More recently, tuberculosis was considered a fairly serious indication for abortion or artificial birth. However, thanks to the advent of new methods of treatment and diagnosis, today you can save the fetus and maintain the health of the mother. A woman must be registered with a pulmonologist or with another suitable specialist.
Tuberculosis and pregnancy
A comprehensive examination is a mandatory procedure for expectant mothers, because thanks to him, diseases are discovered that later become dangerous for the baby. The general condition of a woman is assessed through a blood test, and a fluorographic examination of her family and husband will help determine whether a woman in labor is at risk for developing pulmonary disease or not. Such measures are primarily aimed at the prevention of tuberculosis. This is a very dangerous disease that can be found in any person, regardless of their social status and occupation. Many are carriers of the disease and do not know about it, since even a blood test does not reveal it. Infection is most often in a dormant state for years and is activated at the time of a decrease in immunity.
In pregnant women, all protective functions are physiologically reduced, and they are more susceptible to the influence of viruses.
It must be remembered that pregnancy with pulmonary tuberculosis is a dangerous condition, since against the background of such an ailment serious complications and pathologies begin, and a miscarriage can also occur. The risk of transmitting the disease to the child from the mother is minimal, but it is completely impossible to exclude it.
Classification
There are certain criteria by which this disease is divided:
- active and inactive;
- pulmonary or extrapulmonary;
- primary and secondary, as well as more rare - congenital.
At a time when tuberculosis was detected in the expectant mother in the early stages, then not only an obstetrician-gynecologist, but also a TB doctor should be involved in the management of the woman in labor.
It is believed that if the disease is localized in the chest, then the risk to the fetus will be minimal, unlike the extrapulmonary form. Most often, such a pregnancy ends in premature birth, the babies appear weak and get a minimum score on the Apgar scale.
Symptoms
If the disease affects the patient in the 1st trimester, then this process practically does not have any clinical indicators. The painful condition is due to toxicosis, which is considered the main cause of untimely diagnosis.
Most often, the pathology manifests itself as:
- loss of appetite;
- extensive weakness;
- decrease in body weight.
Tuberculosis during pregnancy, the symptoms of which in the 2nd trimester proceed without any changes, is quite dangerous, since infiltrative and destructive processes are already beginning to spread in the body.
Causes
At the time of gestation, the endocrine system is accompanied by a restructuring of functioning.
Changes occur:
- in metabolic processes;
- the immune and hematopoietic system.
The body receives a significant load, primarily associated with the presence of fetal metabolic products in it. As a result, the number of risk factors often increases. Because of this, the development of the disease due to primary infection with microorganisms is possible.
Most often, tuberculosis during pregnancy affects in the 1st trimester, although they can get sick at any time. At risk are women in the first 6 months after birth. During this period, active lactation begins and the child continues to receive from the mother all the necessary components for his growth, so the body does not cease to be weakened.
Who to contact?
Tuberculosis and pregnancy require the participation of several doctors. If the girl noticed suspicious symptoms in herself, then she must certainly consult her gynecologist. He will ask questions that suggest the presence of the disease.
1. Is there toxicosis?
2. How long have respiratory problems?
3. Have the flu and ARVI been transmitted in recent months?
4. Worsened health or not?
If the attending physician suspects a malaise, then a phthisiatrist, pulmonologist, otorhinolaryngologist and surgeon begin to deal with the patient. Women with tuberculosis often give birth to healthy children, since intrauterine damage is quite rare. Breastfeeding is allowed only to those patients who have an inactive form of the disease.
Influence
According to statistics, if there is a tuberculosis process, then an increase in the frequency of anemia is noted in the body of the expectant mother. And also, the disease leads to late and early gestosis and the outflow of amniotic fluid. At the same time, 46% of women in labor have no complications from pulmonary tuberculosis. Preterm birth occurs only in 6% of cases. The postpartum picture in such women is favorable.
Diagnostics
X-ray examinations, like fluorography, are very undesirable at the time of pregnancy. But in some cases, doctors can still prescribe such procedures. An experienced doctor will definitely ask a woman about probable contacts with patients and previous illnesses, since pregnancy after tuberculosis and at the time of it can be fraught with negative consequences. If the doctor will have reason to assume the presence of this disease, then an x-ray examination is required, regardless of the term. At this stage, this will be considered a justifiable risk, since delayed diagnosis leads to an aggravation of the situation and to irreversible results. At the time of the examination, special protective equipment is used to protect the fetus from the effects of radiation.
When analyzing a blood, it is almost impossible to suspect the presence of an ailment, since an increased level of leukocytes, ESR and decreased hemoglobin are completely characteristic of pregnant women, as well as for this disease.
Recognition of such an ailment is problematic due to erased symptoms, often enough it is diagnosed only before discharge from the hospital. Pregnancy with tuberculosis of the lymph nodes is dangerous, since this disease is difficult to detect and can often be confused with other viruses, such as mononucleosis.
Treatment
In case of detection, immediate treatment with antimicrobial drugs is required. The question immediately arises about their effect on the child, since tuberculosis and pregnancy are two completely versatile concepts. Among all admissible components, “Streptomycin” owns teratogenic properties. It is dangerous because it can cause hearing loss in the baby. Therefore, it is contraindicated for expectant mothers.
The remaining drugs, although they cross the placenta, do not have such an effect on the fetus.
Treatment of tuberculosis during pregnancy is often carried out with drugs:
“Rifampicin.”
“Isoniazid.”
“Ethambutol.”
These drugs are considered the safest for women who are going to have a baby, they are tested by world famous laboratories. Together with them, vitamin B6 is most often prescribed, since it perfectly complements the therapeutic effect.
The doctor will prescribe the necessary scheme according to all the instructions of the drug and the requirements. You need to understand that a disease that is not treated is much more dangerous for a child and mother than synthetic components. Of course, tuberculosis and pregnancy are always difficult, therefore, at the time of wearing, a woman must be constantly monitored by an obstetrician-gynecologist and TB specialist. All additional medicines should be prescribed with caution.
Most often, patients who have been diagnosed with this are hospitalized in a planned manner three times over the entire period.
Danger to the fetus
Pregnancy after pulmonary tuberculosis and at the time of this disease is not dangerous for the baby in the womb. It is believed that the placental barrier itself is impenetrable for microorganisms, so infection most often occurs at the time of delivery. There are exceptions when a baby is born already with affected organs. A mother is taken from a mother who has an active form of the disease, and her baby is isolated until complete recovery.
Interrupt
Today, the preservation of pregnancy is possible in a large number of women infected with tuberculosis, if systematically treated and observed by specialists. Timely recognition and completion of all therapeutic procedures allows you to save the child in patients with limited fibro-focal lesions, freshly identified small focal processes, as well as hematogenously disseminated pulmonary tuberculosis.
But still the interrupt is shown:
- with a disease of the spine in an active form with the appearance of a cavity;
- pelvic injury with the formation of a fistula or abscess;
- fibro-cavernous pulmonary tuberculosis, arising as a result of any form of ailment;
- with infection of the knee, hip and ankle joints.
In the presence of indications for abortion, this process should be carried out in the early stages (up to 12 weeks). Abortion in the subsequent period is impractical, as it most often contributes to the progression and exacerbation of the disease.
Childbirth
Women who have an active form are much harder to give birth than healthy. At the time of intoxication, weak attempts and large blood loss are often found. The process itself takes less time. With this disease, the baby comes out naturally. The use of forceps and a cesarean section is recommended only for medical reasons. The birth of a baby must necessarily take place in a special hospital. If this does not exist in the city, then the hospital staff must be notified in advance of the arrival of such a patient. A woman must wear a protective mask so as not to spread the virus.
At the time of the appearance of the baby, breathing exercises are required. But also doctors often use antispasmodic and painkillers.
If treatment was provided to the patient in a timely manner and she was constantly monitored by specialists, then threats to her life and her baby at the time of the birth process are minimized.
Pregnancy after TB treatment
Every woman who has had such a disease and plans to have a baby should pay special attention to her health. The disease itself is a serious obstacle to successful bearing, since there is a great likelihood of intrauterine development of defects. Therefore, it is very important to visit a TB specialist and a gynecologist and get advice from them before you conceive a child. Planning can be done no earlier than two years after undergoing treatment. This is because the body must recover and gain strength. If you do not follow the doctor’s recommendations, then the ailment often returns at the time of bearing the fetus, as immunity decreases. If obvious symptoms are detected, fluorography is recommended.
Pregnancy after pulmonary tuberculosis is possible and most often ends in a positive outcome, but each case is unique, and therapeutic measures are taken by doctors individually.
In the most positive scenario, after a complete cure of the disease, the birth of the baby proceeds without complications and the consequences of a former illness do not affect the health and well-being of the child. That is why it is necessary to undergo all tests and a full examination in a timely manner.
Forecast
Early diagnosis and treatment started on time provide a favorable outcome for the development of the fetus and further birth. Most often, children in a sick mother are born healthy, the exception is infection due to pathological problems with the placenta, as well as at the time of the attempts themselves. Often, infection occurs after the birth process from a mother who has tuberculosis during pregnancy. The consequences are not very favorable, but, according to experts, you should not excommunicate the child from the mother. An exception are cases when a woman suffers the most difficult and hopeless forms of illness. If bacillus excretion is not observed in the woman in childbirth, then the child is vaccinated with BCG and breastfeeding is allowed. After discharge from the hospital, a mother with a newly-minted member of the community should be constantly monitored by a women's and children's consultation and a tuberculosis dispensary.