The incidence of tuberculosis in pregnancy in UK is increasing among ethnic minority women.
A 25 year old Indian woman with a BMI of 17 was booked in her first pregnancy.
Her antenatal period was uneventful until 33 weeks gestation when she presented in early labour with pathological CTG and a coincidental history of non-productive cough and fever for two weeks. A live female baby weighing 1.4 kg was delivered by caesarean section with an arterial cord pH of 6.9.
Intraoperative findings included extensive segments of small bowel and adnexae matted with caseous tubercles. She developed fever and subacute intestinal obstruction in the early postoperative period. CT scan revealed mediastinal lymphadenopathy and pleural effusion.
Anti-tubercular treatment was started under care of a multidisciplinary team.
She developed caecal perforation on eighth postoperative day requiring urgent laparotomy with right hemicolectomy and end ileostomy. Histology of caecum showed necrotizing mycobacterial inflammation.
Baby needed ventillatory support immediately after birth and developed seizures thereafter. A subdural haematoma was drained on day 4. Gastric aspirate showed acid fast bacilli suggestive of congenital tuberculosis. Baby was treated with six months of antitubercular treatment and signs of right sided hemiplegia persisted at twelve months of age.
An attempt of reversal of ileostomy was abandoned after one year because of extensive peritoneal tuberculosis despite being on antitubercular treatment throughout the same period of time.
Medical assessment of the ethnic minority women upon entry into UK will avoid delay in diagnosis and reduce maternal and perinatal morbidity in this group.
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