Rhinologic Issues in Pregnancy

Abstract

The diagnosis and treatment of rhinitis, sinusitis, and epistaxis during pregnancy present unique challenges to the otolaryngologist. Poorly controlled sinonasal disease may have significant adverse effects on the mother's quality of life and pregnancy outcomes and the lack of adequately controlled safety data limits the clinician's ability to make informed decisions about management. At the conclusion of this discussion, the reader should be familiar with the available literature and evidence-based guidelines regarding the safety and indications for radiographic imaging, clinical testing, medical intervention, and surgical treatment of sinonasal disease in pregnant patients. A review was performed of pertinent guidelines regarding the management of gestational rhinitis, sinusitis, and epistaxis, including the diagnostic and therapeutic limitations and physiological changes specific to pregnancy. A study population of four patients was analyzed to highlight the steps of management by reviewing the patient charts including pertinent history, physical examination, clinical course, and operative reports. Two patients with epistaxis and two patients with rhinosinusitis ranging from 27 to 38 years of age and between 16 and 35 weeks gestation were analyzed. The treatment of sinonasal disease during pregnancy is challenging and a thorough knowledge of the available medical evidence and treatment guidelines is necessary to optimize pregnancy outcomes. When the severity of disease precludes the possibility of delaying treatment, the clinician should provide a limited intervention that optimizes the mother's health without placing the fetus at significant risk.

Rhinitis in Pregnancy among Saudi Women

“…These results were comparable to the West Pomerania study [7]. These changes are attributed to increased blood volume and hormonal alterations which are typically noticed in the first two trimesters, and have a direct influence on the nasal mucosa [10]. Symptoms started to decrease at the end of the pregnancy as blood volume begin to shifts to the extra vascular space.…”

“…The alterations of hormones through pregnancy, especially estrogen, beside the rise blood volume are considered to be the principal cause of PR. That results in direct or indirect increase in nasal vascular engorgement [10,14]. The main originator of allergic rhinitis resulting in its symptoms is the exposure to triggering allergens [16].…”

Endoscopic Sphenopalatine Artery Ligation in Posterior Epistaxis: Retrospective Analysis of 30 Patients

“…General anesthesia can trigger preterm labor in the first two trimesters of pregnancy and the effect of inhaled or intravenous anesthetics on the fetus has not been fully clarified. Therefore, if possible, local anesthesia is preferable for nasal surgical intervention during pregnancy, however considering the possible side effects and receiving the patient's informed consent, TESPAL can be applied under general anesthesia in cases in which the bleeding does not allow local surgical intervention (20). In our study, posterior epistaxis that could not be stopped despite anterior nasal packing was treated successfully with TESPAL in one patient under general anesthesia.…”

Torrential epistaxis in the third trimester: a management conundrum

“…Hormonal changes during pregnancy alter nasal physiology, with oestrogen causing vascular congestion, mucosal oedema and rhinitis, known as the ‘rhinitis of pregnancy’,2 7 affecting 20% of pregnant women 3 8. Progesterone causes an increase in blood volume, which may both exacerbate vascular congestion and hence bleeding, and may mask blood loss in the event of severe epistaxis due to apparently effective cardiovascular compensation 2 6.…”