Active tuberculosis of the respiratory organs as a risc factor in pregnancy

Abstract

Introduction/Background. The problem of tuberculosis in pregnant women deserves special attention during increasing incidence of this disease in Moldova. Risk of maternal and perinatal pathology significantly increased in women with active tuberculosis of the respiratory organs. In this study we analyzed features of the course of pregnancy in 84 patients with active tuberculosis. Direct proportionality was found between the active form of lung specific process and frequency of obstetric complications. Patients, Methods. To achieve this study observational retrospective analysis of obstetrical records of pregnant women with active tuberculosis of the respiratory organs was conducted of PHCF ICSOSMC and SCM N1 (Moldova) during the years 2005-2010. Results. The most common clinical form of tuberculosis of the respiratory organs, found in patients in the study group was found to be infiltrative pulmonary tuberculosis - 52 (61.9%) cases. Second after impact was exudative pleurisy - 16 (19.0%) cases. Disseminated (miliary) form was detected in 6 (7.1%) patients, fibro-cavitary form - 5 (6.0%) patients, nodular form - 5 (6.0%) patients. A woman was diagnosed with generalized tuberculosis affecting the lungs (miliary tuberculosis), pleura (pleural exudative - fibrinous), liver, kidney, intrathoracic lymph nodes. The case resulted in maternal death and intranatal mortality. At 3/4 of patients pregnancy developed on the background of iron deficiency anemia - 69 (82.1%) cases. During pregnancy they were treated anemic. Other complications of pregnancy in patients with active tuberculosis of the respiratory organs were imminent abortion in different terms - 38 (45.2%) cases; placental pathology was found in 22 (26.2%) cases, pregnant swelling - in 4 (4.8%) cases; pregnancy was complicated by gestosis and preeclampsia - in 5 (6.0%) cases. Analyzing the peculiarities of placental pathology there was identified intrauterine fetal chronic hypoxia in 9 (10.7%) cases, placental chronic insufficiency - in 6 (7.1%) cases, fetal growth symmetric form retardation - in 15 (17.9%) cases and asymmetric form - in 3 (3.6%) cases; amniotic fluid pathology was noted in 7 (8.3%) cases. Only 6 (7.1%) pregnancies were uncomplicated. Conclusion. The obtained data are confronted with data from the literature. The increased incidence of pregnancy complications in women with active tuberculosis of the respiratory organs was found. According to foreign studies the complicated evolution of pregnancy occurs in 40.0 to 43.1% of cases, and according to data from this study - up to 70% of cases. Frequently the pregnancy was complicated by iron deficiency anemia (about 80%), much higher than the population average (15-20%). The obstetric complications were significant: gestosis and preeclampsia - 5 (6.0%) cases, placental pathology 22 (26.2%) cases, being accompanied 18 (21.4%) cases of fetal growth retardation. These obstetric complications observed in this study coincided with their incidence in the literature.