Gebelikte Respiratuvar Hastalıklar
Özet
Gebelik döneminde meydana gelen mekanik ve hormonal değişiklikler solunum sisteminde belirgin farklılıklara yol açarak stabil seyreden respiratuvar hastalıkların süperimpoze olmasına neden olabilir. Gravid uterus diyaframı eleve ederek fonksiyonel rezidüel kapasiteyi azaltır. Artan progesteron ise tidal volümü ve dakikalık ventilasyonu artırarak hafif respiratuvar alkaloza yol açar. Gebelikte en sık karşılaşılan kronik respiratuvar hastalıklardan biri olan astım, reversibl hava yolu obstrüksiyonu ile karakterizedir; şiddetli ve kontrolsüz seyrettiğinde spontan abort, preterm doğum, preeklampsi ve fetal büyüme kısıtlılığı riskini artırır. Gebelikte 1.5/1000 oranında görülen toplum kökenli pnömoni ise gebelerde preterm prematür membran rüptürü ve düşük doğum ağırlığı gibi komplikasyonlara neden olabilmektedir. İmmün ve kardiyovasküler sistem değişiklikleri sebebiyle influenza enfeksiyonu gebelerde yüksek maternal mortalite riski taşır. Akut bronşit ve sinüzit genellikle viral kökenli olup semptomatik olarak yönetilirken, aktif tüberküloz tedavi edilmediğinde perinatal ölümlere yol açabilir ve iki aşamalı ilaç protokolü gerektirir. Son olarak, otozomal resesif bir ekzokrinopati olan kistik fibrozis olgularında pulmoner fonksiyonların seviyesi gebelik sonuçlarını doğrudan etkiler ve bu hastaların multidisipliner bir yönetimle kalori alımlarının artırılması, solunum fonksiyonlarının aylık takibi gerekir.
Mechanical and hormonal changes occurring during pregnancy lead to distinct alterations in the respiratory system, potentially causing otherwise stable respiratory diseases to become superimposed. The gravid uterus elevates the diaphragm, reducing functional residual capacity, while increased progesterone raises tidal volume and minute ventilation, resulting in mild respiratory alkalosis. Asthma, one of the most common chronic respiratory diseases in pregnancy, is characterized by reversible airway obstruction; when severe and uncontrolled, it increases the risks of spontaneous abortion, preterm birth, preeclampsia, and fetal growth restriction. Community-acquired pneumonia, observed at a rate of 1.5/1000 during pregnancy, can lead to complications such as preterm premature rupture of membranes and low birth weight. Due to immunological and cardiovascular modifications, influenza infection carries a high risk of maternal mortality in pregnant individuals. Acute bronchitis and sinusitis are generally of viral origin and managed symptomatically, whereas active tuberculosis can lead to perinatal death if left untreated, requiring a two-phase drug protocol. Lastly, in cases of cystic fibrosis, an autosomal recessive exocrinopathy, the level of pulmonary function directly determines perinatal and maternal outcomes, necessitating monthly monitoring of respiratory functions and increased caloric intake through multidisciplinary management.
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