Nasal Congestion or Obstruction During Pregnancy

When a woman becomes pregnant, it is not unusual for the nose to become quite congested... uncomfortably so, even to the point of being unable to breath through the nose.

This condition known as "rhinitis of pregnancy" affects as many as 30% of pregnant women and can start in the second month of pregnancy; it tends to worsen later in pregnancy. The nasal congestion should ease up soon after giving birth and be gone completely within two weeks after delivery.

The nasal congestion occurs due to elevated amounts of estrogen causing swelling of nasal mucous membranes. Furthermore, there is a marked increased in circulating blood in the body which also leads to swelling of the tiny blood vessels lining the nose. Bloodflow causing nasal obstruction (turbinate hypertrophy) is not unusual and even occurs in men (laying down on one side causes nasal obstruction that than switches when laying down on the other side; improves when sitting/standing).

On exam, a common finding are large inferior turbinates. Inferior turbinates are soft tissue outpouchings within the nose that warm and humidify the air as nasal breathing occurs. Normally, they are quite small, but with rhinitis of pregnancy, they can become enormous... even quadrupling in size.

Inferior Turbinates Seen on Exam

Generally speaking, my approach to treating this uncomfortable condition is as follows (assuming all other causes are ruled out and no medical contraindications):

1) Regular HYPER-tonic saltwater nasal irrigations to the nose 3-4x per day. I recommend HYPER-tonic saltwater rather than regular strength saltwater. Why? Salt sucks moisture out of the nose. With regular strength saltwater (aka, normal saline), the saltwater concentration is equal to that found within the body and minimal if any moisture displacement (osmosis) occurs. With HYPER-tonic saltwater, given the increased salt concentration compared to that found within the body, moisture leaves the nose allowing for decongestion to occur.

Nasal irrigations can be performed with Neti Potor NeilMed Sinus Rinse Bottle. Hypertonic salt packetscan be purchased and mixed with 8 ounces distilled water. Or, if you want to make it yourself, 1/2 to 3/4 teaspoon of salt and 1/4 teaspoon of baking soda in 8 ounces of distilled water.

2) Rhinocort AQ (prescription) steroid nasal spray 2 sprays on each side daily. Steroids help to decrease swelling, especially the large inferior turbinates. This steroid nasal spray is the ONLY steroid nasal spray that is Class B for pregnancy.

3) Keep the head elevated when you lie down. This reduces the blood flow to the nose which exacerbates the nasal congestion.

Of course, steps 1 and 2 assume that there is SOME room for the treatment to occur. If the nose is 100% blocked up, use over-the-counter Afrinnasal spray a few times to get things to open up. Once opened up some, immediately start #1 and 2. It is not healthy nor wise to use afrin too much. Ideally, it may need to be used for only 1 day and no more thereafter. Even in non-pregnant individuals, afrin should never be used more than a few consecutive days otherwise risk addiction!

Response to treatment typically occurs within 2 weeks.

Miscarriage During Pregnancy Is Murder Committed by the Mother (According to One Lawmaker)

I know... I know... I'm an ENT, so why am I doing a post on miscarriages? Well, I could not help myself given how outlandish this is... And I did put a picture of a pregnant woman who is smoking and smoking is an ENT problem!

In any case...

So most people in the United States would not bat an eye regarding how abortion can potentially be considered murder.

Most people also would agree with the idea of involuntary manslaughter if a person died due to acts of recklessness or criminal negligence committed by another individual.

Which now goes to the title of this post...

If miscarriage can be shown to be due to "recklessness" or "criminal negligence" of the mother committed against her unborn fetus, is that involuntary manslaughter? For example, if the mom decides to get up to go to the bathroom when told to be on bedrest and a miscarriage occurs, is that manslaughter?

Or what if an uninsured pregnant woman forgoes appropriate prenatal care or is caught smoking during pregnancy (reckless behavior) and miscarries, is that manslaughter?

Such actions can even potentially be considered voluntary manslaughter if it can be proven the mother deliberately committed acts that she knew may potentially by harmful to the fetus. Even if no harm ultimately came to the fetus, it could potentially be considered attempted "assault" and "battery" with the appropriate criminal charges dependent on the degree.

Well, Georgia State Rep. Bobby Franklin, a Republican from Marietta, Georgia, has introduced a 10-page bill (HB 1) earlier this year, that would criminalize miscarriages, making abortion and miscarriage ("prenatal murder" in the language of the bill) potentially punishable by death.

In essence, according to this bill, women who miscarry could become felons if they cannot prove that there was "no human involvement whatsoever in the causation" of their miscarriage. The burden of proof is on the mother.

Furthermore, the bill holds women responsible for protecting their fetuses from "the moment of conception" even though I do believe pregnancy tests aren't accurate until at least 3 weeks after conception.

Now, I'm not an obstetrician, but I do believe most miscarriages occur because the fetus is not developing normally from inherent factors and not external acts.

I'm not exactly sure how the State of Georgia will enforce this legislation if it passes (which I hope won't happen).

The USA is in the midst of spiraling healthcare costs due to defensive medicine being practice by doctors to prevent lawsuits against them. Now think about what would happen if this legislation passes...

Read news article about this here.

Nasal Irrigation Beneficial for Pregnant Women With Allergies

Italian researchers have reported in the International Archives of Allergy and Immunology in Sept 2009 that saline nasal rinsing is a safe and effective treatment option for nasal problems in pregnant women with seasonal allergic rhinitis. In their paper titled "Nasal Lavage in Pregnant Women with Seasonal Allergic Rhinitis: A Randomized Study," the researchers instructed the study group to perform hypertonic saline lavages to the nose 3X per day. Of note, HYPERTONIC saline solution was used instead of the more usual isotonic saline solution.

A statistically significant improvement in rhinitis symptoms (rhinorrea, obstruction, nasal itching and sneezing) was found during the observed weeks 2-6. Furthermore, the mean number of daily antihistamines use per patient per week was significantly reduced at weeks 2, 3 and 6. No adverse effect was reported in the active group.

Read the abstract here.

In our office, we recommend the Neilmed Sinus Rinse bottle as the cheapest and most effective way to perform nasal irrigations. Of note, the Neilmed sinus rinse bottle also comes with hypertonic saline version (along with the more common isotonic version). For convenience, irrigation devices (shown below) are also sold, but much more expensive.

Click here to watch a video of how to perform nasal rinses.