Treatment of inflammation of the maxillary sinuses (sinusitis) in pregnant women, as well as in other groups of patients, depends entirely on the type and severity of the pathology. However, the treatment of pregnant women is significantly complicated by numerous contraindications, therefore, drug therapy and the use of any methods of traditional medicine must be agreed with the doctor. Considering the danger of sinusitis during pregnancy (hypoxia, which can affect the development of the fetus, meningitis, neuritis of the facial nerve, impaired functioning of the organs of hearing and vision, sepsis, etc.), it is not always possible to exclude antibiotics from the list of drugs. However, the danger of their use is often greatly exaggerated.
Types and symptoms of sinusitis
Usually the question "how to treat sinusitis during pregnancy" causes a lot of controversy. However, as mentioned above, the choice and intensity of therapy directly depend on the form of the disease. That is, harmless washing and warming up are appropriate for mild viral sinusitis, but they will not give any effect in bacterial inflammation, which can only be cured with antibiotic therapy. That is why it is important to be able to distinguish between the types of the disease, correctly and in time to identify their symptoms.
So, based on the nature of the pathogen, distinguish between viral (milder form) and bacterial (more severe form) sinusitis. Often, purulent inflammation caused by bacteria develops against the background of viral pathology - a mixed type.
Depending on the location of the focus of infection, one-sided (inflammatory processes in only one sinus) and bilateral (inflammatory processes in both sinuses simultaneously) types of the disease are distinguished.
In addition, sinusitis is classified according to the form of inflammation: catarrhal, purulent, allergic and odontogenic.
The features and speed of the pathology indicate its acute or chronic nature. The most difficult in terms of symptoms and course, as well as its dangerous consequences and the need for active treatment, is bacterial (purulent) inflammation, in which pregnant women need to take antibiotics.
During pregnancy, even with the simplest rhinitis (runny nose), women are advised to see a doctor. It is a cold, let go by itself, or its improper treatment in most cases that lead to the development of sinusitis. If a woman is still trying to heal at home, then it is important to pay attention to the following symptoms, which indicate bacterial inflammation and signal the need to seek medical help as soon as possible. To such manifestations of ARVI, such as nasal congestion and partial loss of smell, are added:
- yellowish or greenish nasal discharge with an unpleasant odor;
- pain, feeling of pressure in the head and in the area of the bridge of the nose;
- pain on palpation of the location of the maxillary sinuses;
- swelling of the face;
- subfebrile temperature (37.1 - 38 degrees).
Medication for sinusitis
During pregnancy, any drug therapy is undesirable. On the other hand, if the disease has already begun to develop, then it is better to cope with it in the early stages in order to prevent the development of complications. So, viral sinusitis in most cases appears during ARVI. Getting into the nasal passages, the virus also penetrates the paranasal sinuses and causes an intensive production of mucus there. It is impossible to neglect the treatment of the common cold at this stage, since a timely cured ARVI will simultaneously relieve the patient of inflammation in the sinuses, thus preventing the attachment of pathogenic microorganisms to the contents of the sinuses.
If the symptoms indicate that pathogens have already entered the sinuses, treatment should begin immediately, since the mucous masses will gradually begin to turn into purulent ones.
In such a situation, antibacterial drugs become the main weapon in the fight against the disease, the action of which is aimed at destroying the bacteria that cause inflammation. Antibiotics are considered to be a strong and dangerous medicine, but the modern pharmacological market offers a wide range of drugs, many of which do not have a strong toxic effect on the body of the expectant mother. If the disease has not yet turned into a particularly severe form, then doctors select the most effective of the least aggressive antibiotics.
During the use of such drugs, it is important to strictly adhere to the doctor's prescriptions regarding the doses and rules for taking the medication. In addition, it is imperative to check the contraindications and dosage indicated in the instructions for the drug. Self-reducing doses or interrupting the course (usually lasting about 10 days) after the first improvements, designed to soften the blow to the body, in fact, only harm. Some bacteria can remain alive and develop resistance to the antibiotic taken.
It should also be borne in mind that there are a large number of antibiotics that can be used only at a certain stage of pregnancy. For example, many medications are strictly contraindicated during the first trimester, but will have the necessary therapeutic effect on the mother's body and will not harm the baby during the third trimester. 
If, according to the doctor, the severity of the disease is not too high, then the patient may be prescribed topical antibiotics (drops, sprays), which go directly to the site of infection, bypassing the gastrointestinal tract. If experts believe that such treatment is not enough, then, as a rule, systemic antibiotics are prescribed in the form of tablets:
- Penicillin. They are easily tolerated by the body, practically do not cause side effects and do not affect the development of the fetus. However, their disadvantage is that many pathogens are already resistant to them. This group includes Amoxiclav, Flemoxin solutab.
- Macrolides. They are used in case of intolerance to antibiotics-penicillins. This group includes Makropen, Sumamed.
- Cephalosporins. Stronger drugs that are prescribed for severe inflammation. This includes Cefuroxime, Ceftriaxone.
In addition, in order to relieve edema and establish normal air exchange, as well as improve the outflow of mucopurulent masses from the maxillary sinuses, doctors may prescribe vasoconstrictor drops to patients. Their appointment, like any drug therapy, is undesirable, but if the potential benefit outweighs the risk, then their use is possible. As a rule, the duration of the course is only a few days, since such drugs are addictive and can provoke many side effects.
Finally, if bacterial sinusitis is caused by odontogenic problems, then it cannot be cured without consulting a dentist. Inflammation of the paranasal sinuses in this case is secondary, and you can get rid of sinusitis by influencing the main cause - tooth inflammation. The same mechanism of action with allergic sinusitis. It can be cured only by eliminating contact with the allergen and taking antihistamines.
Washing "cuckoo"
If a pregnant woman sought medical help at an early stage of sinusitis development, then in addition to drug therapy, she may be prescribed a lavage according to the Proetz method, which is popularly called a "cuckoo".It is effective precisely in the first stages, when the opening connecting the paranasal cavity with the nasal passage is not yet completely blocked and allows you to clear the sinuses from mucous secretions, while disinfecting them. This manipulation is performed on an outpatient basis and, in the case of a positive effect on the body (easier breathing), is repeated up to 10 times.
During the lavage, the patient is in the supine position, with her head thrown back at an angle of 45 degrees. Doctors use special devices (catheter and suction) that are inserted into the patient's nasal passages. Thanks to them, a disinfectant solution enters the nasal cavity, through which mucous exudate is excreted from the sinuses. In order to prevent pathological secretions from entering the larynx, the patient is asked to say "cuckoo" during washing.
However, this seemingly harmless procedure can be dangerous. If a pregnant woman has unilateral sinusitis, then washing can provoke the spread of bacteria into a healthy sinus. In addition, improper performance of the procedure threatens with serious violations of the olfactory function of the body.
If, after one or two procedures, the patient does not experience any improvement in her condition, then it is recommended to stop rinsing.
Puncture
If washing according to the Proetz method is effective at the initial stages of the development of the disease, then in more severe cases, when purulent exudate has already accumulated in the sinuses, and potent antibacterial drugs are contraindicated for a pregnant woman, domestic doctors often resort to a puncture. Under local anesthesia, a woman is pierced the inner wall of the sinus with a Kulikovsky needle (a special long needle with a bent end), thereby opening the outflow for the contents of the sinus. After that, saline or, if necessary, antibacterial drugs are injected into the maxillary cavity.
In especially severe cases, when the disease cannot be treated with prescribed antibiotics (for various reasons, bacteria can be resistant to certain types of antibiotics or antibiotics do not work on a certain specific type of microorganisms), and the patient's condition continues to deteriorate, the puncture can be done not in therapeutic, but for diagnostic purposes. By piercing the wall of the sinus, the doctor takes part of the pathological exudate for research. Sowing and growing bacteria is carried out, after which specialists can choose an adequate treatment.
