Massive hemoptysis and complete unilateral lung collapse in pregnancy due to pulmonary tuberculosis with good maternal and fetal outcome: a case report

Examining family planning and adverse pregnancy outcomes for women with active tuberculosis disease: a systematic review

OBJECTIVES

(1) Summarise and evaluate the current evidence of tuberculosis (TB)-associated pregnancy outcomes, (2) evaluate the state of the science of family planning during TB treatment and (3) provide recommendations to move forward to improve care and outcomes during TB disease.

DESIGN

Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

DATA SOURCES

PubMed, Embase, CINAHL, Cochrane, Web of Science and Scopus were searched from September 2009 to November 2021.

ELIGIBILITY CRITERIA

Studies were included if they assessed pregnant women with active TB, drug-resistant TB (DR-TB) or TB/HIV coinfection and examined pregnancy, maternal, fetal/birth and TB or TB/HIV coinfection outcomes. Studies were also included if they examined family planning services among women initiating TB treatment.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data using PRISMA guidelines and conducted quality assessment using the Joanna-Briggs Institute Critical Appraisal Tools. The level of evidence was reported using the Johns Hopkins Evidence-Based Practice guidelines.

RESULTS

69 studies were included in this review. Case reports, case series, case controls, cohort studies, secondary data analyses and a service delivery improvement project conducted in 26 countries made up the totality of the evidence. Most studies reported pregnancy complications for mothers (anaemia, postpartum haemorrhage, deaths) and fetuses or newborns (low birth weight, premature birth, and spontaneous or induced abortions). Few studies discussed the value of offering family planning to prevent adverse pregnancy outcomes. One study examined the effect of a provider training on contraceptive use with reported increased contraceptive use.

CONCLUSIONS

Integrating family planning services within a TB treatment programme is essential to reduce adverse TB-associated maternal-child outcomes. Despite well-established adverse pregnancy outcomes, little attention has been paid to family planning to prevent poor pregnancy outcomes for women with TB/DR-TB. Recommendations for clinicians, TB programmes and researchers are provided and reflect evidence presented in this review.

Novel approach of rigid bronchoscopy concurrent with cesarean section and bronchial arterial embolism for patients with massive hemoptysis during pregnancy: case reports and literature review

Massive hemoptysis can be life-threatening and is frequently encountered in clinical practice, but rare during pregnancy. There have been limited case reports of massive hemoptysis in pregnancy in patients with conditions such as Takayasu's arteritis, bronchiectasis, bronchial carcinoid tumor, and tuberculosis. The most important management is early control of the hemorrhage and airway protection. We report on 2 patients at 33 and 27 gestational weeks who were admitted to the emergency department because of massive hemoptysis. Therapeutic rigid bronchoscopy with the application of high-frequency jet ventilation was performed under general anesthesia during cesarean section to control potential bleeding and stabilize the airway; this was then followed by bronchial artery embolization (BAE) postsurgically. The lives of both mothers and infants were saved. At the 16- and 11-month follow-ups, the patients showed no symptoms. To our knowledge, this is the first report on the application of therapeutic rigid bronchoscopy concurrent with cesarean section in order to protect the airway and reduce the side effects of the subsequent treatment for both mother and fetus in hemoptysis cases. By reporting these cases and conducting a literature review, we present a novel treatment method for massive hemoptysis in pregnant patients that may improve patients' outcomes.

Unilateral Pulmonary Fibrosis in Pregnancy: A Post-Tubercular Sequelae

Pulmonary tuberculosis (TB) is one of the top 10 leading causes of death in the world. Multi-drug resistant TB can lead to short-term and long-term sequelae causing clinical, psychosocial, and financial burden on the diseased. Pregnancy in a woman with compromised pulmonary function is a challenge for the treating obstetrician. A multidisciplinary approach involving a respiratory physician, pre-conceptional counseling, and delivery at a tertiary care center can reduce maternal morbidity and mortality. Compliance with anti-tubercular treatment with regular follow-up can minimize the long term effects of pulmonary TB.

We report a case of unilateral lung collapse due to multidrug-resistant pulmonary TB in pregnancy with good maternal and fetal outcomes.

Perspectives on tuberculosis in pregnancy

Tuberculosis (TB) has been recognized as an important cause of morbidity and mortality in pregnancy for nearly a century, but research and efforts to roll out comprehensive TB screening and treatment in high-risk populations such as those with a high prevalence of HIV or other diseases of poverty, have lagged behind similar efforts to address HIV infection in pregnancy and the prevention of mother-to-child-transmission. Immunological changes during pregnancy make the activation of latent TB infection or de novo infection more likely than among non-pregnant women. TB treatment in pregnancy poses several problems that have been under-researched, such as contraindications to anti-TB and anti-HIV drugs and potential risks to the neonate, which are particularly important with respect to second-line TB treatment. Whilst congenital TB is thought to be rare, data from high HIV burden settings suggest this is not the case. There is a need for more studies screening for TB in neonates and observing outcomes, and testing preventative or curative actions. National tuberculosis control programmes (NTPs) should work with antenatal and national HIV programmes in high-burden populations to provide screening at antenatal clinics, or to establish functioning systems whereby pregnant women at high risk can drop in to routine NTP screening stations.