Impact of tuberculosis on the evolution of pregnancy, delivery and perinatal outcomes

Abstract

Introduction. Pregnancy, childbirth and the postpartum period in women are factors that contribute to the appearance and exacerbation of inactive outbreaks of tuberculosis. The overload of all body systems during pregnancy conditions the aggravation of the woman's state of health. In pregnant women, the nervous and cardiovascular systems are significantly affected, an increased load on the kidneys is required, associated with an additional excretion function of the products of the metabolism of the fetus. The placenta is included in the hormonal metabolism, thus contributing to the hormonal changes of the woman's organism. Accumulation in the blood of human chorionic gonadotropin, increased level of estrogen, glucocorticoids and aldosterone is disrupting hormonal balance and leading to immunosuppression. During pregnancy, childbirth and lactation, iron loss can be up to 700-800 g, this is with an impact on the health of the mother. The management of TB cases detected in women during pregnancy depends on the time of detection, which has a major impact on the prognosis. Aim of study. Studying the peculiarities of pulmonary tuberculosis in pregnant women and evaluation of risk factors in the development of tuberculosis. Methods and materials. 28 cases of tuberculosis diagnosed in women during pregnancy in 2010-2020 were analyzed. Results. It was established that women diagnosed with tuberculosis during pregnancy had the age of 35-40 years in 12 (42,8%) cases, 20-34 years –in 9(32,2%), and in 7(25%) cases - they had the age of more than 40 years. The gestation term in the analyzed cases were: in the first quarter they were diagnosed with TB 7 (25%), in the second quarter – 13 (46,4%), in the third quarter – 8(28,6%). Screening of TB during pregnancy was by addressing in 100% cases. Contact with other TB patients was established in 13(46,4%) cases. In most cases 13(78,5%) women diagnosed with TB during pregnancy were not officially employed, so the social risk factor is very important. Among the clinical forms of pulmonary TB diagnosed in pregnant women were: infiltrative pulmonary tuberculosis – 17(60,8%), Nodular pulmonary TB – 6(21,4%), TB Pleurisy – 5(17,8%) cases. Pulmonary destruction was present at the radiological examination in 16(57%) cases. Analyzing the type of case was found "New Case" in 21(75%) and "Retreatment" in 7(25%) cases. Anemia had 22(82,1%) of the women included in the study. The treatment for sensitive TB was administered in 19(67,8%) cases and for resistant TB – 9(32,2%). In all cases, treatment was administered according to individual schemes. Adverse reactions of antituberculosis treatment were recorded in 6(21,4%) of patients. Positive result of antituberculosis treatment had 23(82,1%) cases. Pregnancy in women diagnosed with TB ended beneficially – with the birth of a healthy baby in most cases, only in one (3,6%) case the pregnancy was solved with the death of the child. Premature birth was recorded in 1/3 cases. Conclusion. Diagnosed TB in pregnant women has a severe course. Infiltrative pulmonary TB predominates. Administration of antituberculosis treatment is imposed by the gestation term. Pregnant women with suspicious signs should be evaluated for a timely diagnosis of TB.