Features of pregnancy course in women with chemoresistant tuberculosis (a literature review)
Tuberculosis is a global cause of morbidity among women of reproductive age, constituting a serious maternal and perinatal risk in both developed and developing countries. Tuberculosis is the third highest cause of death in women of reproductive age. At the same time, the frequency of diagnosing a specific process in pregnant women and pregnancy in women with tuberculosis is almost the same. Today, against this background, the treatment of chemoresistant tuberculosis (CR-TB) in pregnant women remains controversial.
The purpose. To conduct a review of current literature sources in order to determine the characteristics of gestation in women with CR-TB, which will assist clinicians in the management of such patients.
Results. In pregnant women, extrapulmonary and pulmonary forms of tuberculosis incidence are almost the same. Chest X-ray examination in pregnant women should not be avoided, since the radiation risk for the fetus is insignificant when the abdominal cavity shielding. In women with tuberculosis, childbirth occurs on average at the 38th week of pregnancy, and premature labor is associated with tuberculosis progression. In pregnant women with tuberculosis, the incidence of chorioamnionitis, gestosis, premature birth, anemia, pneumonia, maternal and perinatal mortality is higher than in pregnant women without tuberculosis. Newborns have an increased risk of a premature birth, congenital tuberculosis, intrauterine growth retardation, congenital abnormalities, and distress syndrome. A high frequency of these pathologies in pregnant women and newborns largely depends on tuberculosis progression, chemoresistance of mycobacterium tuberculosis and the adequacy of anti-mycobacterial therapy. Untreated CR-TB is associated with higher maternal mortality, an increased risk of vertical transmission of tuberculosis, spontaneous miscarriage, intrauterine growth restriction, premature birth, increased neonatal mortality. Breastfeeding is possible if there is a sputum culture conversion in mother. The risk of toxic reactions to anti-tuberculosis drugs in breastfed infants is low and may be minimized if a mother with tuberculosis takes medications immediately after breastfeeding. Medical indications for artificial termination of pregnancy at 12–22 weeks’ gestation are severe forms of tuberculosis: disseminated, progressive, chemoresistant, with severe complications.
Conclusions. Considering the analysis of the literature, all pregnant women should be prescribed treatment for CR-TB with second-line anti-tuberculosis drugs based on the drug sensitivity test starting from the second trimester (if a patient is HIV-negative or not in a critical state) with the exception of drugs such as amikacin, streptomycin, prothionamide and ethionamide. A timely and adequate anti-mycobacterial therapy is the key to successful pregnancy outcome. Pregnancy follow-up among women with CR-TB should be based on an interdisciplinary approach including a team of physicians such as a tuberculosis specialist, obstetrician, neonatologist, and public health expert.
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