| disease | Pregnancy Complicated with Tuberculosis |
Pregnancy complicated by pulmonary subcutaneous node has become less common in developed countries in recent years, but it is not rare in developing countries. Before the advent of anti-subcutaneous node drugs, subcutaneous node disease had adverse effects on both pregnant women and their fetuses or infants. However, since the 1970s, the development of anti-subcutaneous node drugs has provided effective treatment for pulmonary subcutaneous node during pregnancy, making pregnancy complicated by pulmonary subcutaneous node no longer a serious issue.
bubble_chart Clinical Manifestations
Patients with active pulmonary subcutaneous nodes, especially those with extensive lesions and grade III, may experience worsening of their subcutaneous node condition due to pregnancy and childbirth. This is particularly true for grade III patients who have not undergone anti-subcutaneous node treatment and lack prenatal care, as pregnancy and childbirth can exacerbate the condition or even lead to death. Active pulmonary subcutaneous nodes, such as hematogenous disseminated pulmonary subcutaneous nodes or chronic fibrocavitary pulmonary subcutaneous nodes, may further deteriorate if pregnancy occurs.
From the perspective of the impact of pulmonary subcutaneous nodes on pregnancy, especially in severe cases, chronic hypoxia caused by the disease can increase the incidence of dead fetus or premature labor. However, since the advancement of anti-subcutaneous node drugs in the 1970s, the prognosis for both mothers and infants has significantly improved with active treatment.
If a pregnant woman has symptoms such as low-grade fever, weight loss, lack of strength, and night sweats, it is important to investigate the cause to rule out the possibility of pulmonary tuberculosis, and to confirm the diagnosis with a chest X-ray and sputum test for acid-fast bacilli.
1. Strengthen prenatal care: Most patients have been clearly diagnosed and treated in time before pregnancy, and pregnancy can achieve good outcomes. If the importance of health education and prenatal care is not generally emphasized, individual patients with grade III pulmonary subcutaneous nodes may experience adverse consequences once pregnant.
2. For untreated disseminated or fibrocavitary pulmonary subcutaneous node patients, artificial late abortion should be performed within 6-8 weeks of pregnancy. After treatment stabilizes the condition, pregnancy can be reconsidered.
3. Drug treatment: The use of streptomycin during pregnancy is no longer recommended. Dnider et al. (1980) pointed out that among 206 pregnant patients treated with streptomycin for pulmonary subcutaneous nodes, 34 infants had auditory nerve involvement, leading to hearing impairment or complete loss. Therefore, streptomycin should not be used during pregnancy.
The first-line drugs for subcutaneous node disease during pregnancy are isoniazid (INH) and ethambutol. Adding vitamin B6 can prevent the potential neurotoxicity of INH to the fetus. Thus, INH and ethambutol are the preferred drugs throughout pregnancy. Second-line drugs mainly include rifampicin, thioacetazone, or kanamycin. Rifampicin is safer to use after 16 weeks of pregnancy. The treatment course should continue for 1-1.5 years after the condition is basically controlled. For patients with high fever and significant toxic symptoms, 12g of para-aminosalicylic acid can be added to 500ml of 5% glucose solution for daily intravenous drip, lasting 1-2 months. After the condition improves, combined anti-subcutaneous node drug therapy can be selected.
4. Obstetric management
(1) Pregnancy management: For patients whose condition allows pregnancy, anti-subcutaneous node treatment and prenatal care must be carried out simultaneously. Severe patients should receive prenatal care checks in a subcutaneous node disease sanatorium or at home, with special attention to emotional comfort and encouragement to eliminate mental burdens, which helps prevent complications like hypertension during pregnancy.
(2) Childbirth management: During labor, pay close attention to energy supply and rest to prevent uterine contraction lack of strength caused by insufficient energy or stress. The second stage of labor often requires forceps or vacuum extraction to avoid excessive fatigue worsening the condition. For cesarean sections, epidural anesthesia is preferred. Postpartum, monitor for bleeding and infection.
(3) Puerperium management: For postpartum women with active pulmonary subcutaneous nodes, extended rest, continued anti-subcutaneous node treatment, and improved nutrition are necessary, along with active prevention and treatment of puerperium infections. Newborns should be isolated from the infected mother and promptly vaccinated with BCG. If the mother has disseminated pulmonary subcutaneous nodes, the infant should receive INH at 15-20mg/kg daily for 1 year. If the subcutaneous node skin test and chest X-ray are negative, BCG can be used. If the skin test is positive but the chest X-ray is negative, continue INH for 1 year. If both tests are positive, additional anti-subcutaneous node drugs are needed.
It is important to note that if postpartum fever of unknown cause cannot be explained by intrauterine infection, consider the possibility of pulmonary subcutaneous node lesion spread and further investigate with a chest X-ray for a clear diagnosis.
