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22 February 2023 : Case report  Indonesia

[In Press] Management of Labor in Pregnancy Complicated with Previous Tuberculosis with Giant Lung Bullae and Intrauterine Growth Restriction: A Case Report

Challenging differential diagnosis, Unusual setting of medical care, Rare coexistence of disease or pathology

Muhammad Alamsyah Aziz1ACEF, Alfonsus Zeus Suryawan1BDEF

DOI: 10.12659/AJCR.939006

Am J Case Rep In Press; DOI: 10.12659/AJCR.939006  

Available online: 2023-02-22, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Tuberculosis (TB) is the leading infectious cause of mortality in developing countries. In pregnancy, TB may cause complications including intrauterine growth restriction (IUGR) and vertical transmission of TB. Recurrent TB infection can cause permanent damage to lung tissue, and formation lung bullae can occur. Giant lung bullae may be harmless in normal conditions, but cause concern if the patient is pregnant.
A 22-year-old G1P0A0 woman at 9 months of pregnancy came to our institution due to labor pain. She also presented with active TB from 1 month before admission. Chest X-ray findings suggestive of tuberculosis and giant bullae were found. She was diagnosed with active 1st phase of labor with active TB and giant lung bullae. The Cardiothoracic Surgery Department was on standby during labor to take countermeasures if bullae rupture occurred. The 2nd stage of labor was shortened with vacuum extraction. After delivery, the patient was shifted to an isolation room and started on antitubercular drugs.
Tuberculosis in pregnancy leads to many adverse outcomes, both in maternal and fetal. Prolong TB infection also causes lung scaring, which leads to formation of bullae. Possible causes of rupture of bullae during pregnancy are Valsalva maneuver during labor, increased alveolar ventilation, and positive‑pressure ventilation during general anesthesia. Normal vaginal delivery would increase the need for Valsalva maneuver, and vacuum extraction is advised to shorten the 2nd stage of labor to minimize the need of Valsalva maneuver and avoid increased intrapulmonal pressure.

Keywords: Latent Tuberculosis; Pulmonary Bullae Causing Pneumothorax; Vacuum Extraction, Obstetrical


22 February 2023 : Case report  Taiwan

A 30-Year-Old Woman with an 8-Week History of Anxiety, Depression, Insomnia, and Mild Cognitive Impairment ...

Am J Case Rep In Press; DOI: 10.12659/AJCR.938732  

22 February 2023 : Case report  Nigeria

Multidrug-Resistant Kocuria rosea and Methicillin-Resistant Staphylococcus aureus Co-Infection in a Nigeria...

Am J Case Rep In Press; DOI: 10.12659/AJCR.938761  

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17 Mar 2023 : Case report  USA

Dermoid Cyst of the Parotid Gland: Case Report of a Rare Entity and Review of the Literature

Am J Case Rep In Press; DOI: 10.12659/AJCR.939411  

17 Mar 2023 : Case report  Japan

A Case of a Refractory Bleeding Giant Vaginal Wall Cavernous Hemangioma Successfully Managed with Sclerothe...

Am J Case Rep In Press; DOI: 10.12659/AJCR.939474  

16 Mar 2023 : Case report  Indonesia

Initial Thrombocyte Concentrate Transfusion in Woman with Chronic Immune Thrombocytopenia Purpura (ITP) Who...

Am J Case Rep In Press; DOI: 10.12659/AJCR.938752  

15 Mar 2023 : Case report  USA

Thoracic Epidural as a Rescue Analgesic in a Patient with a Continuous Erector Spinae Plane Block for Rib F...

Am J Case Rep In Press; DOI: 10.12659/AJCR.938875  

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923