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Impact of pneumonia in pregnancy on maternal and neonatal outcomes in Durban, South Africa

Abstract number: 1733_1108

Khan M., Moodley J., Adhikari M.

Introduction: Pneumonia in pregnancy occurs in <1% of antenatal attendees; an incidence rate not dissimilar to that reported in non-pregnant adults. However the pregnant state and risk factors associated with the development of pneumonia adversely influence the outcome of pregnancy. It is the third leading cause of indirect maternal mortality during pregnancy, labour and the puerperium in the USA and in South Africa, it was the leading cause of maternal deaths due to non-pregnancy related infections.

The contribution of pneumonia and HIV-1 co infection in pregnancy has been poorly documented in South Africa. The aim of our study was to determine the clinical and demographic profile of women admitted to the maternity unit of a tertiary centre in Kwa Zulu-Natal, South Africa and to evaluate the association between pneumonia, HIV-1 infection and maternal and perinatal outcomes.

Methods: The study was performed between January and December 2000 in the antenatal clinic and labour ward of a tertiary centre. The investigation of pneumonia by the attending obstetrician was prompted by symptoms and clinical signs. All women were offered pre and post test counseling for HIV-1.

A control arm of HIV infected and uninfected women without pneumonia were randomly selected from the antenatal population.

Results: Twenty nine pregnant women were diagnosed with pneumonia. Mycobacterium tuberculosis (MTB) was the only causative organism isolated from sputum samples. Of the 14 MTB samples, 10 were smear positive and 8 were culture positive, with one case of drug resistant MTB. EPTB accounted for 9 of the 14 MTB cases. As a result, 3 categories developed: women with probable or confirmed PTB, women with suspected PTB and women with suspected bacterial pneumonia. There were 7 maternal deaths which occurred in women with pneumonia. There were 18 live born neonates, one intra uterine death and 6 stillbirths.

In the control arm of 112 women, a greater number of obstetric co morbidities occurred. There were no maternal or neonatal deaths.

Conclusion: Pneumonia in pregnancy has a low incidence rate yet carries significant maternal and neonatal morbidity and mortality. Risk factors for the development of pneumonia were identified in our study and almost two thirds of the mothers had a chronic cough. In resourced constrained settings with high HIV and TB prevalence, it might be cost effective to do screening chest radiographs in pregnancy.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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