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 pregnancylate 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 Criteria
1. 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/sl
idesets/Treatment_Guidelines/
2003/default.htm
• My web :www.mrcogexam.net

• My blog
http://mrcogfacts.blogspot.com