Tuberculosis_and_Pregnancy_A_Ten_Year_Overview
                     J Obstet Cynecol lnd Vol. 53, No. 5 : Septe111ber/October 2003 Pg 453-457 
Tuberculosis and Pregnancy: A Ten Year Overview 
Suvarna S Khadilkar, Usha Saraiya, 
Ocpart111ent of Obstetrics and Gynecology, Cr111rt Medical College and Cama and A/bless Hospital, Mu11rbai. 
OBJECTIVES- To study the pattern of tubercular desease (TB) over a span of 10 years with a special reference 
to the pregnancy outcome in women with tuberculosis and also to make an attempt to understand whether 
pregnancy alters the course of tuberculosis. METHODS- This is a prospective observational study analyzing 10 
years experience of pregnancies complicated by tuberculosis. The patients were studied over two phases: phase I: 
Jan 1991 to Dec. 1995, [n=76] and phase II: Jan 1996 to Dec. 2000, [n=77]. Pregnancy outcome and course of the 
disease in these 153 pregnant women with tuberculosis were studied. RESULTS - Fifteen percent of women had 
reactivation of tuberculosis. P.ulmonary tuberculosis was by far the most common in both the phases. Cough and 
low grade fever were commonest symptoms. Severity of the disease reduced over the years and was found mainly 
in seropositive patients in phase II. Pregnancy outcome was not adversely affected except for a very high incidence 
of low birth weight babies. There were two maternal mortalities in phase I and one mortality in phase II. 
CONCLUSION -The incidence of TB has remained steady in spite of improved treatment strategies. Perinatal 
mortality decreased with time but the incidence of low birth weight babies remained quite high. The differences in 
the observations in phase I and II were not significant by Z test. Since high index of suspicion helps early 
diagnosis and treatment there is a strong need for health education, antenatal counseling and combined TB and 
AIDS awarness campaign. 
Key words: tuberculosis, pregnancy outcome 
Introduction Material and Methods 
Tuberculosis (TB) continues to be a major health hazard The patients were studied over two phases: phase 1: 
in India even today, despite excellent chemotherapeutic January 1991 to December 1995 and phase II: January 
agents available to us. Timely use of drugs can actually 1996 to December 2000. Total of 153 pregnant women 
cure the disease completely and can prevent the with TB were selected for the study. In phase I there 
morbidity and mortality of pregnancy complicated by were 76 women whereas in phase II 77 women. 
tuberculosis. In India, national tuberculosis program Interestingly a similar study was carried out in the 
was started in 1962. Epidemiological curve of any same hospital in 19601 which reported a very high 
infectious disease has an ascending limb, the summit 18% incidence of the disease which this has 
and a descending limb. After the national tuberculosis gradually fallen after the national tuberculosis 
program we have reached the descending limb on the control program. High degree of clinical suspicion 
epidemiological curve of this disease but the curve has helped to clinch the diagnosis that was further 
plateaued far above the acceptable level. The highest confirmed by supportive diagnostic tests. However, 
incidence of pulmonary TB is usually between 17 to 35 in three patients diagnosis was not suspected but it 
years of age and this also corresponds to the came as surprise at the time of tubal sterilization. 
childbearing years of women. Hence, every effort should Women were clinically suspected to have TB when 
be made to control the disease before, during and after they complained of cough with expectoration for 
pregnancy to prevent the ad verse effects of the disease more than !5 days, had fever for more than one week 
on the reproductive health of the mother. We conducted not responding to routine line of treatment or had 
prospective observational study of pregnancies with symptoms specific to less common sites of TB. All 
tuberculosis aimed at studying the pattern of the these patients were subjected to sputum for AFB, X-
disease over a span of 10 years, the pregnancy ray chest with abdominal shielding, CBC, ESR, 
outcome in patients with TB and whether pregnancy Mantoux test or other specific tests. In phase II even 
alters the course of TB. though rapid culture, PCR and anti-TB antibody tests 
were available more freely we could not use them 
being unaffordable to our women. After diagnosis 
Paper received 011 914102 ; accepted 011 27/9102 they were given three drugs anti-tubercular treatment 
Correspondence : (INH, rifanpicin and ethambutol) for the period of 6-
Suvarna S Khadilkar 9 months. Pyrazinamide was used as a fourth drug 
Department of Obstetrics and Gynecology, in a few women in phase II. The course of the disease 
Grant Medical College, Cama and Albless Hospital, Mumbai. and pregnancy outcome were studied in both the 
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Suvarna 5 Kharli/kar eta/ 
phases and results were compared. All women women preventing the advanced stage of the disease 
were encouraged to breast-feed givine INH making pregnancy more likely. 
prophylaxis to the neonates of sputum positive 
mothers. Tubal sterilization was done in In phase I there were four interesting clinical 
multiparous women. presentations -
Results Case 1. Tubercular meningitis : Fever, headache, 
vomiting and convulsions leading to fatal outcome. 
Out of 153 pregnant women diagnosed to have TB, 
76 belonged to phase I and 77 to phase II of the Case 2. Tubercular mastitis: Pain and swelling in the 
study. Total number of deliveries gradually declined breast leading to abscess fon:na tion needing 
over the study period and there is a slight rise in incision and drainage followed by anti TB drugs. 
overall incidence in phase II (0.38% phase I; 0.5% 
phase II) but this is statistically"'not significant. As Case 3. Abdominal TB leading to subacute intestinal 
seen in Table I majority of women were below25 obstruction responding to conservative treatment. 
years of age. This is the most vulnerable age group. 
Only 4.2% were above 30 years of age. There were Case 4. Pott's spine: Pregnancy and labour were 
more multiparas than primyparas in both the phases uneventful in spite of mechanical disadvantages due 
(Table II). Multiparity adds the problems of anemia, to deformity. Vaidya et aF have reported one interesting 
undernutriton and overcrowding. Women from both phenomenon in patients with Pott's spine and 
the phases match fairly well in age and parity quadriplegia. These patients may get "automatic 
(Tables I and II). Table III shows that majority were hyperreflexia syndrome" characterized by excessive 
diagnosed in third trimester, more so in phase II sweating, headache severe hypertension, convulsions 
(Table III). In 18.5% of patients in phase I and 24.7% and coma. 
in phase II diagnosis was made and full treatment 
Table V shows the analysis of various symptoms. 
completed preconceptionally. Amongst those 
Cough and low grade fever were most common 
diagnosed during pregnancy 15% revealed a past 
presenting symptoms in both the phases. Haemoptysis 
history of tuberculosis. Hence they had reactivation 
has significantly reduced over the years indicating 
of old tuberculosis suggesting that in a small number 
less severity of the disease in phase II. As many as 55% 
pregnancy perhaps worsens the course of the disease. 
of the patients were found to be anemic i.e. Hb