Scribd Logo
Upload

Welcome to Scribd!

  • 88 views

    Tuberculosis in Obstetrics and Gynecology

    Uploaded by

    ameen
    This document discusses tuberculosis (TB) in obstetrics and gynecology. It notes that genital TB is usually secondary to a primary infection elsewhere and spreads to the fallopian tubes in most cases. Symptoms include infertility, menstrual abnormalities, and pelvic pain. Diagnosis involves tests like microscopy, culture, PCR and imaging. Treatment consists of a multi-drug chemotherapy regimen for 6-12 months along with possible surgery for complications. Managing TB during pregnancy requires treating the mother without harming the fetus.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd

    Tuberculosis in Obstetrics and Gynecology

    Uploaded by

    ameen
    88 views42 pages
    This document discusses tuberculosis (TB) in obstetrics and gynecology. It notes that genital TB is usually secondary to a primary infection elsewhere and spreads to the fallopian tubes in most cases. Symptoms include infertility, menstrual abnormalities, and pelvic pain. Diagnosis involves tests like microscopy, culture, PCR and imaging. Treatment consists of a multi-drug chemotherapy regimen for 6-12 months along with possible surgery for complications. Managing TB during pregnancy requires treating the mother without harming the fetus.

    Original Title

    95093246 Tuberculosis in Obstetrics and Gynecology

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses tuberculosis (TB) in obstetrics and gynecology. It notes that genital TB is usually secondary to a primary infection elsewhere and spreads to the fallopian tubes in most cases. Symptoms include infertility, menstrual abnormalities, and pelvic pain. Diagnosis involves tests like microscopy, culture, PCR and imaging. Treatment consists of a multi-drug chemotherapy regimen for 6-12 months along with possible surgery for complications. Managing TB during pregnancy requires treating the mother without harming the fetus.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    88 views42 pages

    Tuberculosis in Obstetrics and Gynecology

    Uploaded by

    ameen
    This document discusses tuberculosis (TB) in obstetrics and gynecology. It notes that genital TB is usually secondary to a primary infection elsewhere and spreads to the fallopian tubes in most cases. Symptoms include infertility, menstrual abnormalities, and pelvic pain. Diagnosis involves tests like microscopy, culture, PCR and imaging. Treatment consists of a multi-drug chemotherapy regimen for 6-12 months along with possible surgery for complications. Managing TB during pregnancy requires treating the mother without harming the fetus.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 42

    Tuberculosis in Obstetrics and Gynecology

    NAME ALEFIYAH SALEEM ID - 07090124

    I had Genital TB too

    Incidence
    1% of the OPD patients in the developing world

    Patients with infertility 5-10%


    Prevalence of HIV rise in TB

    Pathogenesis
    Causative organism mycobacterium TB mostly

    human type Genital TB is always secondary to primary infection ( lungs 50%, lymph nodes, urinary tract, bones and joints) The fallopian tubes are invariably the primary sites of pelvic TB from where secondary spread occurs to other genital organs.

    Mode of spread
    Blood stream 90%

    Lymphatic or direct from infected organs such as

    peritoneum, bowel or mesenteric nodes Ascending male with urogenital TB

    Pathology of pelvic organs

    Fallopian tubes
    Commonest site ( nearly 100%) Bilateral affection Initial site submucosal layer of the ampullary part Infection spread medially destruction of the muscles fibrous tissue thickened calcified Infection spread inward swollen mucosa and destroyed fimbria are everted and abdominal ostium usually remains patent Elongated and distended distal tube give appearance of tobacco pouch Adhesions tubercles burst out (inward pyosalphinx and outward perisalphingitis)

    Salpingitis isthimica nodosa


    Nodular thickening of the tube d.t proliferation of

    the tubal epithelium within the hypertrophied myosalphinx. Etiology unknown Radiology small diverticulum Non specific for TB DD pelvic endometriosis

    Uterus
    60%

    Spread from tubes lymphatic or direct


    Site corunal ends commonly Tubercle is situated in the basal layer and only comes

    to the surface premenstrual After menstruation reinfection lesion in basal layer or from tubes. Endometrial ulcerations may lead to adhesion or synechia ashermans syndrome infertility, secondary amenorrhea or recurrent abortion

    Cervix
    5-15%

    By sexual intercourse is rare


    Ulcerative or bright nodular type Bleed on touch thus confused with carcinoma

    Histology marked epithelial hyperplasia and some

    atypia ( misdiagnosis of carcinoma)

    Vulva and vagina


    Very rare 1%

    Ulcerative with undermined edges


    Or hypertrophied edges Diagnosis by histology

    Ovary
    30%

    Surface tubercles, adhesions, thickening of the

    capsule or even caseating abscess

    Pelvic peritoneum
    Peritonitis 40-50%

    2 types Wet type or exudative ascites with straw colored fluid in the peritoneal cavity, parietal and visceral peritoneum covered with numerous small tubercles Dry type or adhesive dense adhesions with the bowel loops, adhesions are due to the fibrosis when wet heals

    Microscopic appearance
    Typical for TB

    Granuloma with infiltration of multinucleated giant

    cells ( langerhans), chronic inflammatory cells and epitheloid cells, surrounding a central area of caseation necrosis

    Clinical features
    History

    Childbearing period
    PMH- pulmonary TB in adolescence (10-20%) FH- positive

    Asymptomatic
    Incident findings while investigating for infertility or

    DUB

    Infertility Primary or secondary 70-80% Tubal blockage, synechia or ovulatory dysfunction Menstrual abnormalities Menorrhagia or irregular bleeding Amenorrhea or oligomenorrhae

    Chronic pelvic pain tubo-ovarian mass

    Vaginal discharge cervical or vaginal TB


    Constitutional symptoms weight loss, fever,

    anorexia, etc

    Signs
    PA normal Irregular tender mass Feel doughy due to matted intestines Ascites PV ulcers Thickened tubes in the lateral fornices

    Differntial diagnosis
    Pyogenic tubo-ovarian mass

    Pelvic endometriosis
    Adherent ovarian cyst

    Investigation
    Aim is to Identify the primary lesion Confirm the genital lesion

    CBC

    Mantoux test
    CRX Diagnostic uterine curettage premenstruation

    PCR biopsy or first day menstrual discharge


    HSG CT/MRI abdominal and pelvic

    Laparoscopy

    Treatment
    General

    Chemotherapy
    Surgical

    General
    Acute pulmonary infection requires hospital

    admission Pelvic infection doesnt require hospital admission Good healthy diet Use condom during intercourse to avoid the spread of infection

    Chemotherapy
    Initial phase isoniazid, rifampicin, pyranzinamide

    and ethambutol are used for 2 months Continuation phase isoniazid and rifampicin for 4 months One year after treatment diagnostic endometrial curettage and bacteriology examination is done.

    Drug

    Daily dosing

    Thrice-weekly dosing*

    Adverse reactions

    Isoniazid (INH)

    5 mg/kg max. 300 mg Adults: 15 mg per kg Elevation of hepatic orally or IM enzyme levels, hepatitis, neuropathy, central nervous system effects

    Rifampin (Rifadin)

    10 mg/kg max. 600 mg

    Pyrazinamide

    20 -25 mg/kg max. 3gm

    Adults: 10 mg per kg Orange discoloration orally or IV of secretions and urine, gastrointestinal tract upset, hepatitis, bleeding problems, flu-like symptoms, drug interactions, rash Adults: 50 to 70 mg Gastrointestinal tract per kg orally upset, hepatitis, hyperuricemia, arthralgias

    Ethambutol (Myambutol)

    15-20 mg/kg max. 2.5 adults: 25 to 30 mg perOptic neuritis gm kg orally

    Surgery
    Indication 1. Unresponsiveness of active disease in spite of adequate anti- TB chemotherapy 2. TB pyosalpinx, ovarian abscess or pyometra 3. Persistent Menorrhagia or chronic pelvic pain causing functional impairment

    Contraindications
    1. 2. 3.

    Presence of active TB in extra genital sites Favorable response to chemotherapy Accidently discovery of tubo-ovarian mass on laparotomy

    Precautions Anti TB drug therapy should be

    given at full doses for at least 6 weeks prior to the surgery and even continued after the surgery. Type of surgery Total hysterectomy with bilateral salpingooophprectomy Young women preserve atleast one ovary and resection of the mass, drain the pyometra or repair of the fistula.

    TB in pregnancy
    Incidence - 1-2%, increase incidence in patients with

    HIV Risk factors


    1. 2. 3. 4. 5.

    6.
    7.

    PMH or FH positive Low socio-economic status Area with high prevalence of TB HIV infection Alcohol addiction IV drug abuse DM, jejunoileal bypass, Underweight by >=15%

    Diagnosis
    Tuberculin skin test

    CXR after 12 weeks


    Early morning sputum Gastric washing

    Diagnostic bronchoscopy
    PCR

    Congenital TB
    Rare

    Associated with HIV 1. Lesion noted in first week of life 2. Infected maternal genital tract or placenta 3. Cavitating hepatic Granuloma dx by percutanous liver biopsy 4. No evidence of post natal transmission

    Prognosis
    Pregnancy has got no deleterious side effect on the

    course of the disease nor has the disease got any adverse effect on the course of pregnancy. In active disease fetus maybe affected via transplacental or aspiration of the amniotic fluid Untreated patients

    Preterm labor IUGR Perinatal mortality

    Management
    Medical

    Prevention women with positive PPD and

    asymptomatic INH 300mg/day + pyridoxine 50 mg/day start in first trimester and continue for 6-9 months Treatment same as for gynecology Surgery surgery should be avoided usually in pregnancy

    Obstetric management
    TB is not an indication for termination of pregnancy Obstetric management is same for any other pregnant

    women Breast feeding No CI when women is on chemotherapy But avoided if infant is also on chemotherapy because of overdose Active lesions, it is CI as well as baby is isolated from the mother. Infant is given prophylactic INH 10-20 mg/day for 3 months along with BCG vaccination. Contraception for at least 2years after test results are negative.

    Thank you for listening. She is fine now (hopefully!!!).

    You might also like