Features of pregnancy course in women with chemoresistant tuberculosis (a literature review)
DOI:
https://doi.org/10.14739/2310-1210.2019.5.179473Keywords:
tuberculosis, pregnancyAbstract
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.
References
World Health Organization (2019). Global Tuberculosis Report 2018. Geneva.
Raznatovskaya, E. N. & Khudyakov, G. V. (2017). Assessment of palliative patients with chemoresistance pulmonary tuberculosis life quality in the conditions of specialized hospital at the corrective labour colony. Zaporozhye medical journal, 19, 3(102), 358–362. doi: 10.14739/2310-1210.2017.3.100936 [in Ukrainian].
Raznatovska, O. M. & Khudiakov, G. V. (2018). Factors of chemoresistant pulmonary tuberculosis progression in patients receiving palliative treatment. Zaporozhye medical journal, 20, 3(108), 388–391. doi: 10.14739/2310-1210.2018.3.130829 [in Ukrainian].
Knight, M., Kurinczuk, J. J., Nelson-Piercy, C., Spark, P. & Brocklehurst, P. (2009). Tuberculosis in pregnancy in the UK. BJOG, 116, 584–588. doi: 10.1111/j.1471-0528.2008.02097.x
Chopra, S., Siwatch, S., Aggarwal, N., Sikka, P. & Suri, V. (2017). Pregnancy outcomes in women with tuberculosis: a 10-year experience from an Indian tertiary care hospital. Tropical Doctor, 47(2), 104. doi: 10.1177/0049475516665765
El-Messidi, A., Czuzoj-Shulman, N., Spence, A. R. & Abenhaim, H. A. (2016). Medical and obstetric outcomes among pregnant women with tuberculosis: a population-based study of 7,8 million births. American Journal of Obstetrics and Gynecology, 215(6), 797–799. doi: 10.1016/j.ajog.2016.08.009
Jana, N., Barik, S., Arora, N. & Kumarendu Singh, A. (2012). Tuberculosis in pregnancy: The challenges for South Asian countrie. Journal of Obstetrics and Gynaecology Research, 38(9), 1125–1136. doi: 10.1111/j.1447-0756.2012.01856.x
Mathad, J. S. & Gupta, A. (2012). Tuberculosis in Pregnant and Postpartum Women: Epidemiology, Management, and Research Gaps. Clin Infect Dis, 55(11), 1532–1549. doi: 10.1093/cid/cis732
Sugarman, J., Colvin, Ch., Moran, A. C. & Oxlade, O. (2014). Tuberculosis in pregnancy: an estimate of the global burden of disease. Lancet Glob Health, 2(12), e710–716. doi: 10.1016/S2214-109X(14)70330-4
Palacios, E., Dallman, R., Muñoz, M., Hurtado, R., Chalco, K., Guerra, D., Mestanza, L., et al. (2009). Drug-resistant tuberculosis and pregnancy: Treatment outcomes of 38 cases in Lima, Peru. Clin Infect Dis, 48(10), 1413–1419. doi: 10.1086/598191
UNICEF. India statistics. [Cited 27 Jul 2010.]. Retrieved from http://www.unicef.org/infobycountry/india_statistics.html.
Harbuziuk, V. V. & Polova, S. P. (2016). Vahitnist i tuberkuloz: perspektyvy naukovoho poshuku [Pregnancy and tuberculosis: prospects for scientific research]. Vrachebnoe delo, 3–4(1138), 39–44. [in Ukrainian].
Harbuziuk, V. V. & Polova, S. P. (2014). Patomorfolohichna diahnostyka peredchasnykh polohiv u zhinok, khvorykh na tuberkuloz lehen [Pathomorphological diagnostics of preterm labor in women with pulmonary tuberculosis]. Pediatriia, akusherstvo ta hinekolohiia, 462(2), 69–71. [in Ukrainian].
Ünlü, M., Çimen, P., Arı, G. & Şevket Dereli, M. (2015). A Successfully Treated Severe Case of Extensively Drug-Resistant Tuberculosis During Pregnancy. Respiratory Case Reports, 4(1), 67–71.
Tabarsi, P., Moradi, A., Baghaei, P., Marjani, M., Shamaei, M., Mansouri, N., et al. (2011). Standardised second-line treatment of multidrug-resistant tuberculosis during pregnancy. Int J Tuberc Lung Dis, 15(4), 547–550. doi: 10.5588/ijtld.10.0140
Deependra Kumar Rai. (2016). Tuberculosis in pregnancy. Eastern J Medical Sciences, 1(2), 42–45.
Postanova Kabinetu Ministriv Ukrainy «Pro realizatsiiu statti 281 Cyvilnoho kodeksu Ukrainy» vid 15 liutoho 2006 r. №144. [Cabinet of Ministers of Ukraine Resolution On the implementation of Article 281 of the Civil Code of Ukraine from February 15, 2006 No. 144]. Kyiv. [in Ukrainian].
Hurskyy, O. S., & Polyova, S. P. (2013). Pereryvannia vahitnosti u zhinok, khvoryh na tuberkuloz lehen [Therapeutic abortion in women with pulmonary tuberculosis]. Dosiahnennia biolohii ta medytsyny, 1(21) 34–36. [in Ukrainian].
Polova, S. P. & Harbuzyuk, V. V. (2013). Struktura matkovo-platsentarnoi dilianky pry peredchasnykh polohakh u vahitnykh, khvorykh na tuberkuloz [Structure of the uterus-placental area at preterm birth in pregnant women with tuberculosis]. Klinichna ta eksperymentalna patolohiia, 17(4), 103–105. [in Ukrainian].
Yakovleva, А. А., Mordyk, А. V., Zhukova, N. V., Antropova, V. V., & Nikolaeva, I. I. (2012). Analiz techeniya i iskhodov tuberkuleza i beremennosti pri ikh sochetanii u pacientok reproduktivnogo vozrasta [Analyses of pregnancy with tuberculosis course and outcomes in reproductive age patients]. Sibirskoe medicinskoe obozrenie Retrieved from https://cyberleninka.ru/article/n/analiz-techeniya-i-ishodov-tuberkuleza-i-beremennosti-pri-ih-sochetanii-u-patsientok-reproduktivnogo-vozrasta [in Russian].
Harbuzyuk, V. V. (2019). Obgruntuvannia profilaktyky ta likuvalnoi taktyky pry peredchasnykh polohakh u zhinok, khvorykh na tuberkuloz lehen [Substantiation of prophylaxis and curative tactics during preterm labor in women with pulmonary tuberculosis]. Kyiv. [in Ukrainian].
Rohilla, M., Joshi, B., Jain, V., Kalra, J., & Prasad, G. R. V. (2016). Multidrug-Resistant Tuberculosis during Pregnancy: Two Case Reports and Review of the Literature. Case Rep Obstet Gynecol. doi: 10.1155/2016/1536281
Dudnyk, A. & Pavel'chuk, O. (2016). Multidrug-resistant tuberculosis in pregnant women: Treatment and birth outcomes. European Respiratory Journal, 48. doi: 10.1183/13993003.congress-2016.PA1912
Laniado-Laborín, R., Carrera-López, K. & Hernández-Pérez, A. (2018). Unexpected Pregnancy during Treatment of Multidrug-resistant Tuberculosis. Turk Thorac J, 19. doi: 10.5152/TurkThoracJ.2018.17062
Prasad, R., Gupta, N., Singh, A. & Gupta, P. (2015). Multidrug-resistant and extensively drug-resistant tuberculosis (M/XDR-TB): management in special situations. International J of Medical Science and Public Health, 4(12), 1626–1633.
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)