Clinical manifestations and challenges in management of tuberculosis in pregnancy in a rural setting in eastern India

Abstract

Aim: To observe fetomaternal outcomes of both pulmonary and extrapulmonary tuberculosis (TB) in pregnancy as well as effects of pregnancy on TB. Materials and methods: Antenatal patients with history of chronic cough, expectoration, and weight loss were enrolled and included from antenatal, chest medicine, medicine outpatients as well as from obstetric emergency and labor wards. Detailed history, examination, sputum for acid-fast bacilli (AFB), and culture were used to diagnose, and additional investigations, such as cassette-based nucleic acid amplification test (CBNAAT), Mantoux, chest X-ray, and computed tomography (CT)/magnetic resonance imaging (MRI) according to indications were used. Affected patients received antitubercular treatment (ATT) according to Revised National Tuberculosis Control Program (RNTCP) guidelines. Maternal weight gain in pregnancy, time and mode of delivery, fetal prematurity, growth restriction, and medical complications in pregnancy were chief parameters observed. Results: A total of 14 patients were diagnosed with TB in pregnancy over 18 months from August 2015 to January 2017. Women who booked early in pregnancy had better weight gain, later gestation of delivery (38 vs 35 weeks), higher fetal birth weights (2,745 vs 1,835 gm) at delivery than those who booked late. Among the patients who booked late, one developed TB pericarditis, one had central nervous system (CNS) tubercu-loma, and another lady died due to fatal pulmonary embolism from deep vein thrombosis (DVT) due to immobility. One of the preterm babies had congenital TB. Conclusion: Tuberculosis, particularly extrapulmonary and presenting in advanced pregnancy, can be confused and missed, leading sometimes to catastrophic consequences. Clinical significance: Pulmonary TB detected early and treated has an uneventful course in pregnancy. Any duration of TB treatment in pregnancy and postnatally should be accompanied with thromboprophylaxis, if immobility is present.