EC Gynaecology

Diagnosis and management of tuberculosis in pregnancy is a very complex and difficult problem. There are multiple management issues involved in this condition. The diagnosis is usually delayed in developed countries because it is not suspected. However, in countries where there are poor health facilities tuberculosis is a common problem. Migrant population who come from susceptible communities and Aboriginal population are often missed in spite of screening at the time of admission.

 It is often necessary to distinguish clinically from neonatal or congenital infections. Very often patients present with chest infections and this is attributed to the general infective conditions. The clinician will have to look into the possibility of hepatosplenomegaly, lymphadenopathy, respiratory distress and fever. A chest radiography is probably the simplest way of screening the tuberculosis in the mother. Some of the other tests for congenital tuberculosis is an abdominal ultrasound, lumbar puncture and sometimes even a gastric aspirate may be useful. If these are proved positive immediate treatment should be instituted. The first line of treatment is isoniazid, rifampin and pyrazinamide. In some of the conditions the patients the organisms may be resistant to Isoniazid and then this should be replaced by ethambutol.