A 6-week pregnant lady is diagnosed with sputum positive TB. Best management is -
Ans. is 'b' i.e., Start Category I ATT in first trimester * Tuberculosis during pregnancy should be diagnosed promptly and as early as possible. Late diagnosis and care is associated with 4-fold increase in obstetric morbidity and 9-fold increase in preterm labor.* Poor nutritional states, hypoproteinemia, anemia and associated medical conditions add to maternal morbidity and mortality.* True congenital TB is believed to be rare. A fetus can get TB infection either by hematogenous spread through umbilical vein or by ingestion or aspiration of infected amniotic fluid. The risk to neonate of getting TB infection shortly after birth is greater.* ATT should be started as soon as possible, as untreated disease is a hazard to the mother and fetus.* The regimens recommended for use in pregnancy are same as for the nonpregnant state except for withholding of streptomycin. Currently, an intermittent regimen (thrice weekly on alternate days) under the DOTS strategyof RNTCP is being increasingly used worldwide for pregnant women having TB.* None of the AKT drugs are teratogenic and AKT should be started as soon as the diagnosis is made. Sputum positive tuberculosis is category 1.
Wait for 2nd trimester to start ATT
Start Category I ATT in first trimester
Start Category II ATT in first trimester
Start Category III ATT in second trimester
Miscellaneous (Gynae)