Pathology of tuberculosis in maternal mortality: an autopsy study

Tuberculosis is a leading cause of death among women in the reproductive period. Studies suggest that immunobiologic changes in pregnancy influence tuberculosis. However there is a dearth of data on pathomorphology of tuberculosis in pregnancy. Aim To characterize pathomorphologic patterns, co-existing lesions and obstetric complications in maternal deaths associated with tuberculosis. Methods We performed a two-year retrospective study of all autopsies of maternal mortality associated with tuberculosis. Results Among 151 autopsies of maternal deaths a current clinical history or autopsy evidence of tuberculosis was noted in 14 patients. Six among these had died post-partum and four following spontaneous abortions. Multi-organ tuberculosis and isolated pulmonary tuberculosis was observed in ten and three patients respectively. One patient with on-going anti-tuberculosis treatment had massive hepatic necrosis but no tuberculosis at autopsy. Six patients had a poorly reactive tuberculosis pattern. Diffuse alveolar damage was noted in three, two patients each had intracardiac mural thrombi and brain infarcts, one had perforative peritonitis while another revealed features suggestive of aortitis. Fetal outcome was poor with only two live births. Discussion The study suggests that maternal mortality associated with tuberculosis commonly has a florid multi-organ involvement, is often poorly reactive and has a poor fetal outcome.