PREGNANCY AND NEUROLOGICAL DISEASES
Headache and Migraine
• The most common neurological complaint during pregnancy is headache; however, there is a decrease in the prevalence of all types of headache in nulliparous pregnant women, especially in the third trimester. Ergotamines are vasoconstrictors that should be avoided during pregnancy.
Cerebrovascular Diseases
• Relatively rare during pregnancy; but its mortality is high. 0/oSO of the cases are postpartum, 40% are intrapartum and 10% are antepartum. The most common risk factor associated with pregnancy is pregnancy-induced hypertensive diseases.
Convulsive (Epileptic) Diseases
• Despite the recurrence of seizures during pregnancy in 20-30% of epilepsy patients, if seizures have not been experienced for more than 2 years before conception, it is foreseen to discontinue the drugs.
• Seizures cause maternal hypoxemia resulting in fetal damage. In addition, some pregnancy complications are slightly increased in women with epilepsy, including spontaneous abortion, bleeding, hypertensive diseases, preterm birth, IUGR and cesarean delivery. The risk of maternal mortality increases 10 times in women with epilepsy, and postpartum depression is also more common.
• The cause of congenital malformations found to be increased in cases with epilepsy is not due to the disease but to the anticonvulsants used. Therefore, monotherapy should be preferred.
Multiple Sclerosis (MS)
• Relapse rate decreases by 70% during pregnancy; however, the postpartum relapse rate increases markedly. Uncomplicated MS cases generally do not have a negative effect on pregnancy. The delivery method of the cases is vaginal, cesarean section is not necessary. If necessary, epidural analgesia is recommended, not spinal anesthesia, due to the risk of autonomic dysreflexia.
Myasthenia Gravis
• The course of the disease is unpredictable during pregnancy, but it remains stable during pregnancy in most women with stable disease. Exacerbations occur in 1/3 of the cases.
• This disease generally does not have a negative effect on pregnancy. Since myasthenia gravis does not affect the smooth muscles, the patient's labor progresses normally. All kinds of curare effective drugs (magnesium, muscle relaxants, aminoglycoside) should be avoided in patients. There is no indication for cesarean section in patients; however, forceps or vacuum can be applied in the second stage of labor since the patient cannot exert pushing effort.
PREGNANCY AND LUNG DISEASES
Asthma
• The most common lung disease in pregnancy is asthma. There is a 1/3 rule about the course of asthma in pregnancy. Asthma does not change 1/3 during pregnancy, 1/3 decreases, 1/3 increases. 20% of asthma exacerbations occur intrapartum, and cesarean delivery increases the risk of exacerbation of asthma 18 times compared to vaginal delivery.
• As the severity of asthma increases, preeclampsia, preterm labor, IUGR, low birth weight, detachment, premature rupture of membranes, gestational diabetes and perinatal mortality can be seen.
Prostaglandin F2 alpha and ergonovine are contraindicated in pregnant women with asthma as they cause significant bronchospasm.
pneumonia
• Hypoxia and acidosis are poorly tolerated by the fetus and often trigger preterm labor after the second trimester. Every pregnant woman with suspected pneumonia should have a chest X-ray. When pneumonia is encountered during pregnancy, oseltamivir should be added to empirical antibiotherapy.
Strep is the most common cause of bacterial pneumonia.
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Viral causes are the most common cause of pneumonia in pregnancy. Influenza A pneumonia is the most common viral pneumonia. In order to prevent the disease, influenza vaccine should be applied to all cases (regardless of the gestational week) who become pregnant during periods when influenza is common.
Tuberculosis
• It increases the risk of active tuberculosis, preterm birth, low birth weight, IUGR, preeclampsia and perinatal mortality. Breastfeeding is not prohibited during the treatment of tuberculosis.
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• Sarcoidosis does not usually progress negatively during pregnancy. Sarcoidosis in pregnancy usually does not lead to adverse perinatal outcomes, but the risk of preeclampsia, preterm labor and thromboembolism increases.
• Cystic fibrosis is not affected by pregnancy. If the pre-pregnancy FEV is less than 60%, the risk of preterm birth, pulmonary complications, and maternal death within a few years of birth is increased.