ENT Diseases: Diagnosis and Treatment during Pregnancy and Lactation

Description

The book offers a comprehensive overview of ENT diseases during pregnancy, postpartum and lactating period. It brings together the experience of authors from more than 25 countries  and aims to provide a broader  understanding of the diagnosis, prevention and treatment of the ENT pathologies in pregnant and lactating women. The book is organized in 7 main parts according to the ENT subspecialties, and each chapter features a reader-friendly, uniform structure. It includes developments about COVID-19 infection. ENT Diseases: Diagnosis and Treatment during Pregnancy and Lactation will appeal to a wide readership, from ENT practitioners through allergists and pulmonologists, to trainees and students in ENT, obstetrics/gynecology.​ Preface Preface Contents List of Contributors Part I: Physiological Changes During Pregnancy and the Postpartum Period 1: Maternal Physiology During Pregnancy 1.1 Introduction 1.2 Hematological Changes 1.2.1 Blood Volume 1.2.2 Red Blood Cells 1.2.3 Iron Supplementation 1.2.4 Immunological Changes 1.2.5 White Blood Cells and Inflammatory Markers 1.2.6 Coagulation and Fibrinolysis 1.3 Cardiovascular System Changes 1.4 Endocrine System Changes 1.5 Metabolic Changes 1.5.1 Glucose Metabolism 1.5.2 Lipid Metabolism 1.5.3 Protein Metabolism 1.6 Ear, Nose, and Throat Changes 1.6.1 Ear Changes 1.6.2 Nasal Changes 1.6.3 Throat Changes 1.7 Respiratory System Changes 1.8 Gastrointestinal System Changes 1.8.1 Oral Cavity 1.8.2 Gastrointestinal Tract 1.8.3 Liver 1.8.4 Gallbladder 1.9 Renal System Changes 1.10 Reproductive Tract Changes 1.11 Mammary Tissue Changes 1.12 Musculoskeletal Changes 1.13 Skin Changes References 2: Physiological Changes During the Postpartum Period: General Overview 2.1 Introduction 2.2 Physiological Changes During the Postpartum Period 2.2.1 Physiological Changes in the Organs of Reproduction and the Perineum 2.2.1.1 Uterus 2.2.1.2 Cervix 2.2.1.3 Vagina 2.2.1.4 Ovaries 2.2.1.5 Perineum 2.2.2 Physiological Adaptation in the Reproductory System 2.2.3 Physiological Changes in Breasts 2.2.4 Physiological Changes: Lactation 2.3 Physiological Changes in the Endocrine System 2.4 Physiological Changes in Fluid Balance 2.5 Physiological Changes in the Haematological System 2.6 Physiological Changes in the Cardiovascular System References 3: Immune System and Pregnancy 3.1 Introduction 3.2 Endometrium and Menstrual Cycle 3.3 Fertilization and Blastocyst Formation 3.4 Implantation of Blastocyst 3.4.1 Apposition 3.4.2 Adhesion/Attachment 3.4.3 Invasion/Penetration 3.4.4 Placentation 3.4.5 Decidualization and Immune Regulation 3.5 Hormonal Factors in the Implantation 3.6 Cytokines in the Implantation 3.7 The Composition of Immune Cells in Decidua 3.8 Microbiota 3.9 Delivery 3.10 Conclusions References 4: Diagnostic Imaging of the Head and Neck During Pregnancy and the Postpartum Period 4.1 Introduction 4.2 Ultrasonography 4.3 Magnetic Resonance Imaging 4.4 Ionizing Radiation 4.5 Computed Tomography and Angiography 4.6 Nuclear Medicine 4.7 Use of Contrast Media During Pregnancy and Lactation References 5: Treatment of Respiratory Infections in Pregnant Patients: Overview 5.1 Introduction 5.2 FDA Pregnancy Categories 5.3 Current FDA Classification Scheme 5.3.1 Category A 5.3.2 Category B 5.3.3 Category C 5.3.4 Category D 5.3.5 Category X 5.4 Antibiotic Groups 5.4.1 Penicillins 5.4.2 Cephalosporins and Cephamycins 5.4.3 Carbapenems 5.4.4 Glycopeptides and Lipoglycopeptides 5.4.5 Macrolides and Ketolides 5.4.6 Fluoroquinolones 5.4.7 Miscellaneous Antibiotics 5.4.7.1 Clindamycin 5.4.7.2 Metronidazole References 6: The Variations in Communication During Pregnancy and the Postpartum Period 6.1 Introduction 6.2 Birth and Communication 6.3 Communication with Women and Healthcare Providers at Birth and Postpartum 6.4 Communication with Disabled Women Giving Birth References 7: Effect of Pregnancy on the Upper Respiratory Tract and Chest Wall 7.1 Introduction 7.2 Upper Airway Changes in Pregnancy 7.2.1 Nasal Physiological Changes 7.3 Lung and Chest Wall Mechanics in Pregnancy 7.4 Respiratory Muscle Function 7.5 Effect of Pregnancy on Ventilation and Gas Exchange References Part II: General Otolaryngology During Pregnancy and the Postpartum Period 8: ENT Emergencies During Pregnancy 8.1 Introduction 8.2 Epistaxis 8.2.1 Treatment 8.3 Bell’s Palsy 8.3.1 Epidemiology 8.3.2 Physiopathology 8.3.3 Diagnosis 8.3.4 Treatment 8.4 Sudden Sensorineural Hearing Loss 8.4.1 Treatments 8.5 Maxillofacial Trauma 8.6 Deep Neck Infections References 9: Postpartum ENT Emergencies 9.1 Introduction 9.2 Postpartum Thyroiditis 9.3 Epistaxis 9.4 Hereditary Angioedema 9.5 Vertigo 9.6 Laryngeal Oedema 9.7 Bell’s Palsy References 10: Use of Antibiotics During Pregnancy and the Postpartum Period 10.1 Introduction 10.2 Drug Absorption 10.3 Drug Distribution 10.4 Drug Metabolism 10.5 Drug Excretion 10.5.1 Penicillins 10.5.2 Cephalosporins 10.5.3 Carbapenems 10.5.4 Fluoroquinolones 10.5.5 Macrolides 10.5.6 Aminoglycosides 10.5.7 Sulfonamides and Trimethoprim 10.5.8 Tetracyclines 10.5.9 Azteronam 10.5.10 Lincosamides 10.5.11 Linezolid 10.5.12 Metronidazole 10.5.13 Nitrofurantoin 10.5.14 Rifampicin 10.5.15 Vancomycin References 11: Use of Corticosteroid During Pregnancy and the Postpartum Period 11.1 Introduction 11.2 Corticosteroid and Pregnancy 11.3 Corticosteroid and Lactation 11.4 Conclusion References 12: Use of Topical Therapies During Pregnancy and the Postpartum Period 12.1 Introduction 12.2 Topical Ear Drugs (Or Drops)? 12.2.1 Antibiotics 12.2.2 Glucocorticoids 12.2.3 Antiseptics and Acidifying Solutions 12.3 Topical Nasal Drugs 12.3.1 Intranasal Corticosteroid 12.3.2 Intranasal Decongestants 12.3.3 Intranasal Antihistamines 12.3.4 Saline Lavages 12.4 Other Topical Drugs References 13: Locoregional Anaesthesia During Pregnancy and the Post-partum Period 13.1 Introduction 13.2 The Anatomy and Techniques for Nerve Blocks of the Head and Neck 13.2.1 Trigeminal Nerve 13.2.1.1 Trigeminal Nerve Blocks 13.2.1.2 The Trigeminal Cardiac Reflex 13.2.2 Ophthalmic Nerve 13.2.3 Supraorbital and Supratrochlear Nerves 13.2.3.1 Supraorbital and Supratrochlear Nerve Blocks 13.2.4 Nasociliary Nerve 13.2.4.1 Nasociliary Nerve Block 13.2.5 Maxillary Nerve 13.2.5.1 Maxillary Nerve Block Suprazygomatic Approach Greater Palatine Canal Approach Coronoid Approach 13.2.6 Infraorbital Nerve 13.2.6.1 Infraorbital Nerve Block Intraoral Approach Extraoral Approach 13.2.7 Zygomaticotemporal Nerve 13.2.7.1 Zygomaticotemporal Nerve Block 13.2.8 Zygomaticofacial Nerve 13.2.8.1 Zygomaticofacial Nerve Block 13.2.9 Mandibular Nerve 13.2.9.1 Mandibular Nerve Block Gow-Gates Technique Vazirani-Akinosi Closed-Mouth Technique Coronoid Approach 13.2.10 Mental Nerve 13.2.10.1 Mental Nerve Block 13.2.11 Auriculotemporal Nerve 13.2.11.1 Auriculotemporal Nerve Block 13.2.12 Sphenopalatine Ganglion 13.2.12.1 Pterygopalatine Ganglion Block Topical Application Approach 13.2.13 Cervical Plexus 13.2.13.1 Cervical Plexus Block 13.2.13.2 Greater Auricular Nerve Block 13.2.13.3 Greater Occipital and Lesser Occipital Nerve Blocks 13.3 The Anatomy and Techniques for Regional Blocks of the Head and Neck 13.3.1 Regional Anaesthesia of the Ear 13.3.1.1 Block Technique 13.3.2 Regional Anaesthesia of the Nose 13.3.2.1 Block Technique 13.3.3 Regional Anaesthesia of the Scalp 13.3.3.1 Block Technique 13.3.4 Regional Anaesthesia of the Upper Airway 13.3.4.1 Trigeminal Nerve 13.3.4.2 Glossopharyngeal Nerve Glossopharyngeal Nerve Block 13.3.4.3 Vagal Nerve Superior Laryngeal Nerve Block Recurrent Laryngeal Nerve Block 13.4 Local Anaesthetics 13.5 LAST Treatment References 14: General Anesthesia During Pregnancy and the Postpartum Period 14.1 Introduction 14.1.1 Anesthetic Considerations for Nonobstetric Surgery During Pregnancy 14.1.2 Timing of Surgery 14.2 Maternal and Fetal Safety 14.2.1 Maternal Safety 14.2.1.1 Maternal Physiology and Anesthetic Implications Changes in the Cardiovascular System Supine Hypotensive Syndrome Changes in the Respiratory System Changes in the Gastrointestinal System Other Changes 14.2.2 Fetal Safety 14.2.2.1 Fetal Effects of Anesthesia 14.2.2.2 Fetal Effects of Maternal Factors 14.2.2.3 Placental Transfer of Drugs 14.2.2.4 Teratogenicity 14.2.2.5 Risk Categorization of Drugs 14.2.2.6 Fetal Heart Rate Monitoring 14.2.2.7 Avoidance and Treatment of Preterm Delivery 14.3 Anesthetic Drugs 14.3.1 Frequently Used Drugs for Anesthesia and Analgesia 14.3.1.1 Benzodiazepines 14.3.1.2 Opioids 14.3.1.3 Hypnotics 14.3.1.4 Volatile Anesthetics 14.3.1.5 Neuromuscular Blockers 14.3.1.6 Neuromuscular Block Reversal Agents 14.3.1.7 Anticholinergic Drugs 14.3.1.8 Nonopioid Analgesics 14.4 Anesthesia Management 14.4.1 General Anesthesia 14.4.1.1 Preanesthetic Evaluation 14.4.1.2 Rapid Sequence Induction and Intubation 14.4.1.3 Difficult Airway Management Cannot Intubate–Cannot Ventilate 14.5 Anesthesia and Postoperative Analgesia in Lactation 14.6 Cardiopulmonary Resuscitation in Pregnancy 14.6.1 Differences in Basic Life Support and Advanced Cardiovascular Life Support in Pregnant Women 14.6.1.1 Basic Life Support 14.6.1.2 Circulation 14.6.1.3 Airway 14.6.1.4 Perimortem Cesarean Delivery 14.6.1.5 Drugs Used During Advanced Cardiovascular Life Support References 15: Pain Management in Pregnancy and Lactation 15.1 Introduction 15.2 Physiological Changes in Pregnancy 15.2.1 Hormonal Changes 15.2.2 Cardiovascular and Hemodynamic Changes 15.2.3 Respiratory Changes 15.2.4 Hematological Changes 15.2.5 Renal Changes 15.2.6 Gastrointestinal Changes 15.2.7 Musculoskeletal Changes 15.3 Pharmacokinetic Mechanisms in Pregnancy 15.4 Placental Transfer of Drugs 15.5 Nonobstetric Pain Situations in Pregnancy 15.6 Pharmacological Pain Treatment in Pregnancy and Lactation 15.6.1 Medication in Pregnancy 15.7 Medications in the Breastfeeding Mother 15.7.1 Drug Delivery Route 15.7.2 Pharmacokinetic Properties of the Drug 15.8 Infant-Related Features 15.9 Factors Determining the Effect of Drugs on Infants 15.10 Frequently Used Drugs for Pain Management 15.10.1 Acetaminophen 15.10.2 Nonsteroid Anti-inflammatory Drugs (NSAIDs) 15.10.3 Opioid Analgesia 15.11 Local Anesthetics 15.11.1 Glucocorticoids 15.12 Anticonvulsants 15.12.1 Pregabaline–Gabapentine 15.12.2 Topiramat 15.12.3 Carbamazepine 15.12.4 Antidepressants 15.12.5 Triptanes and Ergot Alkaloids 15.12.6 Neuroleptics (Dopamine Antagonists) 15.12.7 Muscle Relaxants 15.12.8 Interventional Analgesics in Pregnancy and Lactation 15.13 Physical Therapy 15.14 Acupuncture 15.15 Botulinum Toxin References 16: Oral Mucosal Lesions During Pregnancy and in the Postpartum Period 16.1 Introduction 16.2 Anatomy of the Oral Cavity 16.3 Structure and Function of the Oral Mucosa 16.4 Oral Mucosal Lesions During Pregnancy 16.4.1 Oral Candidiasis 16.4.2 Pregnancy Gingivitis 16.4.3 Pyogenic Granuloma 16.4.4 Morsicatio Buccarum 16.4.5 Benign Migratory Glossitis 16.4.6 Aphthous Ulcers 16.4.7 Behcet’s Disease 16.4.8 Pemphigus Vulgaris 16.4.9 Gestational Pemphigoid References 17: Snoring and Sleep Apnea During Pregnancy and Postpartum Period 17.1 Introduction 17.2 Sleep Disorders and Pregnancy 17.3 Physiological Changes in Pregnancy 17.3.1 Factors that Prevent SDB During Pregnancy 17.3.2 Factors that Facilitate SDB During Pregnancy 17.4 Snoring in Pregnancy 17.4.1 Epidemiology and Risk Factors 17.4.2 Maternal Morbidity 17.4.2.1 Hypertension and Preeclampsia 17.4.2.2 Diabetes 17.4.2.3 Depression 17.4.2.4 Obstetrical Outcomes 17.5 Fetal/Infantile Morbidity 17.5.1 Infant Birth Weight 17.5.2 SGA/Intrauterine Growth Retardation 17.5.3 Preterm Delivery 17.5.4 Cesarian Section 17.5.5 APGAR 17.5.6 Genetic Disorder 17.5.7 Treatment 17.6 Sleep Apnea in Pregnancy 17.6.1 Epidemiology and Risk Factors 17.6.2 Symptoms 17.6.3 Screening and Diagnosis 17.6.4 Maternal Morbidity 17.6.5 Neonatal Morbidity 17.6.6 Treatment 17.7 Postpartum Period References 18: Dysphagia During Pregnancy and the Postpartum Period 18.1 Introduction 18.2 Initial Approach to a Patient with Dysphagia 18.3 General Considerations About Dysphagia in Pregnancy and Postpartum Period 18.4 Considerations About some Specific Causes of Dysphagia in Pregnancy and Postpartum Period 18.4.1 Achalasia 18.4.2 Other Motility Disorders 18.4.3 Esophageal Tumors 18.4.4 Gastroesophageal Reflux Disease, Peptic Stricture, and Schatzki’s Ring 18.4.5 Other Benign Strictures 18.4.6 Eosinophilic Esophagitis 18.4.7 Functional Dysphagia 18.4.8 Neurological Disorders References 19: Temporomandibular Joint Disorders During Pregnancy and the Postpartum Period 19.1 Introduction 19.2 Signs and Symptoms of Temporomandibular Disorders 19.3 Etiology 19.4 Diagnosis 19.5 TMD in Relation to Pregnancy/Lactation 19.6 Treatment 19.7 Conclusion References 20: Odontogenic Diseases During Pregnancy and Postpartum Period 20.1 Introduction 20.2 Stomatologic Changes Due to Alterations of Pregnancy 20.2.1 Changes in Oral Mucosa 20.2.2 Changes in Oral Microbiota 20.2.3 Changes in Saliva 20.3 Odontogenic and Stomatologic Diseases of Pregnancy 20.3.1 Gingivitis Gravidarum 20.3.2 Epulis Gravidarum (Pregnancy Tumor) 20.3.3 Dental Erosion 20.3.4 Odontogenic Inflammatory Lesions 20.3.5 Caries in Pregnancy 20.3.6 Dental Abscesses in Pregnancy 20.3.7 Odontogenic Inflammatory Cysts in Pregnancy 20.4 Alterations in Preexisting Diseases with Oral Manifestations During Pregnancy 20.4.1 Odontogenic Tumors 20.4.1.1 Ameloblastoma 20.4.1.2 Adenomatoid Odontogenic Tumor 20.4.2 Temporomandibular Disorders 20.5 Effects of Odontogenic and Stomatologic Diseases on Systemic Conditions 20.6 The Postpartum Period References 21: Tonsillopharyngitis During Pregnancy and the Postpartum Period 21.1 Introduction 21.2 Tonsillopharyngitis 21.3 Etiology 21.4 Signs and Symptoms 21.5 Antibiotics in Pregnancy 21.5.1 Classification 21.5.2 Antibiotics in Frequent Use 21.6 Antibiotic Use During Breastfeeding 21.6.1 Milk-to-Plasma Ratio 21.6.2 Excretion of Antibiotics in Breast Milk 21.6.2.1 Penicillins 21.6.2.2 Clavulanic Acid 21.6.2.3 Cephalosporins 21.6.2.4 First-Generation Cephalosporins 21.6.2.5 Second-Generation Cephalosporins 21.6.2.6 Third-Generation Cephalosporins 21.6.2.7 Metronidazole 21.6.2.8 Fluoroquinolones 21.6.2.9 Macrolides References 22: Facial and Deep Cervical Infections During Pregnancy and the Postpartum Period 22.1 Introduction 22.2 Etiology 22.3 Microbiology 22.4 Anatomy 22.5 Clinical Assessment 22.5.1 History 22.5.2 Physical Examination 22.6 Laboratory Evaluation 22.6.1 Blood Tests 22.6.2 Imaging Studies 22.7 Treatment 22.7.1 Airway Management 22.7.2 Medical Treatment 22.7.2.1 Metabolic Support and Liquid Replacement 22.7.2.2 Antibiotic Treatment 22.7.2.3 Analgesia 22.7.3 Surgical Treatment 22.8 Complications References 23: Influenza Occurring in Pregnant Women 23.1 Influenza Virus 23.2 Influenza in Pregnancy 23.3 Clinical and Laboratory Diagnosis 23.4 Complications 23.5 Pregnancy-Related Complications 23.6 Preterm Birth 23.7 Small-for-Gestational Age 23.8 Stillbirth 23.9 Pathophysiologic Mechanisms Underlying Increased Influenza Risk to Pregnant Women 23.10 Prevention and Treatment of Influenza in Pregnancy 23.10.1 Vaccination 23.10.2 Nonspecific Treatment 23.10.3 Antiviral Treatment 23.11 Conclusion References 24: Management of COVID-19 During Pregnancy and the Postpartum Period 24.1 Introduction 24.2 COVID-19 in Pregnant Women 24.2.1 COVID-19 Epidemiology in Pregnant Women 24.3 SARS-CoV-2 Virus Transmission Routes During Pregnancy 24.3.1 Mother-to-Baby Transmission 24.4 Diagnosis of SARS-CoV-2 During Pregnancy 24.5 Clinical Findings in Pregnancy 24.6 Pregnancy Complications 24.6.1 Fetal Complications 24.7 Approach to Pregnant Women with Suspected or Diagnosed COVID-19 24.7.1 Monitoring at Home 24.7.2 Follow-up of Pregnant Women Diagnosed with COVID-19 in the Hospital 24.8 Treatment 24.8.1 Maternal Respiratory Support 24.8.2 Use and Type of Venous Thromboembolism Prophylaxis 24.8.3 Dexamethasone 24.8.4 Antiviral Drug Therapy 24.8.5 Convalescent Plasma 24.8.6 Low-dose Aspirin and Nonsteroidal Anti-inflammatory Drugs (NSAIDs) 24.8.7 Tokolysis 24.9 Fetal Monitoring 24.10 Follow-up of Women Recovering from COVID-19 24.11 Planning Delivery in COVID-19 Pregnant Women 24.11.1 Analgesia and Anesthesia 24.11.2 Psychological Support 24.12 Protective Measures 24.13 Follow-up of a Newborn Born from a Mother Diagnosed with COVID-19 References 25: Head and Neck Trauma During Pregnancy and the Postpartum Period 25.1 Introduction 25.2 Pregnancy-Related Changes to be Monitored 25.3 Assessment of Trauma 25.3.1 Primary Evaluation 25.3.2 Evaluation of Foetal Condition 25.3.3 Secondary Evaluation 25.3.4 Radiological Evaluation 25.4 Choosing the Anaesthetic Method 25.4.1 General Anaesthesia (GA) 25.4.2 Local Anaesthesia (LA) 25.5 Choice of Treatment 25.5.1 Analgesics 25.5.2 Antibiotics 25.5.3 Corticosteroids 25.6 Conclusion References 26: Head and Neck Trauma During Pregnancy and the Postpartum Period: General Overview 26.1 Introduction 26.2 Fetal and Maternal Injury Mechanisms 26.3 Blunt Abdominal Trauma 26.3.1 Protection 26.4 Penetrating Traumas 26.5 Evaluation, Diagnosis, and Treatment 26.5.1 Pre-Hospital Environment 26.5.2 First Evaluation 26.5.2.1 Airway 26.5.2.2 Breathing 26.5.2.3 Circulation 26.5.2.4 Disability 26.5.2.5 Exposure 26.5.3 Second Evaluation 26.5.3.1 Routine Laboratory Tests 26.5.3.2 Radiography 26.5.4 Ultrasonography 26.5.5 Magnetic Resonance Imaging 26.5.6 Computed Tomography Scan 26.5.7 Diagnostic Peritoneal Lavage 26.5.8 Fetomaternal Hemorrhage 26.5.9 Fetal Monitoring 26.6 Specific Maternal Injuries 26.6.1 Thermal Burns 26.6.2 Electric Injuries 26.7 Postpartum Period References 27: The Effects of Vitamin D Deficiency and Its Replacement in the Gestation and Lactation Periods 27.1 Introduction 27.2 Background and Epidemiology 27.3 The Metabolism of Vitamin D 27.4 Measurement Methods of Vitamin D 27.5 Vitamin D Deficiency 27.6 The Maternal and Fetal Outcomes of Vitamin D Deficiency Seen During the Gestation Period 27.7 The Maternal Outcomes Seen During Pregnancy Depending Upon Vitamin D Deficiency 27.8 The Effects of Vitamin D on Fetus 27.9 Vitamin D Treatment References 28: Reliability of Frequently Used Ear, Nose, and Throat Drugs During Pregnancy and the Postpartum Period 28.1 Introduction 28.2 Drug Groups Which are Used in Ear, Nose, and Throat Practice 28.2.1 Medical Treatment of Infections in Ear, Nose, and Throat 28.2.1.1 Antibiotics 28.2.1.2 Beta-Lactam Antibiotics and Pregnancy 28.2.1.3 Penicillin Antibiotics and Pregnancy 28.2.1.4 Cephalosporins Antibiotics and Pregnancy 28.2.1.5 Glycopeptides and Pregnancy 28.2.1.6 Fosfomycin and Pregnancy 28.2.2 Agents That Increase the Permeability of the Outer Membrane 28.2.2.1 Polymyxin and Pregnancy 28.2.3 Protein Synthesis Inhibitors and Pregnancy 28.2.3.1 Macrolide Antibiotics and Pregnancy 28.2.3.2 Clindamycin and Pregnancy 28.2.3.3 Aminoglycosides and Pregnancy 28.2.4 DNA or mRNA Synthesis Inhibitors 28.2.4.1 Quinolones and Pregnancy 28.2.5 Antiviral Treatments 28.2.5.1 Oseltamivir and Zanamivir 28.2.5.2 Amantadine and Rimantadine 28.2.5.3 Acyclovir and Valacyclovir 28.2.6 Antifungal Treatments 28.3 Rhinitis and Rhinosinusitis Treatment 28.3.1 Intranasal Corticosteroids 28.3.2 Antihistamines 28.3.3 Intranasal Antihistamines 28.3.4 Leukotriene Modifiers 28.3.5 Nasal Decongestants 28.3.6 Systemic Decongestants 28.3.7 Inhaled and Oral Preparations of Corticosteroids 28.3.8 Monoclonal Antibodies 28.3.9 Anticholinergic Agents 28.3.10 Theophylline 28.4 Meniere’s Disease Treatment 28.4.1 Antiemetics 28.5 Bell’s Palsy Treatment 28.6 Anticoagulant Medications, Epistaxis, and Treatment in Pregnancy 28.6.1 Anticoagulants 28.6.2 Oral Anticoagulants 28.6.3 Antiplatelet Drugs 28.7 Others References 29: Herpes Simplex Viral Infections in Pregnancy 29.1 Introduction 29.2 Aetiology 29.3 Clinical Features 29.3.1 Orolabial Herpes 29.3.1.1 Primary Infection 29.3.2 Recurrences 29.3.3 Genital Herpes 29.3.3.1 Primary Infection 29.3.3.2 Recurrences 29.4 HSV During Pregnancy 29.4.1 Vertical Transmission 29.4.2 Evidence 29.4.3 Management During Pregnancy 29.4.3.1 Suppressive Therapy at 36 weeks 29.4.3.2 Topical Antivirals 29.4.4 Drug Selection, Dosage and Safety 29.5 Postpartum and Neonatal Management References 30: Headache During Pregnancy and Lactation 30.1 Introduction 30.2 Aetiology 30.2.1 Primary Headaches 30.2.2 Migraine 30.2.3 Tension-type Headache 30.2.4 Cluster Headache 30.2.5 Secondary Headaches 30.2.6 Ischaemic Stroke 30.2.7 Subarachnoid Haemorrhage 30.2.8 Idiopathic Intracranial Hypertension 30.3 Diagnostic Evaluation 30.3.1 Women at Risk of a Severe Underlying Condition Require Thorough Assessment Without Delay 30.3.2 General Principles When Assessing a Pregnant Woman with a Headache 30.3.3 Assessment of Women During the Postpartum Interval 30.4 Treating Headaches in Patients Who Are Pregnant or Lactating 30.4.1 Acute Migraine Treatment 30.4.2 Preeclampsia References 31: Oral Health During Pregnancy and The Lactation 31.1 Introduction 31.2 Periodontal Diseases and Adverse Pregnancy Outcomes 31.2.1 Preterm Birth (PB) and Low Birth Weight (LBW) of Neonates 31.2.2 Pregnancy Hypertension and Preeclampsia 31.2.3 Gestational Diabetes Mellitus (GDM) 31.2.4 Spontaneous Abortion (SA) 31.3 Dental Caries and Adverse Pregnancy Outcomes 31.4 Dental Management Guideline During Pregnancy 31.4.1 Emergency Treatment 31.4.2 Urgent Treatment 31.4.3 Necessary Treatment 31.4.4 Elective Treatment 31.5 Dental Treatment Timings in Pregnant Patients 31.5.1 Treatment for the First Trimester (1–12 weeks) 31.5.2 Treatment for the Second Trimester (13–24 weeks) 31.5.3 Treatment for the Third Trimester (13–24 weeks) 31.6 Dental Care and Oral Health Recommendations for Pregnant Patients 31.7 Oral Health Management 31.8 Dietary Guidelines and Food Recommendations to Provide Essential Oral Health During Pregnancy 31.9 Nicotine, Tobacco, and Alcohol Consumption During Pregnancy 31.10 Mother of Infant-Lactation Period and Breastfeeding References Part III: Otology, Neurotology and Skull Base Surgery During Pregnancy and the Postpartum Period 32: The Management of Hearing Loss During Pregnancy and the Postpartum Period 32.1 Introduction 32.2 Hearing Changes Due To Hormonal Changes 32.3 Otosclerosis 32.3.1 Treatment Approach 32.3.1.1 Follow-up 32.3.1.2 Amplification (Hearing Aids) 32.3.1.3 Medical Treatment 32.3.1.4 Surgical Treatment (Stapedotomy-Stapedectomy) 32.4 Sudden Hearing Loss 32.4.1 Treatment Approach 32.5 Meniere’s Disease 32.5.1 Treatment Approach 32.6 Otitis Media and External Otitis 32.6.1 Treatment Approach References 33: Sudden Sensorineural Hearing Loss During Pregnancy and the Postpartum Period 33.1 Introduction 33.2 Audiological Findings 33.3 Etiopathogenesis 33.4 Acoustic Neurinoma 33.5 Sudden Sensorineural Hearing Loss in the Postpartum Period 33.6 Immune-Mediated Disorders 33.7 The Relationship of Sudden Sensorineural Hearing Loss and Morbidity 33.8 Treatment 33.9 Conclusion References 34: Vestibular Disorders During Pregnancy and the Postpartum Period 34.1 Introduction 34.2 Meniere Syndrome 34.3 Benign Paroxysmal Positional Vertigo (BPPV) 34.4 Vestibular Neuritis 34.5 Migraine and Migraine-Associated Vertigo 34.6 Superior Semicircular Canal Dehiscence (SSCD) 34.7 Perilymph Fistula (PLF) 34.8 Vestibular Schwannoma (Acoustic Neuroma) 34.9 Meningioma 34.10 Otosclerosis 34.11 Conclusion References 35: Meniere’s Disease During Pregnancy and The Postpartum Period 35.1 Introduction 35.2 Meniere’s Disease 35.2.1 Definite MD 35.2.2 Probable MD 35.3 Treatment 35.3.1 Acute Attack (Early 48 h) 35.3.2 Prevention of Attacks 35.4 Pregnancy 35.5 Postpartum Period 35.6 Treatment References 36: Management of Chronic Otitis Media and Its Complications During Pregnancy and the Postpartum Period 36.1 Introduction 36.2 Chronic Otitis Media 36.3 Medication Classification References 37: Otosclerosis During Pregnancy and The Postpartum Period 37.1 Introduction 37.2 Etiology 37.3 Histopathology 37.4 Symptoms, Signs, and Audiogram 37.5 Otosclerosis and Pregnancy 37.6 Treatment 37.6.1 Steps of Stapedotomy 37.7 Hearing Aids References 38: Facial Nerve Disorders During Pregnancy and the Postpartum Period 38.1 Introduction 38.2 Epidemiology and Etiology 38.3 Clinic Course 38.4 Diagnosis 38.5 Prognosis 38.6 Treatment 38.6.1 Eye Protection 38.6.2 Corticosteroid Therapy 38.6.3 Antiviral Therapy 38.6.4 Physiotherapy 38.6.5 Surgical Treatments 38.7 Conclusions References 39: Infections of the External Ear During Pregnancy and the Postpartum Period 39.1 Introduction 39.2 Pathophysiology 39.3 Clinical Presentation 39.4 Treatment 39.5 Complications References 40: Acute Otitis Media and Otitis Media with Effusion During Pregnancy and the Postpartum Period 40.1 Introduction 40.2 Tympanometry 40.3 Audiological Testing References Part IV: Rhinology and Allergy During Pregnancy and the Postpartum Period 41: Rhinosinusitis During Pregnancy and the Postpartum Period 41.1 Introduction 41.2 Respiratory System Physiology in Pregnancy 41.3 Rhinitis Symptoms and Signs 41.3.1 Nasal Congestion and Difficulty Breathing through the Nose 41.3.2 Itching in the Nose 41.3.3 A Discharge from the Anterior or Posterior of the Nose 41.3.4 Odor Disorder 41.4 Clinical Approach 41.5 Pregnancy Rhinitis 41.6 Treatment 41.6.1 Common Cold 41.6.2 Rhinosinusitis 41.6.3 Acute Rhinosinusitis (ARS) 41.6.4 Acute Viral RS 41.6.5 Acute Bacterial RS 41.6.6 Chronic Rhinosinusitis 41.7 Symptoms 41.8 Physical Examination Findings 41.9 Complications 41.10 Radiological Imaging 41.11 Microbiological Tests 41.12 Treatment 41.12.1 Nonpharmacological Treatments 41.12.2 Pharmacological Treatments 41.12.3 Surgical Treatment 41.12.4 Postpartum Infection Control 41.12.5 Breastfeeding References 42: The Management of Nasal Obstruction During Pregnancy and the Postpartum Period 42.1 Introduction 42.2 Dynamic Causes 42.3 Structural Causes 42.3.1 Septal Deviation 42.3.2 Turbinate Hypertrophy 42.4 Rhinitis 42.4.1 Allergic Rhinitis 42.4.2 Hormonal Rhinitis/Pregnancy-Induced Rhinopathy 42.4.3 Acute Infectious Rhinitis 42.5 Rhinosinusitis 42.5.1 Chronic Rhinosinusitis with Nasal Polyps 42.6 Neoplasias 42.6.1 Nasal Granuloma Gravidarum 42.7 Conclusion References 43: Smell and Taste Disorders During Pregnancy and the Postpartum Period 43.1 Introduction 43.2 Sense of Smell 43.2.1 Anatomy and Physiology 43.2.2 Evaluation of the Sense of Smell 43.2.2.1 Psychophysical Tests 43.2.2.2 Electrophysiological Tests 43.2.3 Smell Disorders 43.2.4 Etiology of Smell Disorders 43.3 Sense of Smell During Pregnancy and the Postpartum Period 43.3.1 Olfactory Thresholds During Pregnancy and the Postpartum Period 43.3.2 Identification Thresholds During Pregnancy and the Postpartum Period 43.3.3 Odor Intensity Ratings During Pregnancy and the Postpartum Period 43.3.4 Hedonics, Disgust, and Nausea-Vomiting During Pregnancy 43.3.5 Possible Underlying Causes of Changes in the Sense of Smell During Pregnancy 43.4 Sense of Taste 43.4.1 Anatomy and Physiology 43.4.2 Evaluation of the Sense of Taste 43.4.3 Taste Disorders 43.4.4 Etiology of Taste Disorders 43.5 Sense of Taste During Pregnancy and the Postpartum Period 43.5.1 Taste Thresholds During Pregnancy and the Postpartum Period 43.5.2 Changes in Perceived Taste Intensity During Pregnancy and the Postpartum Period 43.5.3 Changes in the Sense of Taste during Pregnancy and the Postpartum Period 43.6 Treatment References 44: Management of Epistaxis During Pregnancy and the Postpartum Period 44.1 Introduction References 45: Allergic Rhinitis During Pregnancy 45.1 Introduction 45.2 Signs and Symptoms 45.3 Diagnosis 45.3.1 History 45.3.2 Examination 45.3.3 Tests for Specific IgE 45.4 Treatment 45.4.1 Cromolyn Sodium Nasal Spray 45.4.2 Glucocorticoid Nasal Sprays 45.4.3 Oral Antihistamines 45.4.4 Antihistamine Nasal Sprays 45.4.5 Decongestants 45.4.6 Montelukast 45.4.7 Allergen Immunotherapy 45.5 Conclusions References 46: Gestational Rhinitis 46.1 Introduction 46.2 Gestational Rhinitis 46.2.1 GR History 46.2.2 Incidence and Prevalence 46.2.3 Etiology and Physiopathology 46.3 Pregnancy Hormones and Nasal Physiology 46.3.1 Estrogen 46.3.2 Progesterone 46.3.3 Prolactin 46.3.4 Neuropeptides 46.3.5 Placental Growth Hormone 46.4 Risk Factors 46.5 Diagnosis and Clinical Significance 46.6 Impact on Quality of Life 46.7 Differential Diagnosis 46.8 Treatment 46.8.1 Conservative Treatment 46.8.1.1 Physical Exercise 46.8.1.2 Nasal Saline Irrigation 46.8.2 Pharmacological Treatment 46.8.2.1 Decongestant 46.8.2.2 Glucocorticoids 46.8.2.3 Antibiotics 46.8.2.4 Antihistamine 46.8.3 Other Treatments 46.8.3.1 Nasal Continuous Positive Airway Pressure (CPAP) 46.8.3.2 Surgery 46.8.3.3 Nonallergic Rhinitis in Pregnancy References 47: Nasal Polyposis During Pregnancy and the Postpartum Period 47.1 Introduction 47.2 Medical Treatment 47.2.1 Nasal Saline Irrigation 47.2.2 Antibiotics 47.2.3 Intranasal Antibiotics 47.3 Histamine Receptor Antagonists 47.4 Intranasal Antihistamines 47.5 Corticosteroids 47.5.1 Intranasal Corticosteroids 47.6 Antileukotrien Drugs 47.7 Surgical Treatment References 48: Pregnancy Rhinorrhoea 48.1 Introduction 48.2 Causes 48.3 History 48.4 Differential Diagnosis in a Case of Rhinorrhoea 48.4.1 Cerebrospinal Fluid (CSF) Rhinorrhoea 48.4.1.1 CSF Rhinorrhoea Due to Trauma 48.4.1.2 Iatrogenic CSF Rhinorrhoea 48.4.1.3 CSF Rhinorrhoea Related to a Tumour 48.4.1.4 Congenital CSF Rhinorrhoea 48.4.1.5 Spontaneous CSF Rhinorrhoea 48.5 Treatment Options References Part V: Laryngology 49: Laryngopharyngeal Reflux During Pregnancy and Lactation 49.1 Introduction 49.2 Epidemiology 49.3 Pathophysiology 49.4 Clinical Presentation 49.5 Diagnosis 49.6 Treatment 49.6.1 Dietary and Lifestyle Modification 49.6.2 Pharmacotherapy 49.7 Treatment in Breastfeeding Women 49.8 Laryngitis During Pregnancy and Lactation 49.8.1 Acute Laryngitis 49.8.2 Therapy in Pregnant Patients 49.8.3 Advice for Preventing Laryngitis During Pregnancy and Lactation 49.9 Acute Epiglottitis (Supraglottitis) 49.9.1 Treatment During Lactation References 50: Voice Disorders and Therapy During Pregnancy and the Postpartum Period 50.1 Introduction 50.2 Etiological Factors 50.2.1 Hormonal Changes 50.2.2 Anatomic and Physiological Changes 50.2.3 Metabolic Changes 50.2.4 Psychological Changes 50.3 Treatment Methods References 51: Benign and Premalignant Lesions of the Larynx During Pregnancy and the Postpartum Period 51.1 Introduction 51.2 Benign Lesions of the Larynx During Pregnancy and Postpartum Period 51.2.1 Laryngeal Papillomatosis 51.2.2 Vocal Fold Polyps 51.2.3 Reinkes’s Edema 51.2.4 Vocal Fold Cysts 51.2.5 Vocal Fold Nodules 51.2.6 Vocal Process Granulomas 51.2.7 Postintubation Granuloma of the Larynx 51.3 Premalignant Lesions of the Larynx During Pregnancy and Postpartum Period 51.4 Management References Part VI: Head and Neck Neoplasms and Surgery During Pregnancy and the Postpartum Period 52: Head and Neck Cancer in Pregnancy 52.1 Introduction 52.1.1 Signaling Pathway Changes 52.1.2 Immune Evasion 52.1.3 Hormone Induction 52.1.4 Virus Induction 52.2 Subsites Involved in Head and Neck Cancer in Pregnancy 52.2.1 Nasal and Paranasal Cancer 52.2.2 Nasopharyngeal Cancer 52.2.3 Oral Cavity Cancer 52.2.4 Oropharyngeal Cancer 52.2.5 Laryngeal and Hypopharyngeal Cancers 52.2.6 Salivary Gland Cancers 52.2.7 Nonmelanoma Skin Cancers (NMSCs) and Melanoma 52.2.8 Lymphoma 52.2.9 Leukemia 52.3 Management Principles 52.3.1 Goals/Dilemmas 52.3.2 Radiographic Studies 52.3.3 Treatment Timing 52.3.4 Chemotherapy 52.3.5 Radiation Therapy 52.3.6 Surgery 52.3.7 Elective Termination of Pregnancy 52.4 Conclusion References 53: The Management of Neck Mass During Pregnancy and the Postpartum Period 53.1 Introduction 53.2 Differential Diagnosis 53.3 Diagnostic Tools 53.3.1 History 53.3.2 Physical Examination 53.3.3 Diagnostic Imaging 53.3.3.1 Ultrasound Imaging 53.3.3.2 Computed Tomography and Magnetic Resonance Imaging 53.3.4 Ancillary Testing 53.3.5 Biopsy 53.3.5.1 Fine-Needle Aspiration Biopsy 53.3.5.2 Core Biopsy 53.3.5.3 Open Biopsy 53.3.6 Panendoscopy 53.4 Diagnostic Workup 53.5 Management of Benign Neck Masses 53.5.1 Medical Treatment 53.5.2 Surgical Treatment References 54: Cough During Pregnancy and Lactation 54.1 Introduction 54.2 Anatomical and Physiological Changes in the Respiratory System During Pregnancy 54.3 Cough 54.3.1 Etiology 54.3.2 Clinical Evaluation 54.4 Upper Airway Cough Syndrome 54.5 Pregnancy Rhinitis 54.6 Pregnancy and Allergic Rhinitis 54.7 Pregnancy and Vasomotor Rhinitis 54.8 Pregnancy and Gastroesophageal Reflux 54.9 Asthma in Pregnancy 54.10 Treatment 54.10.1 Nasal Saline Irrigation 54.10.2 Intranasal and Oral Decongestants 54.10.3 Corticosteroids 54.10.4 Antihistamines 54.10.5 Leukotriene Receptor Antagonists 54.10.6 Antitussives 54.10.7 Immunotherapy References 55: Salivary Gland Infectious and Inflammatory Diseases During Pregnancy and the Postpartum Period 55.1 Introduction 55.2 Parotid Gland 55.3 Submandibular Gland 55.4 Sublingual Gland 55.5 Physiology 55.6 Patient History and Physical Examination 55.7 Ultrasonography (USG) 55.8 Computed Tomography (CT) 55.9 Magnetic Resonance Imaging (MRI) 55.10 Endemic Parotitis: Viral Parotitis 55.11 Acute Suppurative Sialadenitis 55.12 Sialolithiasis 55.13 Chronic Recurrent Sialadenitis 55.14 Sialadenosis 55.15 Granulomatous Sialadenitis 55.16 Sjogren’s Syndrome 55.17 Points to Consider in Treatment References 56: Thyroid Nodules and Cancer During Pregnancy and the Postpartum Period 56.1 Introduction 56.2 Physiological Changes in the Thyroid Gland in Pregnant Women 56.3 Diagnosis 56.4 Thyroid Nodules and Thyroid Cancer 56.4.1 Thyroid Nodules 56.4.1.1 Epidemiology 56.4.1.2 Diagnosis 56.4.1.3 Management of Thyroid Nodules in Pregnant Patients 56.4.2 Thyroid Carcinoma 56.4.2.1 Differentiated Thyroid Carcinoma (DTC) Progression, Risk of Recurrence, and Prognosis Management Evaluation and Management of Thyroid Cancer During Pregnancy 56.5 Active Surveillance (Watchful Waiting) 56.6 Surgery 56.7 Radioactive Iodine 56.8 Thyroid Hormone Management 56.9 Tyrosine Kinase Inhibitors (TKIs) 56.10 Considerations for the Postpartum Period 56.11 Preconception Planning and Counselling 56.12 Management of Pre-existing Thyroid Cancer During Pregnancy References 57: Management of Parathyroid Disorders in Pregnancy and Postpartum Period 57.1 Introduction 57.2 Calcium and Other Minerals, Vitamin D, Parathyroid Hormone (PTH), Calcitonin Physiology in Pregnancy and Lactation 57.2.1 Calcium and Other Minerals 57.2.2 PTH 57.2.3 Vitamin D Metabolism 57.2.4 Calcitonin 57.2.5 Parathyroid Hormone–Related Protein (PTH-rP) 57.3 Calcium Absorption and Metabolism in Pregnancy and Lactation 57.3.1 Intestinal Calcium and Phosphate Absorption 57.3.2 Renal Handling 57.3.3 Skeletal Calcium Metabolism 57.4 Calcium Disorders During Pregnancy and Lactation 57.4.1 Osteoporosis 57.4.2 Hypoparathyroidism 57.4.3 Hyperparathyroidism 57.4.4 Vitamin D Insufficiency and Deficiency 57.5 Conclusion References Part VII: Lower Airway Diseases During Pregnancy and the Postpartum Period 58: Pulmonary Physiologic Adaptations During Pregnancy 58.1 Introduction 58.2 Anatomic Changes 58.2.1 Upper Airways 58.2.2 Chest Anatomy 58.3 Functional Changes 58.3.1 Lung Volumes 58.3.2 Oxygen Consumption: Carbon Dioxide Production 58.3.3 Ventilation 58.3.4 Blood Gases 58.3.5 Plasma and Blood Volume Increase 58.3.6 Blood Cell Increase 58.3.7 Diffusion Capacity for Carbon Monoxide (DLCO) 58.3.8 Lung Functions 58.4 Changes Caused by Exercise in Pregnant Women 58.5 Changes in Pregnant Women Living at High Altitude 58.6 Sleep-Disordered Breathing During Pregnancy 58.7 Dyspnea 58.8 Adaptations Related to Birth References 59: Lower Respiratory Infections During Pregnancy 59.1 Introduction 59.2 Acute Bronchitis 59.3 Community-Acquired Pneumonia (CAP) 59.4 Influenza Pneumonia 59.5 COVID-19 References 60: Bronchitis During Pregnancy and in the Postpartum Period 60.1 Introduction 60.2 Symptoms and Clinical Findings 60.3 Microbiological Factors 60.4 Maternal Consequences 60.5 Consequences for the Fetus or Neonate 60.6 Treatment and Prophylaxis 60.7 Antibacterial Therapy 60.8 Antiviral Therapy 60.9 Prophylactic Vaccination References 61: Bacterial Pneumonia During Pregnancy 61.1 Introduction 61.2 Community-Acquired Pneumonia in Pregnancy 61.2.1 Clinical Properties and Physical Examination 61.2.2 Laboratory Findings and Imaging 61.2.3 Treatment and Follow-Up 61.2.4 Complications 61.2.5 Prevention 61.3 Hospital-Acquired Pneumonia in Pregnancy 61.3.1 Etiopathogenesis 61.3.2 Diagnosis 61.3.3 Treatment 61.4 Conclusion References 62: Pregnancy and Postpartum Period Community-Acquired Pneumonia 62.1 Introduction 62.2 Pneumonia During Pregnancy 62.2.1 Pathophysiology and Risk Factors 62.2.2 Diagnosis 62.2.3 Etiology 62.2.4 Clinical Course 62.2.5 Bacterial Pneumonia 62.2.6 Viral Pneumonia 62.2.6.1 Influenza Virus 62.2.6.2 Varicella 62.2.6.3 Coronavirus Infections 62.2.7 Fungal Pneumonia 62.2.8 Pneumonia in HIV Patients 62.3 Future Directions for CAP in Pregnancies 62.4 Postpartum Pneumonia References 63: Tuberculosis During Pregnancy 63.1 Introduction 63.2 Effects of Pregnancy on Tuberculosis 63.3 Effects of Tuberculosis on Pregnancy 63.4 Tuberculosis and Newborn 63.5 Latent Tuberculosis Infection and Treatment in Pregnancy 63.6 Clinical Findings and Diagnosis of Active Tuberculosis in Pregnancy 63.7 Active Tuberculosis Treatment in Pregnancy 63.8 Multidrug-Resistant Tuberculosis (MDR-TB) in Pregnancy 63.9 Conclusion References 64: Pulmonary Embolism During Pregnancy and the Postpartum Period 64.1 Introduction 64.2 Diagnosis of PE 64.2.1 Laboratory Tests 64.2.1.1 D-Dimer 64.2.1.2 Arterial Blood Gas Analysis 64.2.2 Compression Ultrasound (CUS) 64.2.3 Echocardiography 64.2.4 Imaging 64.2.4.1 Chest X-Ray 64.2.4.2 MR Pulmonary Angiography (MRPA) 64.2.4.3 Computed Tomography Pulmonary Angiography (CTPA) and Perfusion Scan 64.3 Treatment 64.4 Amniotic Fluid Embolism References 65: Asthma During Pregnancy and Lactation 65.1 Introduction 65.2 Respiratory Physiology During Pregnancy 65.3 Effects of Pregnancy on Asthma 65.4 Maintaining Asthma Control 65.4.1 Pharmacological Therapy 65.4.2 Non-pharmacologic Treatments 65.4.2.1 Patient Education 65.4.2.2 Smoking Cessation 65.4.2.3 Control of Environmental Triggers 65.4.3 Acute Exacerbations 65.5 Maternal and Fetal Monitoring 65.5.1 Maternal Monitoring 65.5.2 Fetal Monitoring 65.6 Supportive Care 65.6.1 Maternal Positioning 65.6.2 Hydration 65.6.3 Medications 65.6.4 Respiratory Infections 65.6.5 Peripartum Care 65.7 Lactation and Asthma 65.7.1 Drug Use in Lactation References 66: Restrictive Lung Diseases in Pregnancy 66.1 Introduction 66.2 Diffuse Parenchymal Lung Diseases 66.2.1 Drug-Induced Lung Diseases in Pregnancy 66.2.2 Connective Tissue Disease-Related Interstitial Lung Disease in Pregnancy 66.2.3 Idiopathic Interstitial Pneumonitis in Pregnancy 66.2.4 Granulomatous Diffuse Parenchymal Lung Diseases in Pregnancy 66.2.5 Other Forms of Diffuse Parenchymal Lung Diseases in Pregnancy 66.3 Diseases of the Chest Wall in Pregnancy 66.4 Neuromuscular Disorders in Pregnancy References Part VIII: Miscellaneous Topics 67: Complementary Medicine Products for Use in Pregnancy and the Postpartum Period 67.1 Introduction 67.2 Complementary and Herbal Medicine 67.2.1 Traditional Chinese Medicine 67.2.2 Omega-3 Dietary Supplements 67.2.3 Quality and Efficacy 67.2.3.1 Quality 67.2.3.2 Efficacy 67.3 Complementary Medicine in Pregnancy and Lactation 67.3.1 Pregnancy and Nursing 67.3.2 Infants and Children References 68: Afflictions of Postpartum Mental Health 68.1 Introduction 68.2 Postpartum Blues 68.2.1 Clinical Characteristics 68.2.2 Epidemiology 68.2.3 Assessment 68.2.4 Risk Factors 68.2.5 Etiology 68.2.6 Prognosis 68.2.7 Differential Diagnosis 68.3 Postpartum Depression 68.3.1 Clinical Characteristics 68.3.2 Epidemiology 68.3.3 Assessment 68.3.4 Risk Factors 68.3.5 Differential Diagnosis 68.3.6 Treatment and Prevention 68.4 Postpartum Anxiety and OCD (Obsessive Compulsive Disorder) 68.4.1 Clinical Characteristics 68.4.2 Epidemiology 68.4.3 Assessment 68.4.4 Risk Factors 68.4.5 Prognosis 68.4.6 Differential Diagnosis 68.4.7 Treatment and Prevention 68.5 Postpartum Psychosis 68.5.1 Clinical Characteristics 68.5.2 Epidemiology 68.5.3 Risk Factors 68.5.4 Prognosis 68.5.5 Differential Diagnosis 68.5.6 Treatment and Prevention References 69: Filler and Neurotoxin Injections During Pregnancy and the Postpartum Period 69.1 Introduction 69.1.1 Fillers 69.2 Fillers in Pregnancy 69.3 Neurotoxins 69.4 Neurotoxin Injections in Pregnant Women 69.4.1 Experimental Reports 69.4.2 Human Reports 69.5 Neurotoxins During Postpartum Period References 70: Female Voice During Pregnancy and Postpartum Period 70.1 Introduction 70.2 Voice in Menstrual Period 70.3 Voice in Pregnancy 70.4 Voice in Postpartum Period 70.5 Voice in Postmenopausal Period 70.6 Conclusion References 71: Nutritional Approaches to Decrease Allergy Outcomes in the Offspring of Allergic Mothers 71.1 Introduction 71.2 Energy Requirement 71.3 Macronutrients 71.3.1 Protein 71.3.2 Carbohydrates 71.3.3 Fiber 71.3.4 Lipids 71.4 Micronutrients 71.4.1 Vitamins and Minerals 71.5 How to Prevent or Decrease Atopic Outcomes of the Offspring During Pregnancy and Lactation 71.6 Nutritional Approach in Lactation and Pregnancy to Reduce Allergic Outcomes 71.7 The Mediterranean Diet References 72: Management of Vascular Lesions During Pregnancy and Postpartum Period 72.1 Introduction 72.2 Vascular Tumors 72.2.1 Infantile Hemangioma 72.2.2 Congenital Hemangioma 72.2.3 Tufted Angioma 72.2.4 Spindle Cell Hemangioma 72.2.5 Epithelioid Hemangioma 72.2.6 Pyogenic Granuloma 72.2.7 Kaposiform Hemangioendothelioma 72.2.8 Kaposi Sarcoma 72.2.9 Angiosarcoma 72.2.10 Epithelioid Hemangioendothelioma 72.2.11 Angiofibroma 72.2.12 Paraganglioma 72.2.13 Tympanic Paraganglioma 72.2.14 Jugular Paraganglioma 72.2.15 Vagal Paraganglioma 72.2.16 Hemangiopericytoma 72.2.17 Vascular Malformations 72.2.18 Capillary Malformation 72.2.19 Venous Malformation 72.2.20 Lymphatic Malformation 72.2.21 Arteriovenous Malformation References 73: General Principles of Ent Surgery in Pregnancy 73.1 Introduction 73.2 Rhinology 73.2.1 Epistaxis 73.2.1.1 Granuloma Gravidarum 73.2.1.2 Complications of Sinusitis 73.3 Otology–Neurotology 73.4 Larynx 73.4.1 Hemangioma 73.4.2 Idiopathic Subglottic Stenosis 73.4.3 Cord Vocal Paralysis 73.5 Approach to Head Neck Tumors 73.5.1 Oral Cavity Cancers 73.5.2 Nasal Cavity Cancers 73.5.3 Larynx Cancers 73.6 Thyroid and Parathyroid Surgery 73.6.1 Thyroid Surgery 73.6.2 Parathyroid Surgery References