Pregnancy with tuberculosis

Pregnancy with tuberculosis
[Summary]



Although pregnancy with tuberculosis in recent years has been in less developed countries, but in developing countries is not uncommon. Appear in the anti-TB drugs, tuberculosis both pregnant women and children, babies have adverse effects, but since the 1970s, due to the development of anti-TB drugs, the patients with pulmonary tuberculosis during pregnancy can have good effect, the pregnancy has not pulmonary tuberculosis become a serious problem.



[Diagnosis]




If pregnant women have low heat, suffering from weight loss, fatigue, night sweats and other symptoms, should attach importance to find out the reasons to exclude the possibility of tuberculosis, and to chest radiography and sputum acid-fast bacilli seized a clear diagnosis.


[Treatment]




1. Strengthen prenatal care: in the majority of patients have been diagnosed before pregnancy and timely treatment, may be a good pregnancy outcomes, such as health education and the importance of prenatal care is not universal attention, individual patients with severe tuberculosis, adverse pregnancy can occur consequences.

2. Disseminated tuberculosis hollow fiber or untreated, shall be in the 6 to 8 weeks pregnant, abortions after trip, were treated in stable condition after pregnancy.

3. Drug treatment: Application of pregnancy has not in favor of streptomycin. Dnider such as that in 1980, 206 cases of pregnancy in the application of streptomycin in the treatment of patients with pulmonary tuberculosis, there were 34 infant cases of acoustic neuroma involvement leaving or complete loss of hearing loss, can no longer use during pregnancy streptomycin treatment.

TB during pregnancy to the first-line drugs isoniazid (INH), ethambutol, such as the addition of vitamin B6 can be used to prevent fetal INH potential neurotoxicity, and ethambutol INH in the first period of the pregnancy drug . While the second line drugs rifampin, ammonia or thiourea mainly kanamycin. Rifampicin in 16 weeks pregnant after the use of more security. Drug treatment for the disease under control, and then continue to apply 1 to 1.5 years. For accompanied by high fever, toxic symptoms of patients, can be used for ammonia acid 12 g increase in 5% glucose solution in 500 ml daily intravenous infusion, continuous 1 to 2 months; condition to be improved, then use a joint anti-TB drugs treatment.

4. Obstetric treatment

(1) dealing with pregnancy: pregnancy can be any condition, anti-TB treatment and prenatal care must be at the same time. Serious TB patients should be in nursing homes or home health care for pregnant women to inspection, with special attention to the spirit of comfort and encouragement eliminate ideological burden, enabling the prevention of pregnancy-related complications such as hypertension.

(2) delivery of treatment: labor began to pay more attention to energy supply and rest, to prevent inadequate supply of heat or mental tension caused by uterine atony. The second stage of forceps or more to attract fetal head of midwifery, so as to avoid excessive fatigue condition to increase. For cesarean section, epidural anesthesia for both properly. Postpartum hemorrhage attention infection.

(3) puerperium treatment: maternal for the activity pulmonary tuberculosis, must be extended rest and continued to increase anti-tuberculosis treatment and nutrition, and active control puerperal infection. With the mother and newborn should be isolated, and promptly vaccinated against tuberculosis. If the maternal disseminated tuberculosis patients, their infants required INH daily 15 ~ 20 mg / kg, in a sustained if tuberculin skin test and chest radiograph were negative, BCG can be used if the skin test positive and negative chest radiograph , then following with INH1; such as skin tests and chest radiograph were positive, then plus his anti-TB drugs.

It should be noted that if the event postpartum unexplained fever, intrauterine infection can not be explained, they should consider whether it is the spread of tuberculosis lesions should be further to chest radiography inspection, definite diagnosis.


[Clinical]




Patients with active tuberculosis, especially more extensive lesions in patients with severe, pregnancy and childbirth can to tuberculosis situation deteriorated, especially severe and not anti-tuberculosis treatment untried pregnant women without prenatal care, pregnancy and childbirth will exacerbate illness substantial (or) died. Active tuberculosis, such as blood disseminated tuberculosis, chronic pulmonary tuberculosis in patients with type hollow fibers such as pregnancy, while the condition may worsen further.

From tuberculosis to look at the impact of pregnancy, particularly in patients with severe chronic illness can be caused by hypoxia, stillbirth or premature increase in the incidence. But in any case, since the 1970s, since the progress of anti-TB drugs, where the active treatment, the prognosis for maternal and child in the past, has been markedly improved.