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