Flu during pregnancy in the first and second trimester: how to treat

Colds and flu during pregnancy: how to distinguish?

The symptoms of ARVI and influenza are very similar to each other: the same cough, sneezing, nasal congestion, chills, fever and headache. But there are some specific symptoms of the influenza virus:

the onset of the disease is usually acute: body temperature rises sharply and high - up to 39-40 degrees; chills, joint pain;
pallor of the skin, sometimes blueness of the nasolabial triangle and a bright blush on the cheeks; photophobia and intolerance to loud sounds;
weakness, feeling of weakness, dizziness;
cough and runny nose do not appear immediately, but only on the second or third day of the disease;
sometimes - abdominal pain, vomiting, diarrhea, especially if it is intestinal flu during pregnancy;
the acute condition lasts about 7 days - longer than the usual ARVI.

But you shouldn’t get too carried away and look for signs of flu during pregnancy on the forum or interview sick friends, because the most reliable diagnostic method is not the assessment of external symptoms, but laboratory tests:

swabs from the mucous membranes of the throat and nose;
blood test for anti-influenza antibodies.

It is especially important to insist on testing if an influenza epidemic has not been officially declared in the region and the doctor limits himself to a visual examination of the pregnant woman and making a diagnosis of ARVI. The treatment tactics and the health of the unborn baby depend on how quickly and correctly the disease of a pregnant woman is diagnosed.

General recommendations for pregnant women who have symptoms of rhinitis

Rinse the nose with a weak saline solution (2 teaspoons of sea salt per glass of water). Saline solution improves the passage of mucous discharge from the nose and reduces the feeling of stuffiness.
Nasal douches (nasal rinsing devices) help very well. You can use regular saline solution for them.
Ventilate the room before going to bed, use humidifiers. Dry air can increase unpleasant symptoms.
Use a high pillow (or several pillows) to sleep so that your head is significantly higher than your torso.
Walking in the fresh air before bed is beneficial.
Do exercises in the morning and breathing exercises several times a day to reduce the symptoms of hypoxia.
Don't wear perfume and try to stay away from smokers.

During pregnancy, vasoconstrictor nasal drops should not be used, as they can provoke vasomotor rhinitis.

Flu during pregnancy: consequences

Flu is dangerous due to complications that can affect any organs and systems of the body. Here are just a few of them:

from the respiratory system: bronchitis, tracheobronchitis, sinusitis, adenoiditis, tonsillitis, otitis media;
from the cardiovascular system: inflammation of the muscles and membranes of the heart, heart failure;
from the reproductive system: hormonal imbalances, miscarriages, premature birth, insufficient blood supply to the placenta, oligohydramnios, intrauterine growth retardation;
During the flu during pregnancy, chronic diseases of the gastrointestinal tract, genitourinary and endocrine systems, cardiovascular diseases and allergic reactions often worsen.

At what time does rhinitis in pregnant women occur and how long does it last?

Most often, pathology occurs:

up to the 20th week of pregnancy inclusive - in this case, rhinitis usually goes away on its own (in about a month or two) and does not manifest itself in later stages;
after the 20th week of pregnancy - this condition can continue until childbirth and after it (after 2-3 weeks).

If the symptoms last longer than two months and are not relieved by any independent actions (vasoconstrictor sprays are prohibited for use!), then the cause may be hidden in a chronic disease.

When is the flu most dangerous for pregnant women?

The most undesirable thing is to get the flu in the first trimester of pregnancy, when the baby’s internal organs are forming. If a woman gets the flu in the first trimester, the pregnancy often ends spontaneously.

If the interruption did not occur, the woman was successfully cured, but is worried about how the baby survived the disease, it is necessary to do an ultrasound within the recommended time frame for screening and donate blood for AFP, hCG and estriol to exclude the possibility of pathologies in the fetus.

In the first trimester, you should especially carefully select medications for influenza. During pregnancy, some medications are allowed, including some antibiotics, but before 12 weeks, many drugs can be used only if the potential benefit to the mother significantly outweighs the possible risk to the child.

In the second and third trimesters, influenza is no longer so dangerous for pregnancy, however, influenza can cause intrauterine infection of the fetus, leading to the birth of children with developmental disabilities and a predisposition to various diseases during the neonatal period.

If a woman falls ill with the flu during pregnancy, she should consult a physician as soon as possible to prescribe treatment. If you are concerned about how the infection affected the fetus, you can seek advice from a geneticist.

Treatment of rhinitis in pregnant women

In our clinic, a thorough diagnosis is carried out to exclude diseases similar to rhinitis in terms of symptoms. After the examination, individual treatment is prescribed depending on the severity, severity and indications.

Treatment is complicated by the fact that many drugs can cause contraction of the myometrium and impaired fetal circulation or vasoconstriction with impaired placental function. Therefore, a doctor must prescribe drug therapy; you cannot use the drugs yourself - they can cause disruption of fetal development.

Prevention of influenza during pregnancy: drugs

To prevent the flu, Oxolinic ointment or Viferon-gel are often used - they are applied to the nasal mucosa before leaving home. If you have to travel on public transport during the height of the seasonal flu epidemic, do not neglect the gauze bandage.

Prevention of influenza during pregnancy involves not only the use of medications, but also maintaining a healthy lifestyle. A pregnant woman should eat well, take vitamins, ventilate the room where she is located more often, and avoid crowded places, especially during epidemics.

The flu vaccine during pregnancy will also effectively protect: it can be done from 14 weeks of pregnancy - the inactivated influenza virus contained in the vaccine is safe for both mother and child.

Currently, viral infections are considered one of the main causes of reproductive losses. On the one hand, the infectious agent has a direct damaging effect on the fetus, and on the other hand, by causing significant changes in the immune reactions of the maternal body, it leads to a complicated course of pregnancy. Influenza and other acute respiratory viral infections transmitted by airborne droplets occupy a special place among infectious diseases of pregnant women.

The relevance of the problem of acute respiratory diseases of a viral nature is determined by their prevalence, uncontrollability, high contagiousness, allergization and the development of secondary immunodeficiency states after the illness.

The environmental features of modern urbanization provide a real basis for the frequent encounters of women with various respiratory viruses throughout pregnancy. In the extragenital pathology of pregnant women, acute respiratory infections occupy the first place in prevalence - more than 2/3 of the total incidence of acute infections. This is due to the high susceptibility of pregnant women to viral infections and the tendency to chronicize pathological processes, which is due to the peculiarities of the immunity of pregnant women.

The effect of viral infection on the course of pregnancy and the condition of the fetus is characterized by two main mechanisms. Firstly, possible infection of the placenta, amniotic membranes, as well as the fetus itself, a teratogenic (causing malformations) effect on the embryo and fetus, the development of local lesions of the fetus, as well as infection of the fetus with clinical manifestations in the postnatal period (after birth). Secondly, a possible indirect effect as a result of the development of fever in a pregnant woman, disruption of homeostasis (equilibrium, constancy) in the body, etc. The variety of clinical effects is explained by the time of infection by pregnancy, the properties and virulence of the virus, the state of the placental barrier and protective forces of the mother , and the fruit.

The main links in the pathogenesis of viral infection in a pregnant woman, which determine the high risk of perinatal pathology, are:

Oxygen starvation of tissues, organs and systems associated with the reproduction of the virus and its toxic effect on the tissues of the respiratory system and the vascular bed;

Activation of the blood coagulation system through the toxic effect of the virus on the vascular wall;

Pathological changes in the immune system that occur under the influence of a viral infection;

Activation of chronic intrauterine infection.

The possibility of transmission of respiratory viruses, which include viruses that cause acute respiratory viral infections, through the placenta from a sick mother to the fetus has been proven, which causes the involvement of all three components of the “mother-placenta-fetus” system in the infectious process.

Modern researchers consider gestosis (toxicosis of the second half of pregnancy), including its severe forms, as a cause-and-effect factor of placental insufficiency (PI); a direct relationship has been proven between the severity of late gestosis and the severity of PI. Recent studies have confirmed the assumption that the placenta serves as a kind of “reservoir” in the process of intrauterine infection, since it has been proven that under the influence of viruses, some structures of the placenta change, and viruses are also reproduced in them.

Specific prevention of influenza does not eliminate the problem of respiratory viral infections, since the share of ARVI of non-influenza etiology is up to 75% even during influenza epidemic periods. In addition, the physiological changes in the immune system that occur in the body of pregnant women do not allow the use of vaccine preparations for the prevention of infectious diseases.

The risk group for ARVI infection includes women who have had these infections more than three times in the year preceding pregnancy. This sign is a classic confirmation of immunological deficiency in the patient. They are characterized by: a protracted, recurrent course of diseases (rhinitis, pharyngitis, laryngotracheitis, bronchitis), the presence of foci of chronic infection (chronic tonsillitis, sinusitis). The pathological process in such patients involves, to one degree or another, other body systems that provide its protection when encountering the external environment. The most common pathology of the digestive tract: from dysfunctions and dysbiosis to chronic colitis, enteritis, enterocolitis, pancreatitis and cholecystitis.

Features of the course of ARVI in pregnant women

Pregnant women are characterized by a protracted course of ARVI in the absence of severe clinical manifestations. This is explained by the ability of respiratory viruses to reproduce in the placenta, as well as the peculiarity of the pregnant woman’s immune system (a state of physiological immunodeficiency).

The main clinical symptoms of acute respiratory infections: symptoms of general intoxication (malaise, weakness, increased fatigue, etc.) against the background of low-grade or normal temperature, symptoms of rhinitis or nasopharyngitis.

The erased clinical picture of ARVI, which is most typical for pregnant women, is often the reason for insufficient attention to the very fact of the disease, both on the part of doctors and the woman herself; however, ARVI leads to a breakdown of physiological immune mechanisms and does not exclude the possibility of complications during pregnancy.

Features of pregnancy after ARVI. The impact of ARVI in pregnant women on the health of their newborns

The most typical complications of pregnancy after ARVI are:

more than doubling the incidence of placental insufficiency;
increase in cases of early onset of gestosis;
oligohydramnios – as a concomitant sign of placental insufficiency, as well as a manifestation of viral damage to the fetoplacental complex;
the threat of premature termination of pregnancy is more common in the 2nd trimester, namely at 17-26 weeks; pregnant women after ARVI are characterized by a constant course of the threat of termination of pregnancy, insensitive to standard therapy;
intrauterine growth retardation and intrauterine fetal hypoxia;
increased incidence of newborns:
hypoxic damage to the central nervous system is most typical for ARVI in the 2nd trimester;
chronic placental insufficiency (inflammatory and degenerative changes in the placenta, impaired differentiation of placental tissue, suppression of compensatory and adaptive vascular reactions of chorionic villi).

Characteristics of the state of the immune system of pregnant women after ARVI

When studying the state of systemic immunity in pregnant women who have had ARVI, depending on the duration of pregnancy, in comparison with similar indicators in healthy pregnant women, the following patterns were identified.

A history of acute respiratory viral infection causes changes in the immune status and is characterized, as a rule, by changes in the content of leukocytes and lymphocytes and their populations. A characteristic feature of the immunogram of pregnant women who have had acute respiratory viral infection is lymphocytopenia (destruction of lymphocytes), while with the physiological development of pregnancy there is an increase in the total number of leukocytes. Lymphocytopenia can be explained by the direct damaging effect of respiratory viruses on lymphoid cells; its degree depends both on the virulent properties of the viral pathogen and on the adaptive capabilities of the body.

The influence of viruses on immunological reactivity lies in the fact that during the course of infection, not one, but a series of indicators that characterize the immune response of the virus-infected organism to foreign antigens changes. A disorder of immunological reactivity occurs, caused by a disruption of all functions of immunocompetent cells as a result of virus multiplication.

The occurrence of defects in immunological reactivity should be considered as an obligatory element of the pathogenesis of ARVI. The presence of these defects does not prevent the formation of specific immunity against a homologous virus.

Methods for the prevention and treatment of ARVI in pregnant women

It is known that specific prevention of influenza and ARVI with vaccine preparations is contraindicated during pregnancy. Researchers both here and abroad are paying attention to the search and implementation of methods for nonspecific protection of the population from respiratory viral infections. It should be noted that one of the most promising methods of tactics for viral infections is immunocorrection. From this point of view, the use of modern immunobiological drugs - adaptogens and eubiotics - is promising.

Therapeutic measures using immunotropic drugs are carried out after acute respiratory viral infection in the 2nd - 3rd trimesters of pregnancy, as well as 10-14 days before the expected due date in the following groups of patients:

those who fell ill with ARVI during pregnancy and suffered similar diseases more than 3 times in the year preceding pregnancy;
pregnant women who have had ARVI with a complicated pregnancy;
if there is a positive prognosis for the development of perinatal pathology.

Preventive actions

All pregnant women should refrain as much as possible from visiting public places with large crowds of people during the threat and occurrence of an epidemic of influenza and ARVI.

Pregnant women who suffer from acute respiratory infections three or more times in the year preceding pregnancy should be considered a high-risk group for the development of complications.

This group of patients, as well as all pregnant women, in the event of the threat and occurrence of an epidemic of influenza and ARVI, should be given a course of nonspecific prophylaxis.

The use of vitamin-mineral complexes helps to form an antiviral immune response, they protect the cell membrane from the damaging effects of an infectious agent (vitamins A, C, E; trace elements selenium, magnesium, iron), herbal medicine can also be used.

Preventive measures are necessary for women at high risk of acute respiratory viral infection at the stage of preconceptional preparation and from the first trimester of pregnancy, as well as for all pregnant women with the threat of an epidemic of influenza and acute respiratory viral infection at any stage of pregnancy.

Causes and symptoms

The nature of the cough helps the specialist to determine its cause and make a preliminary diagnosis.

Influenza – a dry cough, mucous discharge sometimes of a purulent color appears after a few days. The cough is accompanied by severe headaches and muscle pain, high fever and general weakness.
Bronchitis is a sharp spasmodic cough with contraction of the abdominal muscles. A strong cough can trigger the gag reflex. There is pain in the chest area. The cough gets worse in cold or dry air.
Allergic cough is a problem that pregnant women face due to hormonal changes. Contact with an allergen provokes asthma attacks. The discharge is mucous in nature and practically absent.
Rhinitis and pharyngitis are accompanied by a dry cough at night. In rare cases, headaches and the area under the eyes hurt.
Pleurisy - acute chest pain, shortness of breath, high temperature that practically does not go down, frequent dry cough.
Measles is a debilitating cough and rash on the skin.

Causes of cough typical for pregnant women

Dryness in the room, which increases the sensitivity of mucous membranes. This leads to an increased urge to cough. This problem is more common during the winter months in heavily heated areas.
Vasomotor rhinitis during pregnancy is a runny nose caused not by viruses, but by hormonal changes. With a stuffy nose, patients breathe more often through their mouth, which leads to dry mucous membranes, which, in turn, leads to throat irritation.
Heartburn is a typical complaint. Coughing attacks occur in a lying position, when acid flows from the stomach back into the esophagus, irritating the sensitive mucous membrane of the throat, and then the urge to cough occurs.
Cardiac cough occurs after excessive physical activity and as a consequence of heart failure. The blood stagnates, swelling forms in the lungs, which irritates the respiratory receptors and provokes a cough.

Glossary of terms

Bronchitis is inflammation of the bronchi. Intoxication is poisoning of the body by toxic substances formed within itself or received from outside. Contagiousness - contagiousness. A pandemic is an epidemic characterized by the spread of an infectious disease throughout the entire country, the territory of neighboring states, and sometimes many countries of the world (for example, cholera, influenza). Pyelonephritis is a bacterial inflammation of the urinary part of one or both kidneys. Tonsillitis is inflammation of the tonsils. Tracheitis is inflammation of the mucous membrane of the trachea. Epidemic is the spread of any infectious human disease, significantly exceeding the level of normal (sporadic) morbidity in a given territory.
If you had the flu in the first half of pregnancy, it is recommended to do the so-called “triple test” at 16-20 weeks of pregnancy - for alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG) and estriol (three hormones must be tested, since It is often impossible to assess the risk of pathologies based on two or one). These tests suggest the presence of fetal malformations. However, we must remember that the results of this test are indicative and if abnormalities are identified, a number of further studies are carried out, as well as a consultation with a geneticist. Along with the triple test, an ultrasound examination is performed after recovery. Depending on the results of the “triple” test and ultrasound, you can either calm down or be examined further.

More often, the diagnosis is made on the basis of characteristic clinical signs.

Further examination includes the procedure of amniocentesis. During amniocentesis, a sample of amniotic fluid is taken and examined for any pathologies in the baby. Although the procedure is performed very quickly, almost painlessly, under ultrasound guidance, in approximately 1-2% of cases there is a risk of miscarriage or premature birth.

If the flu was suffered in the second half of pregnancy, then to clarify the condition of the fetus, an ultrasound examination, Dopplerography - a study of blood flow in the vessels of the fetus, placenta, umbilical cord, and cardiotocography - a study of the cardiac activity of the fetus are also required.

Effect of the virus

The pathogenic effect of the virus is associated primarily with its biological properties: primary damage to the mucous membrane lining the respiratory tract and toxicity.
The virus penetrates the respiratory tract, settles on the mucous membrane of the respiratory tract, especially the trachea, and begins to secrete toxins (a kind of poison), which are carried through the bloodstream throughout the body. Penetrating through the placenta, damaging it, the virus enters the fetal circulatory system through the bloodstream.

Diagnosis of influenza

More often, the diagnosis is made on the basis of characteristic clinical signs, but if it is difficult to make a diagnosis, the nature of the disease can be clarified using additional research methods.

Currently, to confirm the diagnosis of influenza in medical institutions, the method of fluorescent (glowing) antibodies is used to detect viral antibodies in infected material (to conduct the study, the doctor takes a swab from the nose or throat).