Tuberculosis in pregnancy

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A ppt on Tuberculosis in pregnancy

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Tuberculosis in pregnancyDr.V.Ravimohan : 

Tuberculosis in pregnancyDr.V.Ravimohan

Historical perspective : 

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

Historical perspective… : 

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

? Therapeutic abortion : 

? 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 : 

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… : 

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 : 

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

Perinatal outcome : 

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

Anti-tuberculous therapy : 

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 : 

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 : 

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… : 

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… : 

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

Neonate…. : 

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

Contraception : 

Contraception oral contracepives:effectiveness is reduced

HIV,TB and pregnancy : 

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

Internet resources : 

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

Slide 18: 

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