Tuberculosis and pregnancy

A relatively rare cause of intrauterine damage to the fetus is tuberculosis. Until recently, tuberculosis was considered by doctors as a social disease associated with the weakening of the human body as a result of poor living, nutrition, and work conditions. It was believed that it was enough to raise the standard of living of the population and tuberculosis would disappear by itself. However, this is not entirely true. The latest statistics indicate that there is a tendency for the number of people infected with tuberculosis mycobacteria to increase. Thus, tuberculosis should be considered a common infectious disease, not disregarding, of course, the predisposing factors for its development: overcrowding, insufficient nutrition, poor housing conditions, etc.

The Impact of Pregnancy on Tuberculosis

Not all pregnant women experience an exacerbation of tuberculosis. During pregnancy, tuberculosis rarely worsens in the phases of compaction and calcification, but a sharp exacerbation or progression occurs in the phases of the active process. Particularly severe outbreaks occur in patients with fibrous-cavernous tuberculosis. The first half of pregnancy and the postpartum period are most dangerous for the exacerbation of tuberculosis. Outbreaks in the postpartum period are especially malignant.

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The impact of tuberculosis on the course of pregnancy and childbirth

Adverse effects are observed in severe, destructive or disseminated forms of tuberculosis. Intoxication and oxygen deficiency have an effect. Toxicosis of the first and second half of pregnancy develops more often. Premature births occur more often. Newborns have a more pronounced physiological decrease in body weight and its restoration is slower. Timely prescription of specific therapy allows to bring the pregnancy to a successful birth, avoiding exacerbations of the postpartum period.

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

The pathogen, Koch's bacillus, can penetrate the placenta and amniotic membranes in two ways: hematogenously (through the bloodstream) and by contact. In this case, specific tuberculosis foci (granulomas) develop in the placenta. The destruction of placental tissue creates conditions for the penetration of mycobacteria into the fetus's blood. They usually enter the liver through the umbilical vein, where a primary complex is formed. However, even if this primary complex is absent in the fetus's liver, this does not mean that the fetus is not infected with tuberculosis in utero.

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 specific inflammation occurs.

Most often, pregnant women with tuberculosis do not carry a pregnancy to term, they often have stillbirths; children are often born hypotrophic. This is due to general intoxication of the pregnant woman's body, hypoxia and damage to the placenta (its insufficiency develops). It should be noted that most newborns do not show signs of intrauterine infection.

If intrauterine infection has occurred and caused the development of the disease in the fetus, then its clinical picture is extremely poor. Most often (about 75%) it is prematurity. The disease itself manifests itself in the 3-5th week of life. The child becomes restless, stops gaining weight, there is an elevated body temperature to subfebrile numbers, diarrhea, vomiting, an enlargement of the liver and spleen is observed, accompanied by a yellowish coloration of the skin. Shortness of breath, cyanosis (blueness), cough join in - this indicates the development of pneumonia. For diagnosis, the detection of mycobacteria in the gastric contents is of decisive importance. The prognosis for such children is extremely unfavorable, since the disease often ends fatally (death). And, first of all, this is due to late diagnosis, and, consequently, late treatment.

Management of a child from a mother with tuberculosis

If a pregnant woman has active tuberculosis, regardless of the release of MBT, the following measures are taken:

• the maternity ward is notified in advance about the presence of tuberculosis in the mother in labor;
• the woman in labor is placed in a separate box;
• immediately after birth 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 immunity formation - at least 8 weeks (the child is discharged home to relatives or placed in a specialized department, if indicated):
• Before discharge, an examination of the child's future environment is carried out;
• Before discharge, all premises are disinfected; the mother is hospitalized for treatment.

If the child was in contact with the mother before the BCG vaccine was administered (birth of the child outside a medical institution, etc.), the following measures are taken:

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

If the mother's tuberculosis was not known to the tuberculosis dispensary before birth, but was detected after the child was given the BCG vaccine, the following measures are taken:

• the child is separated from the mother;
• the child is prescribed preventive treatment regardless of the timing of the BCG vaccine administration;
• Such children are under close observation at the tuberculosis dispensary as the most at-risk group for developing tuberculosis.

Prevention of tuberculosis in pregnant women

Prevention of tuberculosis in pregnant women consists of proper and sufficient nutrition. It is also necessary to beware of hypothermia, and most importantly, not to contact with people known to be ill with tuberculosis and carriers of tuberculosis bacteria.

In order to prevent intrauterine infection of the fetus in women who have tuberculosis during pregnancy, specific anti-tuberculosis therapy is carried out.