Patologìâ (Jul 2020)
Clinical cases of management and treatment of women with chemoresistant tuberculosis during pregnancy
Abstract
Importance of chemoresistant tuberculosis (CRTB) is undoubted both in Ukraine and all over the world. Especially alarming fact is that together with high CRTB sickness rate among young working-age people there is the low efficiency of therapy (55 %). Data of many researchers show, that tuberculosis of pregnant women is the reason of many significant complications which make serious maternal and perinatal danger. The problem of CRTB for pregnant woman is especially dangerous because the patient should take antimycobacterial drugs of II grade for a long period and these drugs have teratogenic effect. Purpose. Familiarization of physician-practitioners with the clinical features of the course and treatment of CRTB in women during pregnancy. Materials and methods. 4 clinical cases of own observations of the course and treatment of CRTB in women during pregnancy were described. Results. Among our investigations the artificial termination of pregnancy was inevitable in 3 of 4 presented clinical cases. The first patient had tubal pregnancy. The second patient: together with medical indications for artificial termination of pregnancy (multiresistant tuberculosis, unstable position of fetus), the absence of the patient’s tendency for treatment of multiresistant tuberculosis and problem social factor were observed. The patient informed that pregnancy was undesirable. The third patient had polyresistant tuberculosis and generalized destructive tuberculosis in lungs and besides the artificial termination of pregnancy was also her decision. The fourth patient had medical indications for artificial termination of pregnancy (multiresistant tuberculosis, negative clinical and radiological dynamics) but she refused. With regard to refusal antimicrobial therapy was corrected and aminoglycosides were excluded. The patient was responsible as to her own health and treatment of multiresistant tuberculosis. Under complex simultaneous control of phthisiatrician, obstetrician-gynecologist and neonatologist she terminated complete course of antimicrobial therapy with successful treatment result and gave birth to healthy baby. Conclusions. Summarizing our own observations of the pregnant patients with CRTB the following conclusion can be made: if patients with CRTB have tendency to antimicrobial therapy and desire to give birth the positive results such as CRTB treatment and delivery of healthy baby will be obtained under complex simultaneous control of phthisiatrician, obstetrician-gynecologist and neonatologist.
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