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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 ... 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 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? Please leave a note on the Welcome Page to this website