Pulmonary tuberculosis in pregnancy
Introduction
Introduction to pregnancy with tuberculosis Pulmonary tuberculosis (pulmonary tuberculosis) is an acute, chronic infection caused by acid-tolerant Mycobacterium tuberculosis in the lungs, mainly through the respiratory tract. Although pregnancy has been less common in developed countries in recent years, it is not uncommon in developing countries. Before the advent of anti-tuberculosis drugs, tuberculosis has adverse effects on pregnant women and fetuses and babies. However, since the 1970s, due to the development of anti-tuberculosis drugs, there may be good results for tuberculosis patients during pregnancy, so that pregnancy with tuberculosis is no longer Become a serious problem. basic knowledge The proportion of illness: the incidence rate is about 0.02% - 0.05% Susceptible population: pregnant women. Mode of infection: respiratory transmission Complications: pulmonary candidiasis bacterial pneumonia
Cause
Pregnancy with pulmonary tuberculosis
(1) Causes of the disease
During the pregnancy and childbirth due to autonomic dysregulation, endocrine and metabolic dysfunction in the body, the body's immunity is reduced; in addition, the ovarian hormone is increased, the lung is hyperemia; hyperthyroidism, metabolic rate increases, energy consumption increases; blood cholesterol increases, etc. It is conducive to the growth and reproduction of tuberculosis in the lungs, which lays a foundation for the occurrence and deterioration of tuberculosis. The secretion of adrenal cortex hormones during pregnancy is significantly increased from the 12th week of pregnancy to those who are not pregnant, and then progressively increased to delivery. It can be increased by 3 times. During this period, the capillary permeability increases and the T lymphocyte activity decreases, which makes the tuberculosis in the body easily spread from the lymphatic system to the blood circulation, causing the spread of tuberculosis, leading to the simultaneous development of tuberculosis patients during pregnancy and puerperium. Have extrapulmonary tuberculosis.
(two) pathogenesis
Mycobacterium tuberculosis is transmitted through droplets in the air and enters the lungs through the respiratory tract. 90% of the hosts are asymptomatic. Tuberculosis can be in a static state for a long time. In immunocompromised or other diseases, the host can produce hypothermia, cough, chest pain, and body weight. To alleviate other symptoms, the primary infection in the lung occurs in the lungs, and the lower segment can be spread through the lymphocytes by macrophages or spread to the whole body via the blood system. The pathogens can be in the lungs, liver, spleen, and meninges. Bone, joints, lymph nodes, genitals and even placenta exist. After 1 to 3 months, the host can develop an immune response. The primary or other primary lungs heal, absorb, fibrosis, calcification, and the lesions heal, but the tuberculosis can still be cured. Surviving in the body for many years, when the host immunity is low, the Mycobacterium tuberculosis can move and the lesions become active again.
During pregnancy, if tuberculosis occurs, it can cause placental infection, which leads to congenital tuberculosis infection in the fetus.
1. The effect of pregnancy on tuberculosis
The perception of the effects of pregnancy on tuberculosis has changed several times. It was originally thought that pregnancy is conducive to tuberculosis. Because the uterus is enlarged, the diaphragm is rising, the compression of the chest cavity is conducive to cavity healing, and the prognosis of tuberculosis is improved. This view was changed in the 19th century. Pregnancy has an adverse effect on tuberculosis. Tuberculosis during pregnancy is aggravated with the progress of pregnancy. By 1953, through the comparative study of pregnant and non-pregnant women, it was found that pregnancy and childbirth had no adverse effects on tuberculosis, and pregnancy did not change tuberculosis. Nature and prognosis, future research has different views: there are reports that lymphatic tuberculosis is easy to move during pregnancy, and the healed lung or extrapulmonary tuberculosis has developed into active tuberculosis during pregnancy. Some studies have shown that pregnancy or childbirth Can increase the risk of active tuberculosis, Bi Yao et al (1995) reported 7 cases of acute miliary tuberculosis induced by childbirth, which is related to the severity and diagnosis of tuberculosis during pregnancy, whether there is enough treatment, tuberculosis during pregnancy Increasing incidence and exacerbation are associated with inhibition of cellular immune regulation during pregnancy. The rise of the diaphragm, the lack of oxygen in the lungs caused by the decrease in lung swell, easily lead to infection of the lungs. In the past, due to the recurrence of tuberculosis or the worsening of the disease in the first year after birth, it may be accompanied by rapid hormonal changes after postpartum, changes in cellular immunity, and decreased Nutritional consumption and lack of sleep are related. Now, due to effective chemotherapy drugs, the prognosis of tuberculosis is significantly improved. During pregnancy, the prognosis of postpartum is basically the same as that of women of the same age.
2. The impact of tuberculosis on pregnancy
Pregnant women with active tuberculosis have abortion, intrauterine infection, intrauterine and neonatal mortality, and tubercle bacilli cause chorioamnionitis by infecting the placenta. Jana et al. (1994) reported 79 cases of pregnancy in India. Pregnant women with active tuberculosis, their average fetal birth weight is low, premature delivery, low birth weight, intrauterine growth restriction increased by 2 times, perinatal mortality was 6 times, drugs for the treatment of tuberculosis caused bad to mother and child The possibility of action also exists. The consequences of poor pregnancy are related to the late diagnosis, incomplete treatment and progression of lung lesions. The fetus of pregnant women with tuberculosis can infect tuberculosis through the placenta or inhaled amniotic fluid, which has been isolated from dead infants and placenta tissue. Reports from Mycobacterium tuberculosis, Figueroa et al (2001) have also confirmed that tuberculosis infection during pregnancy can increase the prevalence and mortality of newborns, especially in pregnant women who start treatment late, with increased neonatal mortality, Jana et al. (1999) reported 33 cases of extrapulmonary tuberculosis, lymphatic tuberculosis did not affect the prognosis of pregnancy, and tuberculosis in the kidney, intestines, etc. was associated with low birth weight infants.
Prevention
Pregnancy with tuberculosis prevention
1. Strengthen health education: Do a good job of vaccination of BCG, avoid pregnancy during the active period of tuberculosis; if it is pregnant, abortion should be performed within 8 weeks of pregnancy, pregnancy should be considered after 1-2 years, history of tuberculosis is past, or Tuberculosis patients have a close contact history, and chest X-ray examination should be performed before pregnancy for early detection and management.
2. Strengthen prenatal examination: Increase the number of prenatal examinations so as to keep abreast of changes in the condition and timely discover complications during pregnancy.
Complication
Pregnancy with pulmonary tuberculosis complications Complications pulmonary candidiasis bacterial pneumonia
Can be complicated by pulmonary candidiasis, bacterial pneumonia, pulmonary interstitial fibrosis.
Symptom
Pregnancy with symptoms of tuberculosis Common symptoms Low fever, fatigue, night sweats, pleural thickening, adhesion, weight loss, stillbirth
Patients with active tuberculosis, especially those with moderate and severe lesions, pregnancy and childbirth can cause tuberculosis to worsen, especially for pregnant women who are severe and have no anti-tuberculosis treatment and no prenatal examination. Pregnancy and childbirth will make the disease Increased or even death, active tuberculosis, such as hematogenous disseminated tuberculosis, chronic fibrovascular tuberculosis patients, if pregnant, may further worsen the condition.
From the impact of tuberculosis on pregnancy, especially in critically ill patients due to chronic hypoxia, the incidence of stillbirth or premature birth is increased, but in any case, since the progress of anti-tuberculosis drugs in the 1970s, those who have been actively treated, The prognosis of mother and child has been significantly improved compared with the past.
Examine
Pregnancy with tuberculosis examination
1. Smear of acid-fast bacilli.
2. Tuberculin test.
3, X-ray inspection, be careful.
Diagnosis
Diagnosis and diagnosis of pregnancy complicated with pulmonary tuberculosis
If pregnant women have symptoms such as low fever, weight loss, fatigue, night sweats, etc., they should pay attention to finding the cause to eliminate the possibility of tuberculosis, and give a chest radiograph to check the acid-fast bacilli to confirm the diagnosis.
Should be identified with bronchitis, pregnancy reaction, upper respiratory tract infection, normal physiological changes during puerperium, puerperal infection, bronchiectasis, pneumonia.
