Book of Medical Disorders in Pregnancy - Tintash

CD4 + cell count (200/ml) should
receive pro-phylactic co-trimoxazole or
nebulize pe-ntamidine.
4. Tuberculosis:
TB is of relevance to obstetricians for
three reasons. First, the serious consequences
of untreated TB and the risk
of its spread to others, particularly children.
Secondly, obstetricians may be
consulted by women worried about the
effect of TB - and particularly of the
drugs used in its treatment. Thirdly, the
presence of TB may, in some populations,
indicate the risk of concomitant
infection with HIV.
Routine microscopy and culture of
specimens will not detect tubercle
bacilli. Chest x-ray is suggestive fibre
optic bronchoscopy and aspirations of
secretions with topical anaesthesia are
safe.
The treatment regime is supervised by a
physician who deals with TB. Fears
about the teratogenicity of antituberculous
drugs have in the past been
grounds for termination of pregnancy
but this can no longer be justified.
Standard antituberculous therapy is an
initial three-drug regime for 2 months,
continuing with two of these drugs for a
further 7 months, totaling 9 months of
treatment. A 2-month four-drug regime,
continuing with two drugs to total just 6
months, is also highly effective. In the
developed world, the two drugs used
throughout the treatment period are
usually rifampicin and isoniazid. Most
physicians now prefer pyrazinamide,
which does not have the problems of
ocular toxicity seen with ethambutol,
and clinical improvement is faster.
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Earlier workers suggested avoiding rifampicin
if possible. There is no evidence
of teratogenicity in humans and from
this point of view the drug is now widely
regarded as safe. Isoniazid and ethambutol
similarly have no adverse effects
on the fetus. Streptomycin with its high
risk of fetal (and indeed maternal)
ototoxicity should not be used. The
emergence of multi drug-resistant strains
of TB (MDR-TB), mainly in HIV-positive
individuals, is necessitating a major
reconsideration of treatment stratagems.
A woman who is not coughing sputum
or whose sputum contains no tubercle
bacilli on direct microscopy by an
experienced laboratory may be regarded
as non infectious and isolation is not
necessary. Treatment of individuals whose
sputum is positive on direct microscopy
for tubercle bacilli renders them
non-infectious after about 2 weeks.
5. Restrictive lung disease:
The term covers a highly heterogeneous
group of conditions which produce similar,
but not identical, disturbances of
ventilatory function. A disorder commonly
results from processes affecting
the lung parenchyma referred to as interstitial
lung diseases. It may also occur,
however, as a result of neuromuscular
weakness or chest wall and other skeletal
deformities.
Sarcoidosis:
Sarcoidosis is the parenchymal lung
disease encountered by obstetricians. A
multisystem granulomatous disorder of
unknown cause, the lungs are the organ
most frequently involved. The condition
may be asymptomatic, and discovered
incidentally on chest x-ray. Acute