A pregnant patient complains of nasal stuffiness and rapid breathing. The clinician should recognize that:
A. Elevated progesterone directly stimulates the central respiratory center in pregnancy to enhance loss of CO2
B. Elevated estrogen and progesterone levels causes nasal edema
C. Elevated estrogen and progesterone cause nasal turbinate enlargement
D. All of the above
ANS: D
Increased progesterone directly stimulates the central respiratory system to increase minute ventilation and tidal volume and to decrease blood PCO2. Oxygen consumption and basal metabolic rate also increases. These changes are the basis of an increased awareness of breathing or even dyspnea that is experienced during pregnancy. Nasal congestion or stuffiness may result from increased estrogen and progesterone levels, which increase perivascular edema and enlargement of the nasal turbinates (Baxley, 2008). These changes may also lead to episodes of epistaxis.
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