Tuberculosis In Pregnancy

Clinical description

Caused by Mycobacterium tuberculosis, tuberculosis (TB) is an infection that typically attacks lungs (pulmonary TB, or PTB) but can affect any organ system.

Maternal risks

• Hepatotoxicity of isoniazid is increased in pregnancy, therefore requires increased monitoring.

Fetal risks

• Postnatally acquired infection if mother has active disease.
• Streptomycin is associated with ototoxicity and should be avoided in pregnancy

Signs and symptoms

• Pulmonary TB: new case, confirmed AFB positive

Investigations

• Productive cough
• Pleuritic chest pains
• Haemoptysis
• Bronchial breath sounds

Investigations

• Sputum AFB (via Gene Expert if available)
• HIV testing (if unknown status)

Treatment

• 2 months of RHZE daily followed by 4months of RH daily, also known as 2HRZE/4HR per WHO
• There are no safety studies on Pyrazinamide in pregnancy, but routine use is permissible
• Streptomycin should not be used as it has been shown to have harmful effects on the fetus, such as

hearing loss, vestibular dysfunction

• Dosage is dependent on the weight of the patient
• Isolation if admitted to facility and if suspected or confirmed TB (for first 2 weeks for treatment)
• Pulmonary TB: relapse or treatment failure

Investigations

• Same as above with history of TB treatment

Investigations

• Sputum AFB (via Gene Expert if available)
• Sputum c+s
• HIV testing (if unknown status)

Treatment

• Consult TB Officer for management recommendations

*In pregnancy, treat as new case, avoid streptomycin, and consult physicians.

**Postpartum, neonates born to mother with active disease should be given isoniazid prophylaxis.

Isoniazid = H Rifampin = R Pyrazinamide = Z Ethambutol = E

Clinical description

Streptomycin = S