Tuberculosis in pregnancy Dr.V.Ravimohan

Historical perspective Hippocratic view young woman with tuberculosis should become pregnant to improve her outcome!!

Hippocratic view

young woman with tuberculosis should become pregnant to improve her outcome!!

Historical perspective … 1850 - 1920s tuberculosis was harmful during pregnancy, and termination of pregnancy - recommended

1850 - 1920s

tuberculosis was harmful during pregnancy, and termination of pregnancy - recommended

? Therapeutic abortion Tuberculosis during pregnancy -rarely an indication for a therapeutic abortion But pregnant woman with MDRTB, should be offered abortion counseling  medications used are known to cause fetal abnormalities

Tuberculosis during pregnancy -rarely an indication for a therapeutic abortion

But

pregnant woman with MDRTB, should be offered abortion counseling  medications used are known to cause fetal abnormalities

Diagnosing tuberculosis in pregnancy Symptoms like malaise & fatigue may be ignored in pregnancy  late diagnosis sputum examination and culture - same as for non-pregnant

Symptoms like malaise & fatigue may be ignored in pregnancy  late diagnosis

sputum examination and culture - same as for non-pregnant

Diagnosing tuberculosis in pregnancy… Contrary to popular belief, the Heaf and Mantoux skin tests are probably as reliable as in non-pregnant women.

Contrary to popular belief, the Heaf and Mantoux skin tests are probably as reliable as in non-pregnant women.

Maternal outcome Depends on site & timing of diagnosis Late diagnosis – morbidity increase 4 fold Early diagnosis – outcome similar to non pregnant women

Depends on site & timing of diagnosis

Late diagnosis – morbidity increase 4 fold

Early diagnosis – outcome similar to non pregnant women

Perinatal outcome Late diagnosis incidence of prematurity and LBW Early diagnosis outcome similar to non pregnant woman

Late diagnosis incidence of prematurity and LBW

Early diagnosis outcome similar to non pregnant woman

Anti-tuberculous therapy no increase in congenital malformations or fetal damage when rifampicin, isoniazid and ethambutol are used in combination pyrazinamide is also considered to be a safe drug in pregnancy

no increase in congenital malformations or fetal damage when rifampicin, isoniazid and ethambutol are used in combination

pyrazinamide is also considered to be a safe drug in pregnancy

Congenital tuberculosis Cantewell Criteria Lesion in the first week Primary hepatic complex or caseating granuloma Documented TB of placenta or endometrium Exclusion of TB infection by carrrier

Cantewell Criteria

Lesion in the first week

Primary hepatic complex or caseating granuloma

Documented TB of placenta or endometrium

Exclusion of TB infection by carrrier

Breast feeding appears to be safe when the mother is taking standard anti-tuberculous medication. If the mother is taking isoniazid, pyridoxine supplementation should be given to the child as a small amount of isoniazid is present in breast milk

appears to be safe when the mother is taking standard anti-tuberculous medication.

If the mother is taking isoniazid, pyridoxine supplementation should be given to the child as a small amount of isoniazid is present in breast milk

Breast feeding… It is usually unnecessary for the child to receive treatment unless the mother is diagnosed with open (infectious) at the time of delivery OR contact tracing (which should be performed promptly) reveals that the child has had contact with another infectious member of the family .

It is usually unnecessary for the child to receive treatment unless the mother is diagnosed with open (infectious) at the time of delivery

OR

contact tracing (which should be performed promptly) reveals that the child has had contact with another infectious member of the family .

Breast feeding… Mother with open Tuberculosis Breast feeding can be done with INAH prophylaxis mother can use a mask

Mother with open Tuberculosis

Breast feeding can be done with

INAH prophylaxis

mother can use a mask

Neonate…. INAH prophylaxis is given for 3 months Check Mantoux Mantoux Negative need BCG vaccination

INAH prophylaxis is given for 3 months

Check Mantoux

Mantoux Negative need BCG vaccination

Contraception oral contracepives:effectiveness is reduced

oral contracepives:effectiveness is reduced

HIV,TB and pregnancy If a pregnant women is diagnosed to have active TB should we screen for HIV?

If a pregnant women is diagnosed to have active TB should we screen for HIV?

Internet resources www.nyc.gov/html/doh/html/tb/tb.html www.sanger.ac.uk/Projects/M_tuberculosis/ Pregnancy in tubrculosis:www.nyc.gov/html/doh/html/tb/tbpreg.html www.cdc.gov/nchstp/tb/pubs/slidesets/Treatment_Guidelines/2003/default.htm

www.nyc.gov/html/doh/html/tb/tb.html

www.sanger.ac.uk/Projects/M_tuberculosis/

Pregnancy in tubrculosis:www.nyc.gov/html/doh/html/tb/tbpreg.html

www.cdc.gov/nchstp/tb/pubs/slidesets/Treatment_Guidelines/2003/default.htm

My web :www.mrcogexam.net My blog http://mrcogfacts.blogspot.com

My web :www.mrcogexam.net

My blog http://mrcogfacts.blogspot.com