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TUBERCULOSIS IN

PREGNANCY.
INTRODUCTION.
Chronic bacterial infection by Mycobacterium tuberculosis.
- formation of granuloma in infected tissues and florid cellmediated hypersensitivity.
- usual site of disease is the lung but all other organs may be
affected(* Examples)

PREVALENCE.
*Complicated 2-3% of pregnancies(Whitfield,1987; Stewart,1981).

*12.4 per 100,000 births( New York,1985-1990).

* 94.8 per 100,000 births (New York, 1990-1992).

*0.24% in obstetric population in Ile-Ife(1985-1995; Fasubaa et alunpublished data).

* 0.096%(17/17,638; 1985-1999;Makinde-unpublished data).

*Globally- resurgence of T.B.-HIV pandemic.

CLINICAL FEATURES.
*2 stressful conditions combined in the same woman
(pregnancy+ T.B)
- Symptomatology depends on organs Affected
(Pulmonary, Brain, Eye, Intestines, Bone, breasts,
genito-urinary system skin)
Weight loss, Night sweats,
Nocturnal pyrexia, productive cough, haemoptysis,
dyspnoea, tachypnoea, anaemia,lassitude,enlarged
lymph nodes, abdominal pain and swelling.

PATHOLOGY.
3 main types of tubercle bacilli pathogenic to
man human (endemic to man), bovine
and avian.
*Revise T.B granulomatous lesion.
*AAFB (Ziehl-Neelsen stain)

DIAGNOSIS.
Medical History.
Physical Examination.
TB skin test (Mantoux test(PPD-10 TU,
0-4,5-14,>15mm).
Blood test-IGRAs (Interferon Gamma Release Assays)
CXR(+ Lead shield).
SPUTUM (AAFB).

EFFECT OF TB 0N
PREGNANCY
Effect depends on
Type.
Site and Extent.
Stage of pregnancy.
Nutritional status of mother
Presence of concomitant disease.
Immune status and co-existence with HIV.
Availability of facilities for early diagnosis and
Rx.

EFFECTS OF TB ON PREG.
SPONTANEOUS ABORTION.
PERINATAL MORTALITY.
S.F.D. FETUS.
LBW INFANT.
CONGENITAL T.B.( Haematogenous, Aspiration and
Ingestion of infected amniotic fluid).

EFFECT OF PREGNANCY ON TB.


Theoretically, may cause a flare-up of the
disease due to immune compromise and
poor nutritional status.

MANAGEMENT.
*MULTIDISCIPLINARY .
*EARLY DIAGNOSIS and PROMPT TREATMENT.
*SCREENING FOR OTHER CONCOMITANT
DISEASES LIKE HIV MANDATORY.

ANTI-TB TREATMENT.
ANTITUBERCULOUS TREATMENT
(ATT).
1ST LINE DRUGS-INH (Hepatotoxicity,peripheral neuropathy).
-RIFAMPICIN (Hypoprothrombinaemia in mother and child)
-ETHAMBUTOL(Optic neuritis)
-PYRAZINAMIDE( Possible teratogenic effect, use with caution).

ATT contd.
2nd LINE DRUGS.
STREPTOMYCIN(Ototoxicity,Nephrotoxicity).
FLOROQUINOLONES-CIPROFLOXACIN;
AMOXYCILLIN/CLAVULINIC ACID AS PROPHYLAXIS IN
P.P.R.O.M.
ETHIONAMIDE.
PAS( Possible congenital anomaly)
***AMIKACIN,CAPREOMYCIN,PROTHIONAMIDE-ALL
CONTRAINDICATED.
****MDR TB.

SUPPORTIVE TREATMENT.
***BCG- contraindicated in pregnancy.

DOTS.
PYRIDOXINE PROPHYLAXIS WHILE ON
INH.
VIT K PROPHYLAXIS TO NEONATE TO PREVENT HAEMORRHAGIC DISEASE OF NEWBORN.
ACTIVE MDR TB; IF NON ADHERENT TO TREATMENT REGIME OR TREATMENT < 2 WEEKS SEPARATE BABY FROM MOTHER
OR USAGE OF MASKS BY MOTHER
GIVE INH RESISTANT BCG TO BABY OR BCG +ATT TILL MOTHER IS SPUTUM NEGATIVE.
+EBM (NO TB MASTITIS).

COMORBIDITIES OF HIV+TB; REPLACE PROTEASE INHIBITORS WITH ANOTHER CLASS OR CHANGE RIFAMIPICN TO
RIFAMBUTIN.

TRACE CONTACTS OF INFECTED MOTHER AND TREAT IF POSITIVE.

INTERVENTIONS-PLEURAL TAP, CHEST TUBE DRAINAGE ASCITIC TAP WHEN INDICATED

NUTRITIONAL SUPPORT (HAEMATINICS PROTEIN SUPPLEMENTS)+BED REST

INTRAPARTUM CARE- OPERATIVE VAGINAL DELIVERY+ SPECIAL CONSIDERATIONS DURING C/S.

CONCLUSION
Diagnosis of TB in pregnancy warrants a
high index of suspicion. Offering early
diagnosis and prompt treatment ensures
better maternal and neonatal outcomes.

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