title: Management of rhinosinusitis during pregnancy: systematic review and expert panel recommendations.
abstract: Management of rhinosinusitis during pregnancy requires special considerations.
  
  
  
  1. Conduct a systematic literature review for acute and chronic rhinosinusitis (CRS) management during pregnancy. 2. Make evidence-based recommendations.
  
  
  
  The systematic review was conducted using MEDLINE and EMBASE databases and relevant search terms. Title, abstract and full manuscript review were conducted by two authors independently. A multispecialty panel with expertise in management of Rhinological disorders, Allergy-Immunology, and Obstetrics-Gynecology was invited to review the systematic review. Recommendations were sought on use of following for CRS management during pregnancy: oral corticosteroids; antibiotics; leukotrienes; topical corticosteroid spray/irrigations/drops; aspirin desensitization; elective surgery for CRS with polyps prior to planned pregnancy; vaginal birth versus planned Caesarian for skull base erosions/ prior CSF rhinorrhea.
  
  
  
  Eighty-eight manuscripts underwent full review after screening 3052 abstracts. No relevant level 1, 2, or 3 studies were found. Expert panel recommendations for rhinosinusitis management during pregnancy included continuing nasal corticosteroid sprays for CRS maintenance, using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations, and discontinuing aspirin desensitization for aspirin exacerbated respiratory disease. The manuscript presents detailed recommendations.
  
  
  
  The lack of evidence pertinent to managing rhinosinusitis during pregnancy warrants future trials. Expert recommendations constitute the current best available evidence.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, AZ, USA.
authors.forename: Devyani
authors.initials: D
authors.lastname: Lal
authors.affiliation: University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA.
authors.forename: Ameya A
authors.initials: AA
authors.lastname: Jategaonkar
authors.affiliation: Departments of Medicine and Microbiology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Larry
authors.initials: L
authors.lastname: Borish
authors.affiliation: Division of Maternal Fetal Medicine, St. Josephs Hospital and Medical Center, Phoenix, AZ, USA.
authors.forename: Linda R
authors.initials: LR
authors.lastname: Chambliss
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, AZ, USA.
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Gnagi
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Hwang
authors.affiliation: Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Phoenix, AZ, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Rank
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Stankiewicz
authors.affiliation: Royal National Throat, Nose and Ear Hospital, University College London Hospitals, London, United Kingdom.
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Lund
mesh_terms: D000281:Administration, Intranasal; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002559:Cerebrospinal Fluid Rhinorrhea; D002585:Cesarean Section; D002908:Chronic Disease; D036861:Delivery, Obstetric / Q000379:methods*; D019468:Disease Management; D005260:Female; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D009298:Nasal Polyps / Q000150:complications / Q000601:surgery; D013517:Otorhinolaryngologic Surgical Procedures; D010256:Paranasal Sinuses / Q000601:surgery; D017410:Practice Guidelines as Topic; D016742:Preconception Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000628:therapy*; D012220:Rhinitis / Q000150:complications / Q000628:therapy*; D012852:Sinusitis / Q000150:complications / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D020024:Leukotriene Antagonists