Tuberculosis is a disease that can present great challenges to the patient even before pregnancy can take place. TB is a matter of concern at all times in a woman’s obstetrics career- prior to conception, during pregnancy and in the nursing period.
Tuberculosis of the genital track is a known cause of infertility in women. Tuberculer salpingitis i.e. infection of the Fallopian tubes by the TB bacterium leads to inflammation and subsequent blockage of the passage through which the egg or ovum has to travel in the uterine cavity- so it is obvious that if the tubes are blocked, pregnancy will not take place. These cases do not always come from resource limited settings. Even the affluent and educated are prone to this disease. Unfortunately in our country there is so much social stigma, against TB itself and not only that, infertility is considered a curse. There are two reasons why such women face horrifying discrimination.
If a woman was to get pregnant and she has TB, the diagnosis will often get delayed. This is because most of the symptoms of TB mimic those of pregnancy. Symptoms like lethargy, fatigue, loss of appetite are often ignored by family members and physicians alike. Incase symptoms persist or if a pregnant woman has cough lasting more than 2 weeks- which is not responding to conventional treatment- then the diagnosis of TB should be kept in mind. A pregnant woman should be investigated by blood test, sputum smear and culture. X-ray, if needed, should be performed after protecting the fetus with a lead shield over the abdomen to prevent harmful effects of radiation.
Treatment of TB in pregnancy consists of medicines, diet, fresh air and a positive attitude. The standard first line drugs are safe and do not harm the baby and patients and their family members need to be re-assured about this fact. It is safer to treat the patient than not. The pregnant woman should be counseled regarding side-effects of these medicines. The liver function and visual fields should be tested at periodic intervals.
Now coming to MDR-TB in pregnancy- this can pose a very big challenge as second line drugs are toxic and very harmful to the unborn baby. If such a woman comes during early pregnancy, she should be given an option of therapeutic abortion. If she comes in late, modified treatment should be planned for her.
Once the baby is born, mothers get worried if the baby can contract TB from the breast milk. This is not at all true. The baby can contract TB but from the bacteria in the breath. So the mother should breast-feed after putting a mask on the face.
In conclusion, I believe that pregnancy in TB needs to be tackled immediately and with positive attitude for best results.
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