Tuberculosis and pregnancy

A relatively rare cause of intrauterine fetal damage is tuberculosis. More recently, tuberculosis was considered by doctors as a social disease associated with the weakening of the human body as a result of poor living, nutritional and labor conditions. It was believed that it is enough to raise the standard of living of the population and tuberculosis will disappear by itself. However, this is not quite true. The latest statistics indicate that there is a tendency to increase the number of people infected with mycobacteria tuberculosis. Thus, tuberculosis should be considered as an ordinary infectious disease, without, of course, disrupting factors for its development: crowding, malnutrition, poor housing conditions, etc.

Effect of pregnancy on tuberculosis

Exacerbation of tuberculosis does not develop in all pregnant women. During pregnancy, tuberculosis rarely worsens in the phases of compaction and calcification, but there is a sharp exacerbation or progression in the phases of the active process. Especially severe outbreaks occur in patients with fibrous-cavernous tuberculosis. The first half of pregnancy and the postpartum period are most dangerous for an exacerbation of a tuberculosis. Outbreaks in the postpartum period are especially malignant in nature.

[1], [2], [3], [4], [5], [6]

Influence of tuberculosis on the course of pregnancy and childbirth

Adverse effects are observed with severe, destructive or disseminated forms of tuberculosis. It is affected by intoxication and oxygen deficiency. More often develop toxicosis of the first and second half of pregnancy. Preterm labor often occurs. In newborns, physiological weight loss is more pronounced and recovery is more slowly. Timely appointment of specific therapy makes it possible to bring the pregnancy to safe deliveries, to avoid exacerbations of the postpartum period.

Tuberculosis, most often pulmonary, often accompanies pregnancy. The disease can occur both before the onset of pregnancy, and during it. For the fetus the most dangerous are outbreaks of hematogenous tuberculosis (exudative pleurisy, miliary tuberculosis, tuberculous meningitis, etc.). Danger is also the formation of the primary tuberculosis complex during pregnancy, especially because it is almost asymptomatic, and bacteremia (bacteria in the blood) with it is pronounced.

Pathogen - a stick of Koch - can penetrate into the placenta and amniotic membranes in two ways: hematogenous (blood flow) and contact. In the placenta, specific tuberculosis foci (granulomas) develop. The destruction of the placental tissue creates conditions for the penetration of mycobacteria into the fetal blood. Usually, through the umbilical vein, they enter his liver, where the primary complex is formed. However, even if this primary complex is absent in the liver of the fetus, this does not mean that the fetus is not infected with uterine tuberculosis.

From the primary complex located in the liver, the pathogen spreads throughout the body, but first of all it enters the lungs of the fetus, where a specific inflammation occurs.

Most often, pregnant women with tuberculosis do not have a pregnancy, they often have stillbirths; often children are born hypotrophic. This is due to the general intoxication of the body of pregnant women, hypoxia and placenta damage (its insufficiency is formed). It should be noted that most newborns have no signs of intrauterine infection.

If intrauterine infection did occur and caused the development of the disease in the fetus, then the clinical picture of it is extremely poor. Most often (about 75%) is prematurity. The disease itself is manifested in the 3-5th week of life. The child becomes restless, stops gaining weight, elevated to subfebrile body temperature, diarrhea, vomiting, there is an increase in the liver and spleen, accompanied by icteric staining of the skin. Dyspnea, cyanosis (cyanosis), coughing - this indicates the development of pneumonia. For diagnosis, the detection of mycobacteria in gastric contents becomes crucial. The prognosis for such children is extremely unfavorable, since the disease often ends lethal (death). And, first of all, it is caused by late diagnostics, and consequently, late started treatment.

Keeping a child from a mother with a tuberculosis

If the pregnant woman is sick with active tuberculosis, regardless of the allocation of MW, the following activities are carried out:

• the maternity ward is notified in advance of the presence of tuberculosis in the parturient woman;
• The mother is placed in a separate box;
• immediately after the birth of the child is isolated from the mother;
• transfer the child to artificial feeding;
• the child is vaccinated with BCG;
• the child is separated from the mother for the period of the formation of immunity - not less than 8 weeks (the child is discharged home to relatives or placed under indications in a specialized department):
• Before discharge, a survey of the future environment of the child is carried out;
• before discharge, disinfect all rooms; About the mother is hospitalized for treatment.

If the child before the introduction of the BCG vaccine was in contact with the mother (birth of a child outside the medical facility, etc.), the following activities are carried out:

• the mother is hospitalized for treatment, the child is isolated from the mother;
• vaccination against tuberculosis is not carried out;
• the child is given a course of chemoprophylaxis for 3 months;
• after chemoprophylaxis Mantoux reaction with 2 TE;
• with a negative Mantoux reaction with 2 TE, vaccination with BCG-M is carried out;
• After vaccination, the child remains separated from the mother for at least 8 weeks.

If the tuberculosis of the mother was not known before the birth, it is known to the TB dispensary, and was identified after the introduction of the BCG vaccine to the child, carry out the following measures:

• the child is separated from the mother;
• the child is given preventive treatment regardless of the timing of the introduction of the BCG vaccine;
• such children are under the close supervision of the TB dispensary as the most endangered risk group for tuberculosis.

Preventive maintenance of a tuberculosis at pregnant women

Preventive maintenance of a tuberculosis at pregnant women consists in a correct and sufficient food. It is also necessary to beware of hypothermia, and most importantly, not to communicate with obviously ill tuberculosis and carriers of tuberculosis bacteria.

To prevent intrauterine infection of the fetus in women with tuberculosis during pregnancy, specific anti-tuberculosis therapy is performed.