Diagnosis of tuberculosis during pregnancy
1.Tuberculin skin test: Pregnancy does not affect the results of the tuberculin test, and the tuberculin test does not cause adverse reactions to the woman or the baby.
Imaging (chest X-ray or CT): Chest imaging is still an indispensable method to diagnose tuberculosis. However, because X-rays may image the fetus, they are generally not preferred. When the PPD test is positive, further chest plain radiographs are needed. With lead apron protection for the abdomen of pregnant women, the fetus receives very little X-ray dose, which is a safe limit.
3, sputum smear bacteriological examination: This method has a low positive rate because of the influence of sputum specimen retention and patient excretion factors, and has a low diagnostic rate for early pulmonary tuberculosis. However, if the sputum smear is positive for Mycobacterium tuberculosis, the diagnosis is basically clear.
4.Blood TB antibody test: Its positive rate and specificity are poor, and it can only be used as an auxiliary method.
5, blood T.SPOT test: blood test, convenient and safe, its significance is comparable to tuberculin skin test, the test cost is higher.
Therefore, in the author’s opinion, if TB infection is suspected during pregnancy, PPD test or blood T.SPOT test and sputum smear can be performed first, and if PPD is strongly positive or blood T.SPOT is positive and sputum smear is positive, further chest X-ray examination will be performed. If negative, observation can be done first, and when TB is highly suspected, chest X-ray examination and sputum smear are recommended.
Anti-tuberculosis drug therapy during pregnancy
The current anti-tuberculosis drugs for patients with primary TB are: isoniazid, rifampin, ethambutol, and pyrazinamide. In the first trimester of pregnancy, anti-tuberculosis drugs, like other drugs, have a high risk to malformation. The drug with proven serious side effects is streptomycin, which can affect the occurrence and development of the fetal ear during the embryonic period and lead to congenital deafness, so streptomycin is prohibited during pregnancy.
1. Isoniazid: It is easier to pass through the placenta, and most of the current data show that isoniazid does not cause malformation, so it is a necessary drug with greater safety, and can be combined with small doses of vitamin B6 as appropriate.
2.Rifampicin: Most studies have concluded that rifampicin is not harmful to the fetus and can be used during pregnancy for anti-tuberculosis treatment.
3, ethambutol: easy to enter the fetal blood through the placenta, there is no clear evidence that the drug has images on the development of the fetal optic nerve, so it is safe to use during pregnancy.
4, pyrazinamide: animal experiments and clinical observations have not found the teratogenic effect of this drug, but because of the relatively small number of related studies, its safety is not yet very clear.
Indications for interruption of pregnancy
In patients with active and severe gestational tuberculosis, pregnancy should be interrupted as soon as possible. The current indications for pregnancy interruption are considered to be
1. severe active tuberculosis.
2, combined extrapulmonary tuberculosis with more severe disease.
3, drug-resistant tuberculosis.
4, accompanied by chronic underlying diseases such as: diabetes mellitus, nephropathy, cardiac, hepatic and renal insufficiency, etc.
5, severe pregnancy reactions, affecting anti-tuberculosis drugs.
6, tuberculosis recurrent hemoptysis.
7, HIV-infected patients.
Breastfeeding
In the past, it was suggested that any mother receiving anti-tuberculosis drugs should not breastfeed. However, current research has concluded that the amount of first-line anti-TB drugs secreted into breast milk through breast milk is so small that it does not cause side effects. The American Department of Pediatrics and Respiratory Medicine also believes that the above anti-tuberculosis drugs can be used during breastfeeding.