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Transcript
Tuberculosis in Pregnancy
Max Brinsmead MB BS PhD
May 2015
Incidence

In 1990 there were 6.6 million cases of TB
worldwide

By 2008 this had risen to 9.4 million

30% of those will be in women

And 30% of these will be women of child-bearing age

Pregnancy per se does NOT increase the risk of
TB infection

Concomitant HIV infection is the biggest problem
Diagnosis



Can be quite difficult when symptoms are
nonspecific
And resources are limited
Symptoms of ...






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Investigate by sputum exam for AFB


Malaise
Fatigue
Weight loss
Cough & haemoptysis
Scrofula
Ascites
CXR can be negative in ≈1:6 cases pulmonary TB
Newer tests such as the Quanti-FERON-TB gold
in tube test promising
Effect of TB on Pregnancy

If adequately treated the prognosis is good and
TB per se should not affect outcome

But poor obstetric outcomes are common when
socio economic circumstances are taken into
account

Especially when there is concomitant HIV

There is a risk of mother to child transmission
Mother to Child Transmission of TB

Can occur...




In utero – transplacental
During labour – ingestion
From breast feeding with TB breast abscess
But most occurs by direct exposure to aerosol droplets
during postnatal contact

Newly diagnosed and incompletely treated
mothers should be separated from their infants

And all infants should receive prophylactic
Isoniazid
Treatment of Mothers with TB



Should be the same as for non-pregnant ♀
But try to avoid Streptomycin
2 months of ...


Ethambutal
Isoniazid




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Isoniazid plus Rifampicin
Compliance is a problem
Drug resistance is a problem


Rifampicin
Pyrazinamide
Follow by 4 months of...


Monitor liver function tests
And the safety of 2nd line therapy in pregnancy is unknown
If there is concomitant HIV try to treat that first if
possible

Be aware that drug interactions with HAART occur
Any Questions or
Comments?
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