Tuberculosis in pregnancy: risks to mother and fetus, treatment

About TB heard at least once in your life, and for many it is a disease asocial elements, alcoholics and prisoners. But in reality, this infection has long transcended narrow categories, and it affects many people, up to pregnant women from very wealthy families. The bacterium of tuberculosis, contrary to popular belief, affects not only the lungs, it is not able to infect only the skin appendages – hair and nails, other organs and tissues can be affected. But mostly affects still lungs, which is associated with the peculiarities of their structure and functioning. The situation with the pregnancy on the background of tuberculosis is not the most positive, but quite likely. How do they mix?

General data about tuberculosis in pregnancy

Almost throughout the last century the presence of pregnancy on the background of tuberculosis was unacceptable and recommended that the interrupt it at any time because of the high risk of adverse outcomes. But with the development of medicine, modern methods for the detection of infection and possibilities of its treatment of women today are infected with tuberculosis may well conceive, to fully carry and give birth to completely healthy baby. But you need to know certain features of the disease, approaches to diagnosis and treatment.

Please note

TB refers to a chronic, slowly progressive infections with a bacterial nature. Currently infected with mycobacteria causing tuberculosis, a third of the population. But the infection does not mean disease, is a condition of being a carrier of germs, which at any moment can outgrow in an infection.

This is possible and women of reproductive age who are preparing to become mothers. Activation of infections, long dormant in the body, is formed with significant immune suppression, amid the constant stress and lower social standard of living.

The disease is widespread, the peak of its distribution falls on Asia, where the greatest percentage of ill. The risk of tuberculosis infection is about 10% for life. Women during pregnancy, along with other persons because of the nature of immunity, are at high risk. The infection is often combined with a variety of dangerous infections – hepatitis, syphilis, particularly among anti-social elements.

The causes and conditions of development of tuberculosis in pregnant women

The primary infectious agent – Mycobacterium tuberculosis a special type of Mycobacterium tuberculosis, they are well represented in the external environment, living in water and soil, actively circulate among animals and humans. Pathology is transmitted as any respiratory infection by airborne droplets, and may be also contact-household transmission.

Infection through infected food. Distinguish risk factors for development of infection, which include the presence of congenital or acquired immunodeficiency, including certain viral infections, as well as low income and adverse living conditions, inefficient, poor nutrition, bad habits, age 12-14 years.

Please note

Pregnancy and painful in debilitated women may also be a push to intensify TB infection in the lungs, which could face trouble. It is therefore importantpregnancy planningwith a full preliminary examination, including to this infection. This is because to treat tuberculosis outside of pregnancy is much safer and easier than amid the gestation of the baby.

The infection of this dangerous infection is, the group of women at high risk. These include:

  • previously ill with tuberculosis women if less than 2 years
  • women in the presence of chronic diseases that suppress the immune system
  • contact with patients with active tuberculosis at work or at home
  • living in areas where a lot of patients and a low level of medical care.

It is important

It is important after previously suffering infection to postpone planning for 2-3 years to completely avoid relapse, and rebuild the immune system.

Damage to the lungs in tuberculosis

Differ between pulmonary and extrapulmonary forms of infection, and each of the variants of infection has its own distinctive features. Most prevalent is pulmonary localization, which we’ll talk more.

Forms of pulmonary tuberculosis are divided into two options – primary and secondary.

  • primary infection is formed when the bacilli penetrate for the first time in the respiratory tract that usually occurs in childhood or adolescence. From the lungs, the germs can penetrate into the lymphatic ways and blood, circulating in many internal organs. A strong body and a strong immune system to cope with the impact of the infection on their own, and then the disease does not develop, and a person is specific immunity against tubercle bacilli.
  • secondary infection is formed when the penetration of the pathogen from various internal organs, mainly the lymph vessels, and this kind of pathology is typical for most adults, including pregnant women.

There are also various forms of tuberculous infection of the lungs. These include:

  • Disseminirovanne, which formed multiple lesions in lung tissue
  • acute miliary where lesions in the lungs by the bloodstream, the infection spreads to many other organs
  • focal form, which formed foci, affecting one or more pulmonary segments
  • infiltrative, when formed inflammatory foci in the lungs, which develops inside the tissue necrosis and active decay.

Also typically, the formation tuberculoma of the lung with focal, surrounded by a capsule formation inside the lung tissue, as well as cavitary pneumonia, acute tuberculous inflammation of tissue with active decay. Possible cavernous form of tuberculosis, forming numerous cavities, the cavities where lung tissue is disintegrating, and the lesions of cirrhosis, with the growth instead of lung tissue with connective tissue, which loses its functionality.

Manifestations of pulmonary tuberculosis in pregnancy

In General, the symptoms do not differ from those of ordinary people, and for pregnant typically common symptoms of local lesions of the lung tissue. There is a General intoxication caused by metabolic products of the bacilli is the lethargy with weakness and apathy, malaise. Also typically rise in temperature to subfebrile values on the background of a gradual loss of body weight, decreased appetite and cough. It is initially dry, but then goes in the wet, with the appearance of greenish or yellowish sputum. As disease progression occurs hemoptysis, the presence in the sputum of bloody veins, as well as chest pain on a background of deep breaths and shortness of breath, sweating at night.

Please note

In many ways, the severity of symptoms depends on the General condition of the pregnant woman, in some women tuberculous lesions can occur without any particular symptoms, often manifesting itself even in the presence of serious complications.

Extrapulmonary localization of tuberculosis in pregnancy

Special attention on the female variants of extrapulmonary tuberculosis deserve genital lesions. This form has a secondary origin, arising with the spread of bacteria in the genital area of the initial zone of infection. Usually the infection spreads into force of reduced immunity, existing chronic diseases, stress, malnutrition or other factors. Manifestations of lesions of genital tuberculosis have no special signs, often only infertility or problems carrying a pregnancy, menstrual irregularities and ovulation problems, amenorrhea, irregular cycle, bleeding and pain. On the background of the adhesions formed because of long term inflammation can occur with an ectopic pregnancy, leading to bleeding and loss of the pipe.

How is the tuberculosis in pregnant women: features of disease

Although in General the manifestations of a single, but there are certain peculiarities in the course of tuberculosis in pregnant women, which is worth knowing. These include the involvement of only one lung, the vast majority of women and a predominance of infiltrative variant of the currents over all other options. But unfortunately, about 20% of women complain about health problems already in the stage of collapse of part of lung tissue. About 50% of pregnant women become active refinery mycobacteria, making them a potential source of infection to others. But extrapulmonary TB variants during gestation are extremely rare, often the tuberculosis is combined with syphilis, HIV or STIs, and hepatitis.

Please note

It is also important to know that there is a massive defeat of lung tissue from mothers, and in this form, signs of acute respiratory failure that leads to disruption of the work of many internal organs. In such a situation, a further pregnancy would be extremely difficult for both.

When collapse of the lung tissue dangerous is such a situation not only to the child but also the mother.

What is the danger of tuberculosis in pregnancy

If tuberculosis is not aggressive and life-threatening currents, which is important for immediate delivery or termination of pregnancy for health reasons, he still can greatly harm the pregnancy. On the background of active tuberculosis occur such complications as:

  • Toxicosis early periods with severe nausea and malaise, loss of body weight
  • Very pronounced anaemia with poor prognosis of treatment
  • Hatosy the second half of pregnancy
  • Acute and chronic placental insufficiency
  • The condition of chronic fetal hypoxia
  • Intrauterine growth restriction of the baby’s height and weight increases
  • Problems with the volume and composition of amniotic fluid.

Such complications of gestation do not have specificity in relation to tuberculosis, and therefore can not specify it in his presence. A lot of women have pregnancy from time to time takes place without any deviations at all.

The presence of tuberculosis before birth does not affect the time of occurrence, not more than 5% of children of women with the infection are born prematurely, and most often this is due to the General severe condition, and the presence of serious complications related to tuberculosis. The period after childbirth is no different.

Effects of tuberculosis in pregnancy for the fetus, child

Although at the present level of medicine and timely medical treatment up to 80% of children are born perfectly healthy, even if their mother endured during pregnancy tuberculosis, but also probable and various types of complications associated with the development of the baby. So, the likely slowdown in crumbs, underweight and high riskbirth injury. If the child is born healthy, these complications fade quickly in the first months of life, children do not differ from their peers.

But it is quite another thing if there is congenital tuberculosis. Such a pathology arises in extremely rare cases, and detected in the first months after birth. Usually the infection is transplacental, in the period of fetal development. Infection probably at the time of birth if you have genital tuberculosis. Such cases are typical available forms of disseminated infection in the mother, if mycobacteria are spread by blood flow on the woman’s body.

It is important

Usually the fetus is infected the women who had not received vaccination against TB in childhood or adolescence.

Symptoms of congenital tuberculosis

Manifestations of congenital TB is varied, in early gestation usually provoked miscarriages in later stages it can damage the internal organs of the fetus that threatens death in utero or at birth. When you save the pregnancy babies are born premature, with severe intrauterine hypoxia. Typical constant temperature of the body and refusal of the breast, sharply depressed appetite, weight loss or gain it is below normal, drowsy with the lethargy of an infant, weak reflexes and pale skin with a yellowish tint. Can also be expressed dyspnea with cyanosis of the face and extremities, enlarged spleen and liver, and virtually all groups of lymph nodes.

Mycobacteria form a region of lung tissue numerous large foci of inflammation of various size, often tend to merge. Also affected lung tissue from two sides, can join lesions of the brain and nervous system develop neurological symptoms.

The diagnosis of tuberculosis in pregnant women: normal and decoding

For all women who stand on the account in early terms of pregnancy, the necessary results of previously conductedfluorography of the lungs. During pregnancy this procedure is not carried out, since x-rays affect development of the fetus in the womb, especially at early stages. The latest results of chest x-ray may detect or remove the suspicion that the lesions in his lungs. Such mass screening study allows to identify individuals requiring additional sighting control.

In the presence of a productive cough, suspicion of infection of the research is done for collection of sputumobtained by sputum sown on nutrient medium, exposing the bacteria in the samples and determining their sensitivity to certain antibiotics. Also, the TB bacteria can be detected in smears from the oral cavity. They are detected in PCR reactions that detect DNA of the Mycobacterium. A similar study carried out in the absence of obvious signs of damage. The result should be negative, then the woman is healthy. When you receive a positive response conduct further research.

Confirmation of tuberculosis whenever there is a suspicion, questionable data, data on crops and possible infection, is carried out by a number of studies:

  • tuberculin tests, which include the traditional Mantoux test and its modern counterpart – Diaskintest, which is a more precise result. One of the major drawbacks of these methods include the high sensitisation of the organism, which can then negatively affect the health of the fetus.
  • QuantiFERON test, which is held in the venous blood and has 100% accuracy. It identifies particular gamma-interferon, which is typical only for sticks of tuberculosis. If it is positive, TB is, if a negative diagnosis is removed.
  • holding immunogram, reflecting not only tuberculosis, but the immune status, its possible problems, because of which the infection intensified. This is important during pregnancy, when the immune defenses are in General reduced.

It is important

Fluoroscopy and radiography during pregnancy is not carried out in view of their danger to the fetus, can be assigned to the MRI, which does not allow exposure of the fetus and can detect dangerous lesions in lung tissue. An x-ray or fluoroscopy is carried out for all family members of the pregnant woman with suspected tuberculosis.

Treatment of tuberculosis in pregnancy

Treat this infection a tuberculosis specialist and gynecologist in tandem, used drugsantimicrobial profile, which affect mycobacteria.

Please note

Some of the drugs used in the treatment of infections safe for fetus and mother, although streptomycin, ethambutol and kanamycin may face challenges in the development of the fetus in utero. To use any drugs for treatment of tuberculosis should only after consulting a doctor.

Treatment of TB is long, it is conducted in two stages. Prescribers against the germs of tuberculosis after the 14th week of pregnancy. In the early stages of pregnancy, making decisions about treatment or termination depends on many factors. Shown to interrupt pregnancy in the presence of fibro-cavernous forms of the disease,lesions of bones and joints, bilateral lesion ofthe renal tuberculosis. All other forms allow for the continuation of the gestation and birth of the child at the time. The main decision about the fate of the fetus is accepted by the woman together with your doctor.

It is important

Surgical treatment of tuberculosis of gestation not shown, they are carried out only in the presence of evidence of life shown organ-saving interventions and measures in order to carry the pregnancy to term.

Each specific case of treatment of pregnant women from the period of 14 weeks and the choice of drugs is considered individually.

Part medications against tuberculosis is quite acceptable to receive during gestation, but you need to know about certain consequences for the fetus:

  • the ingestion of isoniazid is the most favorable regarding the mother and baby. But the fetus is perhaps the backlog of psychomotor development, problems with the spinal cord, lesions of the spine, congenital defects of the urinary organs, hemorrhage of varying severity, the reduced supply of vitamins. Use the drug only under strict medical supervision.
  • less effective protionamide, pyrazinamide, and ethambutol, no evidence of an increased risk of congenital anomalies and negative influences on the fetus when administered during gestation. During pregnancy their intake is strictly controlled because of individual influences.
  • receiving ethionamide, Thiacetazone, rifabutin, capreomycin and cycloserine leads to teratogenic effects regarding the fetus, they are strictly prohibited during pregnancy.

Routinely shows three of hospitalization during gestation, they needed to assess the dynamics of infection and the condition of the fetus and the mother.

Whether a termination of pregnancy when infected?

The TB infection is dangerous at any time, but it is particularly damaging in the first trimester, at that time up to a third of exacerbations of infection, with latent period. Aggravation of tuberculosis, before proceeding hidden in the background of pregnancy and childbirth are formed due to various reasons:

  • Possible injury during childbirth
  • The significant loss of blood with the development of anemia
  • Active neuro-hormonal changes in the body
  • Physical and mental stress, changing the stress on the body.

On the background of constant medical supervision for a woman during the period of gestation it is possible to save and successful pregnancy in most cases. The termination of pregnancy in early stages doctors may recommend only certain categories of women who have gestation could threaten their own life and health:

  • fibrous and cavernous form of pulmonary tuberculosis
  • the active form of the infection in the spine and the bones of the skeleton
  • the combination of variant pulmonary tuberculosis with the presence of diabetes
  • in the presence of tuberculous lesions in the knee, ankle or hip joints
  • when bilateral and poor kidney
  • against the background of genital lesions infection
  • in pathology, which requires surgical correction.

The interrupt shown in the period of the first trimester, at a later date it threatens to activation or exacerbation of tuberculosis infection, but the decision on gestation or termination of pregnancy is only the woman and the medical Commission.

When a woman has an active tuberculous process in which it is on a prolongation of pregnancy and subsequent delivery, required range of activities. They include pre-alert the hospital about the presence of women with the infection with giving her a separate box Rajala. Immediately after birth the child is isolated from his mother and is away from breastfeeding in order to protect from infection. He is immediately carried out BCG vaccination, separating it from the mother not less than 8-10 weeks. In the house, where it will reside tiny, thorough disinfection, the mother is treated in terms of TB dispensary.

The presence of tuberculosis does not lead to significant effects on the process of childbirth, but important certain restrictive measures in respect of risk of fetal infection or personnel in contact with blood.

The basics of tuberculosis prevention

The main specific prevention of tuberculosis is vaccination from him in childhood, conducted in the neonatal period, and then in 7 years and 14 years. It is indicated in the presence of negative Mantoux test the results of which addressed the issue of revaccination.

The presence of active tuberculosis in the mother is the reason for her separation with the baby, with inactive tuberculosis a child near the mother. Breast-feeding is allowed in the inactive stage of infection, after discharge both seeing a doctor.

Parezca Allen, pediatrician, medical columnist