Unexpected Cause of Chronic Cough in a Pregnant Woman

Abstract: Cough is an interdisciplinary symptom. Chronic cough in pregnant women requires precise diagnosis, especially when it appears for the first time during pregnancy. Case report. A 32-year old woman was seen by her obstetrician at 13th week of gestation. She had a history of miscarriage and premature birth. She did not report any medical problems and had no aberrations in a physical examination aside from abdominal wall scars caused by trauma during an assault with a knife. At 15th week of gestation the patient reported a severe, dry cough with no symptoms of infection. During the previous pregnancy the cough also appeared and ceased after delivery. She was diagnosed with asthma and gastro-oesopharyngeal reflux and received adequate treatment. A chest X-ray performed before the pregnancy showed elevation of the diaphragm. MRI during pregnancy revealed cavity in the diaphragm and a hernia. She was referred for surgery. Meanwhile, the cough became milder and the operation was postponed. Several weeks later the cough returned. Current treatment was modified, with improvement. As there was a risk of premature birth, the patient received full cycle of steroid therapy at 27th week. The elective caesarean section was performed at 39th weeks. She gave birth to a healthy newborn. The cough regressed during puerperium. Conclusions. The cough can be caused by a wide spectrum of factors. Carefully obtained medical history is crucial in establishing diagnosis. We should bear in mind anatomical changes in the body of pregnant women, which can potentially modify symptoms of certain diseases.

Authors:

Greta Sibrecht, Monika Sierzputowska-Pieczara PhD, Professor Mariola Ropacka-Lesiak MD, PhD

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