Peculiarities of tuberculosis in pregnant women and women during of the first 3 years after childbirth

Abstract

Introduction: The problem of pulmonary tuberculosis in pregnancy has attracted the attention of doctors for many years and it is still a current issue. The disease is a significant contributor to maternal mortality and is among the three leading causes of death among women aged 15-45 years in high burden areas. The exact incidence of tuberculosis in pregnancy, though not readily available, is expected to be as high as in the general population. The clinical and laboratory diagnosis, and therapy during pregnancy and post partum period, deserve special attention. Also untreated pulmonary tuberculosis in a pregnant woman would be a definite risk for transmission of disease to the new born. Limitations in the diagnosis of tuberculosis during pregnancy, safety of antituberculosis therapy and the need for prophylaxis must be in the knowledge of all the physicians giving care to pregnant women. Objectives: The aim of the study was to characterize the type and presentation of tuberculosis in pregnant women and women during of the first 3 years after childbirth. We also aimed to identify any problems and difficulties in the diagnosis and management of tuberculosis associated with pregnancy; evaluation of risk factors that lead to the development of tuberculosis in pregnant women and women during the first 3 years after childbirth. Methodology and materials: This retrospective study was conducted at the Phthisiopneumology Hospital from Chisinau and Institute of Phthisiopneumology from Moldova between 2001-2010. A total of 66 women diagnosed as having pulmonary TB were included in the study. These were divided into two groups: I - 33 cases of pregnancy associated with pulmonary tuberculosis and II - 33 cases of pulmonary tuberculosis in women during of the first 3 years after childbirth. Both the groups have been compared according to age, type of disease, extent of disease. Where possible the diagnosis was confirmed by culture of Mycobacterium tuberculosis. Otherwise, patients were diagnosed on clinical and radiographic evidence and response to treatment. Results: Has been found that most of pregnant women suffering from pulmonary TB included age between 25 - 34 years (66,7%) and women during the first 3 years after childbirth with active TB - 18 - 24 years (48,5%). Pulmonary TB was found at pregnant women more frequently in the third trimester of pregnancy - 57,6%; in group II in the first 12 months after labor - 63,7%. The common causes for a delay in diagnosis were late presentation and non-specific symptoms. TB in pregnant women were detected more frequent by active method (72,7%), in group II - in 57,6% cases, p> 0.05. The structure of the clinical forms in I group show a higher degree of presence Pulmonary infiltrative TB (39,4%) and Pleural TB (39,4%), in II group predominated Pulmonary infiltrative TB - 84,8%, p<0.001. In most cases (72,7%), TB was diagnosed on the background pregnancy. 8 women (24,2%) from I group and 16 (48,5%) women from II group had a positive contact history of TB. The majority of women delivered at term - 87,9%, 12,1% of pregnancies ended in abortion, including two for medical reasons, one initiated by the patient and one pregnancy ended in miscarriage. The main factors to development of tuberculosis among women in both groups had contact with patients with active tuberculosis and concomitant diseases. Conclusions: These findings necessitate more serious thought on the issue of targeted TB screening during pregnancy, postpartum period keeping in mind the consequences of late diagnosis, the nonspecific presentation of the disease during pregnancy and the specific needs and vulnerabilities of both mother and fetus.