Tuberculosis In Pregnancy

Tuberculosis in pregnancy Dr.V.Ravimohan

Historical perspective
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

? 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

Diagnosing tuberculosis in pregnancy
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.

Maternal outcome
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

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

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

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

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 .

Breast feeding…
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

Contraception
oral contracepives:effectiveness is reduced

HIV,TB and pregnancy
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

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

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Tuberculosis In Pregnancy

by Ravimohan Ravimohan on Nov 01, 2007

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