Routine antenatal chest x-ray findings in patients drawn from a currently surveyed population

Abstract

1.1. Analysis is made of the findings on routine chest photofluorography in 3,576 pregnancies. The cases examined were equivalent in number to nearly half of all resident gravidas in a county of 100,000 population, simultaneously undergoing survey and study of tuberculosis.2.2. Four per cent of all patients showed sufficient signs of abnormality to warrant investigation.3.3. Thirty cases of clinically important nontuberculous pathologic conditions were diagnosed, principally cardiovascular disease, a proportion of one in 119 of the total cases.4.4. There were 37 women with 43 pregnancies in whom pulmonary tuberculosis was diagnosed ante partum; one for every 83 cases examined.5.5. The single microfilm screening of all prenatal referrals resulted in the discovery of tuberculosis, not suspected by the obstetrician, in 14 women or one in 255. The remaining cases diagnosed were either known previously, or referred as suspicious.6.6. There were found 10 cases of pulmonary tuberculosis, diagnosed from one to twenty months post partum, never previously suspected. Five of these patients had been reported as normal on the screening examination. Thus, among 42 individuals with tuberculosis in pregnancy, or shortly to develop the disease, our routine screening mechanism failed to yield a warning in one out of eight.7.7. Comparison of the prenatally diagnosed group with those whose cases were discovered post partum shows a marked difference in fatality, with a more disastrous course of the disease in both mothers and infants among the latter group.8.8. Our findings support the view that x-ray examination of the chest in all pregnancies is a highly useful procedure in terms of newly discovered tuberculous lesions otherwise unknown to the obstetrician.9.9. Additional value of the method is attested by the frequency with which nontuberculous thoracic pathology of clinical importance is disclosed. Cases of this nature deserve more investigation than was possible in this study.10.10. Despite the small numbers involved, our findings indicate that a single chest x-ray, in early to mid-pregnancy, is an insufficient sample upon which to assume that clinically important disease is unlikely to develop later in pregnancy or subsequent to delivery. The need for a supplementary examination of all patients, about the time of the initial postpartum visit, is suggested.