Sinusitis during pregnancy

Genyantritis in pregnancy is a disease that many future mothers face. Consider the main causes of the disease, the methods of diagnosis, as well as methods of treatment and prevention.

Sinusitis belongs to this category and is an inflammation of the mucous membrane of the maxillary cavities. The maxillary sinuses are large airway cavities within the maxillary bones. They communicate with the nasal sinus through the mouth. As a rule, the inflammation develops simultaneously or after a lesion of the mucosa, it can be bilateral and one-sided.

[1], [2], [3]

Causes of the sinusitis in pregnancy

Most often, inflammation of the sinuses arises from viral and bacterial infections. Malicious microorganisms fall into the maxillary sinuses from the oral cavity in the presence of dental diseases, from the nasal cavity in rhinitis, as well as in the defeat of the tonsils, that is, adenoiditis and tonsillitis. The development of the disease is facilitated by polyps in the nose, congenital anomalies of the facial skull, curvature of the nasal septum.

The causes of genyantritis in pregnancy are associated with weakening of the immune system. This creates the prerequisites for inflammatory processes. Getting on the mucous membrane of the sinuses and nose, infectious microorganisms cause its puffiness and increase in the production of mucus. Since the outflow of the contents of the sinuses is disturbed, all conditions for the multiplication of bacteria and the development of purulent inflammation are created.

[4], [5]

Pathogenesis

The disease can become acute if it occurs simultaneously with other inflammatory lesions of the body. It appears due to the influence of infectious diseases of the upper respiratory tract, pathologies in the nasopharynx and oral cavity. If the symptoms of the disease are left without medical attention, then in a couple of weeks the pathology takes a chronic form, the treatment of which is rather complicated and long-lasting. Purulent clumps and secretions are characteristic of maxillary sinusitis, very often it is called rhinosinusitis.

The mechanism of development of inflammatory nasal sinus infection is associated with the effect of infectious microorganisms and bacteria. Pathogenesis is based on the effects of streptococci, staphylococci, viral agents, fungi, hemophilic rod, chlamydia on the nasal mucosa. Sinusitis can develop because of the severe course of acute respiratory infections or infectious germs in the respiratory passages.

In some cases, the disease develops due to neglected dental diseases. Congenital curvature of the nasal septum or a prolonged course of allergic diseases also provoke inflammation.

[6], [7], [8]

Symptoms of the sinusitis in pregnancy

The organism of the future mother does not possess high protective properties, therefore even the slightest infection can cause a serious inflammatory process. Symptoms of genyantritis in pregnancy depend on the cause of its development. To suspect an ailment is possible with a long course of respiratory infections and lack of necessary treatment.

• Inflammation of the maxillary sinuses causes deterioration of the general condition. There are headaches, fatigue, weakness, due to congestion of the nose, appetite deteriorates, and the sense of smell decreases.
• When filling the nasal cavity with pus or mucus in them, the pressure increases. This manifests as a bursting pain under the eyes in the cheek area, a slight swelling of the lower eyelids and cheeks on the affected side.
• Unpleasant sensations are enhanced by tilting the head forward. If the patency of the mouths in the nostrils is preserved, then a yellow-green thick mucus is noted.
• When tapping under the eyes, that is, in the area of the projection of the maxillary sinuses, painful sensations arise.

In later stages, sinusitis is accompanied by the release of mucus and pus, severe coughing, fever and chills. Perhaps the development of conjunctivitis and pain with sudden movements of the head. These signs indicate a chronic, that is, a neglected form of pathology.

First signs

Any diseases during pregnancy have a complicated course that threatens with serious consequences for the mother and fetus. The first signs of sinusitis are manifested as follows:

• Difficult, heavy breathing.
• Headache.
• Temperature increase.
• Painful sensations in the nose.
• Stuffy nose.
• Nasal sinuses are filled with mucus and thick purulent secretions.

The disease is accompanied by unpleasant sensations of the whole face. Sometimes it seems that the face is a continuous hematoma. Any movement of the head, turns, and slopes cause piercing sharp pains. If you have this symptom, you should immediately seek medical help.

[9]

Whether the genyantritis is dangerous during pregnancy?

At the first symptoms of ARI and other inflammatory diseases that occur during pregnancy, you need to seek medical help. Many expectant mothers have a question, is it dangerous if the genyantritis is in pregnancy - yes, it is dangerous. Since the disease is characterized by nasal congestion, there is a deficit of oxygen entering the body. This leads to disruption of the normal functioning of organs and systems. For a future mother, this is fraught with malfunctioning of the cardiovascular system, lungs. An ailment can lead to fetal hypoxia and disturbances in its development.

With the progression of sinusitis, serious complications arise, the elimination of which is possible only surgically. At the same time, there is a high risk of harming the future child, since operations during pregnancy are dangerous. Lack of necessary treatment can lead to kidney damage, myocarditis, brain abscess and meningitis.

Forms

According to the international classification of diseases of the 10th revision, sinusitis refers directly to several categories.

Class X Diseases of the respiratory system (J00-J99)

J00-J06 Acute respiratory infections of the upper respiratory tract

• Acute antritis is included in the category (J00- J06) Acute respiratory infections of the upper respiratory tract. Code J01.0 Acute maxillary sinusitis (sinusitis).
• Chronic sinusitis refers to the category (J30- J39) Other diseases of the upper respiratory tract. Code J32.0 Chronic maxillary sinusitis.

Very often there is a need to clarify the origin of the pathogen causing the disease. To do this, use the additional encoding B95-B97. According to the B95 classification, streptococci and staphylococci are the cause of diseases located elsewhere. B96 - other bacterial agents. B97 - viruses that triggered the onset of inflammation.

Purulent antritis in pregnancy

The most dangerous and difficult to cure is purulent sinusitis. In pregnancy, this pathology develops due to lack of proper treatment and lubricated symptoms. Very often, with the appearance of this form of inflammation, doctors fear the spread of infection to nearby organs and tissues.

Symptoms of the disease are manifested as abundant discharge from the nose, loss of smell, pain in the temples and nose, pain in the head, shortness of nasal breathing. Pregnant should alert a night cough, bursting pressure on the roots of the teeth. If the purulent process is started, then there is a decrease in working capacity, a sharp increase in temperature.

Purulent sinusitis during pregnancy develops under the following conditions:

• The presence of pathogenic microflora in the respiratory tract.
• Weakening the protective properties of the mucous membranes of the nasal cavity.
• Anatomic features of the structure of nasal septums.

For diagnosis it is necessary to undergo an examination with an otolaryngologist. The doctor collects an anamnesis, performs an x-ray examination of the nasal sinuses. On X-ray, the disease looks like a blackout. Possible application of diagnostic puncture. This method is used when x-ray revealed pathological changes in sinuses. A sinus puncture allows to pump out the accumulated pus and lower the pressure. If a pregnant woman refuses this procedure, it can lead to conjunctivitis or encephalitis.

Treatment should be comprehensive. To eliminate the disease use antibiotics, physiotherapy and fortifying methods. But the use of antibiotics and any other medication during pregnancy is very dangerous, as it can lead to serious complications. Therefore, to eliminate inflammation, safer plant-based products are recommended, which the doctor selects individually for each patient.

[10], [11], [12]

Complications and consequences

Without timely diagnosis and treatment, sinusitis during pregnancy causes many adverse effects. The outcome of the disease is significantly complicated by the fact that the inflamed sinuses are close to such vital organs as the eyes, the brain and the throat.

Common consequences of rhinosinusitis:

• Inflammation of the auricles.
• Inflammation of the optic nerves.
• Pharyngitis, tonsillitis.
• Osteomyelitis.
• Conjunctivitis.
• Neuritis of the trigeminal nerve.
• Inflammation of the lungs, bronchitis, pneumonia.
• Purulent abscess in the nose.
• Meningitis.

The diseases described above are dangerous for the health of the future mother and her unborn child. To eliminate them requires the use of potent drugs that are contraindicated in pregnancy. Another adverse complication is the transition of the disease to a chronic form. Do not forget that the infection can get into the blood and hurt the baby. In addition, inflammation provokes oxygen starvation of the fetus, which also negatively affects its development.

[13], [14], [15]

Consequences of sinusitis in pregnancy for a child

The defeat of the nasal sinuses causes a permanent nasal congestion, which leads to oxygen deficiency. The consequences of genyantritis in pregnancy for a child depend on how the pathological process takes place in the mother and what treatment was used to eliminate it. The lack of normal breathing in a woman provokes such pathologies in the fetus:

• Hypoxia.
• Disturbances of arterial pressure.
• Problems of the cardiovascular system and the central nervous system.
• Puffiness of eyeball.
• Periostitis.
• Encephalitis.
• Rheumatoid arthritis.
• Rinogenous abscess.

In time, the treatment started and compliance with medical recommendations can avoid the above pathologies.

[16], [17], [18], [19]

Complications

Sinusitis is a serious threat to health. Complications develop due to poor treatment or lack of it. Inflammation provokes swelling of the mucosa of the inner membrane of the nose and maxillary sinuses. The nasal breathing is difficult for the pregnant woman, which causes a huge amount of pathogenic microorganisms to accumulate in the nose. Gradual increase of harmful bacteria aggravates pathology.

All complications are conditionally divided into two groups:

• Acute sinusitis takes a chronic form and is accompanied by painful symptoms. Pathology of the cardiovascular and respiratory systems, shortness of breath, hypoxia, headaches.
• Inflammatory process defeat the pharynx and tonsils, provoking the development of adenoids and tonsillitis. There is hypertrophy of the nasal mucosa and the formation of polyps - tumorous neoplasms.

Consider the complications of the disease, which are manifested by other organs and systems:

• The visual system is a fibrous edema, thrombosis of veins, purulent-inflammatory processes in the soft tissues of the orbit. In addition, there is swelling and redness of the eyelids, visual impairment and limitation of eye mobility, pain when pressing on the orbit.
• Osteoperiostitis is an inflammatory lesion of the bones that occurs due to the transition of the pathological process from mucous membranes to bone tissue. Pathology, can be simple and purulent, but in both cases it is a complication of sinusitis.
• Meningitis - most often occurs due to self-treatment of the disease and the transition of inflammation into a chronic form. There are many kinds of meningitis, but all of them are accompanied by severe headaches, fear of light and sharp sounds, feverish condition.
• Sepsis is the most dangerous complication. Infection of blood arises from the penetration into it of bacteria of decay and their toxins. For treatment it is necessary to eliminate the primary focus of inflammation. But without therapy the sepsis leads to a lethal outcome.

[20], [21], [22], [23]

Diagnostics of the sinusitis in pregnancy

During pregnancy, the expectant mother should pay special attention to her health. At the first signs of inflammatory or any other pathological process, you need to see a doctor. Diagnosis of genyantritis in pregnancy is carried out at the first signs of ailment.

Let's consider the basic diagnostic procedures which are appointed or nominated by the otolaryngologist:

• Gathering anamnesis - the doctor questions about complaints of nasal congestion, the presence of severe pain in the maxillary sinuses, coughing, headaches and other signs of the disease.
• Visual inspection - with its help it is possible to detect reddening and puffiness of the infraorbital area due to reflex dilatation of the vessels.
• Rhinoscopy - on the surface of the nasal mucosa there is inflammation and swelling. There is a discharge of purulent mucus.
• X-rays of the paranasal sinuses - there is a slight darkening in the picture, indicating rhinosinusitis.
• Puncture - puncture of the septum of the maxillary sinuses. With this procedure, it is possible to remove a part of the pus for the study of bacteria and at the time to facilitate breathing.

[24], [25], [26]

Analyzes

If you suspect a sinusitis in the patient take a series of tests that allow you to identify the pathological process. A pregnant woman needs to give a general blood test and urine. The acute inflammatory process is indicated by the high value of ESR and the increased amount of granulocytes.

In addition to donating blood for clarification of the disease, additional studies are being carried out: a nasal swab to test for sensitivity to antibiotic drugs, an x-ray of the sinuses and a CT of the facial part of the skull. The seeding on the nasal and sinus cultures is mandatory. When suspected of the allergic nature of rhinosinusitis, the patient is taking allergic tests to determine the allergen.

[27], [28], [29]

Instrumental diagnostics

Diagnosis of inflammatory lesions of the nasal cavity mucosa is a complex process that involves the use of various methods. Instrumental diagnosis allows you to clarify the presence of pathology.

• Rhinoscopy - examination of the nasal sinuses with the help of mirrors. If the disease proceeds in an acute form, then there is edema of the mucous membrane of the middle nasal passage and diffuse hyperemia of the middle shell from the side of the lesion. The bacterial form is defined as a congestive accumulation of pus, hyperplasia, polyps on the mucosa.
• Radiography - pathology looks like a blackout in the picture. The image is taken in different projections to obtain a more precise result. X-ray features of various forms of sinusitis make it possible to determine the morphology of the disease.
• Diaphanoscopy is the transmission of the affected maxillary sinuses with the help of electric light, Voyachek's diaphanoscope or Goering's lamp. This method determines inflammation only with one-sided lesion.
• CT is a kind of X-ray, gives more accurate information about the presence of the disease.
• Echosinusoscopy is an ultrasound of the nasal sinuses, which has no contraindications. The study is allowed to conduct during pregnancy.

Differential diagnosis

In its symptoms, sinusitis is similar to other diseases, therefore differential diagnostics should be used to detect it. Let us consider in more detail, with what diseases it is necessary to differentiate rhinosinusitis:

• Wegener's granulomatosis is an autoimmune pathology in which granulomas form in the walls of blood vessels. According to medical statistics, in 90% of patients this disease causes damage to the maxillary sinuses and ENT organs.
• Syndrome of immobile cilia is an autosomal recessive disorder that is associated with recurrence of ENT diseases and cardiovascular lesions.
• Ataxia-telangiectasia is a genetic disease that develops against the background of primary immunodeficiency. The disease provokes recurrent sinusitis and sinusitis, pulmonary infections.
• Polyposis of the nose - rhinosinusitis recurs in patients with a tendency to hyperalergic reactions in the nasal cavity. Pathology is associated with bronchial asthma.

Inflammation can develop due to diseases that are remotely related to the nasopharynx. Such pathologies include gastroesophageal reflux disease, various dental diseases, adenoiditis. Since there are many differential diagnoses, only the otolaryngologist should diagnose the disease.

[30], [31], [32],

Treatment of the sinusitis in pregnancy

Elimination of inflammatory diseases in the period of gestation is a complex and lengthy process, as the use of most drugs is contraindicated for future mothers. Treatment of sinusitis during pregnancy can be carried out by such methods:

• Puncture of the nasal sinuses is the most optimal method of treatment of rhinosinusitis. It consists in puncturing the periaplane passage with a special needle and sucking out the purulent contents with a syringe. After that, a medicinal solution with disinfectant properties is poured into the emptied cavity. The procedure removes some of the painful symptoms and facilitates nasal breathing.
• Antibiotic therapy is an effective method of treatment, performed according to the doctor's prescription. When rhinosinusitis during gestation, it is possible to use such agents: Augmentin, Spiramycin, Cephalosproin, Azithromycin. Antibiotics are not used in the early stages of pregnancy.
• Nasal flushing (cuckoo method) - this procedure does not require special punctures. Washing is carried out by means of moving liquids. The pregnant patient should assume a horizontal position, so that the head is below the entire body. After that the doctor gradually pours in one nostril a solution of antiseptic, and with another sucks a purulent liquid. During the procedure, the patient should say "ku-ku", since this sound creates a negative pressure in the nasal cavity. During the procedure, do not inhale, as all the fluid with pus can get into the respiratory tract.

Prevention

Any disease is much easier to prevent than treat. This is especially true during pregnancy, when the female body is greatly weakened. Prevention of ENT diseases and sinusitis in particular, involves strengthening the immune system. It is necessary to avoid hypothermia and perform respiratory gymnastics to enrich the body with oxygen. Do not forget about the right food, which helps prevent many diseases.

There is a complex of preventive measures of sinusitis, the main purpose of which is to ensure the normal removal of mucus from the maxillary sinuses and stimulation of local immunity.

• Regular washing of the nose cleans mucous membranes from potential harmful microorganisms. During the procedure, you can use a solution of sea salt or infusion of chamomile.
• Respiratory gymnastics improves air exchange in the nasal sinuses. Close one nostril, through the other, take a deep breath and exhale through the mouth. It is recommended to perform 8-10 approaches for each nostril up to 5 times a day.
• Massage of nasal sinuses improves their blood circulation and mucus discharge, increases local immunity. If the immune system is greatly weakened, it is recommended to use immunomodulators, which increase the body's resistance to viruses, bacteria and infections.

[33], [34],

Forecast

Genyantritis in pregnancy is a serious disease, without proper treatment it can lead to serious complications. The prognosis of the disease depends on the results of its diagnosis, the form of inflammation and the peculiarities of the patient's body. If the treatment is subject to an acute form of rhinosinusitis, then the prognosis is favorable. Purulent inflammation does not have such a good prognosis, as it can lead to brain damage and death.

[35], [36]