1. Prof. M.C.Bansal
MBBS., MS., FICOG., MICOG.
Founder Principal & Controller,
Jhalawar Medical College & Hospital Jjalawar.
MGMC & Hospital , sitapura ., Jaipur.

2.  Blockede nose or rhinitis occurs in 30 % pregnant
women usually at 3rd month of pregnancy and
continues till1-2 months after delivery.
 Symptoms include blocked nose, sneezing
, rhinorrhoea and nasal itch.
 Nasal congestion is due to increased blood flow
under the effect of increased estrogen -
progesterone levels similar as seen in some
women during pre menstrual phase , after ocs
and local application of estrogen .

3.  Women already having blocked nose prior to
becoming pregnant may suffer considerable
exacerbation.
 Conversely some women particularly suffering
from allergic rhinitis may get some relief due to
increased secretion of cortisol during pregnancy.
 Women more susceptible to nasal obstruction
and infection often catch “ cold virus infection” ,.
Resultant bacterial sinusitis.
 Sinusitis is six time more common in pregnancy.

4.  1. Congenital—Choanal atresia ,septal
deviation.
 2. Traumatic --- septal deviation.
 3. Infection—Acute / Chronic-viral /bacterial /
fungal rhinitis or sinusitis.
 4. Allergy---Allergic rhinitis.
 5 .Autoimmune– Wegner’s granulomatosis
, sarcoidosis , Atrophic rhinitis.
 6. Foreign body.

5.  7. Hormonal rhinitis of pregnancy , ocs pills , pre
menstrual phase.
 8. Iatrogenic—post surgical or drug induced—anti
hypertensive drugs
 9. Pharmacological– Rhinitis medica mentosa.
 10. Vasomotor– secondary to odors ,alcohol
, emotions , temperature variables , atmospheric
pressure variables , bright light , spicy food , GERD.
 11. Neoplastic—
(a)Benign : nasal polyp , inverted papilloma
, pyogenic, grannuloma.
(b) malignant : Adenocrcinoma.

6.  1. Increased hormones --- incre3sd blood to nasal mucosa and
stasis in venous return.
 2. increased allergic nasal problem in pregnant women is common
who produce less estrogen and cortical in response in pregnancy
.reduced ½ life of cortical in pregnancy.
 Electron micrograph band histochemical studies performed on the
inferior turbinates of pregnant women has shown hyperactive
tunical, goblet and seromucinous glands. There was also increase
enzymatic activity, like cholinesterase---parasympathetic activity.
This may be an allergic response to placental or fetal proteins.
 Generalized increase in interstitial fluid volume more so in 3rd
trimester also directly effects the nasal mucosa, contributing to
congestion.

7.  1. History----the relevant points include
duration of problem , side of nasal block
, surgery / injury , exacerbating or relieving
factors , response to previous treatment , atopic
and symptoms associated with sinusitis.
 2.ENT.Examination—Anterior rhinos copy –
Nasal septum deviation , polyp , hypertrophic
turbinate's .
Rigid / flexible nasendoscopy allows complete
examintionof entire nasal cavity and post nasl
space.

8.  3. Investigations ---
(a) RAST—radioallergosorbent- testing for
common environmental allergens , pets , animal
dander , food allergy etc.
(b) Nasal Rhinomtery– To assess air flow.
Increased nitric oxide in rhinitis while it is
decreased in polyps.
(c) Assessment of smell is performed by
‘scratch and sniff’ card or ‘sniffin’stcks.
4. CT –to assess anatomy of nose and sinuses.
(avoided in pregnancy )

9.  1 Medical.
 2 Surgical.
General –allergen avoidance—allergic rhinitis.
Common allergens are pollens, moulds , house
dust mites animal dander , pets ,fumes in
kitchen , perfumes and odours etc. topical saline
spray can offer temporary relief. For rhinitis
control topical cromoglycate inqds dose has an
excellent prophylactic role.

10. 1. Medical-
( a) Topical Steroids--- Intra nasal steroids
(Fluticasone, budesonide and beclomethasone ) can be
used for more severe nasal obstruction . They are not
teratogenic .
topical Ipratropium bromide is safe in watery
rhinorrhoea.
( b ) Nasal decongestant---Xylometazoline spray cause
topical vasoconstriction. Rebound nasal congestion leads
to rhinitis medica mentosa ., rapidly absorbed systemically
hence not to be given to PIH cases. Its use has been
correlated with the development of gastrschisis. Oral
decongestants should be avoided in 1st trimester.
Pseudoephidrine can be used in later part of pregnancy.

11. ( c) Systemic corticosteroid therapy—used only
in state acute asthmatic attack.
(d) Anti histamines---Used safely to treat
allergic rhinitis.Chlorphenermine , triplenamine
levo cetrazine are used .
( e) Antibiotics--- Used for specific acute
infection associated with rhinitis / sinusitis.Broad
spectrum penicillins and marcolides (
erythromycin ) are safe to
use.Sulphonomides, tetracyclines
, chloamphenicol , trimethoprim
,aminoglycosides are to be avoided.

12.  Ideally , surgery is postponed until after
delivery.surgical options are---
1. Inferior Turbinate reduction.
2. Nasal Polypectomy.
3. Endoscopic.