Lung diseases in pregnancy

Some major changes in respiratory system  occur during pregnancy. In the first half only the minute volume increases, in the second half both the residual volume (RV) and expiratory reserve volume (ERV) are decreased, as well as pCO2 in alveoli and arterial blood. Increased values include respiratory volume, minute volume and venous blood oxygen saturation. pO2 of arterial blood and vital capacity (VC) do not change, they tend to decrease just before giving birth. This article discusses the matter of tuberculosis, sarcoidosis, bronchial asthma and pneumonia in pregnancy.

Tuberculosis
thumb|350px|Tuberkulóza – rtg plic A gynecologist encounters tuberculosis in women within areas with higher incidence of this infection. These women are in higher risk, therefore a tuberculin test is indicated. This skin test is of a great importance in pregnancy. When tested positive, an X-ray examination of the chest usually follows with a sample of sputum. Sputum is requred in order to rule out the presence of acid-resistant bacteria. If an acute form od tuberculosis is suspected, women undergo antituberculotic therapy in order to prevent congenital tuberculosis in children and avoid postpartial vertical transmission from the infected mother to the newborn.
 * Therapy:
 * Izoniazid and rifampicin (possibly also etambutol);
 * pyridoxin is co-administered;
 * streptomycin is strictly contraindicated due to possibility of hearing impairment in newborns;
 * the newborn has to be vaccinated (BCG vaccine);
 * if mother had not received antiTBC treatment, the newborn should be isolated until negative tuberculine test result

Sarcoidosis
Sarcoidosis is a granulomatous disease that affects lungs, lymph nodes, heart, CNS, skin, eyes and liver. The disease usually does not affect the pregnancy and is treated with glucocorticoids.

Bronchial asthma
Is an issue in about 1&thinsp;% of all pregnant women, in about 30&thinsp;% the disease gets better with pregnancy, in 20&thinsp;% worsens and in 50&thinsp;% has no effect on the pregnancy whatsoever. Appropriate treatment and monitoring with maintainment of usage of bronchodilatators or corticosteroids is crucial. It is recommended to increase the dosage of glucocorticoids and to use epidural anesthesia during childbirth.

thumb|250px|Pneumonie – rtg plic

Pneumonia
Pneumonia could be caused by bacteria (mostly likely Streptococcus pneumoniae) or by a virus. Bacterial pneumonia is treated with penicilins or cephalosporins. When unsuccessfull, possibility of mycoplasma infection should be considered and treated with erythromycin (for 10–14 days). Viral pneumonia could induce varicella or flu, with very severe course in pregnancy. We use acyclovir for treatment.

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