Maternal and Child Health Programme, IRD Pakistan, Korangi Creek, Karachi, Pakistan.
IRD Global, Singapore, Singapore.
Int J Infect Dis. 2021 Jul;108:391-396. doi: 10.1016/j.ijid.2021.05.072. Epub 2021 Jun 1.
Active tuberculosis (TB) during pregnancy has an adverse effect on maternal and neonatal outcomes. This study analysed the results of a pilot project integrating TB screening into antenatal care (ANC) visits in a high-TB-burden, low-resource setting.
Data were extracted from the TB screening pilot in obstetrician-gynaecologist clinics of six tertiary care facilities in Karachi, Pakistan from April to December 2017. Data from the verbal symptom screening conducted at each ANC visit for all women and the Xpert MTB/RIF testing for all symptomatic women to investigate TB yield were analysed by assessing the numbers screened, presumptive patients and active TB diagnoses among pregnant women and neonates.
Symptom screening was performed on 113,078 pregnant women, 2,965 (2.6%) of whom reported at least one TB symptom. Sputum samples were collected from 2,896 (97.7%) symptomatic women. Of the 27 (0.9%) newly diagnosed bacteriologically positive TB patients, 25 (93%) initiated TB treatment. No case of vertical TB transmission was reported among 26 live births.
TB screening is feasible and should be implemented during routine ANC visits in high-TB-burden settings. There is a need to explore a multi-faceted approach with inclusion of clinical examination and chest X-rays to diagnose TB in pregnant women.
妊娠期间活动性肺结核（TB）对母婴结局有不良影响。本研究分析了在高结核负担、资源匮乏的环境中，将结核筛查纳入产前保健（ANC）访视的试点项目的结果。
本研究从 2017 年 4 月至 12 月在巴基斯坦卡拉奇的六家三级保健设施的妇产科诊所的 TB 筛查试点中提取数据。对所有接受 ANC 访视的妇女进行的口头症状筛查和所有有症状的妇女进行的 Xpert MTB/RIF 检测以调查 TB 检出率的数据进行分析，评估了筛查人数、疑似患者和妊娠妇女及新生儿中的活动性 TB 诊断。
对 113078 名孕妇进行了症状筛查，其中 2965 名（2.6%）报告了至少一种 TB 症状。对 2896 名（97.7%）有症状的妇女采集了痰液样本。在 27 名（0.9%）新诊断的细菌学阳性 TB 患者中，有 25 名（93%）开始接受 TB 治疗。在 26 例活产中未报告垂直 TB 传播病例。
TB 筛查是可行的，应在高结核负担环境中在常规 ANC 访视中实施。有必要探索一种多方面的方法，包括临床检查和胸部 X 射线，以诊断孕妇中的 TB。
