ARVI during pregnancy is a group of clinically similar acute respiratory infections caused by pneumotropic viruses and developed during gestation. It is manifested by rapidly increasing catarrhal syndrome: runny nose, dry cough, sore and sore throat, hoarse voice. There are phenomena of general intoxication: fever, headache, weakness, bruising, myalgia, arthralgia. It is diagnosed with the help of PCR, a general blood test. In the course of treatment, antipyretic, expectorant, antitussive, mucolytic, anti—inflammatory, anti-obstructive drugs are used, in severe cases – donor immunoglobulin, interferon, its inducers, immunomodulators.
ICD 10
J00 B34
General information
According to experts in the field of infectious diseases, obstetrics and gynecology, the prevalence of ARVI during pregnancy reaches 55-82%. The incidence of influenza and other acute respiratory infections in pregnant women is slightly higher than in the general population, and the diseases themselves are longer, more severe, with more complications. When gestation is combined with acute respiratory viral infections, especially influenza, there is more often a need for hospitalization, and the risk of perinatal and maternal mortality increases. Respiratory infections are characterized by an epidemic course with a peak incidence from December to March and rapid spread among organized contingents of people, including in medical institutions.
Causes of ARVI during pregnancy
The causative agents of acute respiratory viral infections are the so-called pneumotropic viruses, which are transmitted mainly by airborne droplets. To date, more than 300 non-cellular infectious agents have been identified that cause colds during gestation. More than half of pregnant women develop the disease when infected with parainfluenza viruses, 15% — influenza viruses of types A and B, 5% — adenoviruses, 4% — pathogens of respiratory syncytial infection, 1.2% – enteroviruses, less than 1% of cases — rhinoviruses, coronaviruses, reoviruses. In 23% of patients, ARVI has a mixed etiology.
The more frequent occurrence and prolonged complicated course of respiratory infections during pregnancy is associated with physiological changes occurring in the body of a woman carrying a child. According to the majority of obstetricians and gynecologists, specific gestational factors affecting the development of ARVI in pregnant women are:
- Decreased immunity. Immune restructuring during pregnancy is aimed at preventing rejection of the fetus, which is genetically alien to the female body. Immunosuppression occurs due to increased levels of progesterone and cortisol. The cellular link of the immune system, which plays a key role in the rapid elimination of the pathogen, is more strongly suppressed.
- Hyperventilation of the lungs. To ensure sufficient oxygenation of the tissues of the mother and the growing fetus, the bronchopulmonary system gradually switches to the diaphragmatic type of breathing. Due to the strengthening of the diaphragm excursions, better ventilation of the alveoli is provided. At the same time, optimal conditions are created for the penetration of viruses into the lower respiratory system.
- Swelling of the mucosa of the tracheobronchial tree. Due to the physiological increase in the volume of circulating blood and concomitant arteriolodilation, a pregnant woman has a fullness of capillaries, leading to swelling of the mucous membranes. Since such changes are similar to inflammatory edema, the addition of infection makes the clinical symptoms more pronounced.
Pathogenesis
Most catarrhal infections caused by viruses are anthroponoses, less often the disease is spread by mammals and birds (swine flu, avian flu). The leading way of infection with ARVI during pregnancy is the airborne transfer of the pathogen from the carrier, the patient, less often — convalescent. Sometimes viruses are transmitted by contact (through a handshake, contaminated environmental objects). The entrance gate usually becomes the epithelium of the nose, nasopharynx, larynx, trachea, bronchi, sometimes the virus is introduced into the mucous membranes of the eyes, gastrointestinal tract. First, the infectious agent attaches to the epithelial cell, then penetrates into it and begins to replicate. The destruction of epithelial cells is accompanied by the spread of viral particles through the mucosa with the development of a local inflammatory reaction.
The ingress of the ARVI pathogen into the bloodstream leads to general intoxication. In response to the presence of viral antigens, protective reactions are activated in the form of lymphocyte proliferation (mainly type T) and enhanced interferon synthesis. After complete elimination of the virus in the uncomplicated course of the cold, the respiratory tract is cleared of the affected epithelial layers. With weakened immunity, the alveoli of the lungs, the mucous membranes of the paranasal sinuses, and the tympanic cavity are involved in the process. In severe cases, the placenta becomes infected, which leads to disruption of fetoplacental blood flow, delayed development and stillbirth.
Symptoms of ARVI during pregnancy
Due to a decrease in immunity in pregnant women, the incubation period is usually shortened to 2-3 days. With high virulence of the pathogen, the first signs of infection may occur several hours after infection. The clinical picture of most catarrhal viral infections is similar. Catarrhal symptoms during pregnancy usually increase gradually, but more quickly than outside of gestation: a woman complains of a runny nose, tickling, sore throat, dry cough, hoarseness of voice.
Viral intoxication is most pronounced in influenza, with other respiratory infections, dizziness, headache, bruising, weakness, soreness of muscles and joints are moderately pronounced. Appetite often decreases. Sometimes there is nausea, vomiting, with adenovirus infection — photophobia, pain, pain in the eyes, enlargement of the cervical and submandibular lymph nodes. Hyperthermia up to 38 ° C is observed within 3-5 days, with influenza — up to 39-40 ° C. Influenza infection is also characterized by redness of the face, neck, mucous membranes, injection of sclera. The duration of the acute period is usually from 7 to 10 days. During the convalescence period, a wet cough with the discharge of mucosal sputum is detected.
Complications
Intense coughing and sneezing caused by acute respiratory viral infections are accompanied by an increase in pressure in the abdominal cavity. This can provoke an increased tone of the uterus and, as a result, increase the risk of termination of pregnancy by spontaneous miscarriage or premature birth by up to 25-50%. Due to nasal congestion and deterioration of ventilation associated with mucosal edema, gas exchange in the lungs is disrupted, blood oxygen saturation decreases, as a result of which fetal hypoxia may occur. Viral damage to placental tissue leads to the development of fetoplacental insufficiency, premature aging of the placenta. After catarrhal infections, 3.2% of pregnant women have premature placental abruption, more often there is weakness of labor, bleeding during childbirth.
Infection with ARVI in the first trimester of pregnancy with transplacental transfer of the virus provokes damage at the cellular level, leads to the formation of true malformations, fetal death, frozen pregnancy. The risk of teratogenesis is especially high (up to 10% of all cases of the disease) in pregnant women with influenza. With intrauterine infection in the II-III trimesters, early and late fetopathies with inflammatory lesions of individual organs (meningitis, encephalitis, pneumonia), generalization of inflammation, the formation of multiple anomalies, antenatal death or fetal development delay are detected. After birth, children often look sluggish, inactive, they have various respiratory disorders.
During pregnancy, acute respiratory viral infections worsen the course of early toxicosis, gestosis, and may be complicated by secondary infections caused by activation of opportunistic microflora against the background of immunosuppression. Most often, acute sinusitis, purulent otitis media, bronchitis, bacterial pneumonia develops. Possible exacerbation of chronic infectious and somatic diseases — rheumatism, pancreatitis, cholecystitis, pyelonephritis, glomerulonephritis. Rare but severe complications of ARVI are secondary myocarditis, pericarditis, myositis, meningoencephalitis, polyneuritis, neuralgia, Reye’s syndrome, toxic-allergic shock.
Diagnostics
During the epidemic, the diagnosis of acute respiratory viral infection during pregnancy does not present any difficulties. In such cases, diagnosis is carried out on the basis of a characteristic clinical picture with catarrhal symptoms and intoxication. In case of sporadic cases of the disease that occurred outside the period of the epidemic outbreak, it is recommended:
- Blood test. Usually, with ARVI, leukopenia, normal or reduced ESR is observed. The number of lymphocytes is often increased due to the T-fraction. A sharp increase in leukocytosis and ESR is a prognostically unfavorable sign and often indicates the addition of a secondary bacterial infection.
- Serological methods. For express diagnostics of seasonal influenza A, B, parainfluenza, adenoviruses, respiratory syncytial viruses, ELISA is used, with the help of which viral antigens are detected in epithelial cells, and PCR diagnostics, which allows detecting the genetic material of pathogens in clinical samples.
Radiography of the lungs, paranasal sinuses is prescribed only for vital indications with reasonable suspicion of secondary pneumonia or sinusitis. To exclude the risk of miscarriage and fetal malformations at 17-20 weeks, the determination of the levels of chorionic gonadotropin and alpha-fetoprotein is shown. The assessment of the probability of premature birth in acute respiratory viral infections at 22-34 weeks of gestation is carried out taking into account data on the content of hormones of the fetoplacental complex (placental lactogen, progesterone, estriol, cortisol).
CTG, fetometry, and phonocardiography are recommended to monitor the condition of the fetus in the third trimester. Possible pathology of the placenta is detected by ultrasound and dopplerography of the uteroplacental blood flow. Differential diagnosis is carried out between different types of acute respiratory viral infections, with highly contagious viral infections (rubella, measles, scarlet fever), bacterial diseases (sore throat, acute pharyngitis, laryngitis, tracheitis, bronchitis, pneumonia). According to the indications, the patient is examined by an infectious disease specialist, a pulmonologist, an ophthalmologist, an otorhinolaryngologist, a neurologist.
Treatment of ARVI during pregnancy
When choosing a medical tactic, the gestational age, the type of pathogen, and the features of the course of the disease are taken into account. Termination of pregnancy in the early stages due to possible fetal abnormalities is recommended only for serologically confirmed influenza. In other cases, gestation can be maintained. Non-drug methods play an important role in correcting the condition of a pregnant woman: providing physical and emotional rest, bed rest if necessary, 7-8-hour night sleep, steam inhalations with herbal decoctions or ready-made inhalation mixtures, aromatherapy. For faster removal of intoxication, it is useful to drink up to 1.5-2 liters of liquid per day, especially acidic drinks. A full-fledged protein diet is recommended, supplemented with products that contain vitamin C (citrus fruits, cabbage, currants, apples) and folic acid (legumes, potatoes).
The possibilities of etiotropic treatment of acute respiratory viral infections are limited by the narrow spectrum of action of drugs, their damaging effect on the fetus, the unexplored side effects of some new drugs. In severe cases of influenza, it is permissible to administer a donor anti-influenza immunoglobulin. To reduce the duration of the disease and reduce the likely complications during pregnancy, pathogenetic therapy can be carried out, including:
- Interferon and its inductors. Due to the risk of gestation interruption, recombinant human interferon is prescribed from week 32 only for severe acute respiratory infections. Although modern stimulators of interferogenesis enhance the synthesis of their own α- and β-interferons with high antiviral activity, they are used in exceptional cases, since the effect of interferon inducers on the fetus has not yet been sufficiently studied.
- Immunomodulators. In pregnancy without rhesus conflict, regardless of the term, it is permissible to prescribe drugs based on imunofan. These agents enhance the production of specific antiviral antibodies, have a pronounced detoxifying effect, and increase the stability of epithelial membranes. Multivitamin complexes and some homeopathic remedies have a moderate immunostimulating effect.
Depending on the clinical symptoms, the patient is undergoing symptomatic therapy using antipyretic, expectorant, antitussive, mucolytic, anti-inflammatory and anti-obstructive agents approved for use during pregnancy. Antibiotics are prescribed only when bacterial complications occur.
The preferred method of delivery is natural childbirth. Since in the acute period of acute respiratory viral infections, the risk of labor anomalies, bleeding, and postpartum purulent-septic diseases increases significantly, pregnancy is recommended to be prolonged until clinically pronounced catarrhal symptoms subside, while simultaneously preventing fetal hypoxia. Anesthesia is indicated in childbirth, after childbirth — the introduction of uterotonics and preventive antibiotic therapy. Caesarean section is performed when obstetric indications are detected.
Prognosis and prevention
Uncomplicated forms of ARVI during pregnancy pass independently or against the background of minimal therapy for 7-10 days. When complications appear, the prognosis becomes more serious. Prevention during the epidemic is aimed at excluding viruses from entering the mucous membranes: limiting the time spent in crowded places, treating the mucous membranes before leaving the house with oxoline ointment, wearing gauze or disposable bandages, rinsing the throat and nose with saline solution after returning from a walk. The effectiveness of seasonal immunization against influenza before planning pregnancy or in the I-II trimesters reaches 55-90%. To increase overall resistance, sufficient rest and sleep, proper nutrition, stress elimination, and vitamin and mineral complexes are recommended. Taking into account the severity of possible complications, when the first signs of ARVI appear, a pregnant woman should immediately contact a women’s consultation.
