Why does shortness of breath occur in early pregnancy? Shortness of breath (fast and difficult breathing) during pregnancy Severe shortness of breath during pregnancy

Shortness of breath can also occur in almost anyone. There are many reasons for this phenomenon. This usually happens with obesity, heavy physical activity, and so on. However, lack of air is often caused by disruptions in work of cardio-vascular system. In addition, pregnant women complain. What is it?

What do expectant mothers complain about?

Pregnancy is difficult period for the female body. In this condition, he experiences enormous stress. Many people feel short of breath during pregnancy. Women complain that they have difficulty breathing. They can only be saved by frequent ventilation.

Many people can sleep exclusively in cool rooms. Otherwise, they simply won’t sleep. Women feel short of breath, find it difficult to walk, and simply suffocate. So why is there not enough air during pregnancy? What is the reason for this and is this condition dangerous?

Most often, shortness of breath occurs during fast walking, physical activity, after climbing stairs, or when performing certain work. If breathing difficulties bother a pregnant woman even during the rest period, then you should seek help from specialists.

Why is there not enough air during pregnancy?

Many people suffer from shortness of breath during pregnancy. However, no need to worry. This phenomenon is temporary and cannot harm the child or the expectant mother. This is due to the special state of the body. The main reasons include:

1. Low hemoglobin level. Anemia during pregnancy is a common occurrence. As a result of development of this disease the amount of oxygen entering the blood is significantly reduced. As a result, a woman simply does not have enough air during pregnancy.
2. Malfunctions of the cardiovascular system. The body of a pregnant woman experiences severe stress. Even minor physical activity can cause shortness of breath. If a woman had problems with her cardiovascular system before pregnancy, she may experience a lack of air at rest. Often this phenomenon is accompanied by fainting or dizziness.
3. Lack of vitamins and minerals. Most often, shortness of breath occurs due to magnesium deficiency. In this case, a pregnant woman may experience tachycardia.
4. Neuroses and constant stress.

How to solve a problem

If you find it difficult to breathe during pregnancy, you should consult a specialist for advice. Usually, shortness of breath in this state of the body is normal. But if a lack of oxygen is felt even during rest, then there is a risk of developing a serious illness.

First, the doctor must conduct a complete examination. A pregnant woman should undergo a general blood test, which will determine the level of hemoglobin. If this indicator is low, then she may be prescribed an iron supplement or a complex of vitamins and minerals, which contains iron and magnesium.

If a pregnant woman feels short of breath, as well as sharp, acute pain in the chest, which radiates to the arm or left shoulder, then it is necessary to immediately contact a medical facility for help. With this condition, the patient's lips may turn blue. It is worth noting that such a phenomenon during pregnancy is extremely rare.

Early pregnancy

Shortness of air may be felt. This phenomenon occurs at 6-8 weeks. It is during this period that hormonal changes are observed in a woman’s body.

Most often during pregnancy there is not enough air due to toxicosis. Many people believe that this phenomenon is accompanied only by nausea and vomiting. In fact, toxicosis has other accompanying symptoms. This is heartburn, pain and heaviness in the stomach, a feeling of fullness in the abdomen from the inside. Similar symptoms may occur in a woman for more than later. These symptoms appear with gestosis.

In the early stages of pregnancy, a woman may feel short of breath after eating. This is observed during the first trimester. In such cases, women try to eat less. However, this does not solve the problem. After eating, you may also experience unpleasant belching, stomach pain and heartburn. This is primarily due to the production of growth hormone. This substance is intensively synthesized by the female body during pregnancy.

Last trimester

During pregnancy, almost all women lack air. This condition is observed in the later stages, when the load on the body increases significantly. This can be explained by physiological changes:

1. Enlargement of the uterus due to fetal growth.
2. Pressure on other organs located in the abdominal cavity.
3. Compression of the lungs. Because of this, the respiratory organs are not able to fully expand.
4. Diaphragm tightness.

In some cases, a pregnant woman may experience severe shortness of breath and even suffocate. Most often, such signs occur in expectant mothers of short stature, as well as in those who are expecting the birth of a large baby.

If there is not enough air, you will have to be patient a little. This is normal. About a few weeks before birth, the fetus descends, making breathing easier. After all, the uterus is located lower.

What to do if you have shortness of breath

To alleviate shortness of breath, you need to:

1. Rest if the problem occurs after physical activity.
2. At the first sign of shortness of breath, doctors recommend getting on all fours, completely relaxing and taking a slow breath and then exhaling. You need to repeat this exercise several times.
3. If there is not enough air during pregnancy, then you should rest with an open window or vent. At the same time, there should be no drafts in the room.
4. You should rest half-sitting. You can use small pillows and bolsters for this. However, sleeping on your back in the last stages of pregnancy is not recommended.
5. Breakfast is a must. Its absence can also cause shortness of breath.
6. Consult your doctor. You may be prescribed soothing and relaxing herbal teas, or aromatherapy using natural essential oils.
7. Don't overeat, and also watch your weight gain. Extra pounds also cause shortness of breath.

Worth benefiting

If during pregnancy, then the expectant mother can exercise a little. It will not be possible to alleviate such a condition completely. However, if desired, you can benefit. Experts recommend doing shortness of breath breathing exercises. This will allow the woman to learn how to breathe correctly during childbirth.

It is worth noting that this practice will allow you to perform several actions at once. A woman, thanks to shortness of breath, can learn to breathe correctly during childbirth. In addition, breathing exercises can improve your well-being when you are short of air.

Shortness of breath during pregnancy usually occurs as a result of physiological changes and less often than other conditions. Due to the lack of appropriate studies, the incidence of these conditions during pregnancy is difficult to estimate. Dyspnea - a feeling of difficulty breathing - should be distinguished from tachypnea - rapid breathing. Respiratory rate plays a critical role in assessing the severity of the disease; clinicians often pay little attention to this indicator. Cyanosis is an unreliable indicator of hypoxia, especially during pregnancy, when anemia is possible.

Causes of shortness of breath

Most probable reasons or known rare complications of pregnancy that cause shortness of breath, such as amniotic fluid embolism. However, most causes are the same, and a pregnant patient with shortness of breath should be treated the same as a non-pregnant patient during evaluation. These causes are divided into physiological, related to the upper respiratory tract, respiratory tract, chest, heart (see Shortness of breath in pregnancy: cardiac causes), and metabolic.

Non-cardiac causes of shortness of breath during pregnancy

Physiological reasons

Physiological shortness of breath usually begins in the first or second trimester of pregnancy and its frequency increases with increasing pregnancy. Physiological shortness of breath is the norm in 60-70% of pregnant women. The main diagnostic challenge is differential diagnosis with more serious conditions. Physiological shortness of breath during pregnancy is relatively mild, rarely severe and, oddly enough, decreases or at least does not increase by the time of birth. Dyspnea at rest is rare and daily activity and exercise capacity are usually not affected.

Numerous studies aimed at assessing lung function during pregnancy have yielded conflicting results. These changes are an adaptive mechanism to the increasing oxygen needs of the growing fetus. The most significant and well-studied changes are a 20-40% increase in minute ventilation (tidal volume x respiratory rate) due to higher tidal volume. The respiratory rate does not change significantly or increases slightly, so this high tidal volume can be attributed to greater respiratory effort. As a result of activation of proprioceptors in the chest wall, a sensation of shortness of breath occurs, which explains why patients sometimes complain of difficulty breathing.

X-rays and pulmonary function tests are important to rule out other causes of dyspnea, but no specific diagnostic test for physiological dyspnea

There are no pregnant women. Diagnosis is based on clinical signs, normal X-ray results chest and lung function tests.

Dysfunctional breathing is common in young women and is also common during pregnancy. Patients usually complain of shortness of breath that occurs unrelated to clinical symptoms and daily activities. Dysfunctional breathing occurs at rest, during conversation, and during physical activity. Shortness of breath is often described as “difficulty taking a deep breath” or “a feeling of difficulty breathing in the chest.” As with physiological dyspnea of ​​pregnancy, physical examination findings are normal, except for possible increased respiratory rate.

The term "dysfunctional breathing" covers many clinical manifestations, the best known of which is hyperventilation. These conditions are not at all life-threatening, but they cause significant concern in patients who have psychological problems or mental illness.

Dysfunction of the vocal cords is also classified as dysfunctional breathing; the manifestations of shortness of breath with it are similar. However, the condition often presents with episodes of shortness of breath and can mimic asthma, with which it is often associated. About 10% of acute asthma attacks are actually the result of vocal cord dysfunction. The disease is diagnosed by history, spirometry, demonstrating a decrease in the volume of inhaled air, and laryngoscopy. revealing the closure of the vocal cords during inhalation and sometimes during exhalation. Examination may reveal frank stridor or inspiratory stridor on auscultation of the chest extending from the vocal cords, but is usually normal between attacks.

Upper respiratory tract

Nasal congestion (see Nasal congestion during pregnancy) due to rhinitis due to swelling of the mucous membrane, hyperemia, congestion in the capillaries and hypersecretion of the mucous membrane, which is caused by increased levels of estrogen, occurs in 30% of pregnant women. It occurs mainly in the third trimester, and with severe congestion, a feeling of shortness of breath occurs.

Airways

Obstructive airway diseases

Asthma is the most common obstructive airway disease encountered during pregnancy. It occurs in 0.4-7% of women, but asthma is usually diagnosed before pregnancy. The disease is characterized by attacks of shortness of breath and stridor, aggravated by physical activity and quickly responding to inhaled beta-agonists. When examined in the absence of treatment or during exacerbations, significant expiratory shortness of breath is detected. The diagnosis is confirmed by 2-week peak flowmetry, which reveals a typical overall decrease and significant variability in peaks. Uncontrolled asthma is diagnosed by one of the following: persistent bothersome symptoms, nocturnal symptoms, frequent use of inhaled beta-agonists, exacerbations and restriction physical activity.

During pregnancy, asthma symptoms worsen in 1/3 of patients, improve in another 1/3, and remain unchanged in the remaining 1/3. However, during pregnancy, more than 30% of women are known to reduce their use of inhaled corticosteroids, which leads to an increase in emergency department visits. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) provokes symptoms or worsens asthma.

Cystic fibrosis and bronchiectasis are usually diagnosed before pregnancy and are characterized by frequent respiratory tract infections and increased coughing with thick, colorless sputum. Shortness of breath occurs in moderate or severe cases of the disease. During exacerbations, hemoptysis and chest pain occur, and episodes of pneumothorax become more frequent, especially in cystic fibrosis. In cystic fibrosis, malabsorption and steatorrhea are often observed; sinusitis - in both diseases.

When auscultating over the affected areas, moist inspiratory rales are usually heard. The diagnosis is confirmed by chest x-ray, but sometimes high-resolution computed tomography (HRTC) is necessary for cystic fibrosis - the method of choice is also when bronchiectasis is suspected. During pregnancy, there is sometimes a need for this study. However, if the result does not change the existing treatment, it can be postponed.

Chronic obstructive pulmonary disease develops when there is a history of smoking for at least 20 pack-years - the number of cigarettes smoked per day multiplied by the number of years of smoking divided by 20 (the number of cigarettes in a pack). In this regard, they are more likely to occur in pregnant women over 35 years of age. The main symptom is shortness of breath during physical activity with decreased tolerance. The disease is accompanied by a cough with morning sputum (chronic bronchitis). During exacerbations, a general weakening of breath sounds or shortness of breath is observed. The disease is extremely common, although it occurs in older women age group. It is more often referred to for medical attention than any other respiratory disease. The disease is not diagnosed until there is a significant decline in lung function. The main diagnostic method is spirometry. The chest x-ray shows normal or only excessive airiness of the lungs.

Bronchiolitis obliterans is a relatively rare and difficult to diagnose disease. Clinical and radiological characteristics are indistinguishable from asthma with mild airway obstruction. There may be a history of respiratory tract diseases in childhood.

Parenchymal and interstitial lung diseases

The incidence of pneumonia in pregnant and non-pregnant women is the same. The onset of the disease is acute with a short history of shortness of breath, cough and fever, sputum and pleuritic chest pain. History of sore throat, cold, and flu-like symptoms precedes it. Sometimes, for example with mycoplasma pneumonia, the disease lasts several weeks. Upon examination, rapid breathing is determined, moist rales and bronchial breathing are heard. The diagnosis is confirmed by chest x-ray, which reveals areas of compaction of the lung tissue. Pneumocystis pneumonia, which complicates human immunodeficiency virus (HIV) infection, usually presents with a dry cough over several weeks and progressive shortness of breath. Chest x-rays usually show bilateral interstitial infiltrates, although this pattern is also observed normally. Bronchoscopy is often necessary to obtain material for cytological examination.

Aspiration pneumonitis is common during pregnancy due to the predisposition to gastroesophageal reflux and may occur during labor or during induction of general anesthesia. The result is a clinical condition indistinguishable from pneumonia, leading to respiratory failure due to acute lung injury or adult acute respiratory distress syndrome (ARDS).

Acute lung injury or acute respiratory distress syndrome occurs in 0.2-0.3% of pregnant women. It is caused by pneumonia, aspiration pneumonitis, eclampsia or amniotic fluid embolism, the symptoms of which appear in the first stage. The diagnosis is confirmed by deterioration of the condition and increased consolidation of all pulmonary fields on radiographs.

In tuberculosis, shortness of breath occurs with extensive bilateral damage to the pulmonary parenchyma. History includes cough with sputum, weight loss, hemoptysis and night sweats, often in combination with underlying risk factors such as ethnicity or family history. A sputum test for acid-fast bacteria and a chest x-ray are necessary, which will reveal severe darkening (if the patient is admitted with shortness of breath), often with the formation of cavities. In the absence of sputum, bronchoscopy is necessary to obtain bronchial washings.

Pulmonary metastases, such as choriocarcinomas, are rare and are easily diagnosed by chest x-ray, which reveals one or more nodules of varying size. Symptoms usually appear with extensive metastases - shortness of breath, cough and hemoptysis. However, when auscultating the chest, pathologies are not heard. When choriocarcinoma metastasizes to the pleura, pleural effusion is detected.

Sarcoidosis is common in young women, especially those of African-Caribbean ethnicity, in whom it is often more severe. In the presence of pulmonary infiltrates or sometimes with extensive mediastinal lymphadenopathy, compressing the main bronchi, shortness of breath appears. In this case, there is a cough, weight loss and damage to other organs - skin or eyes. Auscultation does not detect abnormalities or listen to moist inspiratory rales or wheezing. Sometimes lymphadenopathy and skin lesions are detected. If the clinical picture is appropriate, the diagnosis is confirmed only by chest x-ray. Serum angiotensin-converting enzyme levels are usually increased. Sometimes a biopsy is necessary, for example, of the bronchial mucosa during bronchoscopy.

Drug-induced interstitial lung injury can be caused, for example, by nitrofurantoin or amiodarone. Nitrofurantoin® used for long-term treatment of recurrent infections urinary tract, causes acute and chronic forms of interstitial lung damage with severe, life-threatening hypoxia. Amiodarone, used to treat cardiac arrhythmias at a dosage of 200 mg per day, can cause acute pneumonitis (incidence 0.1-0.5%) followed by pulmonary fibrosis (incidence 0.1%). Such phenomena are more common with increasing doses and prolonged treatment. Common manifestations of these conditions. - shortness of breath and dry cough. When auscultating the chest in the lower parts of the lungs, fine bubble inspiratory rales are heard on both sides.

Lymphangioleiomyomatosis is a rare disease that occurs exclusively in young women of reproductive age, and therefore should be included in the differential diagnosis of dyspnea during pregnancy. Clinical manifestations- interstitial lung disease, recurrent pneumothorax, sometimes bilateral, often there is an obvious connection with tuberous sclerosis. Auscultation of the chest may be normal or may reveal fine inspiratory moist rales. There are some signs that lymphangioleiomatosis may worsen during pregnancy. Suspicion of the disease arises on the basis clinical picture and chest x-ray, but high-resolution computed tomography (HRTC) is needed to confirm the diagnosis.

Cancerous lymphangitis occurs in advanced metastatic breast cancer; it causes severe shortness of breath and a dry cough. As with drug-induced interstitial lung injury, severe hypoxia is observed.

Exogenous allergic alveolitis is a relatively rare disease associated with an identifiable trigger antigen - spores of thermophilic actinomycetes of moldy hay (“farmer's lung”). Progressive shortness of breath, wheezing and cough occur, and X-rays of the lungs reveal infiltrates, often located in the upper lobes.

Fibrosing alveolitis is more common in young women in the second half of life; it is associated with autoimmune diseases - rheumatoid, scleroderma and SLE, and must be taken into account in the differential diagnosis of shortness of breath during pregnancy. It is classified into many conditions, the most common being common interstitial pneumonia and nonspecific interstitial pneumonia. Typical symptoms include progressive shortness of breath, cough, and, on auscultation, bilateral fine-bubbly inspiratory moist rales at mid-to-late inspiration. Sometimes the terminal phalanges of the fingers thicken, but early stages and with a milder course of the disease they do not occur. X-rays of the lower lungs usually show bilateral interstitial opacities, but high-resolution computed tomography (HRTC) is needed to determine the type of disease and possible response to treatment. Lung function tests, as with other interstitial lung diseases, reveal a decrease in transfer factor (diffuse capacity).

In autoimmune diseases, cryptogenic pneumonia occurs, which begins acutely with shortness of breath, cough and hypoxia. Parenchymal opacification is often more focal in nature than in fibrosing alveolitis. During pregnancy the above chronic diseases do not always occur chronically; some of them have a relatively acute onset.

Pleural pathology

Pleural effusion from pneumonia or tuberculosis causes shortness of breath, especially with a moderate or large volume of fluid. Rare causes of pleural effusion during pregnancy are lymphangioleiomyomatosis (chylothorax), choriocarcinoma, breast cancer and other malignant tumors, rupture of the diaphragm during childbirth. Examination of the chest reveals dullness to percussion and absence or muffled breathing over the effusion. A small effusion may be asymptomatic. Whether childbirth predisposes to the accumulation of pleural effusion is controversial. Examination of postpartum chest radiographs revealed an increased number of effusions, but no increase in the incidence of effusions was noted when ultrasound was used.

Empyema and pneumothorax are discussed in another section with reference to noncardiac causes of chest pain.

Chest wall

Obesity (body mass index >30) often leads to shortness of breath and reduced exercise tolerance. All other test results may be normal. Impaired breathing mechanics or paralysis of the diaphragm in kyphoscoliosis, ankylosing spondylitis and neuromuscular diseases leads to respiratory failure. In each patient with one of these diseases who complains of shortness of breath, it is necessary to determine the gas composition of arterial blood to detect hypoxia and hypercapnia.

Rigidity of the diaphragm muscles occurs with ovarian hyperstimulation syndrome and severe polyhydramnios. Treatment depends on the severity of ovarian hyperstimulation syndrome and the length of pregnancy.

Metabolic abnormalities

Anemia is a common condition during pregnancy and usually results in decreased exercise capacity and weakness, but not shortness of breath. The conjunctiva and nail beds should be examined for general pallor, but these signs are unreliable and hemoglobin levels should always be determined.

Sometimes shortness of breath is a manifestation of thyrotoxicosis. Typical symptoms are weight loss, sweating, diarrhea, irritability, tremors, tachycardia and eye symptoms. When examining the neck, a goiter may be detected. The diagnosis is confirmed by thyroid function tests.
Shortness of breath is caused by acute and chronic renal failure, metabolic acidosis and sepsis. However, the diagnosis must correspond to the clinical picture.

The cause of shortness of breath during pregnancy is determined by history and physical examination, but a chest x-ray is necessary to rule out serious illnesses. Many chronic diseases impair fertility and are therefore rarely first identified during pregnancy. Therefore, a careful history taking is necessary.

Anamnesis

History of complaints

• Onset of symptoms relative to gestational age.
• Duration, chronicity, origin and severity of shortness of breath.
• Exercise tolerance, especially daily activities such as climbing stairs.
• The presence or absence of cough, sputum, or hemoptysis.
• Relief when using inhalers.
• Heartbeat.
• Chest pain.
• Weight loss, fever, anorexia, malaise.
• Leg pain.
• Diseases of the nose and paranasal sinuses.
• Sore throat, arthralgia and myalgia.

Previous medical history

Includes the following diseases:

• asthma, hay fever, eczema;
• tuberculosis, BCG (Bacillus Calmette-Guerin), cystic fibrosis, bronchiectasis, other lung diseases;
• sarcoidosis, kyphoscoliosis, neuromuscular diseases, heart disease, recurrent urinary tract infections;
• malignant neoplasms (breast cancer), immunosuppression (HIV+);
• mental illness;
• pulmonary embolism or thrombophilia.

Medicinal history

• Amiodarone, nitrofurantoin, NSAIDs and inhalers.

Psychiatric history

• Symptoms of anxiety or depression. Family history
• Blood clotting disorders, asthma, atopy, tuberculosis, lung cancer and sarcoidosis.

Social history

• Ability to continue normal life, especially going to work, climbing stairs, doing housework, going to the shops.
• Residence or travel to regions with a high prevalence of tuberculosis and contact with patients with tuberculosis.

Physical examination

General appearance: confusion, sweating, tremor, hyperthermia, cyanosis, pallor, obesity, thickening of the terminal phalanges of the fingers, lymphadenopathy, BCG scar, goiter, exophthalmos, eyelid lag. Appearance reflects the severity of the disease or indicates possible causes.

Cardiovascular system: arrhythmia, low or high blood pressure, increased jugular venous pressure, parasternal bulge, gallop rhythm, cardiac murmur, pericardial friction murmur.

Respiratory system: frequency, use of accessory muscles of aspiration, kyphoscoliosis, tracheal displacement, dullness on chest percussion, wheezing, bronchial breathing, weakened or absent breath sounds, moist rales.

Mammary glands: tumors; if indicated, it is better to perform a mammogram.
Neurological symptoms: muscle weakness, fasciculations, weakness of the upper or lower extremities, sensory loss, cerebellar symptoms.

Research methods

X-ray

Often the patient, her partner, medical or other personnel raise the issue of the risk of exposure to ionizing radiation on the fetus.

The absorbed dose of radiation that can be exposed to a fetus during pregnancy is 5 rad—equivalent to 71,000 chest x-rays, 50 computed tomographic angiographies of the pulmonary artery, or V/Q scans. These numbers must be taken into account when discussing the need for research with a pregnant woman.

However, the risk of developing cancer in the fetus over the next lifetime from exposure to any dose of radiation is unknown. The American College of Radiology states that during pregnancy, X-ray procedures should only be performed if they are necessary to treat the patient. As for any side effect on the fetus, it is necessary to take into account the risks of not performing important radiological examinations and inform the patient about this. Most common tests involve minimal radiation exposure. Research plays an important role in accurate diagnosis, which allows an appropriate treatment plan to be developed.

Chest radiography plays a crucial role in the diagnosis of diseases of the respiratory system - pneumonia, pleural effusion, pneumothorax, tuberculosis and sarcoidosis. Without this simple study, it is impossible to adequately treat the patient or correctly assume the causes of shortness of breath. V/Q scanning is necessary to diagnose pulmonary embolism. If the V/Q scan only suggests pulmonary embolism and there is a moderate to high suspicion of pulmonary embolism, computed tomography pulmonary angiography may be helpful. High-resolution computed tomography is used to diagnose bronchiectasis and interstitial lung pathology. If the result is unlikely to change the approach to treatment of the disease, it can be postponed until the postpartum period.

Although the radiation dose from chest CT is acceptable for the fetus, it is believed that there is a high risk of breast cancer in the pregnant woman. In women under 35 years of age, exposure to 1 rad increases the lifetime risk of breast cancer by 14%. With computed tomographic angiography of the pulmonary artery, the dose applied to each mammary gland is 2-3.5 rad.

Lung function

During pregnancy, the most significant indicators of lung function - forced expiratory volume (amount of air) per second (FEV1) and the ratio FEVl/forced vital capacity (FEV1/FVC) - do not change (FVC is the total volume of air that a person can exhale in one breath ). Routine spirometry (FEV1, FVC and FEV1/FVC ratio) on a simple portable spirometer can exclude any obstructive pulmonary disease (asthma, cystic fibrosis, bronchiectasis, chronic obstructive pulmonary disease) of such severity as to cause shortness of breath. With well-controlled asthma, results may be normal. Spirometry in obstructive pulmonary disease is characterized by a low FEV1/FVC ratio (<70%), низкое значение FEV1 (<80%) и типичная выделенная кривая поток-объем, вызванная обструкцией мелких дыхательных путей.

Spirometry should only be performed and interpreted by trained personnel. You cannot draw conclusions from computer printouts. It is necessary to pay attention to the inspiratory flow-volume loop, which can be significantly narrowed with vocal fold dysfunction. Recording peak flow is important for diagnosing asthma, and the greatest benefit will come from measuring it for at least 2 weeks.

More detailed lung function tests, such as diffusion capacity (transfer factor) and static lung volumes, useful for diagnosing and monitoring interstitial lung disease, are performed in a specialized laboratory. For walking oximetry, the patient is asked to walk for 6 minutes with a pocket oximeter placed on the finger. For unexplained shortness of breath, the test is useful for two reasons. First, it demonstrates how far the patient can walk during this time and how many stops he makes; the second - the test detects whether there is a decrease in oxygen saturation during oximetry. In this way, it is possible to objectively determine the distance that the patient can walk and identify significant breathing problems.

Blood tests

When examining a pregnant woman with severe shortness of breath, it is necessary to take blood to determine hemoglobin, white blood cell count, urea, electrolytes, D-dimers and thyroid function tests. The absence of D-dimers eliminates pulmonary embolism and the need for V/Q scanning. D-dimer levels increase progressively before labor and are more suitable for early pregnancy. The presence of D-dimers is relatively non-specific and their levels may be increased, for example during infections.

Arterial blood gases should be determined in any patient requiring further evaluation, and especially in those with suspected pulmonary embolism or pneumonia, as severe hypoxia (low Pa02) usually occurs in these diseases.

When does a patient with shortness of breath need to consult a pulmonologist?

Reasons for referring a pregnant woman to a pulmonologist:

• excessive shortness of breath; progression of shortness of breath;
• acute shortness of breath;
• indications for chest CT;
• the need for detailed pulmonary function testing, including diffusion capacity, static lung volumes, or gait oximetry;
• uncertain spirometry results or interpretations;
• uncertain diagnosis.

Shortness of breath during pregnancy is usually physiological in nature. Generally, a thorough history, physical examination, and chest x-ray can rule out serious illness. If necessary, a simple pulmonary function test is performed, which is crucial for diagnosing diseases of the respiratory system.

Shortness of breath during pregnancy: cardiac causes

Pregnant women often complain of shortness of breath, which may be associated with physiological changes. However, shortness of breath in combination with any of the following conditions raises suspicion of the presence of cardiovascular pathology:

• orthopnea - shortness of breath when lying down;
• paroxysmal nocturnal dyspnea - sudden onset of shortness of breath at night;
• arrhythmia is an irregular heart rhythm.

In the list of indirect reasons maternal mortality In the UK, cardiovascular pathology is in second place after suicide. Cardiomyopathy and congenital heart disease are two main conditions that are life-threatening for the mother and fetus.
In the UK, the initial diagnosis of rheumatic heart disease in pregnancy is very rare, but it can be a problem in some ethnic groups. In addition, there are other noncardiac causes of shortness of breath in pregnant women, such as iron deficiency anemia. Exacerbation of pulmonary disease must be ruled out before searching for serious cardiac causes. This chapter discusses cardiac causes of dyspnea, which can be divided into cardiomyopathies and congenital anomalies.

Cardiomyopathies

Cardiomyopathy during pregnancy is divided into 3 types: postpartum, dilated and hypertrophic. Dilated and hypertrophic cardiomyopathy occurs in any woman and manifests itself at any stage of pregnancy. Postpartum cardiomyopathy occurs mainly in young women of African-Caribbean ethnicity during the last trimester of pregnancy or the first 6 weeks after childbirth.

Postpartum cardiomyopathy

Postpartum cardiomyopathy is rare - 1 case in 3000-15,000 pregnancies. Its pathogenesis is unclear; it is assumed that it is some form of myocarditis, possibly viral. Maternal mortality reaches 20%, but the outcome for the fetus is good.

Treatment is similar to that for any form of cardiomyopathy with reduced ventricular systolic function. The main problem is assessing the risk of relapse in future pregnancies. Regular monitoring of the patient with an ECG is necessary to assess left ventricular function, which helps predict the risk of relapse and the outcome of future pregnancies. However, in subsequent pregnancies there is a significant risk of relapse of symptomatic heart failure and persistent impairment of left ventricular function.

Dilated cardiomyopathy

Pregnant women do not tolerate this disease well. If a patient is classified as a New York Heart Association (NYHA) functional group >11, the risk of maternal mortality is 7%. In addition, there is a high risk of heart failure. Differential diagnosis of dyspnea during pregnancy and heart failure is based on a thorough clinical examination. Heart failure is treated in the same way as in non-pregnant women, but before delivery it is necessary to avoid the use of angiotensin-converting enzyme inhibitors, the use of which is associated with renal agenesis in the fetus.

Hypertrophic cardiomyopathy

Women with hypertrophic cardiomyopathy usually tolerate pregnancy well. Adaptation of the left ventricle occurs physiologically. In this case, the disease proceeds favorably, since the cavity of the left ventricle is small. A heart murmur and increased left ventricular outflow gradient may first appear during pregnancy.

Maternal mortality is rare, and there is no evidence of an increased risk of sudden death during pregnancy. Despite this, the diagnosis and the presence of a genetic component are of considerable concern. Diagnosis in pregnant and non-pregnant women includes an echocardiogram, ECG, exercise testing, ambulatory ECG monitoring, and genetic counseling.

Women with severe diastolic dysfunction develop pulmonary congestion and even sudden pulmonary edema. Long-term use of beta blockers is necessary and low-dose diuretics are helpful. To prevent tachycardia, rest in combination with beta blockers is recommended.

For atrial fibrillation, women with hypertrophic cardiomyopathy are often prescribed low molecular weight heparin sodium (heparin) and beta blockers. If it is impossible to control the heart rhythm after excluding the presence of a thrombus in the left atrium using transesophageal echocardiography, cardioversion is considered.

Finally, it is necessary to discuss genetic risk, including the phenomenon of anticipation, which determines earlier onset and more severe disease in subsequent generations in some families.

The safest method of delivery for mothers with any form of cardiomyopathy is through the vaginal birth canal with good pain relief and the possible use of forceps. With this delivery, compared to a cesarean section, the volume of blood loss is less, and hemodynamic changes occur more slowly.

Congenital heart defect

Congenital heart disease is the most common birth defect in the world. Approximately 1% of newborns worldwide have a heart defect. In the UK, approximately 250,000 adults have congenital heart disease, and men and women are affected equally often. Some people have simple defects, such as small atrial or ventricular septal defects, which may remain clinically asymptomatic until diagnosed by routine testing. Others have complex anomalies that require surgery for survival.

50 years ago, 90% of patients would not have survived to adulthood. Advances in cardiology and cardiac surgery have meant that 85% of these babies survive to childbearing age. The number of new cases increases by approximately 1,600 each year.

Pregnancy in such women carries an increased risk of complications for the mother and fetus. Therefore, doctors must know the clinical manifestations, diagnosis and treatment of these diseases.

Based on the relative risk for the pregnant woman, congenital heart defects during pregnancy are divided into low, moderate and high risk defects.

The following discussion focuses on the clinical presentation and diagnosis of congenital heart defects. Tactics during pregnancy and childbirth depend on the risk category for the patient.

Low risk conditions

Unoperated atrial septal defect

With normal pulmonary vascular resistance, unoperated atrial septal defects are well tolerated. During pregnancy, as cardiac output increases, the tendency for atrial arrhythmia increases. The combination of potential right-to-left shunting and hypercoagulability during pregnancy increases the risk of paradoxical embolism, especially as intrathoracic pressure increases during labor. The same situation occurs when the foramen ovale is not closed. In unrepaired atrial septal defects, thromboembolic prophylaxis rather than antibiotic prophylaxis plays a major role, but potential benefits and risks must be weighed.

Operated coarctation of the aorta

Currently, almost all patients with aortic coarctation are operated on in early childhood. As long as there is no aneurysm at the surgical site, pregnancy poses little risk. The absence of an aneurysm must be confirmed before conception with an MRI or CT scan.

Operated tetralogy of Fallot

Tetralogy of Fallot is the most common congenital defect of the “blue” type. This is one of the first complex congenital defects to be successfully corrected surgically. Most patients with tetralogy of Fallot who live into adulthood have already had surgery, lead almost normal lives, and have no symptoms. They tolerate pregnancy well. However, severe pulmonary insufficiency may occur, and decompensation occurs during pregnancy. This emphasizes the need for regular evaluation of women with congenital heart disease, even after successful surgery, in order to correct any heart defects that could limit its reserve capacity and complicate the course of pregnancy before conception.

Moderate risk conditions

Fontan circulation

Various forms of the Fontan procedure create two separate blood flow systems with a single functioning ventricle of the heart. These patients do not have cyanosis, but they have long-term low cardiac output and are at risk for ventricular failure and atrial arrhythmia. Patients receive anticoagulant therapy with warfarin, which during pregnancy must be replaced with an adequate dose of low molecular weight heparin sodium (heparin*). The outcome of pregnancy for the mother depends on the functional capacity and function of the ventricle. If the only ventricle is the left one, there is a high probability that its function is sufficient. If these conditions are met and the woman knows that the miscarriage rate in the first trimester is 30%, which is 2 times higher than in the general population, there is no reason to discourage the woman from pregnancy, as was done in the past.

Mitral stenosis

Mitral stenosis is the most common chronic rheumatic valvular disorder in pregnant women in the UK, particularly in Indian, Chinese, Eastern European and East African populations. Rheumatic mitral stenosis may remain asymptomatic until the third decade of life, and symptoms often first appear during pregnancy. Other causes of mitral stenosis during pregnancy include congenital commissural fusion or parachute mitral valve and left atrial myxoma.

Hemodynamic disturbances in pregnant women with mitral stenosis - increased pressure in the left atrium, pulmonary veins and arteries - arise as a result of the valve and blood flow through it. Maternal complications include pulmonary edema, pulmonary hypertension, and right ventricular failure. Tachycardia precipitated by exercise, fever, or emotional stress decreases left ventricular diastolic filling time, and the subsequent increase in left atrial pressure decreases cardiac output. The outcome is failure of both ventricles. In pregnant women, increased left atrial pressure also predisposes to the development of atrial arrhythmias, in which loss of atrial contractility combined with rapid ventricular response can have an adverse effect with subsequent pulmonary edema.

Clinical picture. Depending on the severity and duration of valve damage, pregnant women with mitral stenosis develop symptoms of left and right ventricular failure. Symptoms of left-sided heart failure are more often observed - orthopnea, paroxysmal nocturnal dyspnea and dyspnea on exercise. In the absence of long-term valve damage, symptoms of right ventricular failure occur less frequently - peripheral edema and ascites, which is difficult to diagnose during pregnancy.

A thorough examination is aimed at looking for typical auscultatory signs of mitral stenosis - a click of the mitral valve opening and a rumbling diastolic murmur with presystolic amplification. Increased jugular venous pressure, hepatomegaly, a loud pulmonary component of the second heart sound, and right ventricular bulge found during examination confirm the diagnosis of mitral stenosis. Most pregnant women with mitral stenosis present with atrial fibrillation with or without heart failure.

Examination and diagnosis. When examining pregnant women with mitral stenosis, the method of choice is transthoracic echocardiography. It confirms the diagnosis and determines the severity of the stenosis. In addition, echocardiography determines pulmonary artery pressure, right ventricular function, mitral regurgitation, the status of other valves and the configuration of the subvalvular apparatus, which plays an important role in determining the success of percutaneous balloon valvuloplasty of the mitral valve. Invasive diagnostic testing - right heart catheterization is rarely warranted.

Aortic stenosis

Symptomatic disease of the aortic valves in pregnant women is less common than the mitral valve. In the UK, the predominant cause is congenital stenosis due to a membrane on the bicuspid aortic valve. In contrast, in developing countries and ethnic populations in the UK, the most common cause is rheumatic heart disease. During pregnancy, women with bicuspid aortic valves are at risk of aortic dissection due to hormonal influences on connective tissue.

Hemodynamic changes in aortic stenosis depend on the pressure gradient across the aortic valve. The increase in systolic pressure in the left ventricle, necessary to maintain sufficient pressure in the arterial system, leads to an increase in the tension of the ventricular wall. Compensatory left ventricular hypertrophy develops, which can result in diastolic dysfunction, fibrosis, decreased coronary blood flow reserve, and late systolic failure.

The increase in stroke volume and fall in peripheral resistance are largely responsible for the increase in gradient across the aortic valve. The clinical consequences of an increased aortic gradient depend on the degree of preexisting left ventricular hypertrophy and systolic function. With inadequate compensatory changes in the left ventricle, which do not satisfy the need for increased cardiac output in late pregnancy, clinical signs appear. This situation usually occurs with moderate to severe aortic stenosis.

Clinical picture. The clinical picture and symptoms depend on the degree of aortic stenosis. Women with an aortic valve area >1 cm 2 tolerate pregnancy well and have no clinical signs. Women with more severe aortic stenosis may have symptoms of left-sided heart failure, which initially manifest as shortness of breath on exertion. Loss of consciousness or lightheadedness is rare, and pulmonary edema is even rarer.

Because the symptoms of aortic stenosis resemble those of a normal pregnancy, it can be confusing to doctors. Physical findings vary depending on the severity of the disease. The left ventricular impulse is long and displaced laterally. The systolic ejection murmur is heard along the right edge of the sternum, it extends to the carotid arteries, and a systolic click can be heard. During diastolic function, a IV heart sound may appear. A slowly rising pulse and narrow pulse pressure amplitude are characteristic of hemodynamically significant aortic stenosis.

Examination and diagnosis. The diagnosis is confirmed by echocardiography. Aortic gradient and valve area are calculated from Doppler flow studies. In addition, echocardiography reveals left ventricular hypertrophy. Assessment of ejection fraction and left ventricular volume is useful for prognosis of pregnancy and childbirth. In women with ejection fraction<55% риск сердечной недостаточности во время беременности высокий. При клинической картине тяжелого аортального стеноза, если данные неинвазивных обследований неубедительны и необходима чрескожная вальвуло-пластика, показана катетеризация сердца. Если у матери имеется врожденный стеноз аорты, показана эхокардиография плода, поскольку риск подобной аномалии плода составляет приблизительно 15%.

High risk lesions

Marfan syndrome

In pregnant women with Marfan syndrome and a normal aortic root, the risk of dissection is approximately 1%. With an aortic root diameter >4 cm, the risk of dissection increases 10 times; the main risk for the mother with Marfan syndrome is type A aortic dissection, with surgical treatment which maternal mortality rate is 22%. Patients with a poor family history, cardiac involvement, and aortic root diameter >4 cm or rapid aortic dilatation are at high risk for dissection. In these cases, pregnancy is not recommended. For those who choose to continue pregnancy, beta blockers are prescribed and elective C-section. Patients should be aware of the 50% risk of relapse.

During pregnancy, aortic dissection can occur without preexisting disease, likely as a result of hormonal changes and increased stress on the cardiovascular system. A risk factor for aortic dissection during pregnancy is a bicuspid aortic valve with a dilated aortic root. The histological picture is similar to Marfan syndrome.

Eisenmenger syndrome

With pulmonary hypertension of any etiology, there is a high risk of maternal mortality. The risk of death in patients with Eisenmenger syndrome is 40-50%. Women should be discouraged from becoming pregnant. Laparoscopic sterilization is possible, but not without significant risks. Subcutaneous progesterone implantation is as effective as sterilization, but does not carry additional cardiovascular risks. During pregnancy, the woman must be offered an abortion. Women wishing to continue their pregnancy are referred to a specialized center.

Observation during pregnancy

Prenatal care

The level of prenatal care is determined before conception or immediately after pregnancy is confirmed.

Obstetricians and gynecologists at the main district hospital in the UK see few patients with moderate to severe congenital heart disease, so such patients need to be referred to a specialist center for advice. Ideally, moderate-to-high-risk patients should be treated by a tertiary multidisciplinary team with a cardiologist, anesthesiologist, obstetrician-gynecologist, and neonatologist on call 24 hours a day. Low-risk patients can be observed at the place of residence, taking into account the recommendations of a specialist.

Prenatal care and delivery should be carefully planned. The patient must participate in the decision-making process and understand the “minimal risk approach.” Some patients benefit from hospitalization in the third trimester for bed rest, close monitoring of cardiovascular function, and oxygen therapy. Patients admitted to bed rest should receive adequate thromboprophylaxis with low molecular weight heparin sodium (heparin).

Patients with Eisenmenger syndrome (or other forms of pulmonary artery hypertension), Marfan syndrome with an aortic root diameter >4 cm, or severe left-sided obstructive lesions should be advised of the high maternal morbidity and mortality associated with pregnancy. In case of unplanned pregnancy, early abortion is performed. If the patient still wishes to continue the pregnancy, the need for monitoring by a third-level multidisciplinary team should not be emphasized too much.

Anticoagulant therapy during pregnancy and childbirth

Because of chronic or recurrent arrhythmias, slow blood flow, or the presence of metallic valve prostheses, women with congenital heart disease have an increased risk of thromboembolic complications. During pregnancy, the risk of thromboembolism increases 6 times, in the postpartum period - 11 times, so it is important to achieve adequate anticoagulation. However, this treatment is associated with risks and significant complications for the mother and fetus. Warfarin is an effective oral anticoagulant that crosses the placenta and poses a major risk to the fetus. In contrast, sodium heparin (heparin) does not cross the placenta and is therefore safe. It is reportedly less effective in preventing blood clots, especially in women with metal valve prostheses. Therefore, when giving any advice on anticoagulant treatment during pregnancy, the risks and benefits to the mother and fetus must be weighed. Treatment must take into account the needs of the mother and fetus.

If you feel short of breath during pregnancy, then most likely this condition is temporary, harmless, and it is associated precisely with the woman’s “interesting position.” Experts call this lack of air during pregnancy physiological.

Lack of air during pregnancy reasons for the event
pregnant woman on the calf monitor
the doctor is growing trimester

It is explained by the fact that the growing uterus and embryo push everything apart internal organs which are located nearby. At the same time, it also suffers bladder, intestines, stomach and lungs. The diaphragm is exposed to data unpleasant sensations last but not least, which is the only positive aspect of this phenomenon.

Be that as it may, this condition can be an alarming signal: it is necessary to take tests for hemoglobin levels, and also check the functioning of the heart muscle.

Causes of the disease

Let's look at the most likely reasons why there is not enough air during pregnancy:

• the diaphragm, under the pressure of the growing uterus, rises, because of this there is less space in the lungs for their expansion - shortness of breath occurs;
• the growing embryo needs more and more oxygen, which it takes from the bowels of the mother, which is why a woman feels a feeling of lack of air during pregnancy;
• nervous disorders, stressful situations, emotional, hormonal changes in the body expectant mother may cause shortness of breath during early pregnancy;
• Due to a lack of iron, a mild form of anemia develops, so the woman is no longer able to tolerate previous physical exertion, which causes a feeling of lack of air during pregnancy.

It's difficult to breathe

As a rule, this condition, when there is not enough air, lasts until about 32 weeks of pregnancy. At this stage, the baby’s head turns towards the pelvis, and the pressure on the diaphragm and epigastric region becomes less, so air flows better during pregnancy.

Why does it occur in the early stages?

Some women complain that they do not have enough air during pregnancy already in the early stages - 6-8 weeks, when hormonal changes in the body occur.

This may be due to toxicosis. Despite the fact that toxicosis in most cases is manifested by nausea and vomiting, sometimes this condition has other symptoms, including:

• heaviness, pain in the stomach;
• heartburn;
• flatulence.

Very often, literally immediately after conception, the expectant mother begins to have difficulty breathing after eating, even if she has eaten a very small portion. Painful sensations in the stomach may appear, belching, and heartburn may occur.

The same symptoms occur when hydrochloric acid is released: its production is ensured by the synthesis of growth hormone, which is intensively produced in the body of the expectant mother.

Preventive actions

Among the preventive measures that will help prevent or at least reduce the likelihood of oxygen deficiency include:

1. Regular intake of medications that contain sufficient amounts of iron.
2. Take folic acid in moderate doses. This is most relevant for women who suffer from hemolytic disease or are malnourished.
3. Regularly performing moderate exercise.
4. Maintaining a balanced diet.
5. Regularly visit the doctor and undergo the necessary tests.
6. Mandatory consumption of foods such as legumes, dietary meat, nuts, fruits and juices.

Finding out the cause from a doctor

Therapy methods

Let's take a closer look at what you can do if you don't have enough air during pregnancy.

You should never worry that such episodes of oxygen deprivation will harm your baby. If all tests and results of other examinations correspond to the norm, then this condition does not harm the fetus, but only creates some discomfort for the expectant mother.

Preventive actions

A couple of weeks before the expected birth, you will feel much easier: if your stomach drops, expect an early birth.

Possible dangers and risks

Let's consider a number of ailments in which there is not enough air during pregnancy:

• cardiovascular diseases – heart defects, arrhythmia;
• a complication after suffering from influenza or an acute respiratory infection, in which case the heart does not move blood well through the vessels and veins, which is why the organs and tissues of the body suffer from a lack of oxygen;
• allergic diseases – this reaction may appear on a large list of products that are allergenic to humans, for example, pollen, plant fluff, some types of trees, household dust, mold, cosmetics, chemicals (the body may also have a negative reaction to eggs, nuts, milk or insect bites);
• bronchial asthma, and, consequently, dyspnea;
• overweight, obesity, unhealthy diet;
• if a lack of oxygen occurs during a conversation, this indicates that a narrowing of the small bronchi has occurred;
• chronic diseases of the lungs, bronchi, high blood pressure.

Majority allergic reactions accompanied by a lack of inhaled oxygen. The intensity of this feature is determined by the state of the expectant mother’s body. That is why, if you experience such signs, you must definitely visit a specialist to exclude possible complications.

Find out also: why you should be afraid and.

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Attention!

The information published on the website is for informational purposes only and is intended for informational purposes only. Site visitors should not use them as medical advice! The site editors do not recommend self-medication. Determining the diagnosis and choosing a treatment method remains the exclusive prerogative of your attending physician! Remember that only complete diagnosis and therapy under the supervision of a doctor will help you completely get rid of the disease!

Shortness of breath can occur for various reasons: during physical activity, excess body weight, cardiovascular disorders or lung diseases. However, many pregnant women complain that despite the absence of all the above factors, due to lack of air they are forced to sleep with open windows and a half-sitting position, otherwise they begin to choke. In most cases, if there is not enough air during pregnancy, this is a physiological phenomenon associated with the particular state of the expectant mother’s body. However, shortness of breath, especially if it is severe and occurs even at rest, can be a danger signal.

What reasons can cause shortness of breath

Physiological

In the early stages, attacks of shortness of breath may occur due to toxicosis. Contrary to the opinion that early toxicosis- This is only nausea and vomiting, it also has other symptoms, including difficulty breathing. In this case, shortness of breath goes away on its own, along with signs of toxicosis, when the body fully adapts to the new condition.

In most cases, it becomes difficult to breathe during pregnancy at the end of the second – third trimester. By this time, the baby in the womb has grown so much that the uterus puts pressure on the lungs, and they can no longer expand completely when inhaling. 2 to 4 weeks before birth, the baby lowers his head into the pelvis, and then shortness of breath usually decreases or disappears altogether.

Pathological

Difficulty breathing during pregnancy can be caused by conditions that arise due to disruption of the functioning of individual organs or diseases.

A weak cardiovascular system, which experiences increased stress during pregnancy, can respond to shortness of breath. And if a woman was diagnosed with coronary heart disease before pregnancy, breathing difficulties are a common occurrence.

Often there is not enough air during pregnancy if oxygen enters the blood in less quantity. This happens with anemia - a low level of hemoglobin, which serves as an oxygen transporter.

Breathing problems can be caused by a deficiency of magnesium in the body, causing disruption of the heart muscle and vascular spasms.

Shortness of breath is caused by many diseases of the respiratory system: the lungs, bronchi, trachea, as well as the diaphragm and chest muscles that ensure the normal functioning of the respiratory system.

The cause of lack of air can be neuroses and stress. Strong excitement stimulates increased production of adrenaline, which tells the body to move more air through the lungs and speed up the heart rate. As a result of this, shortness of breath appears.

The cause of lack of air can be compression of a large vein by the growing uterus, which receives blood from the lower extremities. In this case, shortness of breath occurs if you lie on your back. This dangerous symptom, you should definitely inform your doctor about it.

How to deal with shortness of breath during pregnancy

You should tell your doctor in detail about the occurrence of shortness of breath, as well as other unusual symptoms that occur during pregnancy. If it turns out that the cause is a disease, the doctor will choose a treatment method that is applicable to pregnant women. Yes, when bronchial asthma this can be inhalations, for anemia - taking iron supplements, for coronary disease - magnesium supplements.

Shortness of breath caused physiological reasons, does not pose a danger, but only causes discomfort. You can try to prevent, alleviate or eliminate it using home methods:

• If shortness of breath occurs after physical activity, this is a signal from the body that you need rest.
• Try to visit more fresh air.
• You need to sleep in a ventilated room, preferably on a high pillow, and in the second half of pregnancy, preferably on your side, not on your back.
• During an attack of shortness of breath, it is recommended to get on all fours and take several slow breaths. This will reduce the pressure on the diaphragm and lungs.
• Do not forget that you should not overeat during pregnancy - you need to eat often, but little by little.
• Good help breathing exercises, contributing to a greater supply of oxygen to the lungs. Your doctor will recommend such exercises; those taught before childbirth are also great.

One of the most unpleasant symptoms for expectant mothers is shortness of breath during pregnancy. If anyone doesn’t know, it’s a feeling of lack of air when you inhale, but you literally can’t breathe. There is a lack of oxygen. At the same time, the heart rate increases greatly.

Due to this ailment, the vast majority of expectant mothers are forced to keep windows or vents open around the clock and are unable to lead a normal lifestyle due to very poor tolerance to physical activity - their breathing stops literally immediately.

There are many causes of shortness of breath:

• overload of the mother’s cardiovascular system (the heart and blood vessels must now work not for one organism, but for two);
• lack of oxygen (oxygen inhaled by the mother is distributed between her and the baby);
• iron deficiency anemia (low hemoglobin);
• real heart problems (defects, etc.);
• the uterus, which supports the lungs from below (usually in the eighth month of pregnancy and later); - rhinitis in pregnant women (hormonally caused “stuffy” nose), when nasal breathing is difficult, shortness of breath occurs;
• acute and chronic renal failure;
• thyrotoxicosis (pathology of the thyroid gland).

And although in most cases shortness of breath in expectant mothers is normal, it is imperative to complain about it to the gynecologist leading the pregnancy. And he will probably refer her to a therapist and, possibly, a cardiologist, endocrinologist and pulmonologist.

What tests and examinations are coming?

1. Blood pressure measurement. This procedure awaits a woman at every doctor’s appointment. But in case of shortness of breath and periodic surges in pressure (including the so-called syndrome white coat) a woman is recommended to take measurements independently, at home, 2 times a day.
2. Pulse measurement. Often shortness of breath is accompanied by tachycardia. This is a very unpleasant condition. Normally, the pulse of women during pregnancy is 80-100 beats per minute, slightly higher than outside pregnancy. But in some women, the pulse goes off scale to 150-170 beats with little physical activity. This is a very big load on the heart.
3. ECG. Standard pregnancy test. Normally, the ECG results should read “sinus rhythm,” but “sinus tachycardia” is also a variant of the norm. The main thing is that there are no records of deviation of the electrical axis of the heart.
4. General analysis blood with determination of hemoglobin. The fact is that the feeling of shortness of breath, lack of air and tachycardia is a clear sign of a lack of iron in the body. Usually happens when hemoglobin is below 100-110. Once hemoglobin increases, breathing will immediately become easier. And your strength will increase noticeably.
   Attention! Low hemoglobin is dangerous for both mother and fetus. Anemia in the first trimester of pregnancy provokes abnormal development of the placenta and miscarriages. In the second and third trimester - delayed fetal development and oxygen starvation. After birth, children also suffer from anemia and lag behind in physical and intellectual development.
5. 5. Holter monitoring. This is a heart rate test. It is carried out throughout the day. This is something like an ECG recording that is done over several hours. Accordingly, this study is many times more reliable than it. Of course, the downside for the expectant mother is the inconvenience - you will have to walk around for a day with sensors on your body and a small device (recording) on ​​your belt. Plus keep a diary in which to record all your actions. Physical activity - walking - is especially important. Be sure to go up and down the stairs a couple of times and write down the time in your diary.
   If, apart from an increased heart rate in response to physical activity, no problems are identified, then you can relax. After the birth everything will pass. But doctors usually play it safe and advise you to also undergo an ultrasound examination of the heart.
6. Ultrasound of the heart. The procedure is even more unpleasant than Holter monitoring. It would seem like an ordinary ultrasound. What's unpleasant about it? But no. The fact is that during an ultrasound of the heart, the doctor presses very hard on the ribs with the sensor. And for women who have intercostal neuralgia, this action will bring severe pain. But this nuance, of course, is not a reason to cancel this examination. Especially if a caesarean section is planned.


7. Consultation with an endocrinologist and possibly an ultrasound of the thyroid gland. Especially if you have symptoms such as:
   • weight loss;
   • sweating;
   • diarrhea;
   • irritability;
   • blurred vision.

How to deal with shortness of breath if no abnormalities are found?

If the examination results indicate that everything is in order, take the following measures.

1. Stay outdoors more often, or at least ventilate the room. You absolutely need an influx of oxygen. Always sleep with the window open.
2. Find a body position in which the uterus does not put too much pressure on the diaphragm, then it will be easier for you to breathe. Breathing problems usually occur when sitting.
3. Walk slowly, never rush. And if you are walking alone, always have a phone and some money for a taxi, just in case. You never know...
4. If your doctor does not mind, start taking motherwort and valerian decoctions alternately. They are very calming, including slightly reducing attacks of shortness of breath and tachycardia.
5. Eat little by little. Remember that a full stomach, coupled with a huge uterus, puts pressure on the diaphragm and does not allow you to breathe freely.
6. Avoid strenuous physical activity.
7. Humidify the air at home during the heating season. It is much easier to breathe with humid air, and the nasal mucosa will not dry out.

What to do if an attack of shortness of breath begins?

Try to calm down and stop if you are in motion. Next, you need to sit down if possible and start breathing as follows: take a deep breath and exhale. This way the body will receive enough oxygen for both itself and the fetus. Remember that your labored breathing threatens the child with hypoxia.

If you are at home, take a position in which your lungs will be as free as possible - get on all fours. And keep breathing deeply. By the way, such breathing not only saturates well with oxygen, but also calms you down. And during childbirth, it is very useful - it relieves a little pain by relaxing the muscles of the uterus and promotes rapid dilatation of the cervix.

Remember!

09.05.2019 19:12:00 The causes of shortness of breath, especially acute ones, can be very severe, including cancer. Therefore, if you feel unwell, be sure to inform your doctor. How to stimulate digestion to lose weight?

09.05.2019 18:35:00