Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Tuberculosis In Pregnancy


Published on

a presentation about tuberculosis and pregnancy

Published in: Technology, Health & Medicine
  • Be the first to comment

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> </li></ul><ul><li> </li></ul><ul><li>Pregnancy in </li></ul><ul><li> </li></ul>
  18. 18. <ul><li>My web </li></ul><ul><li>My blog </li></ul>