Angina during pregnancy in the first trimester and at a later date: treatment, consequences
The content of the article:
- The causes of angina
- Symptoms of sore throat in pregnant women
- The effect of angina on the embryo, fetus, consequences for the child
- Diagnostics
- Treatment of angina during pregnancy
- Video
Angina during pregnancy can develop at any time. The danger of the disease is the development of early and late consequences for the mother and child. There is also a risk of transition of pathology into a chronic course. The method of therapy should be determined by the physician. Early diagnosis is extremely important for the choice of tactics for managing a pregnant woman.
If symptoms of a sore throat appear, a pregnant woman should consult a doctor as soon as possible.
Angina, or acute tonsillitis, is a common acute disease characterized by damage to the lymphoid tissue of the tonsils with a high risk of complications.
Treatment of angina in the first trimester of pregnancy, as in the second and third trimester, depends on the etiological agent, the state of the mother's body and the degree of development of the fetal organ systems.
The causes of angina
The causative agent of sore throat can be viruses, bacteria and atypical microflora.
A sore throat is most often caused by viruses or bacteria
The development of inflammation of the tonsils is facilitated by the presence of acute and chronic foci of upper respiratory tract infection, a decrease in general and local immunity, adverse environmental conditions, carious teeth, concomitant chronic somatic diseases in the stage of exacerbation or decompensation (diseases of the lungs and cardiovascular system), metabolic disorders (obesity), endocrine system pathology (hypothyroidism, diabetes mellitus).
Due to hormonal and physiological changes in the body during pregnancy, in the event of a disease, pregnant women are at greater risk of developing complications.
The greatest danger of a viral or bacterial infection is in the period up to 12 weeks, when the organs and tissues of the unborn baby are laid.
Viral sore throat, transferred in the second half of pregnancy, is a risk factor for the development of intrauterine infection due to transplacental transmission of the virus to the fetus. Respiratory viruses that cause perinatal damage, in 11% of cases, can persist and multiply in the placenta, fetal brain and choroid plexuses of the lateral ventricles of the brain.
Enterovirus infections are quite common. Enteroviruses are transmitted to pregnant women through direct contact with a patient with an intestinal infection or with damage to the upper and lower respiratory tract.
With the development of angina in early pregnancy against the background of influenza or parainfluenza, miscarriages are noted in 25-50% of cases. The frequency of defects is low.
With herpes sore throat, heart defects, abnormalities in the development of the gastrointestinal tract, hydrocephalus, pneumonia, jaundice, anemia may occur. Also, infection of the fetus with the herpes virus leads to spontaneous abortion, premature birth.
In most cases, the cause of bacterial sore throat is pyogenic streptococcus
The most common cause of angina is a bacterial infection: staphylococci, streptococci, diplococci, Haemophilus influenzae, anaerobes, spirochetes, chlamydia, mycoplasma and others.
Among bacterial pathogens, beta-hemolytic group A streptococcus, or pyogenic streptococcus, is of great importance.
The source of infection is a sick person during an exacerbation or a carrier of bacteria. Transmission mechanism: airborne, contact, food. The pathogen can penetrate the fetus through the placenta and cause pathological changes in developing organs.
Symptoms of sore throat in pregnant women
Clinical manifestations of angina in pregnant women include:
- sore throat, worse when swallowing and talking;
- an increase in body temperature up to 38 ° C and above;
- headache, chills, joint pain, weakness;
- fibrinous or purulent plaque on the surface of the tonsils and in the lacunae;
- enlargement and soreness of the lymph nodes in the corner of the lower jaw.
Usually the symptoms of angina are complemented by inflammation and soreness of the lymph nodes in the area of the angle of the lower jaw.
Sore throat is especially difficult in late pregnancy. Oxygen uptake increases progressively in the second and third trimesters. The growing fetus puts pressure on the diaphragm, making breathing difficult, especially when exercising or moving. Therefore, any inflammatory changes in the upper respiratory tract can affect the general condition, leading to the development of tissue hypoxia in the mother and fetus.
Physiological immunosuppression of pregnant women can contribute to the generalization of inflammation and an increased risk of bacterial complications.
Why is streptococcal sore throat dangerous for an expectant mother? The danger lies in the development of early (abscesses, neck phlegmon, otitis media) and late (acute rheumatic fever, myocarditis, polyarthritis, glomerulonephritis) complications, as well as the risk of becoming a chronic disease.
The effect of angina on the embryo, fetus, consequences for the child
When an infection occurs during pregnancy, the embryo and fetus are affected not only by pathogens, but also by toxic products that are formed as a result of metabolism in the mother during the decay of the infectious agent. Also, hyperthermia and hypoxia, which occur during an acute inflammatory process, have an effect.
One of the possible complications of angina in pregnant women is placental insufficiency
The consequences of angina in the 1st trimester of pregnancy depend on the gestational age: in the first 6 days after fertilization, the zygote may die or completely regenerate; during the period of embryo and placentogenesis (from the 7th day to the 8th week of pregnancy), fetal death, the development of deformities, and primary placental insufficiency are possible.
Angina in the 2nd trimester is dangerous by the development of sclerotic changes in organs and tissues. Formed pathology of various organs and systems of the fetus with angina in the second trimester of pregnancy can be determined using ultrasound.
The third trimester is characterized by the fact that the fetus acquires the ability to specifically respond to the introduction of the causative agent of infection by leukocyte infiltration, humoral and tissue changes.
In the presence of a purulent-inflammatory focus in the mother's body, for example, an abscess, hematogenous infection of the fetus is possible. In this case, bacterial damage to the placenta with subsequent violation of the placental barrier leads to the spread of bacteria through the bloodstream and the development of intrauterine sepsis.
In severe cases, the outcome of an infection that affects the fetus may be:
- death of the ovum;
- spontaneous abortion;
- premature birth (for example, premature birth at 37 weeks against the background of fetal hypoxia);
- intrauterine growth retardation;
- antenatal death;
- placental insufficiency;
- violation of the adaptation of the newborn;
- various manifestations of a local and generalized infectious process.
Diagnostics
On examination, pharyngoscopy is performed. The pharyngoscopic picture of acute inflammation of the tonsils is characterized by hyperemia and tissue edema. Purulent plugs are visualized in the lacunae.
Pharyngoscopy is performed to confirm the diagnosis.
In the diagnosis of tonsillitis, the main method is bacteriological inoculation of the discharge from the mucous membrane of the tonsils and oropharynx with the determination of sensitivity to antibiotics. In some cases, an additional PCR (polymerase chain reaction) method is required to identify certain DNA or RNA fragments of the pathogen cells.
The doctor usually prescribes a bacteriological culture of secretions from the mucous membrane of the oropharynx and tonsils
There is also a method for the rapid diagnosis of streptococcal infection, based on the determination of the antigen of group A beta-hemolytic streptococcus, without prior isolation of a pure culture of the pathogen. The test detects the presence of bacteria within 5-10 minutes. But in parallel, a classical bacteriological culture is prescribed to confirm the preliminary diagnosis and possible correction of treatment.
The relevance of early diagnosis of streptococcal tonsillitis is determined by the need for timely, rational antibiotic therapy and prevention of complications that are dangerous for both the mother and the fetus.
At the stage of primary diagnosis, a clinical blood test and a general urine analysis are performed.
Electrocardiography is recommended to exclude cardiac pathology. According to indications, the pregnant woman is sent for a consultation with a rheumatologist, cardiologist, infectious disease specialist, immunologist, endocrinologist, dentist.
Treatment of angina during pregnancy
Given the brightness of the clinical manifestations of angina, the severity of the woman's condition and the risk of complications, hospitalization is often required.
How to treat a sore throat and what, only a specialist decides. After examination, taking material for research, the doctor assesses the severity of the patient's condition and determines what can be prescribed at this stage of pregnancy, because not all drugs are safe for the fetus.
A pregnant woman with acute tonsillitis can be observed simultaneously by several specialists: obstetrician-gynecologist, infectious disease specialist, otorhinolaryngologist, cardiologist, rheumatologist.
Treatment of angina at home is carried out after consulting a doctor, as a rule, in the absence of an elevated body temperature, which can be regarded as a mild course of the disease with minimal risk to the mother and unborn child.
When the body temperature rises above 38 ° C, the antipyretic drug that can be drunk at any stage of pregnancy is Paracetamol. It can be taken at 500 mg no more than 4 times a day.
As a local therapy, Miramistin solution is often prescribed
It is recommended to gargle with a solution of Furacilin, Miramistin, inhalations with mineral water, a solution with sea salt.
The use of antibiotics in pregnant women is possible only in cases where the indications or the expected effect of therapy outweighs the potential risk to the fetus. At the same time, it is safe to prescribe penicillins, inhibitor-protected penicillins, cephalosporins. Tetracyclines, doxycycline, fluoroquinolones, co-trimoxazole and sulfonamides are contraindicated during pregnancy.
Considering what formidable consequences angina can have, it is very important to consult a doctor in a timely manner to select adequate treatment and prevent complications.
Video
We offer for viewing a video on the topic of the article.
Alina Ervasova Obstetrician-gynecologist, consultant About the author
Education: First Moscow State Medical University. THEM. Sechenov.
Work experience: 4 years of work in private practice.
Found a mistake in the text? Select it and press Ctrl + Enter.
