Treatment of angina in pregnant women in the 3rd trimester

Angina during pregnancy is quite common. This is due to a decrease in the immune defense of a woman's body during pregnancy. The body of the expectant mother undergoes some changes on the part of the endocrine, reproductive, cardiovascular, respiratory systems, which leads to a partial malfunction of the name system.

A woman becomes more susceptible to infectious pathogens, therefore, ARVI, exacerbations of chronic diseases are more often observed. In the third trimester of pregnancy, negative factors of an exogenous and endogenous nature affect the fetus to a lesser extent in comparison with the first months. This is due to:

practical complete formation of organs, systems of the fetus, so they are not so susceptible to mutations;
good protection of the placenta;
the development of some protective factors in the fetus.

The listed types of protection do not guarantee the absence of complications. There is still a high risk of fetoplacental insufficiency, fetal hypoxia, and premature birth.

The progression of angina contributes to the formation of abscesses, phlegmon in the oral cavity with spread to the fiber. As a result, the risk of swelling of the neck with difficulty breathing and the development of hypoxia increases. Bleeding is possible from the blood vessels that feed the tonsils when they are purulently melted. The condition requires immediate medical attention.

Generalization of streptococcal infection leads to systemic complications. Infection predisposes to the development of rheumatic fever with damage to the valvular apparatus of the heart, joints, (migratory polyarthritis), kidneys (glomerulonephritis). In sepsis, foci of infection can have different localization, for example, in the lungs, kidneys, skin.

With cardiac lesions, a woman is worried about angina pectoris, shortness of breath. On the electrocardiogram, with ultrasound, changes are recorded that are characteristic of the valve integument, myocarditis, endocarditis, pericarditis.

Renal dysfunction is manifested by pain in the lumbar region, dysuric disorders. In laboratory urine tests, bacteria, an increased level of leukocytes, erythrocytes, and protein are recorded. Ultrasound diagnostics reveals damage to the cups, pelvis, and kidney glomeruli.

How to suspect a sore throat?

The appearance of a sore throat is one of the first clinical signs that make it possible to suspect the presence of an inflammatory process in the tonsils, posterior pharyngeal wall.

Usually, the next day, malaise begins to bother, appetite decreases, body aches appear, which is a sign of intoxication syndrome. Fever at first does not exceed 37.5 degrees (with catarrhal sore throat), but can reach 39 degrees in case of development of purulent tonsillitis. With the progression of the disease, the pathological process spreads to the surrounding structures of the tonsils, the process of chewing, swallowing, opening the mouth becomes difficult.

The catarrhal form is characterized by an increase in the tonsils due to infiltrative processes, edema. They turn red, but they do not have a coating.
Follicular, lacunar forms develop with suppuration of follicles, which are visualized in the form of grains, with the accumulation of purulent masses in the lacunae. Purulent films appear on the surface of the tonsils. As a result, a pronounced intoxication syndrome develops.
The ulcerative-necrotic form is manifested by the formation of ulcerative foci on the surface of the tonsils. The plaque becomes dull, gray in color; when trying to remove it, a bleeding wound remains. The process gradually covers the posterior pharyngeal wall, palate, uvula, and arches.

Secondary forms of tonsillitis are also isolated, which develop as a complication of the underlying disease, for example, scarlet fever, infectious mononucleosis, enterovirus infection. Among the specific forms of angina, it is worth highlighting the fungal type, Simanovsky-Vincent tonsillitis.

Sore throat treatment

Complex therapy for tonsillitis allows you to achieve good results in a short time, thereby preventing the appearance of undesirable consequences. In order to minimize the load on the woman's body, eliminate pathogenic microorganisms and reduce the severity of clinical symptoms, it is recommended to adhere to the following directions in treatment:

adherence to a certain regimen of the day, nutrition;
fight against streptococcus;
reduction of the inflammatory process, damage to the tonsils;
prevention of febrile hyperthermia;
strengthening the immune system.

Now let's take a closer look at what is included in each treatment point.

Compliance with the regime

Due to the fact that the immunity of a pregnant woman is weakened, he needs strength to recover, therefore, angina during pregnancy requires bed rest for up to 10 days. During this period, the pathogen circulates through the bloodstream, so there is a high risk of complications.

Adequate antibiotic therapy allows you to cope with the pathogen in a shorter time, but the body still needs time to recover.

During the acute period, a woman can infect people around her, so the use of a medical mask is recommended.

Drinking plenty of fluids helps to speed up the elimination of toxic substances secreted by pathogenic microorganisms. As a result, the concentration of toxins decreases, the severity of the intoxication syndrome decreases, which leads to a decrease in hyperthermia.

The drinking regime may include compotes, juices, jelly, fruit drinks. The enveloping properties of the jelly prevent further damage to the tonsils, stimulate regenerative processes. In addition, it should be noted that a full-fledged drinking regimen prevents dehydration of the body associated with increased sweating, shortness of breath.

In the third trimester of pregnancy, the drinking volume should be calculated by the doctor to avoid the appearance of edema.

The "pregnant" period, especially after 6 months, is quite often characterized by edematous syndrome. This is due to the compression of veins, lymphatic vessels by an enlarged uterus, which makes it difficult for blood to drain from the lower extremities. The size of the uterus shifts the intestines, from which the woman experiences constipation, and pain in the lumbar region is caused by an increase in the load on the spine.

As for a nutritious diet, a woman is prohibited from adhering to strict diets, since the body must receive a sufficient amount of nutrients to replenish energy reserves and increase immune defenses.

During the period of illness, chicken broth, vegetable, fruit juices, light salads are recommended. Solid, fatty, fried, spicy foods, coffee, carbonated drinks should be excluded from the diet.

In addition, a pregnant woman needs:

avoid stress;
devote enough time to sleep, rest;
ventilate the room regularly.

It is prohibited in the treatment:

independently remove films from the surface of the tonsils, which predisposes the spread of infection, the formation of an open wound;
apply procedures associated with high temperatures, for example, hot compresses, showers, foot baths;
the use of antibacterial agents without prior agreement with a doctor, as well as premature termination of antibiotic therapy.

Earlier discontinuation of antibacterial agents leads to reactivation of pathogenic microorganisms, which is manifested by the return of clinical symptoms.It is worth noting that in this case it is advisable to prescribe antibacterial agents of another group, since the pathogen could already develop resistance to previous medicines.

The danger of incomplete antibiotic therapy lies in the persistence of streptococcus in the body, the risk of developing serious complications against the background of mild symptoms.

Antibiotics

Treatment of angina involves the use of antibacterial drugs necessary to eliminate the infectious pathogen. In the case of catarrhal sore throat, systemic antibiotics can be dispensed with, provided early diagnosis, the beginning of an intensive therapeutic course.

If a sore throat appears, a pregnant woman should immediately start gargling with antiseptic solutions.

Timely initiation of therapy allows you to stop the spread of infection, reduce the inflammatory process. Even if it turns out that this is a common pharyngitis, rinsing will only be beneficial.

Purulent forms of tonsillitis require the appointment of antibiotic therapy, taking into account the sensitivity of the pathogen. Usually the cause of sore throat is streptococcus, so drugs are used that have a detrimental effect on it.

Penicillins, for example Flemoxin, Augmentin, Amoxiclav. They are quite widely prescribed for pregnant women, since they do not have a negative effect on the fetus.
Cephalosporins (Cefalexin, Cefepim, Ceftriaxone, Cefuroxime). Prescribed in the absence of effect, intolerance to penicillins. Not toxic to the embryo.
Macrolides (Sumamed, Erythromycin) are used in a short course in the absence of the possibility of using the above antibiotics. There is a low risk of side effects, however, in consultation with a doctor, they can be prescribed.

We emphasize that not all antibacterial agents are approved for use in pregnant women in the 3rd trimester:

Doxycycline, tetracycline - easily penetrate the placenta, disrupt the exchange of minerals, are deposited in the tooth buds, bones, liver.
Fluoroquinolones (norfloxacin, ofloxacin), after overcoming the placental barrier, damage the articular structures (cartilage, ligaments, bones).
Macrolides (clarithromycin, roxithromycin) are toxic to the embryo.
Aminoglycosides (streptomycin, gentamicin), upon penetration to the fetus, affect the kidneys, hearing organs, which leads to deafness.
Co-trimoxazole (biseptol), when taken in high doses, overcomes the placental barrier, leading to the formation of heart defects, mutations.

Local treatment of affected tonsils

It is possible to act directly on the pathological focus with the help of solutions for local use. Thanks to regular rinsing and irrigation of the tonsil surface, it is possible to prevent the spread of infection and reduce inflammation.

Rinsing must be repeated every 2 hours, alternating with irrigation of the tonsils, resorption of tablet forms of drugs with antimicrobial action. Of the safest, widely used antiseptic solutions, we highlight the following.

Furacilin is an antimicrobial drug that has a detrimental effect on streptococci, staphylococci. To prepare the solution, dissolve 2 tablets in a glass of hot water, cool, use to gargle. Also, the medicine is sold in a ready-to-use form.
Chlorhexidine is an antiseptic that allows you to cleanse the tonsils from microbes, purulent films, and reduce inflammation. For rinsing, a ready-made solution of 0.05% is used. If a different concentration is indicated, dilution with boiled water is required before use.
Miramistin is a modern antiseptic with high efficiency. For the convenience of irrigation of the tonsils, the bottle is equipped with a special nozzle.
Ingalin is available in the form of a spray, solution, consists of an antiseptic, eucalyptus oil, mint. In addition to antimicrobial action, it has an anti-inflammatory, analgesic effect.
Chlorophyllipt is an extract from eucalyptus leaves. It has anti-inflammatory, antimicrobial effects. Releases in the form of a solution, spray, tablets.
For resorption, tablets Lizobact, Faringosept are prescribed.

From folk recipes, a solution of soda, salt (1 tsp each) is used in a glass of water. In the absence of an allergic reaction to iodine-containing drugs, you can add 2 drops of iodine. Rinse twice a day.

Fighting fever

Angina during pregnancy is often accompanied by hyperthermia. If the temperature reaches 37.5 degrees, a woman is advised to drink plenty of fluids, a warm shower, and wipe her body with a diluted vinegar solution.

When the temperature exceeds 38 degrees, in addition to the listed measures, it is necessary to take antipyretic drugs. Antipyretics should not contain aspirin.

Prolonged febrile / hectic hyperthermia leads to hypoxia, fetal growth retardation, placental insufficiency, and premature birth.

Prevention

Prevention of tonsillitis involves strengthening the immune system, preventing a decrease in immune defense even at the planning stage of pregnancy. Angina during pregnancy is quite common, but women need to try to avoid it. What is needed for this?

A prophylactic course of therapy for chronic diseases before pregnancy, which will reduce the risk of exacerbation of the pathology, which reduces the immune defense.
Treatment of infectious diseases at the stage of pregnancy planning.
A healthy diet ensures a sufficient intake of vitamins, proteins, fats, carbohydrates in the body of the expectant mother, fetus. Thanks to this, the development of the embryo proceeds in accordance with the gestational age.
A good rest, sleep.
Reducing the influence of stress to prevent hormonal fluctuations.
Regular airing of the room, wet cleaning, use of a humidifier.
Walks in the park area, trips to the forest, to the sea to change the climate, strengthen the immune system.
Dosed physical activity, such as water aerobics.
Clothing should be suitable for the weather, which will avoid hypothermia, the negative effects of drafts, getting wet in the rain.
Compliance with culinary technologies, which prevents the development of toxic infections, dysentery, salmonellosis. It is also recommended not to visit unverified catering facilities.
Compliance with personal hygiene, frequent hand washing.
Using a medical mask in a conversation with a sick person.
Crowds of people should be avoided, especially during periods of epidemic.

Finally, I would like to note that regular preventive examination by an obstetrician-gynecologist allows you to diagnose pathology in a timely manner. Timely started treatment is a guarantee of a mild course of the disease, preventing the development of severe complications.