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MRCOG Antenatal Part 2 Revision - Hay > TB in pregnancy TOG 2023 > Flashcards

TB in pregnancy TOG 2023 Flashcards

1
Q

Global burden TB
0 Which area has highest incidence of TB
Highest mortality from TB

A

Incidence - South east asisa
Deaths - SEA

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2
Q

Rates of TB in UK

A

6.9/100,000

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3
Q

Highest risk of developing TB when in UK

A

1st 5 years

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4
Q

Most common clinical form of TB

A

Pulmonary - Ghon focus

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5
Q

What proportion present as extra pulmonary TB

A

20%
Most common in UK cervical lymph node

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6
Q

If immunocompromised or HIV +ve most common presentation

A

Extra-pulmonary

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7
Q

Most common Sx TB

A

Fever
Night sweats
Cough
Weight loss

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8
Q

What is STOP programme

A

Stop TB in pregnancy = screen migrant women from high prevalence countries for latent TB

New migrants registering with GP offered screening for latent TB

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9
Q

What are the investigations for TB

A

Screening tests
○TB skin test (TST)
○Interferon gamma release assay (IGRA)

Confirmatory tests
○Microscopy
○Culture and sensitivity

Additional tests
○Imaging studies

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10
Q

When is false +ve seen in Tb skin test

A

previous BCG vaccination, previou stuberculous infection and infection with non-tuberculous mycobacterium

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11
Q

When is false -ve seen with TB skin test

A

Recent TB infection,immunocompromised status, sarcoidosis, non-Hodgkin’slymphoma and recent live vaccination with measlesor chickenpox

New C-Tb test - fewer false +ve

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12
Q

Are the skin test results effected by BCG?
Is the interferon gamma release assay?

A

Skin test - Yes
IGRA - No

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13
Q

What stain used for microscopy

A

Ziehl-Neelsen - identify acid fast bacilli

Can miss 1/3rd active cases

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14
Q

How long do results from culture and sensitive take?

A

4-8 weeks for culture
further 6-8 for sensitive

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15
Q

In culture +ve Tb what proportion have normal CXR

A

14%

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16
Q

Flow diagram explain management of suspect TB

A
17
Q

Effect of pregnancy on TB

A
  • Moren susceptible to TB - primary/reativeation
  • Dx more challenging
18
Q

Effect of TB on pregnancy

A
  • Anaemia 41%
  • Preamaturity 32%
  • SGA 22%
  • Oligohydarmnios
19
Q

If HIV +ve increase risk of reactivation

A

20 X

21 X higher rate of TB than general population

Increase risk of complications

20
Q

Treatment of TB in prengnay

A

Same as non pregnancy
2 months all 4 drugs
4 months Isoniazid/Rifampixin

(if HIV further 10 months of 2 drugs)

21
Q

Drug given to alongside isoniazid

A

Pyridoxine 10 mg/day

22
Q

What additional dug of neurological TB

A

Steroids - Dex or pred for 4-8 weeks

23
Q

Effect of streptomycin in pregnancy?

A

15% deafness
Not advised in pregnancy

24
Q

Treatment for latent TB, when recommended?

A

isoniazid for 6 months or a combination of both isoniazidand rifampicin for 3 months.

If HIV +ve

25
Q

Main SE to monitor for?

A

Hepatoxicity - more likely 3rd/PP

26
Q

Difference Congenital and neonatal TB

A

Congenital - acquired AN or intrapartum
Neonatal - PP

Perinatal - covers both

27
Q

Where is the primary focus in neonates?

A

Liver
Miliary pattern on CXR

28
Q

How can perinatal TB be Dx

A

Placental histology/culture
CXR
Aspirates

29
Q

Presentation in neonate

A

Presentations include respiratory distress, failureto thrive, irritability, lymphadenopathy, pyrexia of unknown origin,unexplained anaemia and hepatosplenomegaly.

30
Q

Perinatal TB mortality rate
- Treated
- Not treated

A

Treated - 20%
Not treated 40%

31
Q

If active maternal TB and no perinatal TB - what to do

A

isoniazid preventive therapy at 10 mg/kg/day is recommendedfor 6 months along with pyridoxine

32
Q

Can mother breast with TB

A

Once completes at least 2 weeks for treatment

  • No if infection HIV/breast TB/multi drug resistance
33
Q

In UK which neonates should have TB vaccine?

A

In the UK the BCG vaccine is recommended for neonates whose parents or grandparents were born in a country where the annual incidence of TB is 40/100 000 or greater, or if a newborn baby is living in areas of the UK where the annual incidence of TB is 40/100 000 or greater.

34
Q

When can BCG be given to neonates of HIV mothers

A

If HIV negative at 12-14 weeks and exclusively bottle fed

MRCOG Antenatal Part 2 Revision - Hay (72 decks)

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