Tuberculosis In Pregnancy

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a presentation about tuberculosis and pregnancy

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Tuberculosis In Pregnancy

  1. 1. Tuberculosis in pregnancy Dr.V.Ravimohan
  2. 2. Historical perspective <ul><li>Hippocratic view </li></ul><ul><li>young woman with tuberculosis should become pregnant to improve her outcome!! </li></ul>
  3. 3. Historical perspective … <ul><li>1850 - 1920s </li></ul><ul><ul><li>tuberculosis was harmful during pregnancy, and termination of pregnancy - recommended </li></ul></ul>
  4. 4. ? Therapeutic abortion <ul><li>Tuberculosis during pregnancy -rarely an indication for a therapeutic abortion </li></ul><ul><li>But </li></ul><ul><li>pregnant woman with MDRTB, should be offered abortion counseling  medications used are known to cause fetal abnormalities </li></ul>
  5. 5. Diagnosing tuberculosis in pregnancy <ul><li>Symptoms like malaise & fatigue may be ignored in pregnancy  late diagnosis </li></ul><ul><li>sputum examination and culture - same as for non-pregnant </li></ul>
  6. 6. Diagnosing tuberculosis in pregnancy… <ul><li>Contrary to popular belief, the Heaf and Mantoux skin tests are probably as reliable as in non-pregnant women. </li></ul>
  7. 7. Maternal outcome <ul><li>Depends on site & timing of diagnosis </li></ul><ul><li>Late diagnosis – morbidity increase 4 fold </li></ul><ul><li>Early diagnosis – outcome similar to non pregnant women </li></ul>
  8. 8. Perinatal outcome <ul><li>Late diagnosis incidence of prematurity and LBW </li></ul><ul><li>Early diagnosis outcome similar to non pregnant woman </li></ul>
  9. 9. Anti-tuberculous therapy <ul><li>no increase in congenital malformations or fetal damage when rifampicin, isoniazid and ethambutol are used in combination </li></ul><ul><li>pyrazinamide is also considered to be a safe drug in pregnancy </li></ul>
  10. 10. Congenital tuberculosis <ul><li>Cantewell Criteria </li></ul><ul><ul><li>Lesion in the first week </li></ul></ul><ul><ul><li>Primary hepatic complex or caseating granuloma </li></ul></ul><ul><ul><li>Documented TB of placenta or endometrium </li></ul></ul><ul><ul><li>Exclusion of TB infection by carrrier </li></ul></ul>
  11. 11. Breast feeding <ul><li>appears to be safe when the mother is taking standard anti-tuberculous medication. </li></ul><ul><li>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 </li></ul>
  12. 12. Breast feeding… <ul><li>It is usually unnecessary for the child to receive treatment unless the mother is diagnosed with open (infectious) at the time of delivery </li></ul><ul><li>OR </li></ul><ul><li>contact tracing (which should be performed promptly) reveals that the child has had contact with another infectious member of the family . </li></ul>
  13. 13. Breast feeding… <ul><li>Mother with open Tuberculosis </li></ul><ul><li>Breast feeding can be done with </li></ul><ul><li>INAH prophylaxis </li></ul><ul><li>mother can use a mask </li></ul>
  14. 14. Neonate…. <ul><li>INAH prophylaxis is given for 3 months </li></ul><ul><li>Check Mantoux </li></ul><ul><li>Mantoux Negative need BCG vaccination </li></ul>
  15. 15. Contraception <ul><li>oral contracepives:effectiveness is reduced </li></ul>
  16. 16. HIV,TB and pregnancy <ul><li>If a pregnant women is diagnosed to have active TB should we screen for HIV? </li></ul>
  17. 17. Internet resources <ul><li>www.nyc.gov/html/doh/html/tb/tb.html </li></ul><ul><li>www.sanger.ac.uk/Projects/M_tuberculosis/ </li></ul><ul><li>Pregnancy in tubrculosis:www.nyc.gov/html/doh/html/tb/tbpreg.html </li></ul><ul><li>www.cdc.gov/nchstp/tb/pubs/slidesets/Treatment_Guidelines/2003/default.htm </li></ul>
  18. 18. <ul><li>My web :www.mrcogexam.net </li></ul><ul><li>My blog http://mrcogfacts.blogspot.com </li></ul>

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