Medical and Surgical Complications in Pregnancy
A lady diagnosed with sputum positive TB. Best management is (AIIMS May 2013)
|A||Wait for 2nd trimester to start ATT|
|B||Start Category I ATT in I trimester|
|C||Start Category II ATT in I trimester|
|D||Start Category III ATT I trimester|
Start Category I ATT in I trimester
1. Tuberculosis during pregnancy should be diagnosed promptly and as early as possible.
2. Late diagnosis and care is associated with 4-fold increase in obstetric morbidity and 9-fold increase in pre-term labour.
3. Poor nutritional states, hypo-proteinemia, anaemia and associated medical conditions add to maternal morbidity and mortality.
4. A foetus can get TB infection either by hematogenous spread through umbilical vein to foetal liver or by ingestion or aspiration of infected amniotic fluid True congenital TB is believed to be rare.
5. The risk to neonate of getting TB infection shortly after the birth is greater
6. ATT should be started promptly as untreated disease presents a hazard to the mother and foetus.
7. The same regimens are recommended for use in pregnancy as for the non-pregnant state except for withholding of Streptomycin. Doubts about the use of Pyrazinamide in pregnancy have since been set as rest. Currently, an intermittent regimen (thrice weekly on alternate days) under the DOTS strategy of RNTCP is being increasingly used world-wide for the pregnant women having TB
8. None of the ATT drugs are teratogenic and ATT should be started as soon as the diagnosis is made. sputum positive tuberculosis is category 1