SEXUAL

TRANSMITTED
INFECTION IN
PREGNANCY
Presented by: Marie Charisma Ubia

Are those that are spread through sexual

contact with an infected partner.

STD can be prevented to some extent with

the use of condoms.

Sexual Transmitted Infection and Pregnancy

STD : SEXUAL TRANSMITTED

INFECTION AND PREGNANCY

WHAT IS A STI?

Any infections contracted through sexual

intercourse or other intimate sexual
contact.
Most STIs spread during vaginal or anal sex,
but other forms of sexual contact, such as
oral sex, can also spread disease

15 million cases of STIs cases are reported

annually in the United States

Can be transferred from one person to

another through sexual contact

WOMAN WITH CANDIDIASIS

Candidiasis Vaginal Infection spread by the fungus

Candida

Thick Vaginal discharge

(resembles

cream cheeze)
(extremely pruritic) ~ itchy

Occurs more frequently during pregnancy because of the

increased estrogen level which causes the vaginal PH to
be less acidic.
Also occurs in women with Gestational DM and Women
with HIV.
Diagnosed by microscopic analysis of the vaginal discharge
mounted on a wet slide.

TREATMENT
Vaginal application of an over the counter
anti fungal cream such as miconazol
(moistat) for 7 ays or single dose of oral
fluconazole (Difluean)
If infection present in the vagina during
childbirth may cause candidal infection or
thrush in the newborn.

Signs and Symptoms

Itchiness , irritation , soreness , burining 2

redness in the vagina and latria (sometimes
swelling)

Discomfort of pain during sex

Burning sensation during urination
Odorless vaginal discharge thats often white creamy
or cottage-cheesy.

SEE PRACTITIONER
Will give prescription or recommend a specific over
the counter anti fungal cream or suppository thats
safe during pregnancy
Ypu can soothe the intching with an ice pack and
soaking for 10 minutes in a cool bath
Wont affect the baby.
Thrush Characterized by white patches on the sides
and roof of the mouth and sometimes on the tongue.

How to reduce chances of getting yeast

infection
Keep genital area dry
Wear breathable cotton underwear and avoid
pantyhose and tight pants.
Clean genital area gently with warm water
Always wipe from front to back
Eat yogurt that contains a live culture of
Lactobacillus Acidophillos which can help
maintain the proper bacterial balance in your
gut and vagina.

WOMAN TRICHOMONIASIS
TRICHOMONIASIS (AKA TRICH)
Fairly common STD caused by microscopic
parasite/single cell protozoan spread by
coites.
Trichimonas Vagiralis (T. Vagiralis)
highly contagious protozoan.
Signs and symptoms
Vaginal discharge (greenish-yellow and frothy
with small bubbles)

Burning sensation when they urinate

Pain during sexual intercourse.
Abdominal Discomfort

Consequences of Trichomoniasis
Preterm labour
Low birth weight infants (growth restriction)
Pre mature rapture of membranes
Post-cesarian infection

TREATMENT / DRUG OF CHOICE

Single-dose oral metroridazol (Flagyl)

Bacterial Vaginosis(BV)
Local infection of the vagina
Gardnerella Vaginalis
Most common infection in pregnant women.
Mild infection and is easily treatable with
medication
Bacterial imbalance/not sexually tranmitted

S/SX
Asymptomatic 50%-70%.
Foul smelling vaginal discharge.
Discharge usually thin and dull gray or whit

Drug of choice
Metronidazol orally (Flagyul) (7days)
Tindazole (Tindamax) oral med (7days)
Clindamycin (Cleocin &Clindesse) (7days)
Topical med inserted into the vagina)

* Untreated G.Vaginalis infections are

associated with amniotic fluid infections,
preterm labor and premature rapture of
membranes.

A WOMAN WITH SYPHILIS

Syphilis Systematic disease caused by the
spirochele Treponemd pallidum.
Transmitted through sexual contact
All women are screened for syphilis at first
prenatal visit by a VDRL , ART , or FTA-ABS
antibody reaction test.
Longenital Syphilis
Results through transplacental transmission
of bacteria to the baby
Transmission is possible at any stage of
pregnancy
Can result in death , multiple organ problems
, pneumonia or anemia

Ears, eyes, liver, bone marrow, skin, bones

and heart.
Increases the chance of stillborn pregnancy
40% of fetal death rate in infected infants.
Screened through cord blood sample
Overly large placenta
Enlarged liver of spleen

SIGNS AND SYMPTOMS

FIRST STAGE
known

as the primary syphilis

painless

and highly infectious sore(s)with raised edges

called chanre (about 3 weeks after infection)

Chancre

maybe inside the vagina or mouth(may not see

it).Could also show up on labia perinuem ,anus of lips

Secondary Stage
Non itchy rash , commonly on their palms
and sores
Lesions in mouth and vagina
Painless but infectious wart like sores in the
genital area
Flu-like symptoms
Weight loss
Hair loss

Tertiary Syphilis
Serious
Lethal

heart and abnormalities

lesions on bones, skin and organs

Meningitis
Late

Neurosyphilis can lead to seizures, blindness,

hearing loss, dementia, psychosis spiral cord problems

and death.
*Syphilis makes pregnant women more susceptible to HIV

A WOMAN WITH CHLAMYDIA

Chlyamydia most common type of vaginal
infections seen in both pregnant and nonpregnant women.
Caused by a bacterium called Chlamydia
Trachomatis
Affects both men and women
The Bacterium can also cause infection in the
anus(rectum),the back of the throat and the
eyes.
Caused by sexual intercourse (oral, anal or
genital contact)

SIGNS AND SYMPTOMS

No symptoms(asymptomatic)
70% of women have mostly no signs and
symptoms
Pain on passing urine
Vaginal discharge containing puss
Mild lower abdomal pain
Pain during sex
Bleeding after sex or in between periods
Severe pelvic pain

TREATMENT
Drug of Choice

Azithromycin (Zithromax) 7 days

Amoxicillin (Amoxil) 7 days
Erythromycin

Complications

Associated with premature rapture of membranes

Preterm labor
Endometritis during post partum
Pelvic Inflammatory Disease(PID) (Long term effect)
Infertility

Effects to the Infant

Conjunctivitis
Pneumonia after birth
How it is Diagnosed
Standard test of urine test or a vaginal swab
Nucleic acid amplification test (NAAT) is then
used to analyse the sample.
Treatment
Benzathire penicillin G
One injection (drug or choice)

If is allergic to penicillin, patient needs to be dedensitized

to the drug first, so she can receive it.
Temporary Reactions to treatment
o fever,
o Chills
o Headache
o Muscle and joint pain
o Hypotension
o Tachycardia
Jarisch-Heryheimer reaction- caused by asudden
destruction of spirochetes
-reaction last for 24 hrs then fades

A WOMAN WITH HERPES SIMPLEX

VIRUS TYPE 2 INFECTION (HSV -2)
Caused by herpes simplex virus (HSV-2)
Genital herpes
Transmitted through genital or oral sex
Has been associated with spontaneous
abortion , intrauterine growth retardation,
preterm labor, congenital and neonatal
herper infection
Newborn could also be infected by HSV -1
Caesarean birth is opted if HSV is present
during childbirth

SIGNS AND SYMPTOMS

Blistering and ulcetation of the external genitalia and cervix
Vulval pain,itching and tingling sensation
Dysuria
Vaginal discharge
Lesions of the internal thigh, buttocks and perinuem
Fever
Headache
Myalgia
Neonatal Herpes
Babies up to 28 days old are infected
Rare but life threatening disease
Can cause eye, throat infections
Damage the central nervous system
Can cause mental retardation or death

TREATMENT
Acyclouvir (IV)
(antiviral medication) for women(pregnant)
who get very sick during primary infection.
Valacyclovir (Valtrex)
Sitz Baths
Applying warm, moist tea bags to the area.
Applying warm, moist tea bags to the area.

DIAGNOSIS

Made by the appearance of lesions

Pap-smears
Enzyme-linkcal immonosorbent assay (ELISA)

A WOMAN WITH GONORRHEA

Std caused by the aram-negative coccus

Neisseria gonorrhoeae.
Transmitted through genital, oral or anal sex
Incubation period is usually two to ten days
after exposure
Associated with high rates of miscarriage
( spontaneous), preterm birth, infection of
the amniotic sac and fluid, preterm
premature raputure of membranes(PPROM),
P10 and infertility, extopic pregnancy

Can be passed on to the baby

Most common effect the eyes of the baby
which may lead to blindness if untreated.
(opthalmia neonatorum)

SIGNS AND SYMPTOMS

Mostly asymptomatic
Cervix,

Vagina , Urethrn
Abnormal vaginal discharge
Pain/burning during urination
Spotting and pain during intercourse

Anal infection
Discharge
Itching/Pain

during bowel movement

Throat and mouth

Redness
Soreness

Treatment
Amoxicillin
Azithromycin

HUMAN PAPILLOMAVIRUS (HPV)

20 million people are currently infected with

HPV

Very common amongst sexually active college

students

SIGNS & SYMPTOMS

Most common manifestation of HPV is warts

Includes warts on skin such as plantar warts or in
the genital area, known as genital warts

TREATMENT

Trichloroacetic acid
Bichloroacetic acid
Applied

to the lesions
Large lesions maybe removed by

Laser therapy
Cryocautery
Knife excision
Healing 4-6 weeks
Sitz bath and a lidocaine cream may soothe during
healing

SIGNS & SYMPTOMS

May be associated with discomfort such as

itching, burning, or tenderness in the genital
area

Most women with HPV do not have any

symptoms at all

EFFECTS ON PREGNANCY

HPV has no effect on the fetus whatsoever

during pregnancy and does not rule out a
vaginal delivery

In some, the warts may be so large it can

block the birth canal; in this case Cesarean
section may be performed

HEPATITIS B

What is Hepatitis B?
Hepatitis means inflammation of the liver.
HepatitisB is a contagious liver disease that
results frominfection with the Hepatitis B
virus. When a personbecomes infected, the
Hepatitis B virus can stay in thepersons
body for the rest of his or her life and
causeserious liver problems.

Hepatitis B virus (HBV) is a small

encapsulated DNA virus that belongsto
thehepadnavirusesandinfectsnearly350
millionp eople worldwide

Source of hepatitis B infection and risk

of chronic infection
1. Horizontal transmission (10%):
Injection drug use Infected
unscreened blood products
Tattoos/acupuncture needles Sexual
(homosexual and heterosexual)
Close living quarters/playground play
as a toddler (may contribute to high
rate of horizontal transmission in
Africa).
2.

Vertical transmission (90%): HBsAgpositive mother.

Can Hepatitis B be spread to babies?

Yes.The Hepatitis B virus can be spread to a
baby during childbirth. This can happen
during a vaginal delivery or a c-section.
How serious is Hepatitis B?
When babies become infected with Hepatitis
B, they have a 90%chance of developing a
lifelong, chronic infection.As many as 1 in 4
people with chronic Hepatitis B develop
serious healthproblems.Hepatitis B can cause
liver damage, liver disease, and liver cancer.

How common is Hepatitis B?

About 350 million people worldwide and 1.2
million people in the UnitedStates are infected
with Hepatitis B.
Can doctors prevent a baby from getting Hepatitis
B?
Yes. Babies born to women with Hepatitis B get
two shots soon after birth.
One is the first dose of the Hepatitis B vaccine
and the other shot is called HBIG.
The two shots help prevent the baby from
getting Hepatitis B. The shots work best when
they are given within 12 hours after being born

What is HBIG?
HBIG is a medicine that gives a babys body a
boost or extra help to fight the virus as
soon as he or she is born. The HBIG shot is
only given to babies of mothers who have
Hepatitis B.
How many Hepatitis B shots does baby need?
After the first dose is given in the hospital,
the next dose is given at 1- 2 months of age.
The last dose is usually given by the time the
baby is one year old. We can ask doctor or
nurse when the baby needs to come back for
each shot. Prevent Hepatitis B. Get the baby
vaccinated.

How do I know the baby is protected?

After getting all the Hepatitis B shots, doctor will test the babys
blood.The blood test and doctor tells that the baby is protected
and does not have Hepatitis B.The blood test is usually done 1-2
months after the last shot. We have to be sure to bring our baby
back to doctor for this important blood test.
Can Hepatitis B vaccine be given during pregnancy or lactation?
Yes. Hepatitis B vaccine contains no live virus, so neither
pregnancy nor lactation should be considered a contraindication to
vaccination of women.
On the basis of limited experience, there is no apparent risk of
adverse effects to developing fetuses when Hepatitis B vaccine is
administered to pregnant women.
Meanwhile,new HBV infection in a pregnant woman might result in
severe disease for the mother and chronic infection for the
newborn.

Can Hepatitis b immunoglobulin be given during pregnancy?

Hepatitis b immune globulin Pregnancy Warnings

Hepatitis B immune globulin has been assigned to pregnancy

category C by the FDA. Animal studies have not been reported.
There are no controlled data in human pregnancy. Hepatitis B
immune globulin should only be given during pregnancy if clearly
needed. Its use is recommended for postexposure prophylaxis
during pregnancy by the American College of Obstetricians and
Gynecologists.

Hepatitis B is not spread by the following:

1. Breastfeeding: It is safe for a mother to
breastfeed her baby. She cannot give her baby
Hepatitis B from breast milk.
2. Cooking and eating: It is safe to prepare and
eat meals with other family members.
Hepatitis B is not spread by sharing dishes,
cooking or eating utensils, or drinking glasses.
3. Hugging and kissing: Mother can hug and kiss
her baby, family members, or others close to
mother. But the mother cannot give anyone
Hepatitis B from hugging and kissing them
4. Also, Hepatitis B is not spread through
sneezing or coughing.

Why should pregnant women be concerned

about Hepatitis B?
Hepatitis B is a serious liver disease that can
be easily passed to others. It is important
for a woman to find out if she has Hepatitis
B, so she can get medical care. It is also
possible for a pregnant woman with Hepatitis
B to pass the virus to her baby at birth.
Fortunately, there is a vaccine to prevent
babies from getting Hepatitis B.

How can I make sure my family is protected from Hepatitis B?

We have to get everyone tested for Hepatitis B. Babys father
and everyone else who lives in the house should go to the doctor
or clinic to be tested.
Testing the family members helps to tell if they have Hepatitis B.
If they do not have Hepatitis B, the doctor will talk to them
about getting the Hepatitis B vaccine to protect them from
getting the infection.
Cover cuts and sores Since Hepatitis B is spread through blood,
people with Hepatitis B should be careful not to expose other
people to things that could have their blood on them.
It is important not to share personal items such as razors, nail
clippers, toothbrushes, or glucose monitors.
Cuts and sores should be covered while they are healing.
People should not chew food for their baby Tiny amounts of
blood can sometimes be in a persons mouth. So people should
not pre-chew food before feed it to their baby.

HIV / AIDS
HIV is the virus that causes AIDS
The definition of AIDS relates to CD4+ T-cells
Count
Healthy adults usually have CD4+ T-cell counts of
1,000 or more
Aids and some HIV sufferers have less than 200
CD4+ T-cells

FURTHERMORE

Minority women in U.S are one of the fastest

growing populations affected

Ranks among the top three leading causes of death

for minority women aged 24-44
Since the mid-1990s,HIV testingand preventive
measures have resulted in more than a 90% decline
in the number of children infected with HIV in the
womb.
And after three decades of research, doctors now
understand how to craft a detailed plan to keep
babies of HIV-positive women from getting the
virus.

SIGNS & SYMPTOMS

rapid weight loss

dry cough

recurring fever or profuse night sweats

profound and unexplained fatigue

swollen lymph glands diarrhea

white spots or unusual blemishes on the

tongue, in the mouth, or in the throat

EFFECTS ON PREGNANCY

Spontaneous abortion

Stillbirth

Maternal mortality

Newborn mortality

Low birth weight

Preterm delivery

Amnionitis (inflammation)

TREATMENT

Antiviral drugs drugs that boost the immune system have

allowed many people with HIV to resist infections, stay
healthy, and prolong their lives, but these medications are
not a cure
There is no vaccine to prevent HIV and AIDS researchers
are working on developing one
Doctors do not know of any way to rid the body of HIV

WHEN ARE ANTI-HIV MEDICATIONS USED TO

PREVENT MOTHER-TO-CHILD TRANSMISSION OF
HIV?
Anti-HIV medications are used at the following times to
reduce the risk of mother-to-child transmission of HIV:
During pregnancy, pregnant women infected with HIV
receive a regimen (combination) of at least three
different anti-HIV medications.
During labor and delivery, pregnant women infected
with HIV receive intravenous (IV) AZT and continue to
take the medications in their regimens by mouth.

After birth, babies born to women infected with HIV

receive liquid AZT for 6 weeks. (Babies of mothers who
did not receive anti-HIV medications during pregnancy
may be given other anti-HIV medications in addition to
AZT.)

MODES OF TRANSMISSION

blood
blood products
sexual fluids
People can be infected and NOT look sick or even
have AIDS but can still transmit HIV

HOW DO ANTI-HIV MEDICATIONS HELP

PREVENT MOTHER-TO-CHILD TRANSMISSION
OF HIV?

Taking anti-HIV medications during pregnancy

reduces the amount of HIV in an infected mothers
body. Having less HIV in the body reduces the risk
of mother-to-child transmission of HIV.
Some anti-HIV medications also pass from the
pregnant mother to her unborn baby through the
placenta (also called the afterbirth).
The anti-HIV medication in the babys body helps
protect the baby from HIV infection. This is
especially important during delivery when the
baby may be exposed to HIV in the mothers
genital fluids or blood.

Tuberculosis
INTRODUCTION

Pulmonary tuberculosis is an infectious disease of

the lungs caused by acid fast bacilli (AFB) known
as mycobacterium tuberculosis characterized by
low grade fever, loss of weight, chronic cough, etc.
The bacteria gets into the lungs through inhaled
air contaminated by the sputum of positive cases.
About 45% of total population is infected by TB of
which 60% is adult.

CONT..

The incidence ranges between 1-2%

amongst the hospital deliveries.
Infact in 1993, WHO pronounced
tuberculosis a global health emergency.
In 2000, WHO showed the emergence of
multidrug resistant tuberculosis (MDR-TB)
all over the world.

CONT..

The lung is the major site of involvement, but

the lymph gland, meninges, bones, joint,
intestine and kidneys can also be infected.
The person becomes infected by inhaling the
infectious organisms mycobacterium
tuberculosis, which is carried on a droplet nuclei
spread by airborne transmission.
The women can remain asymptomatic for long
periods of time as the organism may be dormant.

CAUSATIVE AGENTS:

Mycobacterium Tuberculosis(Human type)

Mycobacterium Tuberculosis(Bovine type)

PREDISPOSING FACTORS

Positive family history or past history.

Low socio-economic status.
Area of high prevalence of tuberculosis.
HIV infection.
Alcohol addiction.
Intravenous drug abuse.

CLINICAL FEATURES:

Evening pyrexia(low grade fever)

Loss of weight
Night sweating/Sleep sweats
Chronic fatigue
Loss of appetite, pale and ill looking
Chronic cough
Malaise
Haemoptysis
Breathlessness

DIAGNOSTIC EVALUATION:

Positive family history

Clinical features
X-ray examinations(after 12 weeks)
Early morning Sputum for AFB examination
Diagnostic bronchoscopy
Gastric washing

CONT..

Tuberculin skin test with purified protein

derivates(PPD) montox test when 10 mm
is considered positive esp. in presence of
risk factors.
Extra-pulmonary sites; lymph nodes,
bones (rare in pregnancy)
Direct amplification test to detect
Mycobacterium tuberculosis.

Congenital tuberculosis is diagnosed by:

a. Lesion noted in the 1st week of life.
b. Infection of the maternal genital tract or
placenta.
c. Cavitating hepatic granuloma diagnosed by
percutaneous liver biopsy at birth.
d. No evidence of postnatal transmission.

EFFECT ON PREGNANCY
MOTHER:

Pregnant women with untreated TB are more likely to have preeclampsia, spontaneous abortion, preterm labour, difficult labour
and PPH.
Intrauterine fetal death.
Anemia

FETUS:
Under weight infant
Low apgar score
Perinatal death
IUGR
Preterm labour.
New born baby is at risk of postnatally acquired TB if mother has
still TB at the time of birth.

Effect of pregnancy on TB:

Higher risk of relapse in the puerperium.

This may be due to the disturbed nights,
increased work and anxiety for care of a new
born.

PREVENTION

The BCG vaccine has been incorporated into the

National immunization policy of many countries,
especially the high burden countries, thereby
conferring active immunity from childhood. Nonimmune women travelling to tuberculosis endemic
countries should also be vaccinated. It must,
however, be noted that the vaccine is
contraindicated in pregnancy.
The prevention, however, goes beyond this as it is
essentially a disease of poverty. Improved living
condition is, therefore, encouraged with good
ventilation, while overcrowding should be avoided.
Improvement in nutritional status is another
important aspect of the prevention.

CONT

Pregnant women living with HIV are at higher risk

for TB, which can adversely influence maternal
and perinatal outcomes. As much as 1.1 million
people were diagnosed with the co-infection in
2009 alone. Primary prevention of HIV/AIDS is,
therefore, another major step in the prevention
of tuberculosis in pregnancy. Screening of all
pregnant women living with HIV for active
tuberculosis is recommended even in the
absence of overt clinical signs of the disease.

CONT..

Isoniazid preventive therapy (IPT) is another

innovation of the World Health Organisation
that is aimed at reducing the infection in HIV
positive pregnant women based on evidence
and experience and it has been concluded
that pregnancy should not be a
contraindication to receiving IPT. However,
patient's individualisation and rational
clinical judgement is required for decisions
such as the best time to provide IPT to
pregnant women.

CONT

Most importantly, governments commitments

are highly encouraged so that the World
Health Organisation and all other
international bodies involved in fighting
tuberculosis may succeed in chasing this
monster out of all communities.

THERAPEUTIC MANAGEMENT
The principles of treatment for the pregnant woman
with TB are same as in the non pregnant patient.
The treatment of TB in pregnancy is important for two
reason.
For serious consequences of untreated TB and the risk of
its
spread to newborns.
Secondly the effect of the drugs used in its treatment on
the fetus.
1.Women with positive purified protein derivates (PPD)
and no evidence of active disease (asymptomatic),
Isoniazid prophylaxis 300mg/day is started after the
first trimester and continued for 6-9 months.
Pyridoxine (vit.B6) 50mg/day is added to prevent
peripheral neuropathy.

2.Women with active tuberculosis should receive the

following drugs orally daily for a minimum period of 9
months.
Drug

Daily doses-PO

Major side effects

Isoniazid
(pyridoxine)

5 mg/kg upto 300mg

50mg daily

Hepatitis, peripheral
neuropathy,
hypersensitivity.

Rifampicin

10 mg/kg upto 600mg.

Nausea, vomiting,
hepatitis, orange
discoloration of urine
and secretion, febrile
reaction.

Ethambutal

15 mg/kg upto 2.5 gm

Skin rash, optic

neuritis, decreased
visual activity.

Pyrazinamide

15-30mg/kg upto 2gm.

Hepatotoxicity, skin
rash, arthralgias,
hyperuricemias, G.I.
upset.

CONT..
3.Surgical management should be withheld, if
possible, but if deemed necessary should be
restricted for first half of pregnancy beyond 12
weeks.

OBSTETRICAL MANAGEMENT
During pregnancy

Supervision and joint care with obstetrician and

chest physician is necessary.
In the first trimester anti-TB drug should be
continued. The choice of drug and the dosage
may have to be modified. Morning sickness may
pose some difficulties.
In 2nd and 3rd trimester, the status should be
reviewed. Women will need advice regarding
workload, diet and rest.
Treatment with iron, folic acid and vitamin is
necessary to improve general condition/health.

DURING LABOUR

Close monitoring of pulse and respiratory rate

are necessary especially in pulmonary TB.
Normal vaginal delivery is routine for women
with tuberculosis and low forcep may be used to
short the 2nd stage of labour.
Spinal or epidural anesthesia are preferred than
inhalation anesthesia for fear of contamination.

DURING POSTNATAL PERIOD

After delivery the women with active disease

must stay in hospital or transferred to a
hospital for two or three weeks to allow them
a period of rest before they return to their
house hold duties.
Breast feeding is not contraindicated when a
woman is taking anti-tuberculosis drugs.
Breast

feeding should be avoided if the infant is

also taking the drugs (to avoid excess drug level)
In active lesion, not only is breast feeding
contraindicated but the baby is to be isolated
from the mother following delivery.

CONT
Baby

should be given prophylactic isoniazid 1020mg/kg/day for 3 month when the mother is
suffering from the active disease.
If the mother is on effective chemotherapy for
at least 2 weeks, there is no need to isolate
the baby. BCG should be given to the baby as
early as possible.

CONT..

Pregnancy is to be avoided until quescence is

assured for about two years.
Oral contraceptives should be avoided when
rifampicin is used.
Due to accelerated drug metabolism,
contraceptive failure is high.
Puerperal sterilization should be considered if
the family is completed.

NURSING MANAGEMENT

Review the woman's history for risk factors such

as immuno-compromized status, recent
immigration status, homeless, over crowded
living conditions and injectable drug use.
At antepartum visits, be alert for clinical
manifestation of TB including fatigue, fever or
night sweats, non productive cough, slow weight
loss, anemia, haemoptysis and anorexia.

CONT

If the TB is suspected or the woman is at risk for

developing TB, anticipate screening with purified
protein derivative (PPD) administered by
intradermal injection.
If the client has been exposed to TB, a
reddened induration will appear within 72
hours.
If the test is positive anticipate a follow up
chest x-ray with lead shielding over the
abdomen and sputum culture to confirm the
diagnosis.

CONT..
Complaining

with the multidrug therapy is

critical to protect the woman and her fetus
from progression of TB.
Provide education about the disease process,
the mode of transmission, prevention,
potential complications, and the importance of
adhering to the treatment regimen.

CONT..

Stressing the importance of health promotion

activities throughout the pregnancy is important.
Some suggestion might include;
Avoiding crowded living conditions.
Avoiding sick people.
Maintaining adequate hydration.
Eating a nutritious well balanced diet.
Keeping all prenatal appointments to evaluate
fetal growth and well being.
Getting plenty of air by going outside frequently.

CONT..

Determining the woman's understanding of her

condition and treatment plan is important for
compliance.
Breast feeding is not contraindicated during the
medication regimen and should be encouraged
Management of the newborn of a mother with TB
involves preventing transmission by teaching the
parent not to sneeze, cough or talk directly into
the newborns face.

HOW DO YOU MANAGE THE NEWBORN ?

If the mother is non-infectious, she can

handle her baby. Ordinary BCG vaccination is
given to protect the baby.
If the mother is infectious, the baby must be
separated from the mother until she
becomes non-infectious. The baby must Be
given a dose of BCG vaccine. The infectious
mother can handle her baby only after
successful BCG vaccination i.e. after a period
of eight weeks.

CONT..
If the separation of mother and baby is not
practicable, the baby may be given
protective dose of isoniazide as
prophylactic:10-20 mg/kg/day for 3 months.

THANK YOU