the severity of bronchial asthma is taken into account:

With intermittent asthma the basic drug is not prescribed. Before possible contact with an allergen, when the first signs of bronchospasm appear and at the time of an attack, inhaled short-acting bronchodilators from the group of β2-agonists are used.
For persistent forms of asthma: basic therapy with inhaled glucocorticoids of category B is recommended, which, depending on the severity of asthma, are combined with antileukotrienes, short- or long-acting beta-agonists. The attack is controlled with inhaled bronchodilators.

The use of systemic glucocorticosteroids, which increase the risk of developing hyperglycemia, gestational diabetes, eclampsia, preeclampsia, and low birth weight birth, is justified only if basic pharmacotherapy is insufficiently effective. Triamcinolone, dexamethasone, and depot forms are not indicated. Prednisolone analogues are preferred. During an exacerbation, it is important to prevent or reduce possible fetal hypoxia. For this, inhalations with quaternary derivatives of atropine are additionally used, oxygen is used to maintain saturation, and in extreme cases, artificial ventilation is provided.

Although delivery by natural birth is recommended in cases of mild bronchial asthma, in 28% of cases, if there are obstetric indications, a cesarean section is performed. After the onset of labor, the patient continues to take basic medications in the same dosages as during gestation. If necessary, oxytocin is prescribed to stimulate uterine contractions. The use of prostaglandins in such cases can provoke bronchospasm. During breastfeeding, it is necessary to take basic antiasthmatic drugs in doses that correspond to the clinical form of the disease.

Prognosis and prevention

Adequate treatment of bronchial asthma during pregnancy can completely eliminate the danger to the fetus and minimize threats to the mother. Perinatal prognosis with controlled treatment does not differ from the prognosis for children born by healthy women. For preventive purposes, patients at risk who are prone to allergic reactions or suffering from atopic diseases are recommended to quit smoking and limit contact with household, industrial, food, plant, and animal exoallergens. To reduce the frequency of exacerbations, pregnant women with asthma are advised to take exercise therapy, therapeutic

Bronchial asthma is a chronic disease, prone to relapsing. Its main symptom should be considered attacks of suffocation, during which spasm of the smooth muscles of the affected bronchi occurs, increased secretion of thick, viscous mucus and swelling of the mucous membrane of the respiratory tract. A woman should remember this if she experiences the disease for the first time during pregnancy or if she already has it by the time she contacts an obstetrician-gynecologist. Such cases are not uncommon, because most often the disease manifests itself in early or teenage years, which leads to an increase in asthmatics of childbearing age. However, one should not think that bronchial asthma and pregnancy are incompatible. Of course, the patient will need increased attention from medical personnel, but this does not mean that pregnancy is contraindicated for bronchial asthma.

Mainly bronchi of different calibers (sizes) are affected. Their wall is inflamed. The sputum is thick, viscous and transparent. The mucous membrane of the respiratory tract is swollen.

Usually, the doctor is able to diagnose bronchial asthma through a thorough interview with the woman, auscultation (listening to breathing sounds through the chest wall) and several additional studies, the decision about which is made in connection with the data collected during the interview. For example, if a patient states that she suffers from allergies and experiences attacks due to contact with allergens, a test will be performed that will assess the status of the body when in contact with various substances that can cause allergies. Sputum is also examined for the presence of Courshman spirals (viscous, long pieces of sputum) and Charcot-Leyden crystals (fragments of destroyed eosinophil blood cells that have entered the sputum due to an inflammatory and allergic process in the bronchi). Another laboratory test is a general and immunological blood test to check for an increase in the blood of the same eosinophils and immunoglobulin E, which is involved in allergic reactions.

In addition to assessing the allergic status and laboratory tests of sputum and blood, a respiratory function test is required using spirometry and peak flowmetry. These techniques allow one to estimate the patient's basic tidal volumes and capacities and compare them with normal values typical for a person of a given age, height, gender, race and build. In this case, the subject breathes into a special apparatus, which records all the data and demonstrates the results in the form of numerical data and plotting graphs, even the shape of which can tell a specialist a lot.

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

The most important step during diagnosis is determining whether the treatment is effective for a given patient. This is important for determining the so-called stage of the disease and adjusting treatment measures in connection with the new physiological state of the woman and its characteristics. The treatment needs to be effective.

How does asthma complicate pregnancy?

Complications that can arise due to bronchial asthma during pregnancy are associated, first of all, with the severity of the disease in the mother and how often its exacerbations occur, as well as how effective and extensive the treatment was chosen before pregnancy.

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

Of all of the above, hypoxia of the mother and fetus has a direct connection with the disease, since in an asthmatic the respiratory function is almost always impaired, the only question is the degree of these impairments. In this case, the chosen treatment is of greatest importance for the prevention of complications.

Failures associated with the functioning of the immune system help reduce the patient’s body’s resistance to viral, bacterial and fungal infections. In this regard, intrauterine infection often occurs. In addition, damage to the blood vessels of the placenta (the “baby place”; the viability of the fetus is maintained by the placenta) may occur by immune complexes, which often results in delayed fetal development.

Hemostatic disorders can be expressed in chronic thrombohemorrhagic syndrome (a disorder of the coagulation system, when coagulation is alternately sharply increased, and multiple blood clots occur in microvessels, or significantly reduced, which leads to hemorrhages in them) of the placental vessels, which will also slow down the development of the fetus.

It should be noted that the clinical manifestations of bronchial asthma itself do not differ from those outside pregnancy. They are expressed in wheezing, shortness of breath, dry cough and attacks of suffocation, usually occurring with difficulty in exhaling.

As a rule, the disease is not a contraindication to pregnancy, but it must be remembered that an uncontrolled, severe course of the disease with frequent, difficult-to-control (stop) attacks can lead to complications in the mother and fetus, including premature birth, threatened miscarriage, hypoxia and fetal asphyxia during childbirth. Often in such cases it is necessary to perform surgical delivery.

How to choose the right treatment

In addition to the fact that the patient will receive drug treatment, the woman must give up smoking and permanent (constant) exposure to harmful volatile substances on her body. Of course, quitting smoking should be final, because the latter has a detrimental effect not only on the course of bronchial asthma, but also on the fetus during pregnancy.

It is advisable to treat bronchial asthma in a pregnant woman without losing attention to the trimester (an interval of three months, part of pregnancy, there are three of them: the first, second and third).

In the first trimester, treatment usually has no characteristic features. Therapy is carried out in accordance with the stage of the disease. The main drugs are various inhaled agents used during an attack (Salbutamol) and daily to prevent attacks (Beclamethasone). To prevent attacks, different medications can be used in tablet form, depending on the severity of the disease.

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

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

How does childbirth occur in patients with bronchial asthma?

Often, childbirth in patients suffering from mild bronchial asthma occurs naturally and without complications. The disease does not worsen. However, childbirth can also be complicated. The most common complications include:

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

If it is decided that labor should occur spontaneously, then before delivery a puncture of the epidural space is performed (a puncture of the spinal canal to enter the space near the hard shell of the spinal cord), after which the drug bupivacaine is injected there, which causes additional dilation of the bronchi. In addition, during childbirth, the usual, previously chosen treatment for bronchial asthma is continued.

If, after labor has begun, the patient develops signs of cardiopulmonary failure or status asthmaticus (a prolonged attack of bronchial asthma that does not stop with therapy), then this is an indication for surgical delivery.

Risks for the newborn

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

If the baby was born by caesarean section, the risk of developing the disease increases.

What a woman should remember

Treatment of the disease during pregnancy is mandatory. You can choose drugs that will not harm the fetus and mother. If the patient’s condition is stable and there are no exacerbations, then both pregnancy and childbirth will proceed without complications.

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

Treatment of bronchial asthma in women during pregnancy

The main objectives of the treatment of bronchial asthma in pregnant women include normalization of respiratory function, prevention of exacerbations of bronchial asthma, elimination of side effects of anti-asthmatic drugs, relief of attacks of bronchial asthma, which is considered the key to the correct uncomplicated course of pregnancy and the birth of a healthy child.

BA therapy in pregnant women is carried out according to the same rules as in non-pregnant women. The basic principles are increasing or decreasing the intensity of therapy as the severity of the disease changes, taking into account the characteristics of the course of pregnancy, mandatory monitoring of the course of the disease and the effectiveness of the prescribed treatment using peak flowmetry, the preferable use of the inhalation route of drug administration.

Medicines prescribed for bronchial asthma are divided into:

basic - controlling the course of the disease (systemic and inhaled glucocorticoids, cromones, long-acting methylxanthines, long-acting β2-agonists, antileukotriene drugs), they are taken daily, for a long time;
symptomatic, or emergency medications (inhaled fast-acting β2-agonists, anticholinergic drugs, methylxanthines, systemic glucocorticoids) - quickly eliminating bronchospasm and its accompanying symptoms: wheezing, a feeling of “tightness” in the chest, cough.

Treatment is chosen based on the severity of bronchial asthma, the availability of anti-asthmatic drugs and the individual living conditions of the patient.

Among β2-adrenergic agonists during pregnancy, it is possible to use salbutamol, terbutaline, fenoterol. Anticholinergics used in the treatment of bronchial asthma in pregnant women include ipratropium bromide in the form of an inhaler or a combined drug “Ipratropium bromide + fenoterol”. Drugs of these groups (both beta2-mimetics and anticholinergics) are often used in obstetric practice to treat threatened miscarriage. Methylxanthines, which include aminophylline and aminophylline, are also used in obstetric practice in the treatment of pregnant women, in particular in the treatment of gestosis. Cromones - cromoglycic acid, used in the treatment of bronchial asthma as a basic anti-inflammatory drug for mild bronchial asthma, due to their low effectiveness, on the one hand, and the need to obtain a quick therapeutic effect, on the other (taking into account the presence of pregnancy and the risk of development or increase phenomena of fetoplacental insufficiency in conditions of unstable disease), have limited use during pregnancy. They can be used in patients who have used these drugs with sufficient effect before pregnancy, provided that the disease remains stable during pregnancy. If it is necessary to prescribe basic anti-inflammatory therapy during pregnancy, preference should be given to inhaled glucocorticoids (budesonide).

With intermittent bronchial asthma, most patients are not recommended to take daily medications. Treatment of exacerbations depends on the severity. If necessary, a rapid-acting inhaled beta2-agonist is prescribed to eliminate the symptoms of bronchial asthma. If severe exacerbations are observed with intermittent bronchial asthma, then such patients should be treated as patients with persistent bronchial asthma of moderate severity.
Patients with mild persistent bronchial asthma require daily use of medications to maintain disease control. Preferable treatment with inhaled glucocorticoids (budesonide 200–400 mcg/day or
For persistent bronchial asthma of moderate severity, combinations of inhaled glucocorticoids (budesonide 400–800 mcg/day, or beclomethasone 500–1000 mcg/day or equivalent) and long-acting inhaled beta2-agonists 2 times a day are prescribed. An alternative to a beta2-agonist in this combination therapy is long-acting methylxanthine.
Treatment of severe persistent asthma includes high-dose inhaled glucocorticoids (budesonide > 800 mcg/day or > 1000 mcg/day beclomethasone or equivalent) in combination with long-acting inhaled β2-agonists twice daily. An alternative to long-acting inhaled β2-agonists is an oral β2-agonist or long-acting methylxanthine. Oral glucocorticoids may be prescribed.
After achieving control of bronchial asthma and maintaining it for at least 3 months, a gradual reduction in the volume of maintenance therapy is carried out, and then the minimum concentration required to control the disease is determined.

Along with the direct effect on asthma, such treatment also affects the course of pregnancy and fetal development. First of all, these are antispasmodic and antiaggregation effects obtained when using methylxanthines, a tocolytic effect (decreased tone, relaxation of the uterus) when using β2-agonists, immunosuppressive and anti-inflammatory effects when carrying out glucorticoid therapy.

When carrying out bronchodilator therapy, patients with threatened miscarriage should give preference to tableted β2-mimetics, which, along with bronchodilator, will also have a tocolytic effect. In the presence of gestosis, it is advisable to use methylxanthines - aminophylline - as a bronchodilator. If systemic use of hormones is necessary, prednisolone or methylprednisolone should be preferred.

When prescribing pharmacotherapy to pregnant women with bronchial asthma, it should be taken into account that for most anti-asthmatic drugs no adverse effects on the course of pregnancy have been noted. At the same time, there are currently no drugs with proven safety in pregnant women, because controlled clinical trials are not conducted in pregnant women. The main task of treatment is to select the minimum required doses of drugs to restore and maintain optimal and stable bronchial patency. It should be remembered that the harm from the unstable course of the disease and the respiratory failure that develops for the mother and fetus is disproportionately higher than the possible side effects of drugs. Rapid relief of exacerbation of bronchial asthma, even with the use of systemic glucocorticoids, is preferable to a long-term uncontrolled or poorly controlled course of the disease. Refusal of active treatment invariably increases the risk of complications for both mother and fetus.

During childbirth, treatment for bronchial asthma does not need to be stopped. Therapy with inhaled drugs should be continued. For women in labor who received tableted hormones during pregnancy, prednisolone is administered parenterally.

Due to the fact that the use of β-mimetics during childbirth is associated with the risk of weakening labor activity, when carrying out bronchodilator therapy during this period, preference should be given to epidural anesthesia at the thoracic level. For this purpose, puncture and catheterization of the epidural space in the thoracic region at the level of ThVII–ThVIII is performed with the introduction of 8–10 ml of 0.125% bupivacaine solution. Epidural anesthesia allows you to achieve a pronounced bronchodilator effect and create a kind of hemodynamic protection. No deterioration of fetal-placental blood flow was observed during the administration of local anesthetic. At the same time, conditions are created for spontaneous delivery without the exception of pushing in the second stage of labor, even in severe cases of the disease that disable the patient.

Exacerbation of bronchial asthma during pregnancy is an emergency condition that threatens not only the life of the pregnant woman, but also the development of intrauterine hypoxia of the fetus until its death. In this regard, treatment of such patients should be carried out in a hospital setting with mandatory monitoring of the state of the function of the fetoplacental complex. The mainstay of treatment for exacerbations is the administration of β2-agonists (salbutamol) or their combination with an anticholinergic drug (ipratropium bromide + fenoterol) via nebulizer. Inhaled administration of glucocorticosteroids (budesonide - 1000 mcg) through a nebulizer is an effective component of combination therapy. Systemic glucocorticosteroids should be included in treatment if, after the first nebulized administration of β2-agonists, no sustained improvement was obtained or an exacerbation developed while taking oral glucocorticosteroids. Due to the peculiarities that occur in the digestive system during pregnancy (longer gastric emptying), parenteral administration of glucocorticosteroids is preferable to taking drugs per os.

Bronchial asthma is not an indication for termination of pregnancy. In the case of an unstable course of the disease, severe exacerbation, termination of pregnancy is associated with a high risk to the patient’s life, and after the exacerbation has stopped and the patient’s condition has stabilized, the question of the need to terminate the pregnancy disappears altogether.

Delivery of pregnant women with bronchial asthma

Delivery of pregnant women with a mild course of the disease with adequate pain relief and corrective drug therapy does not present any difficulties and does not worsen the condition of the patients.

In most patients, labor ends spontaneously (83%). Among the complications of childbirth, the most common are rapid labor (24%) and prenatal rupture of amniotic fluid (13%). In the first stage of labor - anomalies of labor (9%). The course of the second and third stages of labor is determined by the presence of additional extragenital, obstetric pathology, and the characteristics of the obstetric and gynecological history. In connection with the available data on the possible bronchospastic effect of methylergometrine, when preventing bleeding in the second stage of labor, preference should be given to intravenous administration of oxytocin. Childbirth, as a rule, does not worsen the condition of patients. With adequate treatment of the underlying disease, careful management of labor, careful observation, pain relief and prevention of purulent-inflammatory diseases, complications in the postpartum period are not observed in these patients.

However, in severe cases of the disease, disabling patients, a high risk of development, or with the presence of respiratory failure, delivery becomes a serious problem.

In pregnant women with severe bronchial asthma or uncontrolled bronchial asthma of moderate severity, status asthmaticus during this pregnancy, exacerbation of the disease at the end of the third trimester, delivery is a serious problem due to significant impairments in the function of external respiration and hemodynamics, and a high risk of intrauterine fetal suffering. This group of patients is at risk of developing severe exacerbation of the disease, acute respiratory and cardiac failure during delivery.

Considering the high degree of infectious risk, as well as the risk of complications associated with surgical trauma in severe illness with signs of respiratory failure, the method of choice is planned vaginal delivery.

During vaginal delivery, before induction of labor, puncture and catheterization of the epidural space in the thoracic region at the ThVIII–ThIX level is performed with the introduction of a 0.125% solution of marcaine, which provides a pronounced bronchodilator effect. Then labor is induced by amniotomy. The behavior of the woman in labor during this period is active.

With the onset of regular labor, labor pain relief begins with epidural anesthesia at the L1–L2 level.

The introduction of a long-acting anesthetic in low concentration does not limit the woman’s mobility, does not weaken efforts in the second stage of labor, has a pronounced bronchodilator effect (increasing the forced vital capacity of the lungs - FVC, FEV1, POS) and allows you to create a kind of hemodynamic protection. There is an increase in shock output of the left and right ventricles. Changes in fetal blood flow are noted - a decrease in resistance to blood flow in the vessels of the umbilical cord and the fetal aorta.

Against this background, spontaneous delivery becomes possible without the exception of pushing in patients with obstructive disorders. To shorten the second stage of labor, an episiotomy is performed. In the absence of sufficient experience or technical capabilities to perform epidural anesthesia at the thoracic level, delivery should be performed by cesarean section. Due to the fact that endotracheal anesthesia poses the greatest risk, the method of choice for pain relief for caesarean section is epidural anesthesia.

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Pregnancy and asthma are not mutually exclusive. This combination occurs in one woman out of a hundred. Asthma is a chronic disease of the respiratory system, which is accompanied by frequent attacks of coughing and suffocation. In general, the disease is not an absolute contraindication for bearing a child.

It is necessary to closely monitor the health of pregnant women with this diagnosis in order to identify possible complications in time. With the right treatment tactics, childbirth takes place without consequences, and the child is born completely healthy. In most cases, a woman is given low-toxic drugs that help stop attacks and alleviate the course of the disease.

This disease is considered the most common among pathologies of the respiratory system. In most cases, asthma begins to progress during pregnancy, and symptoms become more severe (short-term attacks of suffocation, cough without phlegm, shortness of breath, etc.).

An exacerbation is observed in the second trimester of pregnancy, when hormonal changes occur in the body. In the last month, the woman feels much better, this is due to an increase in the amount of cortisol (a hormone produced by the adrenal glands).

Many women are interested in whether it is possible for a woman with this diagnosis to become pregnant. Experts do not consider asthma a contraindication to bearing a child. In a pregnant woman with bronchial asthma, health monitoring should be more strict than in women without pathologies.

To reduce the risk of complications, you need to take all the necessary tests and undergo comprehensive treatment when planning a pregnancy. During the period of bearing the baby, maintenance drug therapy is prescribed.

Why is bronchial asthma dangerous during pregnancy?

A woman suffering from bronchial asthma during pregnancy is more likely to experience toxicosis. Lack of treatment entails the development of severe consequences for both the mother and her unborn child. Complicated pregnancy is accompanied by the following pathologies:

respiratory failure;
arterial hypoxemia;
early toxicosis;
gestosis;
miscarriage;
premature birth.

Pregnant women with severe asthma have a higher risk of dying from preeclampsia. In addition to a direct threat to the life of a pregnant woman, bronchial asthma has a negative impact on the fetus.

Possible complications

Frequent exacerbations of the disease lead to the following consequences:

low birth weight of the baby;
intrauterine development disorders;
birth injuries that occur when the baby has difficulty passing through the birth canal;
acute lack of oxygen (fetal hypoxia);
intrauterine death due to lack of oxygen.

With severe forms of asthma in the mother, children are born with pathologies of the cardiovascular system and respiratory organs. They fall into the group of potential allergy sufferers, and over time, many of them are diagnosed with bronchial asthma.

That is why the expectant mother needs to be especially careful about her health when planning a pregnancy, as well as during the entire period of bearing the baby. Failure to comply with medical recommendations and improper treatment increases the risk of complications.

It is worth noting that pregnancy itself also affects the development of the disease. With hormonal changes, the level of progesterone increases, due to changes in the respiratory system, the content of carbon dioxide in the blood increases, breathing becomes more frequent, and shortness of breath is more common.

As the baby grows, the uterus rises in the diaphragm, thereby putting pressure on the respiratory organs. Very often during pregnancy, a woman experiences swelling of the mucous membrane in the nasopharynx, which leads to exacerbation of asthma attacks.

If the disease manifests itself in the early stages of pregnancy, then diagnosing it is quite difficult. According to statistics, the progression of asthma during pregnancy is more common in severe forms. But this does not mean that in other cases a woman can refuse drug therapy.

Statistics indicate that with frequent exacerbations of bronchial asthma attacks in the first months of pregnancy, children born into the world suffer from heart defects, pathologies of the gastrointestinal tract, spine and nervous system. They have low body resistance, so more often than other children they suffer from influenza, ARVI, bronchitis and other diseases of the respiratory system.

Treatment of asthma during pregnancy

Treatment of chronic bronchial asthma in pregnant women is carried out under the strict supervision of a doctor. First of all, it is necessary to carefully monitor the woman’s condition and fetal development.

For previously diagnosed bronchial asthma, it is recommended to replace the medications that were taken. The basis of therapy is the prevention of exacerbations of symptoms and the normalization of respiratory function in the fetus and expectant mother.

Doctors carry out mandatory monitoring of external respiration function using peak flowmetry. For early diagnosis of fetoplacental insufficiency, a woman is prescribed fetometry and Dopplerography of blood flow in the placenta.

Drug therapy is selected taking into account the severity of the pathology. It should be borne in mind that many drugs are prohibited for pregnant women. The group of medications and dosage are selected by a specialist. Most often used:

bronchodilators and expectorants;
asthma inhalers with drugs that stop an attack and prevent unpleasant symptoms;
bronchodilators, help relieve cough attacks;
antihistamines help reduce allergies;
systemic glucocorticosteroids (for severe forms of the disease);
leukotriene antagonists.

The most effective methods

Inhalation therapy is considered the most effective. For this purpose:

portable pocket devices into which the required volume of medication is administered using a special dispenser;
spacers, which are a special attachment for an inhaler;
nebulizers (with their help the drug is sprayed, thus ensuring the maximum therapeutic effect).

Successful treatment of asthma in pregnant women is facilitated by the following recommendations:

Eliminating potential allergens from the diet.
Using clothes made from natural materials.
Use of products with a neutral pH and hypoallergenic composition for hygienic procedures.
Elimination of potential allergens from the environment (animal hair, dust, perfume smell, etc.).
Carrying out daily wet cleaning of residential premises.
Frequent exposure to fresh air.
Elimination of physical and emotional stress.

An important stage of therapeutic therapy is breathing exercises; it helps to establish proper breathing and provide the body of the woman and fetus with sufficient oxygen. Here are some effective exercises:

bend your knees and tuck your chin while exhaling through your mouth. Perform 10-15 approaches;
Close one nostril with your index finger and inhale through the other. Then close it and exhale through the second one. The number of approaches is 10-15.

They can be performed independently at home, but before starting classes, you should definitely consult a doctor.

Forecast

If all risk factors are excluded, the treatment prognosis is favorable in most cases. Following all medical recommendations and regularly visiting your doctor is the key to the health of the mother and her unborn child.

In severe forms of bronchial asthma, a woman is placed in a hospital, where her condition is monitored by experienced specialists. Among the mandatory physiotherapeutic procedures, oxygen therapy should be highlighted. It increases saturation and helps relieve asthma attacks.

In the later stages, drug therapy involves taking not only basic medications for asthma, but also vitamin complexes and interferons to strengthen the immune system. During the treatment period, it is necessary to take tests to determine the level of hormones produced by the placenta. This helps to monitor the dynamic condition of the fetus and diagnose the early development of pathologies of the cardiovascular system.

During pregnancy, it is prohibited to take adrenergic blockers, some glucocorticosteroids, and 2nd generation antihistamines. They tend to penetrate the systemic bloodstream and reach the fetus through the placenta. This negatively affects intrauterine development and increases the risk of developing hypoxia and other pathologies.

Childbirth with asthma

Most often, birth in patients with asthma occurs naturally, but sometimes a caesarean section is prescribed. Exacerbation of symptoms during labor is a rare occurrence. As a rule, a woman with such a diagnosis is placed in a hospital in advance and her condition is monitored before the onset of labor.

During childbirth, she is necessarily given anti-asthma drugs, which help stop a possible asthma attack. These medications are absolutely safe for the mother and fetus and do not have a negative effect on the birth process.

With frequent exacerbations and transition of the disease to a severe form, the patient is prescribed a planned cesarean section, starting from the 38th week of pregnancy. If you refuse, the risk of complications during natural childbirth increases, and the risk of death of the child increases.

Among the main complications that occur in women giving birth with bronchial asthma are:

Early discharge of amniotic fluid.
Rapid birth.
Complications of childbirth.

In rare cases, an attack of suffocation may occur during labor, and the patient develops heart and pulmonary failure. Doctors decide on an emergency caesarean section.

It is strictly forbidden to use drugs from the prostaglandin group after the onset of labor, as they provoke the development of bronchospasm. To stimulate contraction of the uterine muscles, oxytocin can be used. For severe attacks, epidural anesthesia can be used.

Postpartum period and asthma

Very often, asthma after childbirth can be accompanied by frequent bronchitis and bronchospasm. This is a natural process that is the body’s reaction to the load it has endured. To avoid this, women are prescribed special medications; it is not recommended to use medications containing aspirin.

The postpartum period for asthma includes the mandatory use of medications, which are selected by a specialist. It is worth noting that most of them tend to pass into breast milk in small quantities, but this is not a direct contraindication for use during breastfeeding.

As a rule, after delivery, the number of attacks decreases, the hormonal levels return to normal, and the woman feels much better. It is imperative to exclude any contact with potential allergens that could provoke an exacerbation. If you follow all medical recommendations and take the necessary medications, there is no risk of developing postpartum complications.

In cases of severe disease after childbirth, the woman is prescribed glucocorticosteroids. Then the question may arise about abolishing breastfeeding, since these medications, penetrating into milk, can harm the baby’s health.

According to statistics, severe exacerbation of asthma is observed in women 6-9 months after childbirth. At this time, the level of hormones in the body returns to normal, the menstrual cycle may resume, and the disease worsens.

Planning pregnancy with asthma

Asthma and pregnancy are compatible concepts, provided the correct approach to the treatment of this disease. In case of previously diagnosed pathology, it is necessary to regularly monitor the patient even before pregnancy and prevent exacerbations. This process includes regular examinations with a pulmonologist, taking medications, and breathing exercises.

If the disease manifests itself after pregnancy, then asthma control is carried out with redoubled attention. When planning to conceive, a woman needs to minimize the influence of negative factors (tobacco smoke, animal hair, etc.). This will help reduce the number of asthma attacks.

A prerequisite is vaccination against many diseases (flu, measles, rubella, etc.), which is carried out several months before the planned pregnancy. This will help strengthen the immune system and develop the necessary antibodies to pathogens.

(hereinafter referred to as BA or asthma) is a chronic inflammatory disease of the respiratory tract. Accompanied by shortness of breath, coughing attacks and suffocation - this is how the respiratory organs react to external irritants. The protective system is triggered, they narrow, mucus is produced abundantly, which disrupts the flow of air into the lungs. The disease is characterized by periodic exacerbations and remissions. Strong occurs during the acute phase. Provocateurs can be various irritants - strong laughter, crying, physical activity, allergens and even the weather. Internal factors - disorders of the immune and endocrine systems. The disease is often hereditary. Unfortunately, pregnant women also suffer from it, which greatly worries parents who fear about the health of their baby.

How does the disease affect the child?

Stages and duration

There are 3 stages of asthma:

Preasthma. Recognized by the occurrence of chronic asthmatic bronchitis, pneumonia and bronchospasm.
Choking attacks. Their duration is from 2-3 minutes to several hours (the chest is tight, dry cough, breathing with noise and whistling, the skin becomes covered with perspiration, the face becomes bluish, the end of the attack is accompanied by a cough with copious sputum production).
Asthmatic status. Characterized by suffocation that lasts for several days. Medicines generally do not bring the expected relief, which also affects the condition of the woman’s fetus.

During pregnancy, any stages and forms can be present.

Asthma is not a contraindication to the birth of a child, but requires increased medical supervision.

If asthma is mild, it may hardly bother the expectant mother. This cannot be said about those whose disease is severe.

Severe asthma in pregnant women causes dramatic changes in the woman’s immune system and has a negative impact on both the mother and the fetus.

If there were no asthma attacks before pregnancy, this does not mean that they will not appear during pregnancy. For some, asthma appears at the beginning of the period, for others in the second half. In this case, the first option can be confused with toxicosis.

In the video, a pulmonologist talks about why asthma can first develop during the development of a child in the womb.

Pre-asthmatic attacks may begin in the first trimester. In this case, ultrasound examinations of the fetus are regularly performed to prevent intrauterine oxygen deprivation. It is difficult to predict how seizures will affect the unborn baby. It happens that a woman’s condition improves if a more serious form does not occur.

The first 12 weeks are very difficult, it is better not to refuse hospitalization to reduce the risks to the fetus. Asthma can lead to hypoxia, which affects the mental development of the child. Correctly selected treatment will not cause discomfort or aggravate the disease. The main thing is to prevent the development of a severe third stage.

The second half of the term is easier to bear. The amount of progesterone in the blood increases, the bronchi become wider. The placenta itself is formed in such a way that it produces steroids to protect the baby from inflammation.

Risks for baby and mother

The effect on the fetus during pregnancy and bronchial asthma is most serious in the third trimester. If complications are observed during the first pregnancy, then they cannot be avoided during subsequent ones.

Asthma during pregnancy can cause:

miscarriage;
bleeding;
birth injuries;
premature birth;
labor disturbances;
postpartum exacerbation of the disease;
complications on the mother’s lungs and heart.

For a child, the most important thing is oxygen, which he receives through his mother, because she breathes for her baby, who is in the womb. Lack of oxygen leads to developmental problems, low weight and premature birth. It is possible that a child inherits asthma from his mother. In this case, the newborn often develops upper respiratory tract diseases.

The possibility of unpleasant consequences increases if a woman takes medications uncontrollably or self-medicates. Any deterioration in health requires immediate consultation with a doctor.

Let's talk about childbirth

How to make it easier

An asthmatic woman should be under the supervision of a doctor already at the stage of pregnancy planning. At the initial stage, it is important to minimize all external stimuli that provoke attacks. You can learn to control them or make them less debilitating and dangerous.

Expectant parents are sometimes so worried that they ask whether it is possible to give birth with asthma, and are afraid to even plan for the birth of a long-awaited child.

Asthma is not a contraindication for pregnancy and childbirth.

BA responds well to therapy. In order for the gestation process to be as successful as possible, it is necessary to take preventive measures:

maintain cleanliness at home;
do not have pets;
stop using chemicals;
remove all things on which dust accumulates;
take balanced vitamin complexes (must be prescribed by a doctor);
replace bedding with synthetic ones (you may be allergic to down and feathers);
spend more time in the fresh air, create and follow a set of physical exercises suitable for pregnant women.

Registration at the dispensary with your therapist is also required. A woman’s task is to improve her health, and then childbirth will take place without difficulty and risks.

Process Features

BA must be controlled for all 9 months. If all medical instructions are followed, the birth is successful, without a cesarean section.

Since the baby may be born prematurely, it is recommended to be hospitalized several weeks before the birth process begins.

Frequent complications in asthmatic women in labor:

early discharge of amniotic fluid;
sudden and rapid birth.

During normal childbirth, if a sudden attack of suffocation occurs, surgical intervention is prescribed. It is noted that asthmatic manifestations rarely occur, provided that the woman in labor took prescribed medications.

A severe form will most likely result in a cesarean section at 38 weeks, but it is prescribed when the attacks subside and the disease enters a favorable stage. At this stage, the baby is considered full-term, healthy and capable of independent life.

During normal childbirth, oxygen inhalation is performed. It is recommended to notify your doctor about the medications you are taking and take a regular inhaler with you. Humidified oxygen may be given during childbirth for asthma. Even at birth, treatment will continue. If a woman has severe status asthmaticus, she may be kept in the intensive care unit or intensive care unit until discharge.

Treatment of a woman

Treatment of asthma during pregnancy requires special treatment, because all medications taken pass through the placenta. They should be used minimally. If asthma is of little concern, and there are no risks for the child and woman, it is recommended to abandon therapy altogether.

Since it is impossible to cure the disease completely, medications that do not cause uterine contractions are prescribed to relieve symptoms. For minor manifestations, it is better to limit yourself to inhalation of a safe saline solution.

If a woman’s condition is monitored by several specialists, their treatment actions must be coordinated.

It is important to get vaccinated against influenza. It is harmless and is valid for one season. The following groups of medications provide effective assistance:

anti-edema medications;
drugs that relax the bronchi: Berotek (from the 2nd and 3rd trimester);
:, in the second and third trimester;
drugs that strengthen the immune system (provided that they were taken before conception);
anti-inflammatory drugs for inhalation, for example in small doses (for example, Budesonide is indicated for severe forms).

Many medications for asthma in pregnant women are prohibited. The following inhalers should not be used:

Theophedrine, Antastman, all powders according to Kogan: they contain a high content of belladonna components, barbiturates, which can be dangerous to the fetus;
Betamethasone and: have a negative effect on the child’s muscular system;
long-acting medications: use of any form is prohibited;
Adrenaline: in the normal state is indispensable for stopping suffocating attacks, but in pregnant women it can cause uterine spasms;
Salbutamol, Terbutaline: not prescribed in the last months, as they can prolong labor;
Theophylline: prohibited in the last trimester, as it tends to penetrate the bloodstream and increase the baby’s heart rate.

The use of certain antibiotics is prohibited (Tetracycline, Tsiprolet, etc.). 2nd generation antihistamines have side effects that adversely affect the condition of the mother and fetus.

It is necessary to take prescribed medications; the absence of medication assistance is unsafe for the unborn child. Many pregnant women refuse to take medications, but this is dangerous because the child will suffocate while in the womb during a severe attack.

Asthma in pregnancy is treated whenever possible with conventional inhaled medications. Their concentration in the blood is low, but the effect is maximum. Doctors recommend choosing inhalers without freon.

The child's waiting state may change the effects of some medications, causing them to no longer have the expected effect. This happens when attacks occur more than twice a week, suffocation occurs at night several times a month, and you have to use medications every day to relax the bronchi. In such a situation, the doctor suggests other treatment regimens.

Preventive treatment also includes suitable gymnastics, which makes coughing easier. Swimming relaxes the bronchi.

It is important for pregnant women to follow several tips:

The disease is often associated with a cold. It must be treated in a timely manner, sometimes requiring antibiotics approved for pregnant women.
If a caesarean section was performed, as after any operation, painkillers are used. If this is a patient with “aspirin” asthma, non-narcotic analgesics are prohibited.
A pregnant woman should make it a rule to keep a diary for taking medications and to monitor her condition, since in most cases the outcome of pregnancy worsens due to uncontrolled treatment.
Reduce the amount of surrounding allergens. Avoid disease-causing food additives and strong odors. If it is impossible to get rid of the animal, then minimize contact with it and do not let it into the rooms where the woman is. Smoking, including passive smoking, is prohibited.
Choose personal hygiene items with a soft composition. The air in the room should not be dry; ionizers and humidifiers will solve the problem.
If shortness of breath appears while expecting a baby, this is not always a symptom of illness. Perhaps these are just temporary changes in the body, but you need to undergo an examination.

During pregnancy, the essence of asthma treatment is its prevention and improvement of lung function. Not only the woman herself, but also those close to her should show attention, help, care and exercise control over her condition.