Tuberculosis Study Guide - M.M. Savula 2002

Tuberculosis and Pregnancy

Before the Introduction of modern antituberculosis drugs into practice, Pregnancy in a woman with tuberculosis severely worsened her prognosis and promoted the progression of the disease. Nowadays, it is usually possible to cure the woman, and pregnancy ends in a normal delivery with the birth of a healthy child.

Pregnancy places an additional strain on a woman's body, requiring the mobilization of all physiological systems. Therefore, pregnant women are classified as a high-risk group for developing tuberculosis. A woman can contract tuberculosis at any stage of pregnancy and during the postpartum period. The most dangerous periods for the onset or exacerbation of tuberculosis are considered to be the first months of pregnancy, the final weeks before delivery, and the first 6 months postpartum. The disease that develops in the early months of pregnancy progresses in the same way as in non-pregnant women, but often coincides with early toxicosis. In these women, it is sometimes difficult to distinguish whether the deterioration of well-being, weakness, weight loss, increased sweating, and low-grade fever are related to pregnancy or are manifestations of tuberculous intoxication. Furthermore, pregnant women and their healthcare providers often have an excessive fear of X-ray examinations, which leads to disease progression and The Development of forms that are difficult to treat. Therefore, any unexplained deterioration in a woman's condition should serve as a signal for an in-depth examination. X-ray Examination (chest radiography with the abdomen shielded by a lead-lined rubber apron) can be performed at any stage of pregnancy if indicated. For women with a cough, sputum examination for MTB must be arranged.

If tuberculosis develops In the second half of pregnancy, it is more often oligosymptomatic but retains a tendency to progress; therefore, before discharge from the maternity hospital, postpartum women undergo an X-ray examination.

If Pulmonary Tuberculosis or tuberculosis of other Organs is diagnosed for the first time during pregnancy or in the postpartum period, specific Treatment must be started immediately. It causes less harm to the child than untreated maternal tuberculosis.

Pregnancy in a woman with active tuberculosis is undesirable because it can promote the progression of the disease. At the same time, there is no significant risk of tuberculosis exacerbation if a year or more has passed since the successful completion of treatment.

A particular risk of tuberculosis exacerbation or progression

during pregnancy exists:

♦ in women who have recently had tuberculosis (less than a year after completing treatment);

♦ in women with extensive tuberculous processes, regardless of their phase;

♦ in healthy women living in a focus of tuberculosis infection (having contact with a patient with open tuberculosis);

If a woman who has tuberculosis (or had it in the past) or has contact with patients with open tuberculosis becomes pregnant, the paramedic or midwife is obliged to refer her for a consultation with a phthisiologist and an obstetrician-gynecologist, who will jointly decide on the continuation of pregnancy and treatment tactics.

Indications for termination or continuation of pregnancy

In cases of localized forms of tuberculosis of any site, the pregnancy is maintained, provided that the sick woman receives full-course treatment.

Termination of pregnancy is indicated:

♦ in patients with fibrocavernous, chronic disseminated, or Cirrhotic pulmonary tuberculosis;

♦ when tuberculosis is complicated by Cor Pulmonale, concomitant Diabetes Mellitus, and other chronic lung diseases;

♦ in cases of Renal tuberculosis with chronic renal failure of grades I–III.

Termination of pregnancy must be performed before 12 weeks of gestation against the Background of intensive antituberculosis therapy, which is carried out before and after the termination. Women tolerate termination of pregnancy after three months no better than childbirth, so it is performed only under exceptional indications.

Termination of pregnancy is undesirable in cases of Miliary tuberculosis and Tuberculous meningitis. Intensive Tuberculosis Treatment is indicated for these patients.

Treatment of pregnant and postpartum women with tuberculosis is initiated immediately after the Diagnosis of tuberculosis or its exacerbation is established, and is conducted according to generally accepted principles. Pregnant women can be prescribed isoniazid (always in combination with Vitamin B6), rifampicin, and ethambutol.

The administration of streptomycin and kanamycin to pregnant women must be avoided, especially During the first 3 months of pregnancy, as this can cause Hearing loss and even deafness in the newborn. Ethionamide (prothionamide) is also not prescribed to pregnant women during the first half of pregnancy. If indicated, treatment can be carried out at any stage of pregnancy and during Lactation. The efficacy of treatment is the same as in non-pregnant women.

Management of Labor. In women with localized active forms of tuberculosis and in cases of clinical cure, labor proceeds normally. In women with extensive forms of tuberculosis (fibrocavernous, chronic disseminated) and in cases complicated by pulmonary-cardiac insufficiency, premature labor is possible. If symptoms of pulmonary-cardiac insufficiency worsen, a Cesarean Section is performed in The First stage of labor, and Obstetric Forceps are applied in the Second Stage.

In pregnant women with bone tuberculosis and significant Changes in the pelvis, a cesarean section is performed. Women with active tuberculosis must be admitted to specialized departments or separate wards for delivery. After delivery, they are transferred to a tuberculosis dispensary to continue treatment.

Breastfeeding, BCG Vaccination. Newborns of mothers with active tuberculosis (especially those with bacterial shedding) must be isolated from the mother immediately after birth. Breastfeeding is prohibited for them. Mothers with inactive tuberculosis are allowed to breastfeed.

Children of mothers with tuberculosis are born healthy, free from tuberculosis infection, and, in the absence of general contraindications, are immunized with the BCG vaccine. During the period of Immunity development (6–8 weeks), the child must be isolated from the sick mother. If the mother has active pulmonary tuberculosis, she should be hospitalized after delivery to undergo full treatment. The child is given to the family. If home care is not possible, the child is placed in an orphanage with the mother's consent until her recovery.

Before a baby is discharged from the maternity hospital, all adult family members must undergo chest X-ray screening. If There is a tuberculosis patient in the family, they are admitted to a hospital or sanatorium, and the residence is disinfected.

Questions

1. At what stages of pregnancy is the risk of developing or exacerbating tuberculosis the highest?

2. Where should a pregnant woman with unexplained symptoms of intoxication or a cough be referred for a consultation?

3. Can pregnant women with tuberculosis be treated with anti-tuberculosis drugs?

4. Which drugs are undesirable to prescribe to them?

5. To which departments are women with tuberculosis admitted for delivery?

6. Who must authorize breastfeeding for a woman who has or has had tuberculosis?

7. Should newborns born to mothers with tuberculosis receive the BCG vaccine?

Case Studies

- A woman with Infiltrative pulmonary tuberculosis in the destructive phase, MTB+, gave birth to a healthy, full-term baby.

1. Should the baby receive the BCG vaccination?

2. Can the woman breastfeed the baby?

3. What should be the management strategy for the mother and baby after discharge from the maternity hospital?

- A 22-year-old woman, 11 weeks into her first pregnancy, is diagnosed with limited Focal pulmonary tuberculosis in the infiltrative phase, without bacterial shedding.

1. Would you recommend that the woman undergo induced termination of pregnancy?

2. If not, should she be treated with anti-tuberculosis drugs?