Pneumonia in pregnancy

Introduction to pregnancy complicated with pneumonia Pregnancy with pneumonia is inflammation of the lung parenchyma caused by different pathogens, often involving small bronchi and alveolar. It is a serious medical complication during pregnancy. Although it is rare during pregnancy, it is one of the common causes of non-obstetric infection in pregnant women. It is also one of the main causes of non-obstetric death. basic knowledge The proportion of illness: 0.021% Susceptible population: pregnant women Mode of infection: respiratory transmission Complications: bacteremia, sepsis, shock, disseminated intravascular coagulation, adult respiratory distress syndrome, renal failure, premature delivery

Pregnancy with pneumonia

(1) Causes of the disease

Bacteria, viruses, fungi, and protozoa can cause pneumonia. More than 50% of acute pneumonia is caused by Streptococcus pneumoniae infection, followed by viral infection, and Pyreneoplasma pyogenes, Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella, etc. can also cause Pneumonia, the most common type of pregnancy with pneumonia is pneumococcal pneumonia and varicella viral pneumonia. The pathogen invasion is mainly caused by aspiration of the oropharyngeal colonization bacteria with secretions and aerosol inhalation, causing direct planting of bacteria, adjacent parts. Spread of infection or other parts of the bloodstream is rare.

(two) pathogenesis

Reduced immune function during pregnancy, affected by progesterone after pregnancy, respiratory mucosal congestion, edema, thickening, increased respiratory secretions, is not conducive to the local defense mechanism of the respiratory tract, pregnancy with anemia, asthma, tuberculosis, pregnancy-induced hypertension, smoking, drug abuse, When infected with HIV, it is easy to cause lung infection.

1. The effect of pregnancy with pneumonia on pregnant women It is generally believed that the effect of pregnancy with pneumonia on pregnant women is greater than that of non-gestational pneumonia. The mortality rate of pregnant women with pneumonia is 0 to 4%, and Yost reports that 133 cases of pregnancy are combined. There is no case of maternal death in pneumonia. The level of mortality is related to the severity of the disease and whether it is given reasonable treatment. Due to the unique physiological state during pregnancy, some complications of pneumonia during pregnancy with pneumonia are also significantly increased compared with non-pregnancy. The incidence of mechanical ventilation, empyema, pneumothorax, cardiac tamponade and atrial fibrillation increased, and the occurrence of these complications was also closely related to the patient's visit.

2. The effect of pregnancy with pneumonia on the fetus The size of the fetus depends on the severity of pneumonia. The prevalence of preterm birth in general pregnancy with pneumonia is 4% to 44%. Madinger reported that 5 cases of premature delivery occurred in 5 cases of pregnancy complicated with pneumonia. Berkowitz reported that neonates with pregnancy-associated pneumonia had an average body weight of 400 g less than the control group, and the intrauterine mortality rate was 2.6%, while Madinger reported a 12% intrauterine mortality rate.

3. Does pregnancy increase the risk of pneumonia? The physiological changes in the respiratory system during pregnancy make pregnant women more susceptible to pneumonia. Due to a series of changes in maternal immune function during pregnancy, such as lymphocyte proliferative response decline in the middle and late stages of pregnancy, the activity of natural killer cells declines. The number of helper T lymphocytes is reduced. In addition, it has been found that trophoblast cells can produce an immunosuppressive substance to reduce the maternal ability to recognize the tissue-compatible antigen of the fetus. The physiological changes of these immune functions affect the fetus in intrauterine growth and pregnancy. It is important to maintain it, but this cell-mediated reduction of immune function also reduces the immune function of the mother's external pathogens, so that during pregnancy, infectious diseases that are caused by low cellular immune function are more likely to occur. Pneumonia, especially viruses and fungi, are more likely to erode the body during pregnancy and cause disease. In addition, as the gestational age increases, the uterus gradually increases, the lateral sacral elevation increases by 4 cm, and the transverse diameter of the thoracic cavity increases by 2 to 4 cm. Increased by 5 to 7 cm, these physiological changes make it difficult for the secretions of the respiratory tract of pregnant women to be completely removed. Airway obstruction is aggravated, which increases the incidence of pulmonary infection. The elevation of the diaphragm increases the functional residual capacity and increases the oxygen consumption by 20%. This makes the pregnant woman's tolerance to hypoxia decrease. This performance is more pronounced in the third trimester.

Pregnancy with pneumonia prevention

1. General precautions for pneumonia

(1) Eat high-protein, high-calorie and vitamin C-rich foods to increase the body's resistance.

(2) Keep warm when the weather changes suddenly.

(3) During the epidemic of viral or bacterial infections, minimize access to public places, avoid contact with infected people, and avoid contact with infected parrots, birds or poultry to prevent the occurrence of parrot fever pneumonia.

(4) Strengthen the sanitation management of water supply systems, humidifiers, sprayers, etc. of air conditioners to reduce the infection of pneumococcal disease.

2. Specific preventive measures for pneumonia Currently, there have been great progress in the development and application of immunoglobulins and various pneumonia-specific vaccines during pregnancy, but most of the preventive effects are poor.

(1) Pneumococcal vaccine can be used to prevent pneumococcal pneumonia and reduce the emergence of drug-resistant pneumococci. This vaccine is recommended for pregnant women with sickle cell anemia, but normal healthy pregnant women do not advocate it.

(2) The flu vaccine is of protein origin and is safe for pregnant women. It is recommended that all pregnant women in the second trimester should be vaccinated against influenza.

(3) If pregnant women exposed to varicella virus infection suspect suspicious varicella virus infection, varicella zoster immunoglobulin (VZIG) should be used to prevent or reduce the symptoms of varicella virus infection within 96 hours after exposure. Usually the dose is 12.5 U / kg intramuscular, but this passive immunization method is limited to patients with protective immunodeficiency, recently developed an attenuated liver virus vaccine, can reduce the incidence of pregnancy with varicella virus infection, but not During pregnancy, this vaccine may be used for immunization prevention in women of childbearing age who are serologically proven to be susceptible to varicella virus or varicella virus, but should be vaccinated for at least 3 months before gestation.

Pregnancy with pneumonia complications Complications bacteremia septic shock diffuse intravascular coagulation adult respiratory distress syndrome renal failure premature delivery

Pneumonia in pregnancy is often severe, easy to develop into bacteremia or sepsis, can cause toxemia due to endotoxin, shock, disseminated intravascular coagulation, adult respiratory distress syndrome, heart failure, renal failure, etc. Multiple organ failure (MSOF), with serious consequences, can lead to death, affecting perinatal children can cause fetal death, premature birth, low birth weight and intrauterine infection (especially viral pneumonia).

Pregnancy with pneumonia symptoms Common symptoms Bronchoalal alveolar chest pain Mucus purulent cough foam mucus dyspnea

Lobular pneumonia

The incubation period is 1 to 2 days, and the onset is urgent. About 50% of the patients have a harbinger of upper respiratory tract infection or have cold, tiredness and other incentives, followed by fever, chills, cough, chest pain, cough mucus or rust stain, lesions Difficulty breathing and cyanosis occur frequently. If not treated in time, there may be confusion, convulsions, coma, shock, sometimes complicated with pleurisy and pericarditis. Typical signs are tactile speech tremor, percussion dullness, auscultation, reduced breath sounds, audible And bronchial breath sounds, the pathogens are more common with pneumococcus, streptococcus, staphylococcus, Klebsiella, and Escherichia coli.

2. Lobular pneumonia

The lesions are in the bronchioles, interstitial lungs and alveoli. The clinical manifestations are fever, headache, myalgia, cough, cough foam mucus or mucopurulent sputum. The signs are slightly turbid in the middle and lower part of the lung, and the auscultation is low. Bronchoalveolar sound, and there is a wet voice, the pathogen is more common with viruses, mycoplasma, and rickettsia.

Interstitial pneumonia

The lesion site is in the bronchial wall, the peribronchial tissue and the alveolar wall. The inflammation spreads along the interstitial lymphatic vessels, causing localized lymphangitis and lymphadenitis. The clinical manifestations are hypothermia, cough, myalgia and mucous sputum. The signs are not obvious. The pathogen Viruses such as measles, varicella-zoster virus are more common.

Examination of pregnancy complicated with pneumonia

The pathogen diagnosis is mainly based on respiratory secretions, sputum, blood or pleural effusion examination and culture, specific antibody detection, PCR detection of specific pathogen DNA and other methods. Currently, it is not sensitive and simple for Chlamydia pneumoniae pneumonia. The diagnosis method, parrot fever pneumonia mainly based on the presence or absence of occupational history, exposure history, blood and bronchial secretions for bacterial culture to find pathogens, double serum antibody titer has a 4-fold increase or a single titer of 1:64 or more has a diagnosis Value, currently using direct immunofluorescence, has high sensitivity and specificity.

Chest X-ray examination: can understand the location and extent of pneumonia, and is helpful for estimating the condition and pathogen. The X-ray of lobar pneumonia is characterized by dense and dense shadows caused by lung parenchymal lesions, and bronchial airway signs and lobular pneumonia can be seen. The X-ray showed irregular flaky or spotted edge blurred shadows distributed along the lung texture. The X-ray of interstitial pneumonia showed a thin, dense, irregular strip-like shadow on one or both sides of the lung. The hilar is stretched outwards, interlaced into a network, with diffuse small dot-like density in the middle, and the hilar lymph nodes on both sides are enlarged and the edges are blurred. It is generally not suitable for X-ray examination during pregnancy. Protect it.

Diagnosis and differential diagnosis of pregnancy complicated with pneumonia

The diagnosis of pneumonia is mainly based on medical history (including epidemiological history), typical symptoms, signs and X-ray examinations. The symptoms are often different due to different pathogens and conditions. If pregnant women have symptoms such as low fever, nasal congestion and mild cough, they cannot be easily diagnosed. Upper respiratory tract infection without severe treatment.

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