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 pregnancylate 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 Criteria1. Lesion in the first week

2. Primary hepatic complex or caseating granuloma

3. Documented TB of placenta or endometrium

4. 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