Pregnancy and pulmonary tuberculosis.

There are 1565 premature and full-term deliveries in patients with tuberculosis at The New York Hospital included in this report. About 10% of the patients had active pulmonary tuberculosis immediately before or during gestation. The obstetric management of the patient with inactive tuberculosis is similar to that of the nontuberculous woman. In patients with active or recently active tuberculosis, delivery under regional anesthesia, with forceps when necessary to avoid excessive straining during the second stage of labor, is advised. Tuberculosis is not an indication for cesarean section. Chemotherapy is now the cornerstone of all therapy for tuberculosis; the various regimens and modifications depend on the type and extent of the disease. The best combination of drugs is isoniazid and ethambutol. Therapy in all cases must be multiple drug, continuous, and long-term. Prophylactic isoniazid is used infrequently during pregnancy and only in special circumstances. Results of treatment with the newer antituberculosis drugs show that the disease progressed in less than 1% of patients between 1957 and 1972 compared to 3 to 4% of patients from 1933 to 1956. Infants born to the 1565 tuberculous mothers reported here were of average weight, and none of the 1588 infants (23 sets of twins) had congenital tuberculosis. Patients should be carefully followed postpartum with sputum tests and x-rays. They should also be given medical and socioeconomic counseling.