Tuberculosis in pregnant women.

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PowerPoint Presentation on
Tuberculosis in Pregnant women
BCDA COLLEGE OF PHARMACY AND
TECHNOLOGY
Name: Arshad Molla ROLL: 20101920046
REG. NO: 202010201910058 SUB: PHARMACOLOGY III
SUB. CODE: PT-618
SUBMITTED TO:
Mrs. Priyanka Chakraborty ( Assistant professor)
Ms. Anusree Basu ( Assistant professor)

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Contents
 Introduction
 Predisposing Factors
 Clinical features
 Diagnostic evaluation
 Effect on pregnancy
 Congenital TB
 Therapeutic management
 Drugs used
 Obstetrical management
 Post natal period
 Conclusion
 Reference

3. z INTRODUCTION
Pulmonary tuberculosis is an infectious disease of the lungs caused by acid fast
bacilli (AFB) known as mycobacterium tuberculosis characterized by low grade
fever, loss of weight, chronic cough, etc. The bacteria gets into the lungs through
inhaled air contaminated by the sputum of positive cases. The incidence ranges
between 1-2% amongst the hospital deliveries. Infact in 1993, WHO pronounced
tuberculosis “a global health emergency". The lung is the major site of involvement,
but the lymph gland, meninges, bones, joint, intestine and kidneys can also be
infected. The person becomes infected by inhaling the infectious organisms
mycobacterium tuberculosis, which is carried on a droplet nuclei spread by airborne
transmission.
Causative agents:
Mycobacterium Tuberculosis (Human type)
Mycobacterium Tuberculosis (Bovine type)

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 Predisposing factors:
Positive family history or past history, Low socio-economic status, Area of high
prevalence of tuberculosis, HIV infection, Alcohol addiction, Intravenous drug abuse.
 Clinical features:
Evening pyrexia(low grade fever), Loss of weight, Night sweating/Sleep
sweats,Chronic fatigue Loss of appetite, pale and ill looking, Chronic cough, Malaise,
Hemoptysis, Breathlessness
 Diagnostic evaluation:
Positive family history, Clinical features, X-ray examinations(after 12 weeks), Early
morning Sputum for AFB examination, Diagnostic bronchoscopy, Gastric
washing,Tuberculin skin test with purified protein derivates (PPD) montox test when
≥10 mm, Extra-pulmonary sites; lymph nodes, bones (rare in pregnancy), Direct
amplification test to detect Mycobacterium tuberculosis.

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Effect on pregnancy
 MOTHER:
 Pregnant women with untreated TB are more likely to have pre-
eclampsia, spontaneous abortion, preterm labour, difficult labour
and PPH. Intrauterine fetal death.. Anemia(Late diagnosis -
morbidity increase 4 fold)
 FETUS:
 Under weight infant. Low apgar score. Perinatal death• IUGR.
Preterm labour. New born baby is at risk of postnatally acquired
TB if mother has still TB at the time of birth.

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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.
 Congenital tuberculosis is diagnosed by:
 a. Lesion noted in the 1st week of life.
 B. Infection of the maternal genital tract or placenta.
 C. Cavitating hepatic granuloma diagnosed by percutaneous liver biopsy at birth.
 D. No evidence of postnatal transmission.
 Congenital TB caused by: haematogenous dissemination from an infected
placenta, through an umbilical cord vein, Fetal aspiration of amniotic fluid

7. z Therapeutic management
 • The principles of treatment for the pregnant woman with TB are same as
in the non pregnant patient.
 • The treatment of TB in pregnancy is important for two reason.
 ✓ For serious consequences of untreated TB and the risk of its spread to
newborns.
 ✓ Secondly the effect of the drugs used in its treatment on the fetus.
 Women with positive purified protein derivates (PPD) and no evidence of
active disease (asymptomatic), Isoniazid prophylaxis 300mg/day is started
after the first trimester and continued for 6-9 months. Pyridoxine (vit. B6)
50mg/day is added to prevent peripheral neuropathy.

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 Women with active tuberculosis should receive the following drugs
orally daily for a minimum period of 9 months.
 Surgical management should be withheld, if possible, but if deemed
necessary should be restricted for first half of pregnancy beyond 12
weeks.

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Obstetrical management
 During pregnancy:
 Supervision and joint care with obstetrician and chest physician is necessary. In
the first trimester anti-TB drug should be continued. The choice of drug and the
dosage may have to be modified. Morning sickness may pose some difficulties.
In 2nd and 3rd trimester, the status should be reviewed. Women will need advice
regarding workload, diet and rest. Treatment with iron, folic acid and vitamin is
necessary to improve general condition/health.
 During labour:
 Close monitoring of pulse and respiratory rate are necessary especially in
pulmonary TB. Normal vaginal delivery is routine for women with tuberculosis
and low forcep may be used to short the 2nd stage of labour. Spinal or epidural
anesthesia are preferred than inhalation anesthesia for fear of contamination.

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During postnatal period
 After delivery the women with active disease must stay in
hospital or transferred to a hospital for two or three weeks to
allow them a period of rest before they return to their house hold
duties.
 Breast feeding is not contraindicated when a woman is taking
anti-tuberculosis drugs.
1. Breast feeding should be avoided if the infant is also taking the drugs (to avoid excess drug
level).
2. In active lesion, not only is breast feeding contraindicated but the baby is to be isolated from
the mother following delivery.

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1. Baby should be given prophylactic isoniazid 10-20mg/kg/day for 3 month when the mother is
suffering from the active disease.
2. If the mother is on effective chemotherapy for at least 2weeks, there is no need to isolate the
baby. BCG should be given to the baby as early as possible.
 Pregnancy is to be avoided until quescence is assured for about
two years.
1. Oral contraceptives should be avoided when rifampicin is used.
2. Due to accelerated drug metabolism, contraceptive failure is high.
3. Puerperal sterilization should be considered if the family is completed.

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How do you manage the newborn ?
• If the mother is non-infectious, she can handle her baby. Ordinary
BCG vaccination is given to protect the baby.
• If the mother is infectious, the baby must be separated from the
mother until she becomes non- infectious. The baby must Be given
a dose of BCG vaccine. The infectious mother can handle her baby
only after successful BCG vaccination i.e. After a period of eight
weeks.

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Conclusion:
Streptomycin can cause permanent deafness in the baby, so
ethambutol should be used instead of streptomycin.
✓ Isoniazid, rifampicin, pyrazinamide and ethambutol are safe to
use.
✓Second-linedrugs such as fluroquinolones, ethionamide and
protionamide are teratogenic, and should not be used.. Oral
contraceptives should be avoided when rifampicin is used.
For Children:
✓ Ethambutol should not be given to children below 6years of age.

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References:
 1. K.Park, Park's textbook of Preventive and Social Medicine,
21st Edition, Page no : 164-175.
 2. S.Durga, G.Saraswoti, Midwifery Nursing (Part-1), 2nd
Edition, Page no :379-382.

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Thank You