Nasal obstruction during pregnancy, or rhinitis of pregnancy, has been accepted as a distinct and very common pathological and clinical entity for many years. It is believed to occur in anywhere from 5-32% of pregnant women and most commonly is first noted during the end of the first trimester, and may persist up to the time of delivery or a few weeks afterward. The nasal obstruction is associated with clear rhinorrhea and physical exam shows edematous nasal mucosa. This condition is caused by a number of related factors. The generalized increase in interstitial fluid volumes seen during pregnancy also affects the nasal mucosa, and is made worse by the direct effect of estrogen on the nasal mucosa, which causes increased vascularity and mucosal edema. Electronmicrographic and histochemical studies performed by Toppozada on the respiratory epithelium of pregnant women have suggested that an overactivity of the parasympathetic system leading to increased glandular secretion and vascular congestion is responsible for the state of nasal congestion. This overactivity of the parasympathetic system may be an allergic response to placental proteins, fetal proteins or a women's own sex hormones.
The treatment of this condition is complicated by the fact that many patients seek relief from over the counter topical decongestants, leading to a superimposed rhinitis medicamentosa, and the fact that the physicians are limited in terms of the medications that are safe to use during pregnancy. While the use of antihistamines has not been linked to any increases in the rate of fetal malformations, certain antihistamines carry a warning in the PDR that they should not be used during pregnancy. Systemic decongestants, while not teratogenic, carry the theoretical risk of causing placental insufficiency due to vascular constriction, and of aggravating hypertension of pregnancy. In light of this, the physician must carefully consider the risk benefit ratio before prescribing either of these two classes of medications Antibiotics should only be administered for specific infections, such as purulent sinusitis that may develop as a result of the generalized mucosal edema. Corticosteroid nasal aerosols may be very useful in refractory rhinitis of pregnancy as well as in treating superimposed rhinitis medicamentosa. Because of the very low systemic absorption seen at therapeutic dosages, the use of nasal steroids is safe during pregnancy. Lastly, intraturbinal corticosteroid injection, while not very popular, can be very effective in severe rhinitis, and has no risks other than those inherent to the procedure, namely inadvertent embolization to the retinal artery. The rate of systemic absorption is extremely low and thus its use during pregnancy is considered safe.
So I've been shooting Flonase. I've been taking Claritin. I'm huffing Vicks. I even ate Chinese for lunch just so I could eat the spicy mustard by the spoon. It's not helping. I need a decongestant. And now? I probably need an antibiotic too, because I'm pretty darn sure this has turned into a full blown sinus infection. I have "safed" myself into a sinus infection. Whee.
If there are any of you who know what I'm talking about and have some advice, please feel free to leave it for me.
Labels: General Bitching, Try Try Again----- COMMENT: AUTHOR: Tracy DATE:Tuesday, May 29, 2007 at 1:15:00 AM EDT I feel your pain. I, too, had rhinitis of pregnancy (about a year ago to the day!) and it was so bad that I ended up whacking my eardrum out of place and had to take nasal steroids in order to hear again out of one ear. I know this grosses a lot of people out, but may I highly recommend sinus washing. NeilMed makes a lovely nose douche that will clean out your sinuses and make you feel SOOOO much better! Promise! And there's no meds, so you don't have to worry about how it affects the baby! ----- COMMENT: AUTHOR: Paper Whore DATE:Tuesday, May 29, 2007 at 7:54:00 AM EDT I had that too in the first trimester of my pregnancy with Gavin. I ended up needing a prego-safe antibiotic (K-pac or K-flex or some ancient antibiotic). My doc also recommended the Robitussin that only has Guaifenesin in it (no other active ingrediants). You might ask your doctor about that, too. Are you going through your OB or PCP? I found I had much better luck with my OB because they were more current on what meds are safe for pregnancy. ----- COMMENT: AUTHOR: gail DATE:Tuesday, May 29, 2007 at 11:35:00 AM EDT Gah, suckage....... I hope you feel better soon! ----- COMMENT: AUTHOR: Oh, The Joys DATE:Tuesday, May 29, 2007 at 12:28:00 PM EDT Aw, nuts. That sounds sh*tty sh*tty sh*tty. ----- COMMENT: AUTHOR: KimmieRo DATE:Tuesday, May 29, 2007 at 1:08:00 PM EDT I recommend NeilMed too. It feels gross, like when you get water up your nose swimming- but it helps SO much. You can get it in the pharmacy section at most stores. All it is is warm water mixed with a little packet of baking soda and salt. So no drugs, just relief! ----- COMMENT: AUTHOR: Luanne DATE:Friday, June 1, 2007 at 10:48:00 AM EDT Hi. I just found your blog today from reading another. I am 25 wks. and have had a stuffy nose since at least wk. 6. I was told I could take the Robitussin DM, Sudafed, and Children's Benadryl to help me sleep. I was doing great with all that until about 3 days ago when my other children had a cold and shared with me so nicely. Now I feel as though I am back to square one. I have also used Afrin nasal spray, it dries you out in the nose and seems to help and I couldn't find anything dangerous on using it. Good luck! ----- COMMENT: AUTHOR: DATE:Friday, December 4, 2009 at 6:01:00 AM EST [url=http://community.bsu.edu/members/buy+online+Viagra.aspx]buy cheap Viagra online no prescription[/url]