Monday, July 12, 2010

Asthma How to prevent pregnancy

Pregnant women with asthma to be active and properly adopt measures to prevent asthma attacks, in order to smoothly through the pregnancy safely, and to ensure normal delivery.
Pregnant women with asthma, about 23% increase in pregnancy or recurrence of symptoms, which is called "pregnancy asthma." So, What is the relationship between asthma and pregnancy, and effects?

(1) the impact of pregnancy on asthma: now that the major impact of pregnancy on asthma are two aspects: ① mechanical factors: With the enlarged uterus, elevated diaphragm, thoracic diameter increased, so call gas reserve volume and functional residual capacity decreased, tidal volume increased, also increase the oxygen consumption, but because of the diaphragm and chest wall muscle activity was not affected, so this was not caused by mechanical factors that increase asthma attacks, but it can aggravate asthma attack When hypoxemia; ② pregnancy changes of the endocrine system: endocrine system, pregnant women, the complex physiological changes occur, including progesterone, estrogen can influence the increase in gas made smooth muscle tension, and thus participate in the regulation of asthma , especially pregnant women increase in prostaglandin F, and prostaglandin F2a on airway smooth muscle incorporated strong role, while asthma has on prostaglandin F2a sensitive, easy to cause asthma attacks. In addition, it was also found that maternal asthma and IgE her body related to the content of IgE decreased in normal pregnant women, if the increased IgE in asthmatic pregnant women, suggests she may exacerbate asthma.

(2) an asthma attack, the impact on pregnant women and fetuses: asthma in pregnant women and fetuses affected depends largely on the ability to effectively control asthma attacks. The commonly used drugs to control asthma most of the pregnant women and fetuses no significant side effects. After proper treatment and good control of asthma attack pregnant women, usually in the whole process of pregnancy does not cause abortion, premature delivery, prolonged labor and dystocia, most pregnant women can be more smoothly and safely through the entire pregnancy and normal delivery. Mild asthma attack, not much impact on the fetus, newborn delivery and birth weight rating of the number of pregnant women with normal deliveries of newborns did not differ. If a longer period of pregnant women with asthma not under control, may cause serious complications in pregnant women and fetuses. Pregnant women, pre-eclampsia occurs, pregnancy-induced hypertension, toxemia of pregnancy, hyperemesis gravidarum, vaginal bleeding and obstructed labor. Fetal growth retardation in the womb, expired products, low body weight. If severe asthma attack can cause serious maternal and fetal hypoxia, dysfunction, resulting in lower birth weight of newborns, or nervous system is not normal, and some even threaten the lives of pregnant women and fetuses, perinatal mortality than normal birth 2 times higher.

Pregnant women with asthma to be active and properly adopt measures to prevent asthma attacks, in order to smoothly through the pregnancy safely, and to ensure normal delivery. This could take the following methods:

(1) Prevention: Pregnant women with asthma should be avoided whenever possible trigger factors of asthma, such as pollen, dust, coal smoke flavor, spices, cold air and pets, no smoking and avoid passive smoking, avoid mental stress, to prevent respiratory infections. Active treatment "potential" disease. Mattress and pillows need to set the cap airtight jacket, a week with 60 ℃ water washing blanket, to keep indoor humidity below 50%. Using the vacuum cleaner to wear face masks. In addition, the concentration of allergens in the air increased the season to avoid going out at noon. For some long-term inhaled corticosteroids in asthma, pregnant women should not be suddenly stopped, as has been found inhaled corticosteroids for pregnant women and fetuses with special effects. Mild to moderate asthma patients are known to pregnancy or plan to become pregnant, they can switch to inhaled cromolyn sodium, no teratogenic effect on pregnant women and no adverse effects, is preferred to prevent pregnancy asthma drugs.

(2) observe the condition of measures: asthma, pregnant women and fetuses on the need to check with the appropriate method to observe the changes of the disease. Every pregnant woman regularly when measured by peak expiratory flow rate has been applied to childbirth, and this is because the peak expiratory flow rate can be estimated indirectly airway hyperresponsiveness and airway allergic inflammation, not only that, in pregnant women, chest tightness, shortness of breath symptoms, can have an objective basis for the differential diagnosis, one for early detection of fetal asphyxia; the performance of some pregnant women with asthma although not significant, but the drop in peak expiratory flow rate, when prompted to inadequate fetal oxygen supply, has a potential danger, the need for immediate and reasonable treatment. In addition, regular monitoring of the fetus should, in addition to observe the fetal heart rate and fetal movement, the necessary, but also the conduct of electronic fetal heart rate monitoring.

(3) drug treatment measures: maternal asthma attack according to the national re-select the appropriate level of the drug.

1, if the asthma attack, less than 2 times per week, nocturnal asthma attack less than 2 times per month may make use of β2 agonists, each 2 press, 1 every 4 hours. After the two β2 agonist inhalation, oral and other channels, in the conventional dose no harm to the fetus. If you disappear after treatment of pregnant women with asthma, peak expiratory flow rate returned to normal, while β2 agonist inhalation suspension, asthma appears to re-use. If symptom control is not satisfactory, can be added with oral theophylline, aminophylline general use long-term, per night for 1 piece, in order to control nocturnal asthma, there would be Peter, the use of theophylline in serum for tea time concentration of alkali.

2, when the pregnant women inhaled β2 agonist, increased requirements or daily routine applications need to control asthma, suggesting that the situation has been mild to moderate asthma, inhaled corticosteroids need to be applied by the long-term observation, the daily acid times the dose of chlorine Pine 200-800 microgram is generally believed that no side effects on the fetus, as the preferred inhaled corticosteroid drugs. If the condition can not control, plus a general use of oral prednisone daily or every other day Dayton suits.

3, severe asthma attack when pregnant women take 1-2 days of intravenous hydrocortisone, asthma improved immediately after the auxiliary switch to oral prednisone and inhaled chlorine propionate times loose, and gradually reduce the intensity until the deactivate oral pine, alone propionate inhaled chlorine Song Wei hold times can also be combined with other asthma medicines.

Of particular note is that previous maternal glucocorticoid asthma have more concerns, fears of pregnant women in particular have adverse effects on the fetus. Foreign scholars in recent years by the long-term animal studies and clinical observations, in particular, confirmed by pharmacokinetic studies, hydrocortisone, prednisone and prednisolone have little effect on the fetus, and the concentration of dexamethasone into the larger placenta , on the role of fetal and maternal similar effects. According to the results, if the pregnant woman with asthma whose condition requires application of oral prednisone, prednisolone or intravenous hydrocortisone, or for pregnant women and fetal safety, but not dexamethasone is preferred. In addition, the first 3 months of pregnancy should avoid systemic use of glucocorticoids. Certain glucocorticoid dependent asthma, systemic administration should be changed to inhaled drugs, including the preferred acid chloride Song times. For these patients, delivery process is the key, should be given adequate time to enter the delivery room of glucocorticoids, to prevent the delivery of physiological stress led to decreased in vivo glucocorticoid, asthma attacks. Non-steroid dependent asthma in pregnancy, it should be minimal with or without corticosteroids.

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