How dangerous is pneumonia in early pregnancy, methods for its detection and treatment. Symptoms and treatment of pneumonia during pregnancy

is an infectious pulmonary pathology, mainly bacterial origin. This is a very common disease, causing mortality in 9% of cases. Pneumonia during pregnancy poses a serious threat to the life and health of both the fetus and the mother. The situation is complicated by the limited choice of therapeutic agents.

The danger of pneumonia during pregnancy

Pneumonia in the early stages is not an indication for abortion. At timely application Seeing a specialist increases your chances of recovery significantly. However, there are frequent cases in which pneumonia is confused with a common cold, and in the meantime the disease progresses, causing infection of the placenta and negatively affecting the development of the baby and the health of the mother. Pregnant women are often diagnosed with microplasma pneumonia caused by activities pathogens. Possible risks for the health of mother and fetus:

• Placental insufficiency may develop.
• There is a risk of premature birth or miscarriage.
• Chronic fetal hypoxia.
• Gangrene of the lung in the mother.
• Myocarditis.
• Obstructive syndrome.
• Pneumonia can lead to.
• Blood clotting disorders.
• Malformations of the fetus cannot be excluded.
• A woman may develop blood poisoning.

All of these are very dangerous, despite the fact that they are not so common. Therefore, it is necessary to promptly inform your doctor about pathological changes in your health. It is very important to prevent the development of pneumonia in the early stages.

Pneumonia in pregnant women can occur in different ways. The following are classic symptoms of pneumonia that require close attention:

• Constant cough.
• Fever and chills.
• Fever.
• Difficulty breathing, shortness of breath.
• Weakness.
• Pain in chest.
• Pain in muscles and joints.

Blurry symptoms are the main problem of diagnosis during pregnancy, therefore, in order to exclude pneumonia and prevent the development of deviations in the child and health problems in the mother, you should be attentive to the signals of your body and seek help medical assistance even with signs of a common cold, accompanied by cough, runny nose, etc.

Methods for diagnosing the disease

To detect pneumonia in pregnant women, standard diagnostic techniques are used:

• Anamnesis collection.
• Analysis of urine.
• Blood analysis.
• Oximetry.
• Listening to the chest with a stethoscope.
• Coagulogram.
• X-ray examination thoracic.
• Fiberoptic bronchoscopy is performed to exclude tuberculosis.
• CT scan.
• Ultrasound examination of the fetus.

Differential diagnosis is important. The presence of the following pathologies should be excluded:

• Oncological process.
• Pulmonary embolism.
• Lupus pneumonitis.
• Tuberculosis.

Methods of therapy during pregnancy

Only a doctor should prescribe treatment for pneumonia for pregnant women.

Pneumonia during pregnancy in the first trimester can provoke spontaneous miscarriage or fetal death due to oxygen starvation and exposure to toxic substances. In addition, in the first three months, the development of vital organs in the child occurs, which makes it unacceptable antibacterial therapy and detoxification treatment of pneumonia.

Therefore, the doctor must carefully examine the pregnant woman and select the most gentle therapeutic course so as not to cause additional harm to both the woman herself and her unborn child. At severe degrees pneumonia, abortion is recommended.

The second and third trimester are not so dangerous, since antibiotics are allowed. But pneumonia can cause premature onset labor activity. The greatest danger from pneumonia is directly during childbirth, since there is a high probability that placental or respiratory failure will occur.

Approved medications

If a pregnant woman has pneumonia, it is very important that the woman is under medical supervision around the clock. Treatment of pneumonia is impossible without the use of antibiotics. Drugs are selected according to the duration of pregnancy, the woman’s health condition, and the type of pneumonia pathogen. Most often, expectant mothers are prescribed antibacterial agents from a series of penicillins. In the presence of complications, it is advisable to use drugs from a number of macrolides or cephalosporins. These are like this medicines, like or . In addition to antibiotics, other medications are prescribed during pregnancy.

• To facilitate the discharge of sputum and its rapid removal, the use of drugs such as ACC, Ambrobene, etc. is indicated.
• Vitamin complexes to maintain the body's resources.
• dilates the bronchi, relieves shortness of breath.
• To prevent allergies, antibiotics are prescribed antihistamines latest generation, for example, Zyrtek, Erius, etc.
• Immunostimulating drugs.
• Human immunoglobulin prevents intrauterine infection.
• Suppositories with interferon for rectal administration.
• Drugs such as Actovegin or Riboxin prevent the development of placental insufficiency.
• At normal temperature Inhalation using a nebulizer is recommended.
• And physiotherapy for pregnant women - these are effective healing techniques, with the help of which you can restore health if you combine them with drug therapy.

Traditional medicine recipes

The treatment of pneumonia in pregnant women must be approached comprehensively and the safest and most gentle methods must be chosen in order to minimize harm to the health of the unborn child and the woman herself. Application folk remedies advisable only on recommendation experienced specialist. Unconventional treatment pneumonia does not replace full-fledged drug therapy, and it is usually carried out only as an auxiliary therapeutic method. The most famous and effective folk recipes:

• Grind the horseradish root, pour the mixture with alcohol, and leave for three or four hours. Use the resulting composition for inhalation.
• Drink hot milk with butter dissolved in it.
• Boil the crushed elecampane in a water bath for 2–3 hours. Drink three tablespoons several times a day.
• Prepare a decoction of eryngium, eryngium and birch buds, mix it with natural liquid honey, consume a teaspoon twice a day.
• Eat more garlic.
• Make compresses from mashed potatoes on the chest area.
• Grind the raisins in a blender or using a meat grinder, then prepare a decoction from it, which should be taken three times a day before meals.

Prevention

Pneumonia during pregnancy is a serious threat to health, so attention should be paid to preventive measures:

• Maintain good hygiene by washing your hands frequently.
• Avoid places with large crowds of people, especially in the cold season.
• Treat colds in a timely manner.
• Eat a balanced diet so that the body is provided with a sufficient amount of vitamins and microelements.
• Strengthen your immune system by taking daily walks.
• Dress for the weather.
• Do not neglect regular examinations with a gynecologist; inform your doctor about the slightest ailment.
• Avoid contact with sick people.
• Don't get too cold.
• Do not smoke or drink alcohol under any circumstances.
• Fulfill special gymnastics for pregnant.
• Carry out daily wet cleaning and ventilate the room.

During pregnancy, it is very dangerous to self-medicate and take medications for pneumonia without examination by a doctor, since there is a risk to the health of not only the woman, but also her unborn child. If incorrectly selected therapeutic tactics the risk of complications increases several times; pneumonia may drag on, which is fraught with additional health problems.

Pneumonia is a life-threatening illness. Pneumonia during pregnancy is doubly dangerous. It can significantly harm the health of the mother and unborn child, even leading to death. Therefore, when the first symptoms occur pathological condition you need to contact a specialist.

Pathogenesis

Pneumonia develops when an infection enters the body. Viral agents, fungi, bacteria (Klebsiella, pneumococci and others) can be provocateurs of the disease. Pathogen infection occurs by airborne droplets. The disease is seasonal and develops in cold weather when the immune system cannot resist infection. In addition, during pregnancy the body's defenses are weakened.

Pneumonia rarely develops as independent disease. It is usually a complication of another respiratory illness. For example, FLU, rhinitis, bronchitis.

Factors that provoke pneumonia:

The above does not cause the disease, but increases the risk of its development. Therefore, it is necessary to carefully monitor your health. If symptoms of pneumonia occur in pregnant women, you should immediately contact the clinic.

Clinical picture

The clinical picture of the pathological condition manifests itself differently, depending on the degree of damage and the pathogenic agent. However, stand out general manifestations in adults:

The symptoms of pneumonia are similar to those of a common cold. Therefore, pregnant patients rarely pay attention to them and consult a doctor only when the pathology has become severe.

Diagnostic measures

If pneumonia is suspected, the doctor refers the patient for diagnostics:

Impact x-rays is undesirable during pregnancy. If this research method is still necessary for pneumonia, you need to inform your doctor about your pregnancy. He will give you a special apron to cover your belly and protect your unborn baby from negative influence x-ray.

Consequences

Pneumonia while expecting a baby poses a threat to mother and child. However, due to the pathological condition, there is no need to have an abortion because the disease is treatable.

For mother

If treatment for pneumonia is started in a timely manner, adverse consequences rarely occur. When treatment is prescribed for later development of the pathological condition, intrapulmonary and extrapulmonary complications are possible. The first include:

• abscess, gangrene;
• swelling;
• exudative pleurisy;
• empyema of the pleural membrane;
• respiratory failure;
• broncho-obstructive syndrome.

Extrapulmonary complications of pneumonia:

• sepsis;
• inflammation soft shells spinal cord and brain;
• infectious-toxic shock;
• DIC syndrome;
• inflammation of the endocardium, myocardium.

In particular severe cases pneumonia is fatal.

For a child

Pneumonia is especially dangerous for the embryo in the first trimester (up to 12 weeks), when it is just beginning its formation and development. Often, pneumonia in the mother leads to miscarriage or miscarriage.

If a woman develops pneumonia at a later stage, when all the organs of the unborn child are already formed, this can provoke premature birth or the birth of an underweight baby. If you have pneumonia, you will have to give up lactation, because pathogenic microorganisms can enter the newborn’s body with breast milk. In addition, for pneumonia they are prescribed medications that adversely affect the child’s health. Without mother's milk, the baby does not receive the necessary useful elements, gets sick more often.

Therapy methods

Serious consequences can be avoided if treatment is started at initial stages pneumonia. Therefore, if a pregnant woman experiences cold symptoms, she should contact medical institution for diagnostics. If the diagnosis is confirmed, treatment for pneumonia is carried out in a hospital or out-of-hospital setting.

Is it possible to take antibiotics for pneumonia in pregnant women?

Treatment for pneumonia during pregnancy includes taking antibiotics. Only a doctor can select medications that have less impact on the fetus. Features of antibiotic therapy for pneumonia:

Pregnant women should not self-medicate. Taking medications must be agreed with your doctor.

Taking medications for pneumonia

In addition to antibacterial drugs are appointed:

The exact dosage and duration of treatment are also determined by a specialist. It is prohibited to prescribe medications yourself for pneumonia.

ethnoscience

In addition to conservative methods, pneumonia can be treated with drugs alternative medicine. Their great amount, the most effective:

1. Dissolve 1 tbsp in 300 ml. l. butter. Take orally for better sputum removal.
2. Grind half a glass of raisins in a food processor or meat grinder. Pour a glass of water and put on low heat for ten minutes. Drink 3 times a day after meals.
3. Mix 1 cup of crushed aloe leaves, 40 grams of birch buds, 60 grams of eryngium greens. IN medicinal collection add 1 kg natural honey. Keep in a water bath for a quarter of an hour. Drink three times a day before meals.

Traditional recipes cannot replace basic treatment and relieve pneumonia. They can only relieve the symptoms of pneumonia. Any unconventional method therapy is agreed with the doctor.

Forecast

With pneumonia in pregnant women, labor goes through naturally. You can breastfeed only after the condition has normalized.

If the disease is detected on early stages, the prognosis in most cases is favorable for both mother and child. If pneumonia gets too severe and you do not follow all the doctor’s recommendations and instructions during treatment, you may die.

Prevention of pneumonia

Preventive measures to prevent the development of pneumonia:

Pneumonia is easier to prevent than to be treated for it for a long time. Especially while expecting a baby.

During pregnancy, a woman is responsible not only for her health, but also for the safety of the unborn baby. Of course, all kinds of diseases that it carries expectant mother during this exciting period, the vital activity of the fetus may also be threatened, one of the most dangerous diseases is pneumonia during pregnancy.

In order to protect yourself and your unborn baby, you need to be vigilant throughout your pregnancy, even if you have the slightest sign of discomfort, contact your doctor. You must understand that pneumonia and pregnancy are real things, so now we will talk about what kind of disease this is, how it can affect the course of pregnancy, we will find out its symptoms and methods of control.

By its nature, pneumonia or pneumonia is an acute infectious disease that affects the lung tissue and affects mainly the respiratory system, but also affects harmful influence for the whole body.

Often this disease is of a bacterial nature, and its main pathogens are considered to be pneumococcus and staphylococcus bacteria. In addition to the microorganisms mentioned, pneumonia during pregnancy, and indeed in all other people, can be caused by streptococci, Legionella, Haemophilus influenzae or coli etc.

In addition to bacterial origin, pneumonia can have viral nature, that is, this disease can develop even from a common cold. It is for this reason that it is so important to be vigilant and, as mentioned earlier, to respond promptly to any manifestations of illness.

You should also understand that the most likely scenario for developing pneumonia is a decrease in protective functions body. This suggests that your immunity needs to be strengthened and during pregnancy, try not to overwork too much, avoid unnecessary physical activity, follow a daily routine, always get enough sleep, eat right, don’t get nervous, and don’t get too cold or overheated.

Especially dangerous time are the so-called periods of vitamin deficiency, occurring in autumn and spring. At this time, the chance of getting sick increases, so it is better to avoid large crowds of people, and it also makes sense to consult with your doctor about taking vitamin complexes, which will increase immunity and have a positive effect on the course of pregnancy.

Pneumonia and its effect on the fetus

Due to the fact that pneumonia in pregnant women, as in any other case, affects the lungs and responds with an inflammatory process in the tissues of the organ varying degrees severity, this affects the respiratory process.

Of course, with difficulty breathing, which is certainly accompanied by pneumonia, the human body, namely organs and tissues, receive less oxygen, which even under normal conditions poses a certain danger.

If we talk about pneumonia in pregnant women in particular, and about the woman’s body in general during this period, it’s easy to guess that the fetus also needs to receive a sufficient amount of oxygen for normal development. If the expectant mother has pneumonia, a lack of oxygen supply to the fetus can cause the development of various pathologies and complications, including miscarriage. As you can see, the consequences are very serious and you cannot take this disease lightly.

It is worth noting here that pneumonia poses the greatest danger in the early stages of pregnancy, that is, in the first trimester. In the early stages, fetal development is a decisive factor, and pneumonia can contribute to complications in both mother and baby. In this case, the manifestations of pathologies in both are divided into two groups:

1. Extrapulmonary - we're talking about about the development of meningitis, sepsis, disseminated intravascular coagulation syndrome (DIC), endocarditis, myocarditis, as well as infectious or toxic shock.
2. Intrapulmonary - in in this case complications are of a different nature and abscesses, gangrene, edema or pleurisy may develop in the lungs.

Often the problems described above still concern the mother, but if we talk about the second point, then similar complications can affect the baby. In addition, in the first trimester, pneumonia has an adverse effect on the development of fetal tissue, and in especially severe cases it can cause pregnancy loss or miscarriage.

As for the second trimester, there is still a danger, but pneumonia has less of an effect, especially if the formation of fetal organs is completed. At this time, in addition to proper treatment, it is necessary to be under the supervision of a doctor, who will monitor the child’s development and ensure that the disease does not threaten him.

If pneumonia makes itself felt in the third trimester, the risks are minimal and the main focus is on treating the mother. The fact is that the disease can lead to premature birth, and even on the eve of the appointed time, such an illness can adversely affect the process of childbirth. Depending on the severity of the pneumonia and its progression, the doctor may prescribe a cesarean section.

Symptoms of the disease

It is extremely important to begin treatment for pneumonia during pregnancy as quickly as possible, because the sooner you detect the disease, the less time it will have to progress and the faster it will be possible to cope with it. In addition, shortening the duration of the disease is very important not only for the health of the mother, this way you minimize the risk of exposure to the fetus and protect your baby.

However, in order to start treatment in a timely manner, you need to know what to look for, that is, have an idea of ​​what symptoms are typical for pneumonia:

1. The first symptom is the appearance of a cough. Often on early stages The cough is dry, but it doesn't go away long time. Then the attacks become more frequent, more violent, the cough turns into a wet one and phlegm begins to come out. At the same time, coughing in itself is dangerous for the baby, since the uterus of a pregnant woman becomes toned, which also leads to undesirable consequences.
2. The appearance of shortness of breath, difficulty breathing and fatigue. These symptoms often go unnoticed, especially in the later stages, when the belly is larger and mommy gets tired even from a short walk, so be careful.
3. As pneumonia progresses, chest pain may appear, especially when trying to take a deep breath.
4. Often, pneumonia is accompanied by an increase in temperature, up to 38-39 degrees of mercury, but there are cases with low temperature, almost imperceptible.
5. General malaise, intoxication, loss of appetite, systematic fatigue, etc.

During pregnancy, some symptoms may go completely unnoticed. Example with fatigue and shortness of breath in the later stages we brought. The same applies to difficulty breathing; pregnant women often complain about this when the stomach grows strongly and props up the diaphragm.

However, upon detection primary symptoms in the form of cough and shortness of breath, you should already be concerned and consult a doctor as soon as possible, since this is the first sign. Don't blame everything on common cold and self-medicate; during pregnancy, any little thing should be supervised by a specialist.

Diagnostic measures

Of course, it is necessary to know the symptoms of the disease; they will serve as the first signal to go to the doctor. But not less important nuance are diagnostic measures, so let's give them some attention.

When checking a patient for pneumonia, the doctor should first listen and “tapping” (percussion) the lungs for wheezing and noise, which often appear at the earliest different stages pneumonia as a result of inflammation of the lung tissue.

Another absolutely safe diagnostic method for a pregnant woman and fetus is general and biochemical blood tests, which not only help to identify certain types of pneumonia, but also contribute to more accurate treatment.

As for fluorography of the thoracic region, this procedure is best performed after the 20th week of gestation, since by this time the baby has already formed all the vital signs. important organs. But if to make a diagnosis it is necessary to study the pulmonary pattern and look at the picture, fluorography can be done in the early stages.

Treatment methods

As for control methods, pneumonia during pregnancy is not treated as usual, since there are a number of drugs that are contraindicated for the unborn baby and his mother.

In addition, for obvious reasons, pregnant patients are often treated in a hospital, because it is much easier to monitor the condition of the fetus and mother. As for control methods, it is necessary to treat pneumonia with antibiotics, but only those that do not harm the development of the fetus and do not have side effects.

In addition, treatment of pneumonia in pregnant women involves combating symptoms. It is always very important to reduce or get rid of cough. In addition, anti-inflammatory and expectorant drugs, as well as vitamin complexes, are prescribed to maintain immunity.

Otherwise, you must strictly adhere to all doctor’s instructions, pay attention to any changes in symptoms and general health. Be vigilant, maintain your immunity and regularly visit your doctor to monitor the progress of your pregnancy.

Not really

Pneumonia is an acute infectious disease, mainly bacterial etiology accompanied by symptoms of infection lower sections respiratory tract (fever, cough, sputum production, possibly purulent, chest pain, shortness of breath) and radiological signs“fresh” focally infiltrative changes in the lungs in the absence of an obvious diagnostic alternative.

Classification
The therapist supervising pregnant women uses clinical classification pneumonia, taken International classification diseases X revision:

out-of-hospital (home) acquired outpatient;
in-hospital (nosocomial) hospital;
on the background immunodeficiency states;
atypical pneumonia.

In obstetric practice, we often have to deal with the first group of pneumonia.

VP - acute illness, which arose in a community setting (outside a hospital or diagnosed within the first 48 hours of hospitalization or developed in a patient who was not in a long-term medical observation unit for more than 14 days; accompanied by symptoms of a lower respiratory tract infection and radiological signs of “fresh” focal changes in the lungs.

In 92% of cases community-acquired pneumonia(VP) develop in II and III trimesters gestation and are complicated premature birth in 44% of cases. 68% of pregnant women with CAP have severe concomitant somatic diseases and/or complicated pregnancy.

Pneumonia can be lobar, when a whole lobe or several lobes of the lung is affected, or focal, if inflammatory process covers only lobules, segments and acini. IN last years classical cyclic flow lobar pneumonia is rare, due to early use antibiotics.

ICD-10 code. 0.99 Other maternal diseases, classified elsewhere, but complicating pregnancy, childbirth and postpartum period. 0.99.5. Respiratory diseases complicating pregnancy, childbirth and the postpartum period. J.18. Pneumonia without specifying the causative agent. J.18.0. Bronchopneumonia, unspecified. J.18.1. Lobar pneumonia, unspecified. J.18.8. Other pneumonia, causative agent not specified. J.18.9. Pneumonia, unspecified.

Diagnostics
The diagnosis is established on the basis of: complaints of the pregnant woman; clinical and laboratory methods studies: clinical blood test and sputum culture, chest x-ray in 2 projections (in severe cases and ineffective therapy).

In approximately 20% of pregnant women, objective signs of CAP may differ from typical ones or be completely absent.

To confirm clinical diagnosis CAP and treatment of a pregnant woman on an outpatient basis is sufficient to conduct a clinical and biochemical blood test. Data clinical analysis blood do not allow us to speak about the potential causative agent of CAP. However, leukocytosis more than 12x10 9 /l indicates high probability bacterial infection; leukopenia below 3x10 9 /l or leukocytosis above 25x10 9 /l are prognostically unfavorable signs. Biochemical tests blood tests (functional tests of the liver, kidneys, glycemic levels, etc.) do not provide any specific information, but detected abnormalities may indicate damage to a number of organs and systems.

Sputum examination in outpatient settings is not mandatory, because it does not have a significant impact on the choice of initial therapy.

In the hospital, a bacterioscopy of a Gram-stained smear and culture isolated during sputum culture is required. Detection in smear large quantity gram-positive or gram-negative microorganisms with typical morphology can serve as a guide for empirical therapy. Sputum culture is performed when the obtained samples meet the cytological criteria: more than 25 polymorphonuclear leukocytes and less than 10 epithelial cells in the field of view at low magnification. Quantitative assessment of microflora is considered necessary, since concentrations of more than 1 million microbial bodies in 1 ml of sputum are diagnostically significant. results bacteriological research can be obtained in 3-4 days, so the choice of first-line antibiotic is made empirically. Determining the sensitivity to antibiotics of microflora isolated from sputum, as well as blood, pleural fluid will help to adjust therapy, especially when the prescribed treatment has been ineffective.

Serological diagnosis of atypical CAP pathogens is not considered among the mandatory studies.

In recent years, to determine the severity of the condition, C-reactive protein, however, it should be taken into account that pregnant women have a positive early dates pregnancy.

Bronchoscopy is indicated for pneumonia in immunosuppressed patients, suspected pulmonary tuberculosis in the absence of productive cough, lung cancer, aspiration, foreign body bronchus, etc.

Biochemical blood tests are required in case of severe CAP, renal and/or liver failure, diabetes, as well as for timely detection of possible side effects of antibacterial therapy.

Ultrasound examination of the heart and organs abdominal cavity carried out at differential diagnosis sepsis and endocarditis.

Severe CAP is an indication for blood culture for aerobes and anaerobes (blood is taken from different veins with an interval of 30 minutes).

Epidemiology
Pneumonia is one of the most common acute infectious diseases and are one of the leading causes of death from infectious diseases. According to official statistics(Central Research Institute for Organization and Informatization of Health Care M3 of the Russian Federation), in 1999 in Russia, 440,049 cases of the disease were registered among persons aged >18 years (3.9%o), and in 2003 in all age groups the incidence rate was 4.1%. According to the Ministry of Health and Social Development of the Russian Federation, in 2003, 44,438 people died from pneumonia in our country, which is 31.0 cases per 100 thousand population. Mortality from pneumonia is the lowest (1-3%) in young and middle-aged people without concomitant diseases. The highest mortality from CAP is recorded in men of working age. Women get pneumonia slightly less often than men

However, pneumonia is the most common non-obstetric infectious cause maternal mortality. The exact frequency of pneumonia complicating pregnancy is unknown, but approximate figures vary from 1 case in 1287 births to 1 case in 367 births. Despite taking antibiotics wide range action, mortality from pneumonia in pregnant women reaches 4%, and perinatal mortality ranges from 3 to 12%.

Etiology
Typical pathogens CAP in pregnant women are Streptococcus pneumoniae (30-50% of cases), the share of atypical microorganisms ( Mycoplasma pneumoniae, Chlamidia pneumoniae, Legionella pneumophila.) account for 8 to 30% of cases of the disease: Rare (3-5%) pathogens of CAP include Staphylococcus aureus and Klebsiella, and even less often - other enterobacteria. Often, mixed or co-infection is detected in patients with CAP. Thus, in 50% of pregnant women with pneumococcal etiology of CAP, serological signs of active mycoplasma or chlamydial infection are detected.

Among other causative agents of CAP, respiratory viruses (influenza viruses type A and B, parainfluenza, adenovirus and respiratory syncytial virus) are often mentioned, but they cause direct damage and are a kind of “conductor” of bacterial infection. Caused by viruses such pathological changes V lung tissue can't be called pneumonia

CAP may be associated with new, previously unknown pathogens causing disease outbreaks identified in recent years: SARS-associated coronavirus, avian influenza virus, metapneumovirus.

Due to the limited sensitivity of bacteriological research methods, the etiology of CAP cannot be established in 25-60% of cases.

For some microorganisms (Streptococcus viridans, Staphylococcus epidermidis, other coagulase-negative staphylococci, Enterococcus spp., Neissera spp., Candida spp) the development of bronchopulmonary inflammation is uncharacteristic. Their isolation from sputum most likely indicates contamination of the material by the flora of the upper respiratory tract, and not the etiological significance of these microbes.

Pathogenesis
Anti-infective protection of the lower respiratory tract during pregnancy, as well as outside, is carried out by mechanical factors, as well as mechanisms of nonspecific and specific (cellular and humoral) immunity.

There are 4 pathogenetic mechanisms, with varying frequencies, responsible for the development of pneumonia:

aspiration of oropharyngeal secretions;
inhalation of aerosol containing microorganisms;
hematogenous spread from an extrapulmonary source of infection (tricuspid valve endocarditis, septic thrombophlebitis of the pelvic veins, etc.);
direct spread of infection from adjacent affected tissues (for example, liver abscess) or as a result of infection from penetrating lung injuries. Aspiration of the contents of the oropharynx is the main route of infection of the respiratory sections of the lungs, and therefore the main pathogenetic mechanisms development of pneumonia, both community-acquired and hospital-acquired. Microaspiration of oropharyngeal secretions is a physiological phenomenon observed in 70% healthy people during sleep. However, in normal conditions cough reflex, well-coordinated mechanism of mucociliary clearance, antibacterial activity of alveolar macrophages and secretory immunoglobulins ensure the elimination of infected secretions from the lower respiratory tract. In cases of damage to the “self-cleaning” mechanisms of the tracheobronchial tree, for example, with a viral respiratory infection when the function of the cilia of the bronchial epithelium is disrupted and the phagocytic activity of alveolar macrophages is reduced, favorable conditions for the development of pneumonia. Penetration of even single highly virulent microorganisms that are resistant to the action of protective forces macroorganism, also leads to the development of P.

Inhalation of microorganism aerosol - less frequent path development of P. It plays a major role in infection with obligate pathogens.

Hematogenous and direct spread of the pathogen from the source of infection are even less important in terms of frequency of occurrence.

A pregnant woman is not usually considered an immunologically “compromised” host. However, pregnancy is associated with complex hormonal and immunological changes that can expose women to more high risk the occurrence of a severe infection. On the one hand, an increase in estrogen levels during the gestational period causes hyperemia and swelling of the mucous membrane, hypersecretion of mucus in upper sections respiratory tract, which helps reduce local immunity and more free penetration of infection into the lower Airways. On the other hand, increased production of progesterone and cortisol suppresses cellular humoral immunity, and estrogen enhances the growth of certain pathogenic microorganisms. In addition to the above immunological changes, respiratory system During pregnancy, it undergoes significant physiological changes. Thus, the growing uterus causes the diaphragm to rise by 5 cm at full term. Muscle tone abdominal wall decreases, the ligamentous apparatus of the ribs relaxes, and the circumference of the chest increases by 7 cm, which is associated with a decrease in functional residual capacity lungs by an average of 21% by the end of pregnancy. Under the influence of progesterone respiratory center minute ventilation increases compensatoryly (by 19-48%), mainly due to an increase in the volume of air exchanged during one breath; as well as an increase in breathing rate. That is why from the early stages of gestation a woman is in a state of hyperventilation.

Thus, the presented immunological and physiological changes may contribute to an increased incidence of pneumonia during pregnancy.

Clinic
The diagnosis is established on the basis of: complaints from a pregnant woman about the acute onset of the disease with chills, a laxative fever, cough with discharge mucopurulent sputum, shortness of breath at rest and with minor physical activity, weakness, sweating, headache and etc.; classical objective data (rapid breathing, locally auscultated bronchial breathing, sonorous fine-bubble rales or inspiratory crepitus, as well as symptoms of consolidation of pulmonary tissue with shortening of percussion sound, increased vocal tremor and bronchophony). Approximately 20% of pregnant women do not have an acute febrile onset, chest pain, or objective symptoms VP.

When diagnosing CAP, the therapist, together with the obstetrician, must consultatively decide where the pregnant woman will be treated, since treatment is in outpatient and inpatient conditions differ in volume diagnostic studies and tactics of antimicrobial therapy.

Indications for hospitalization of pregnant women with CAP can be divided into 3 groups:

1 - directly related to severe course VP: tachypnea more than 30 per minute, hypotension (SBP< 90 мм рт.ст.), нестабильная гемодинамика, гипотермия (<35°С) или гипертермия (>40°C), leukopenia less than 4.0 or leukocytosis more than 20x1000 μl, anemia (Hb<90 г/л), возможная аспирация, плевральный выпот, многодолевое поражение легкого, инфекционные метастазы, септический шок, неэффективное амбулаторное лечение в течение 3 дней, нарушение сознания;
2 - associated with concomitant somatic diseases (chronic obstructive pulmonary diseases, hypertension and cardiovascular diseases, heart failure, chronic hepatitis, chronic nephritis, acute or chronic renal failure, diabetes mellitus, systemic connective tissue diseases, etc.;
3 - associated with the complicated course of pregnancy itself (early toxicosis of moderate and severe degree, threat of miscarriage, feto-placental insufficiency, acute and chronic intrauterine fetal hypoxia, intrauterine growth retardation, etc.

When deciding on the place of treatment for a pregnant woman with CAP, one should also take into account the social and living conditions of the patient, as well as the wishes of her and her relatives regarding the place of treatment. However, it must be remembered that in the first 3 days of outpatient treatment, a pregnant woman needs daily examination by a general practitioner or patronage by a qualified nurse.

Obviously, most pregnant women with CAP are subject to hospitalization, and in the first half of pregnancy it is preferable to go to a therapeutic hospital, and from the 2nd half to an obstetric hospital. In cases where a pregnant woman has severe VP: tachypnea >30 bpm, SBP<90 мм рт.ст., двусторонняя или многодолевая пневмоническая инфильтрация, быстрое прогрессирование очагово-инфильтративных изменений в легких, септический шок или необходимость введения вазопрессоров более 4 часов- требуется неотложная госпитализация в ПИТ.

Differential diagnosis.
Differential diagnosis is carried out on the basis of clinical laboratory and instrumental research methods with congestive heart failure, thromboembolism of the branches of the pulmonary artery, lung cancer, sarcoidosis, drug-induced pneumopathy, alveolar hemorrhages.

Treatment
Antibacterial therapy should be prescribed no later than 4 hours after diagnosis, which in real conditions will almost always be empirical, focused on the most likely pathogens of the disease, taking into account knowledge of local epidemiology, resistance, features of the clinical course and severity of the disease, gestational age, allergic history, concomitant diseases, intolerance or undesirable effects of antibiotics, cost of the drug. Single and daily doses of AB should be average therapeutic without any reduction in dosage due to pregnancy. Reducing dosages is possible only in cases of severe renal failure.

Antibacterial treatment regimens for nosocomial pneumonia are presented below.

Antibacterial therapy for CAP of known etiology

S. pneumoniae
Drug of choice (treatment regimen):
Inside 7-10 days:
Amoxicillin 500 mg 3 times a day;
Spiramycin 3 million IU 3 times a day;
Cefuroxime 500 mg 2 times a day.
IV 5-10 days
Benzylpenicillin 2,000,000 units 4 times a day;
Ceftriaxone 1 g 1 time per day;
Cefotaxime 1 g 3 times a day.

IV 5-10 days
Amoxicillin/clavulanate 1.2 g 3 times a day;
Vancomycin 1 g 2 times a day;
Imipinem 500 mg 3-4 times a day;
Meropenem 500 mg 3-4 times a day;

Cefazolin 1 g 3 times a day.

H influenzae
Drug of choice (treatment regimen):
IV 10-14 days:
Piperacillin/tazobactam 2.5 g 3 times a day;
Cefepime 1 g 2 times a day IV;
Cefotaxime 1 g 3 times a day;
Ceftriaxone 1 g 1 time per day;

Alternative drugs (treatment regimens):
IV 10-14 days

M. catarrhalis
Drug of choice (treatment regimen):
IV 10-14 days

Ampicillin/sulbactam 1.5 g 4 times a day;
Piperacillin/tazobactam 2.5 g 3 times a day;
Spiramycin 3 million IU 3 times a day;
Cefepime 1 g 2 times a day;
Cefotaxime 1 g 3 times a day;
Ceftriaxone 1 g 1 time per day.

Legionella spp.
Drug of choice (treatment regimen):
Inside 3 days
Azithromycin 0.5 g 1 time / day.

Inside 2-3 weeks:
Roxithromycin 150 mg 2 times a day;
Spiramycin 3 million IU 3 times a day.

IV 2-3 weeks:
Spiramycin 3 million IU 3 times a day.

M. pneumoniae
Drug of choice (treatment regimen):

Inside 3 days:
Azithromycin 0.5 g 1 time / day;

Inside 2-3 weeks:
Roxithromycin 150 mg 2 times a day;
Spiramycin 3 million IU 3 times a day.

IV 2-3 weeks:
Spiramycin 3 million IU 3 times a day.

C. pneumoniae
Drug of choice (treatment regimen):

Inside 3 days:
Azithromycin 0.5 g 1 time / day.

Inside 2-3 weeks:
Roxithromipine 150 mg 2 times a day;
Spiramycin 3 million IU 3 times a day.

IV 2-3 weeks:
Spiramycin 3 million IU 3 times a day;

Pseudomas aerugenosa
Drug of choice (treatment regimen):

IV 10-14 days:

Piperacillin/tazobactam 2.5 g 3 times a day;
Ceftazidine 1 g 3 times a day;
± aminoglycoside

Alternative drugs (treatment regimens):
Ceftazidine 1 g 3 times a day i.v.
+ Gentamicin 80 mg 2 times/day IM
+ Spiramycin 3 million IU 3 times a day IV or orally.

S. aureus
Drug of choice (treatment regimen):

IV or IM 10-14 days:
Oxacillin 2 g 4 times a day.

Alternative drugs (treatment regimens):

IV 10-14 days:
Vancomycin 1 g 2 times a day
Spiramycin 3 million IU 3 times a day
Cefazolin 1 g 3 times a day;
Cefuroxime 500 mg 2 times a day;

Enterobacteriaceae (E.coli, Klebsiella, Proteus, Enterobacter)
Drug of choice (treatment regimen):
IV 10-14 days:
Cefepime 1 g 2 times a day;
Cefotaxime 1 g 3 times a day;
Ceftriaxone 1 g 1 time per day
+ Aminoglycoside;
Imipinem 500 mg 3 - 4 times a day;
Meropenem 500 mg 3 - 4 times a day;

Alternative drugs (treatment regimens):

IV 10-14 days:
Ampicillin/sulbactam 1.5 g 4 times a day;
Piperacillin/tazobactam 2.5 g 3 times a day;
CAP (mild, moderate, not requiring hospitalization)

In the first trimester of pregnancy
Amoxicillin orally 0.5-1 g 3 times / day. 7-10 days or
Amoxicillin-clavulanate orally before or during meals 625 mg 3 times / day. 7-10 days or
Amoxicillin-clavulanate orally before or during meals 825 mg 2 times / day. 7-10 days or
Spiramycin orally 3,000,000 IU 2-3 r/day. 10-14 days
or From 20 weeks of pregnancy

Azithormicin orally 0.5 g 1 r / day. - 1st day, then 0.25 g 1 r / day. 4 within 4 days or
Roxithromycin orally 0.15 mg 2-3 times / day. 7-10 days or
Cefuroxime axetil orally after meals 0.5 g 2 times / day 7-10 days
Cefixime 400 mg 1 r / day. 7-10 days

Parenteral antibiotics for the treatment of CAP in outpatient settings do not have proven advantages over oral ones. They can be used only in isolated cases (for example, with expected low compliance with oral medications, refusal or impossibility of timely hospitalization).

If there is a real need to use antibacterial drugs parenterally, preference should be given to drugs with a long half-life (for example, ceftriaxone, prescribed once a day).

If macroaspiration is suspected, when the etiological significance of oropharyngeal anaerobes becomes real, combined treatment is recommended:

Inside 2-3 weeks:
Amoxicillin/clavulanate 625 mg 3 times a day
EP (requiring hospitalization)

When treating in general departments, it is possible to carry out “step therapy”, which involves the two-stage use of antibacterial drugs: switching from parenteral to oral administration, taking into account the clinical condition of the pregnant woman. Transfer to an oral antibiotic is acceptable if there is clinical improvement, hemodynamic stabilization, ability to eat independently, and absence of malabsorption. In most cases, this is feasible on days 2-4 of parenteral therapy.

Drug of choice for stepwise therapy (treatment regimen):

Ampicillin sodium 1 g 4 times a day IM for 2-4 days,
then Ampicillin trihydrate 250-500 mg 4 times a day orally for 7-10 days;
Ampicillin/sulbactam 1.5 g 4 times a day IM for 2-4 days, 4 times a day IM 2-4 days,
then Ampicillin trihydrate 250-500 mg 4 times a day orally for 7-10 days
Amoxicillin/clavulanate 1.2 g 3 times a day. IV 2-4 days,
then Amoxicillin/clavulanate 625 mg 3 times a day;
Spiramycin 3 million IU 3 times a day. IV 2-4 days,
then Spiramycin 3 million ME. 3 times/day 7-10 days;
Cefuroxime sodium 500 mg -1 g 2 times/day i.v.
then Cefuroxime axetil 500 mg 2 times a day;

Alternative drugs (treatment regimens):

IV 10-14 days:
Cefotaxime 1 g 3 times a day;
Ceftriaxone 1 g 1 time per day;
Cefepime 1 g 2 times a day;
+ Spiramycin 3 million 3 times a day;
Amoxicillin/clavulanate 1.2. g 3 r/day.
Empirical antibiotic therapy for CAP in the intensive care unit

Drug of choice (treatment regimen):
IV 10-14 days:
Cefotaxime 1 g 3 times a day;
Ceftriaxone 1 g daily;
Cefepime 1 g 2 times a day;
+ Spiramycin 3 million IU 3 times a day;

The effectiveness of antimicrobial chemotherapy depends on many factors: the pathogen, the severity of the disease, the prevalence of pneumonic infiltration, concomitant diseases, the timeliness of the therapy initiated, etc. Adequate antibacterial therapy leads to a decrease in respiratory symptoms (cough, shortness of breath), a decrease in fever, and the level of leukocytes in the peripheral blood . The most demonstrative response to therapy is the timing of achieving apyrexia. Thus, in young pregnant women with pneumococcal pneumonia, body temperature normalizes on average 2.5 days after the start of treatment. In cases of complications of this pneumonia with secondary bacteremia, the duration of fever after the start of treatment is 6-7 days. In most cases of mycoplasma pneumonia, persistent apyrexia is achieved on days 1-2 of therapy. On X-ray examination, infiltrative changes in pneumococcal pneumonia persist for 4 weeks, and in legionella pneumonia - 7-12 weeks. Often pregnant women do not have fever from the very beginning of the disease. In these cases, one should focus on other signs of intoxication (headache, anorexia, cerebral symptoms, etc.), as well as the absence of progression of the disease during the period of treatment.

As a rule, the “automatic” change of antibiotics every 7-8 days is not sufficiently justified, based on the erroneous idea that changing antimicrobial drugs leads to a decrease in antibiotic resistance.

Indications for changing antibiotics are clinical ineffectiveness of therapy, the development of adverse drug reactions requiring discontinuation of antibiotics, or the use of drugs with cumulative toxicity (for example, aminoglycosides).

The main criterion for discontinuing antibiotics is regression of clinical symptoms. The persistence of post-infectious asthenia, individual laboratory tests (ESR), band shift, and/or radiological changes is not a reason to continue antibiotic therapy in a pregnant woman with CAP

Antibacterial therapy may be ineffective in case of an erroneous diagnosis of pneumonia, due to both hidden non-infectious pathology and the influence of “infectious” causes (resistant pathogens, non-bacterial pathogens - fungi, viruses, as well as superinfection, pleural empyema) and the wrong choice of antibiotic, dose and route administration, violation of the antibiotic regimen, etc.

During pregnancy, the following antibacterial drugs are contraindicated: doxycycline, co-trimoxazole, sulfonamides, fluoroquinolones. An absolute mistake in the treatment of CAP in pregnant women is the prescription of gentamicin, since aminoglycosides are inactive against pneumococcus and intracellular pathogens.

It is irrational to use combinations of bactericidal (penicillin) and bacteriostatic (erythromycin) antibiotics, as well as a fixed combination of ampiox, where the dose of oxacillin is insufficient.

Currently, there is no relevant evidence on the advisability of prescribing various biogenic stimulants, antihistamines, as well as the routine prescription of non-steroidal anti-inflammatory drugs and antifungal drugs. The effectiveness of these drugs has not been confirmed by the results of randomized controlled trials, which requires further study and does not provide grounds for recommending them for the treatment of CAP in pregnant women.

When dysbiosis develops against the background of antibacterial therapy, antifungal drugs (nystatin, fluconazole) and/or agents that normalize intestinal microflora (hilak, linex) are added to the treatment.

Antibacterial therapy is the only scientifically based treatment for CAP.

BIBLIOGRAPHY.

1. Arkhipov V.V. and others. Lung diseases during pregnancy./Edited by Chuchalin A.G., Krasnopolsky V.I., Fassakhov R.S. -M.: Publishing house "Atmosphere", 2002, - 88 p.
2. Ionikov V. E. Differential diagnosis and antibacterial therapy of pneumonia. //Consilium medicum.-2001. - Volume 3, No. 12. - pp. 569-572.
3. Rational pharmacotherapy of respiratory diseases: Hand. for practicing doctors/A.G. Chuchalin, S.N. Avdeev, V.V. Arkhipov, S.L.Babak and others; Under general ed. A.G. Chuchalina.-M., 2004.-874 p.
4. Sinopalnikov A.I., Strachunsky L.S. New recommendations for the management of adult patients with community-acquired pneumonia. // Clinical microbiology and antimicrobial chemotherapy. - 2001. - Volume 3, No. 1. - P.54 - 67.
5. Sidorenko S.V. Problems of etiotropic therapy of community-acquired respiratory tract infections. //Consilium medicum. - 2002. -Reprint, - pp. 2-7.
6. Strachunsky L.S. Antibacterial therapy of community-acquired pneumonia in an outpatient setting. //Consilium medicum. - 2002. -Vol. 4, No. 4. - P.180-185.
7. Shekhtman M.M. Guide to extragenital pathology in pregnant women. - M., “Triad X”, 1999. - 816 p.
8. Yakovlev S.V. Form of antibacterial therapy and prevention of infections in obstetrics and gynecology. //Infection and antimicrobial therapy. - 2001. - Volume 1, No. 3. - P.1 - 4.

Pneumonia in itself is a serious pathology that poses a risk to the life of any person. And the occurrence of pneumonia during pregnancy is especially dangerous for both the woman and the fetus.

Like other diseases of pregnant women, pneumonia is more dangerous in the early stages, when the organs and tissues of the embryo have not yet had time to form. At later stages, the disease poses a risk not so much for the child as for the mother (maximum - during childbirth).

The difficulty with pneumonia in pregnant women is that it is immediately extremely similar to a common cold. And until the temperature rises to a critical level, a woman often does not even seek help. And treatment at home with symptomatic remedies only aggravates the course of the disease.

But even when contacting a physician, pneumonia can be difficult to diagnose due to the undesirability of X-ray examination. When prescribing treatment, careful selection of antimicrobial drugs is also required to minimize their effect on the fetus.

Related factors

Of course, pneumonia can occur in any pregnant woman. And more often it manifests itself after suffering from an acute respiratory viral infection, which is not surprising to catch at work or in transport. But pregnant women with accompanying factors such as:

• immunodeficiency, incl. HIV;
• diabetes;
• lung and heart diseases;
• long-term use of steroid hormones;
• chest injuries;
• artificial ventilation;
• prolonged stay without consciousness.

Signs of pathology

The symptoms of pneumonia during pregnancy are not particularly different from those in general. At first, signs of a common ARVI may be observed: cough, runny nose, weakness and low-grade fever. But over time, these manifestations increase, after which sharp pain appears in the chest on one or both sides.

The pain usually worsens with coughing and deep breathing. In this case, the temperature reaches 39-39.5. Dyspnea and tachycardia develop compensatoryly. The cough can be either dry, barking, or wet with purulent or bloody (rusty) sputum.

Depending on the microorganism that was the causative agent, the symptoms of the disease may differ slightly. For example, bacterial pneumococcal pneumonia has an acute onset and pronounced symptoms. While atypical mycoplasma is characterized by a smooth onset and mild symptoms. Pneumonia of viral etiology is characterized by severe muscle and joint pain.

Although the line between severe acute respiratory infections and mild pneumonia is completely unclear, pneumonia in pregnant women causes much more severe consequences and therefore requires careful diagnosis.

If pneumonia is diagnosed in time and antimicrobial therapy is started, it does not leave consequences. But in case of untimely treatment and self-medication at home, both pulmonary and extrapulmonary complications are often determined. Intrapulmonary include:

• abscess or gangrene of the lung;
• pulmonary edema;
• exudative pleurisy;
• pleural empyema;
• respiratory failure;
• broncho-obstructive syndrome.

Dangerous extrapulmonary consequences of pneumonia in pregnant women include:

• sepsis;
• meningitis;
• infectious-toxic shock;
• DIC syndrome;
• endocarditis and myocarditis.

Possible complications for the fetus

In the first trimester (up to the 12th week), pneumonia in the mother has a particularly strong effect on the differentiation of fetal tissues. Both the disease itself and the use of antibiotics cause great harm. Often at this stage, pneumonia causes miscarriage or fading of pregnancy.

If the pathology occurs later, after all organ systems have had time to form, then it often becomes the cause of premature birth. Also, the baby may be born at term, but at low birth weight.

The presence of pneumonia in the mother during childbirth makes breastfeeding impossible due to the risk of infection of the fetus and exposure to antibiotics through breast milk. This also negatively affects the health of the newborn, since he cannot obtain the necessary antibodies from the mother's milk.

How to identify the disease

Pneumonia can be suspected based on characteristic symptoms. When you consult a doctor, he will detect the presence of wheezing and dullness of pulmonary sound upon percussion. But to confirm the diagnosis, the pregnant woman will have to undergo an x-ray. To do this, the stomach is covered with a special apron that does not let the rays through.

If foci of inflammation are detected in the lungs on the image, antibiotic therapy is started immediately. To accurately determine the pathogen and select drugs to which it is sensitive, a sputum test is taken for microscopy and bacterial culture.

Therapy methods

Even the most severe episodes of pneumonia are not an indication for termination of pregnancy, since it only causes a deterioration in the woman’s condition. In case of mild inflammation, treatment can be carried out at home; in case of moderate and severe inflammation, hospitalization is inevitable. Moreover, until 22 weeks of pregnancy, a woman is in a regular hospital, and after 22 weeks - in an obstetric hospital.

In the treatment of pneumonia in pregnant women, the following are used:

• antibiotics;
• detoxification agents;
• expectorants;
• desensitizing;
• diuretics;
• vitamins;
• immunostimulants.

Within 4 hours after diagnosis, the pregnant woman is prescribed empirical antibiotic therapy. Usually drugs from the group of cephalosporins, penicillins or lincosamides are used. And after the results of the sputum analysis come back, the drug can be replaced with another, more specific against the identified pathogen.

Treatment for pneumonia usually takes no more than a month. If after a month of therapy the symptoms persist, then this course is considered protracted.