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Affect on Baby and Safe Treatments

If you’ve ever had cold sores — those annoying, painful, tiny, fluid-filled blisters that usually form around your mouth and on your lips — you know how inconvenient they can be.

But also if you’ve ever had cold sores (and therefore already have the virus that causes them), did you know they can recur, especially when you’re under stress or are undergoing hormonal fluctuations?

Stress and hormonal changes. That sounds an awful lot like pregnancy.

Cold sores in pregnancy aren’t unheard of, and they don’t usually have any impact on your growing baby. So first, let out a deep sigh of relief. Next, read on — because there are still important things to know about cold sores if you’re expecting.

Cold sores are caused by a virus — the herpes simplex virus (HSV). Of the two types of HSV, cold sores are generally caused by HSV-1, whereas genital herpes is usually a result of exposure to HSV-2. There have been a few instances where HSV-1 sores have been found in the genitals and vice versa.

Once you’ve had a cold sore (oral herpes), the virus remains in your system for life — it’s just not active unless you have a current outbreak.

But when we say that stress and hormones can cause the virus to reactivate, it’s important to know that stress and hormones don’t cause the virus in the first place.

If you’ve never had HSV, you can only get it through contact with someone who has. When it comes to a first-time cold sore infection, this can happen via activities like:

• kissing
• sharing food or utensils
• using someone else’s ChapStick or lip gloss
• oral sex

Here’s the really good news: If you already have the virus that causes cold sores, and you have an outbreak of oral herpes during pregnancy, it’s most likely not going to have any impact on your growing baby.

Cold sores are a localized infection, usually around the mouth area. They don’t typically cross the placenta and reach your baby.

The highest risk scenario is if you get HSV for the first time during your third trimester of pregnancy.

When you get the virus for the first time, your body hasn’t developed any protective antibodies to it yet. And while HSV-1 is usually associated with oral herpes, it can cause a genital herpes outbreak, which can be dangerous to your baby — especially as they pass through the birth canal.

Birth-acquired herpes is serious. However, it’s a concern with genital rather than oral herpes. That being said, because the same virus can cause both, it’s important to talk to your OB about any cold sores during pregnancy.

The most common treatment for cold sores is docosanol (Abreva), an over-the-counter topical cream. But the Food and Drug Administration hasn’t evaluated it for safety in pregnancy.

While some research has determined that it’s “likely safe” during pregnancy, at least one pharmaceutical company that manufactures the drug warns against using it unless it’s definitely needed — which really means you need to check with your doctor. There may be other treatments you should try first.

If you’ve had herpes in the past, your doctor may recommend antivirals — like acyclovir or valacyclovir — starting at week 36 and continuing until delivery of your baby, even if you don’t have a current outbreak of lesions around the genital area. This helps prevent reactivation and spread of the virus to the genital area.

This precaution is because you shouldn’t expose your baby to herpes in the vaginal area during delivery.

Alternatively, your doctor may suggest a cesarean delivery, which avoids the birth canal altogether — something that’s especially important if you have a current outbreak of genital herpes.

Cold sores are highly contagious, despite the fact that they won’t affect your baby in the womb. If you have them after your baby is born, avoid kissing those adorable little cheeks or touching any sores and then touching your newborn without first washing your hands with soap.

In the extremely rare event that you have cold sores on either breast, avoid breastfeeding from that breast while you’re still contagious.

Your cold sores are contagious until they crust over, at which point they’ll start to heal.

If you do pass a cold sore infection on to your newborn, it’s known as neonatal herpes. While not as serious as the birth-acquired version, it can still cause serious complications in a baby who hasn’t yet developed a robust immune system.

The cold sore on your mouth is likely to be more of an annoyance to you than a serious risk to your developing baby, particularly in your first two trimesters of pregnancy and especially if you’ve had one before. But you should still let your OB know about it.

The virus that causes cold sores — usually HSV-1 — can also cause genital herpes, which is more of a risk to your pregnancy and growing little one.

If you have an outbreak in your third trimester — or if you acquire the virus for the first time in your third trimester — your doctor may want you to follow certain treatment or precautionary guidelines, like antivirals or a cesarean delivery.

Signs, symptoms and causes of hemorrhoids in pregnant women - NEARMEDIC network of clinics

The main causes of hemorrhoids in pregnant women can be as follows:

1. Chronic constipation. In this case, the stretching and tension of the walls of the rectum increases during defecation, which leads to the formation of hemorrhoids. In pregnant women, constipation occurs much more often due to a decrease in intestinal tone.
2. Inactive lifestyle. With hypodynamia, blood stagnation occurs in the venous plexus of the rectum, which eventually leads to vein thrombosis and the formation of hemorrhoids. Features of the condition do not always allow pregnant women to be mobile, therefore they have a high risk of developing this disease.
3. Disturbance of blood circulation in the lower half of the body. During pregnancy, the uterus grows and compresses the inferior vena cava. This leads to stagnation of blood in the veins of the legs and rectum. During childbirth, a woman's intra-abdominal pressure rises greatly - this can cause hemorrhoids after pregnancy.

Signs of hemorrhoids in pregnant women

The longer the period, the higher the likelihood of developing the disease. Most often, hemorrhoids appear in the 3rd trimester or after childbirth.

The blood vessels of the hemorrhoidal plexus of the rectum gradually dilate. Over longer periods, the stretching of the veins becomes even stronger. With the expansion of the walls of the veins of the rectum, they lose their elasticity. This provokes protrusion of the veins under the mucous membrane.

If hemorrhoids protrude only into the lumen of the rectum and do not come out of the anus, then we are talking about the treatment of hemorrhoids of the 1st stage. The farther, the larger the knots become and the more they sag from the anus. In the second stage of hemorrhoids, the nodes sag from the anus, but are easily set back on their own. The third stage occurs when the nodes can no longer cope back.

The symptoms of the disease depend on its stage.

1. Internal hemorrhoids. Symptoms are mild, there is no sagging of hemorrhoids from the anus. At this stage, women may experience pain during bowel movements, slight bleeding or fresh blood on the stool, and itching and discomfort in the anus.
2. External hemorrhoids. The main symptom is the sagging of one or more purple-red nodes from the anus. This manifestation is the main sign of what is required, and not of another disease, such as anal fissure. Walking, sitting and defecation in this case become extremely painful.

Urgent medical attention is required in case of infringement of the hemorrhoid - a pregnant woman experiences very severe pain in the anus with fever.

Treatment of hemorrhoids during pregnancy

If a woman already has any symptoms of hemorrhoids - itching, pain in the anus, bleeding from the anus, etc. - professional treatment is required.

At NEARMEDIC, the first stage of treatment is the preventive measures described above, which stop the progression of the disease. Then the woman is prescribed drugs, both local and systemic. But due to pregnancy, local therapy is preferable, as this reduces the risk of side effects, increases the effectiveness of treatment and reduces the negative effects of drugs on the child. In any case, the medicine is prescribed only by the attending physician who observes the woman during pregnancy.

In the case when a woman already has prolapsed nodes that cannot be set, an operation is prescribed. Other indications for surgical intervention are infringement or necrosis of the hemorrhoid, as well as acute inflammation. Most often, in NEARMEDIC surgery is postponed until the postpartum period, and during pregnancy they are limited to conservative treatment.

Prevention of hemorrhoids during pregnancy

Due to the fact that all pregnant women are at high risk of developing hemorrhoids, NEARMEDIC clinic doctors strongly recommend that preventive measures be taken throughout pregnancy, without waiting for symptoms to appear.

1. Relief of constipation. To do this, you need to adjust your diet: eat more foods that contain coarse vegetable fiber - vegetables, fruits, cereals, cereals, prunes. Dairy products also have a beneficial effect on digestion. On the contrary, it is better to refuse meat and other foods rich in protein. As well as from an excess of fat, coffee and hot spices.
2. Hygiene. It is recommended to wash the perineum and anus after each act of defecation. In addition, once a day you can take sitz baths with antiseptics: chamomile infusion, a weak solution of potassium permanganate, etc.

Doctors

Who treat hemorrhoids during pregnancy

Clinics in Moscow

For all questions, you can contact the single contact center: +7 (495) 6-171-171

Dermatoses of pregnancy

Cost: from 1500 rubles
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Pregnancy is a wonderful time for any woman, especially when it is a planned and desired event in the life of a couple. Unfortunately, due to various circumstances, pregnancy does not always occur naturally - in such cases, modern medicine offers various procedures for assisted reproductive technologies. This makes the woman's attitude to such a natural process even more reverent. And here, often, our skin can present surprises. A number of skin conditions can worsen during pregnancy. However, traditionally prescribed drugs have limitations for use in such a situation. And here it is important that the specialist has experience in treating such situations.

Our Clinic is unique in some way, since many years of experience in managing women with skin diseases during pregnancy is not only the head physician, who has been a consultant at the D.O. Ott, but also other specialists who are employees of the Department of Skin Diseases of the First Medical University. Academician I.P. Pavlov.

Now let's try to explain the causes and identify the most common skin diseases during pregnancy.

During pregnancy, the main cause of skin lesions is considered to be changes in the immune system of the pregnant woman. Pathological processes can be manifested by an exacerbation of chronic skin diseases or the appearance of specific pregnancy-associated dermatosis, the so-called "pregnancy dermatosis".

Changes on the skin are very diverse both in manifestations and in the mechanisms of development. Conventionally, they can be divided into 3 groups:

I. Pregnancy stigmas:

Chloasma is the most famous of them. As a development mechanism, various functional endocrine-metabolic changes during pregnancy are assumed. It appears as brownish spots of indefinite outlines, often symmetrical, on the skin of the cheeks, forehead, chin, neck without subjective sensations. Chloasma can occur at different gestational ages, intensifying as it develops and disappearing without a trace shortly after childbirth. But with subsequent pregnancies, chloasma occurs again. Exposure to sunlight enhances the severity of spots.

Pregnancy melanosis - skin changes in the form of hyperpigmentation in the nipples, genitals, white line of the abdomen, also without subjective sensations or inflammation. After childbirth, these disorders disappear. Chloasma and melanosis usually do not require special treatment and spontaneously regress after delivery.

II. Skin diseases relatively common during pregnancy:

This group includes a variety of skin changes and diseases that often accompany pregnancy, as well as some common dermatoses, the course of which usually worsens during gestation. The main mechanism is a change in hormonal ratios in the body of a pregnant woman. This, in turn, affects the functionality of the immune and nervous systems, the state of the gastrointestinal tract, kidneys, cardiovascular activity, water-salt metabolism, etc.

This group includes: hyperhidrosis

• hypertrichosis
• palmoplantar telangiectasias
• erythema of the palms
• alopecia - hair loss
• onychodystrophy - changes in the nail plates

Most of these and other conditions, as a rule, disappear after childbirth. Their treatment, if necessary, is symptomatic.

The course and severity of symptoms of other skin diseases also change during pregnancy. These primarily include eczema, atopic dermatitis, psoriasis, lichen planus, acne, Dühring's herpetiformis. During pregnancy, they often worsen, and exacerbations are usually more pronounced, more severe than before gestation. Sometimes, on the contrary, during pregnancy, a remission occurs, which continues until childbirth, after which another exacerbation occurs. Correction of exacerbations of these dermatoses during pregnancy is very difficult. Many medicines used under normal conditions affect the development of the fetus. Therefore, external symptomatic therapy becomes the leading method.

III. Actually dermatoses of pregnant women

The four skin diseases characteristic of pregnancy, gestational pemphigoid, polymorphic dermatosis of pregnancy, atopic dermatitis of pregnancy, and cholestasis of pregnancy can be distinguished by clinical presentation, histopathology, risk of fetal complications. Only gestational pemphigoid and intrahepatic cholestasis of pregnancy are associated with significant risk to the fetus. Because all of these dermatoses are characterized by pruritus, careful evaluation of any pruritic pregnancies is necessary.

Pregnancy pemphigoid , formerly known as herpes gestationis, is the rarest of the skin disorders of pregnancy and is an autoimmune disease. Clinically, it manifests itself in the form of papules and plaques, transforming into vesiculobullous elements, localized in the umbilical region with spread to the chest, back and limbs. Pemphigoid usually resolves spontaneously within a few months after delivery. As a rule, there is a recurrence of dermatosis during subsequent pregnancies with an earlier onset of dermatosis and greater severity compared to the previous pregnancy. Treatment should be aimed at reducing itching and blistering. In mild cases, topical corticosteroids and antihistamines are effective. In severe pemphigoid, it is advisable to use systemic corticosteroids.

Polymorphic dermatosis of pregnancy (PEP) - is a benign, pruritic inflammatory disease. It usually occurs at the end of the third trimester or immediately after delivery in the first pregnancy. Urticarial papules and plaques appear first on the abdomen and, unlike gestational pemphigoid, do not affect the umbilical region. The rash usually spreads to the thighs and buttocks, and can rarely be widespread. Eruptions with clear boundaries regress spontaneously within 4-6 weeks without treatment. Treatment for PEP is based on symptomatic relief with topical corticosteroids and antihistamines. If the rash becomes generalized, a short course of systemic corticosteroids may be used.

Atopic dermatitis of pregnancy (AEP) is the most common skin disorder in pregnancy. AEP is a benign disease characterized by an pruritic eczematous or papular rash. Two-thirds of AEP cases are characterized by eczematous skin changes localized to atopic areas of the body such as the neck and flexor surfaces of the extremities. The remaining cases are characterized by a papular rash in the abdomen and extremities. Lesions usually respond well to treatment and resolve spontaneously after delivery. However, AEP is more likely to recur in subsequent pregnancies. Dermatosis does not significantly affect the fetus, but there is an increased risk of developing atopic dermatitis in an infant.

Intrahepatic cholestasis of pregnancy (ICP) - characterized by itching with acute onset, which often begins on the palms and soles, and then generalizes. The skin has mostly secondary lesions such as excoriations but may also have papules. In 10%, jaundice develops due to concomitant extrahepatic cholestasis. After giving birth, itching goes away within a few weeks. There is a risk of recurrence in subsequent pregnancies. Diagnosis of ICP is important because there is a risk of complications for both mother and fetus.

Treatment is aimed at normalizing the level of bile acids in the blood serum in order to reduce the risk to the fetus and to control symptoms in the mother.

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