DISEASES AFFECTING

PREGNANCY
(Tuberculosis & STD)
TUBERCULOSI
S IN
PREGNANCY
Introduction

■ Untreated tuberculosis (TB) disease represents a greater hazard to a pregnant woman

and her fetus than does its treatment. Treatment of pregnant women should be initiated
whenever the probability of TB is moderate to high. Infants born to women with
untreated TB may be of lower birth weight than those born to women without TB and,
in rare circumstances the infant may be born with TB. Although the drugs used in the
initial treatment regimen for TB cross the placenta, they do not appear to have harmful
effects on the fetus.
 After the discussion, you should be able to:
 Define tuberculosis
 Identify the risk factors of tuberculosis.
 Explain the pathophysiology of the disease.

Objectives: 

Enlist the symptoms of tuberculosis.
Enlist the medications used for tuberculosis
and it’s side effects.
What is Pulmonary Tuberculosis?
Pulmonary tuberculosis (PTB) is a chronic respiratory disease common among crowded and
poorly ventilated areas.
• An acute or chronic infection caused by Mycobacterium tuberculosis, tuberculosis is
characterized by pulmonary infiltrates, formation of granulomas with caseation,
fibrosis, and cavitation.
• Tuberculosis is an infectious disease that primarily affects the lung parenchyma.
• It also may be transmitted to other parts of the body, including the meninges, kidneys,
bones and lymph nodes.
• The primary infectious agent, M. tuberculosis, is an acid-fast aerobic rod that grows
slowly and is sensitive to heat and ultraviolet light.
Statistics and Incidences

■ Tuberculosis is a worldwide public health problem that is closely associated

with poverty, malnutrition, overcrowding, substandard housing, and
inadequate health care.
• M. tuberculosis infects an estimated one-third of the world’s population
and remains the leading cause of death from infectious disease in the world.
• According to the WHO, an estimated 1.6 million deaths resulted from TB
in 2005.
• In the United States, almost 15,000 cases of TB are reported annually to the
CDC.
• After exposure to M. tuberculosis, roughly 5% of infected people develop
active TB within a year.
• In pregnancy, the incidence ranges between 1-2%
amongst the hospital deliveries in the tropics
predominantly seen in underprivileged sectors of the
society.
Risk Factors
Causes of acquiring tuberculosis include the following:
• Close contact. Having close contact with someone who has an active TB.
• Low immunity. Immunocompromised status like those with HIV, cancer, or
transplanted organs increases the risk of acquiring tuberculosis.
• Substance abuse. People who are IV/injection drug users and alcoholics have a
greater chance of acquiring tuberculosis.
Risk Factors
• Inadequate health care. Any person without adequate health care like the homeless,
impoverished, and the minorities often develop active TB.
• Immigration. Immigration from countries with a high prevalence of TB could affect
the patient.
• Overcrowding. Living in an overcrowded, substandard housing increases the
spreading of the infection.
CLINICAL
MANIFESTATIO
NS
• Nonspecific symptoms. Nonspecific
symptoms may be produced such as
fatigue, weakness, anorexia, weight
loss, night sweats, and low-grade
fever, with fever and night sweats as
the typical hallmarks of tuberculosis.
• Cough. The patient may experience
cough with mucopurulent sputum.
• Hemoptysis. Occasional hemoptysis
or blood on the saliva is common in
TB patients.
• Chest pains. The patient may also
complain of chest pain as a part of
discomfort.
PATHOPHYSIOLOGY
• Inhalation. Tuberculosis begins when a susceptible person inhales mycobacteria and
becomes infected.
• Transmission. The bacteria are transmitted through the airways to the alveoli, and are
also transported via lymph system and bloodstream to other parts of the body.
• Defense. The body’s immune system responds by initiating an inflammatory reaction
and phagocytes engulf many of the bacteria, and TB-specific lymphocytes lyse the
bacilli and normal tissue.
• Protection. Granulomas new tissue masses of live and dead bacilli, ate surrounded by
macrophages, which form a protective wall.
• Ghon’s tubercle. They are then transformed to a fibrous tissue mass, the central
portion of which is called a Ghon tubercle.
• Scarring. The bacteria and macrophages turns into a cheesy mass that may
become calcified and form a collagenous scar.
• Dormancy. At this point, the bacteria become dormant, and there is no further
progression of active disease.
• Activation. After initial exposure and infection, active disease may develop
because of a compromised or inadequate immune system response.
Assessment and Diagnostic Findings
To diagnose tuberculosis, the following tests could be performed:
• Sputum culture: Positive for Mycobacterium tuberculosis in the active stage of the disease.
• Ziehl-Neelsen (acid-fast stain applied to a smear of body fluid): Positive for acid-fast bacilli
(AFB).
• Skin tests (purified protein derivative [PPD] or Old tuberculin [OT] administered by
intradermal injection [Mantoux]): A positive reaction (area of induration 10 mm or greater,
occurring 48–72 hr after interdermal injection of the antigen) indicates past infection and the
presence of antibodies but is not necessarily indicative of active disease. Factors associated with
a decreased response to tuberculin include underlying viral or bacterial infection, malnutrition,
lymphadenopathy, overwhelming TB infection, insufficient antigen injection, and conscious or
unconscious bias. A significant reaction in a patient who is clinically ill means that active TB
cannot be dismissed as a diagnostic possibility. A significant reaction in healthy persons usually
signifies dormant TB or an infection caused by a different mycobacterium.
Assessment and Diagnostic Findings
• Enzyme-linked immunosorbent assay (ELISA)/Western blot: May reveal presence
of HIV.
• Chest x-ray: May show small, patchy infiltrations of early lesions in the upper-lung
field, calcium deposits of healed primary lesions, or fluid of an effusion. Changes
indicating more advanced TB may include cavitation, scar tissue/fibrotic areas.
• CT or MRI scan: Determines degree of lung damage and may confirm a difficult
diagnosis.
• Bronchoscopy: Shows inflammation and altered lung tissue. May also be performed to
obtain sputum if patient is unable to produce an adequate specimen.
• Histologic or tissue cultures (including gastric washings; urine and cerebrospinal
fluid [CSF]; skin biopsy: Positive for Myco­bacterium tuberculosis and may indicate
extrapulmonary involvement.
Assessment and Diagnostic Findings
• Needle biopsy of lung tissue: Positive for granulomas of TB; presence of giant cells
indicating necrosis.
• Electrolytes: May be abnormal depending on the location and severity of infection; e.g.,
hyponatremia caused by abnormal water retention may be found in extensive chronic
pulmonary TB.
• ABGs: May be abnormal depending on location, severity, and residual damage to the
lungs.
• Pulmonary function studies: Decreased vital capacity, increased dead space, increased
ratio of residual air to total lung capacity, and decreased oxygen saturation are
secondary to parenchymal infiltration/fibrosis, loss of lung tissue, and pleural disease
(extensive chronic pulmonary TB).
■ If the patient is under medical supervision
Effects of
with adequate treatment, pregnancy has got
no deleterious effect on the course of the
Tuberculosis
disease nor the disease has any adverse effect in Pregnancy
on pregnancy.
■ In active disease, fetus can be affected by
transplacental route or by aspiration of
amniotic fluid.
■ In untreated patients, the incidence of
IUGR, Preterm Labor and Perinatal
mortality is high.
MANAGEME
NT
Medical ■ The principles of treatment for the pregnant woman
with TB are same as in the non- pregnant patient.

Management ■ The treatment of TB in pregnancy is important for

two reasons:
 For serious consequences of untreated TB and the risk
of its spread to newborns.
 Secondly the effect of the drugs in its treatment on the
fetus.
Medical  Women with positive purified protein derivates

Management (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.
Medical Drug Daily doses-PO Major side effects

Management Isoniazid (pyridoxine) 5 mg/kg up to 300mg

50mg daily
Hepatitis, peripheral
neuropathy,
hypersensitivity.

■ Women with active Rifampicin 10 mg/kg up to 600 mg Nausea, vomiting,

hepatitis, orange
tuberculosis should discoloration of urine and
receive the following secretion, febrile reaction.
drugs orally daily for a
minimum period of 9
Ethambutal 15 mg/kg up to 2.5 gm Skin rash, optic neuritis,
months. decreased visual activity.

Pyrazinamide 15-30 mg/kg up to 2 gm Hepatotoxicity, skin rash,

arthralgias,
hyperuricemias, G.I.
upset.
Surgical Management

■ Surgical management should be withheld, if possible, but if

deemed necessary should be restricted for first half of
pregnancy beyond 12 weeks.
MIDWIFERY
ROLE
 Independent

■ Advising parents about TB. Midwives are

more likely to meet and be involved in the
diagnosis and treatment of pregnant women
with TB.
 Dependent

■ Give medicines to treat or cure TB that are

effective and safe to use in pregnancy.
■ Provide support and motivation for women to
take the medication regularly.
 Collaborative

 Seek assistance and guide them in managing

or take over to treat or cure the disease to a
specialist for specific service to perceived
patients standards of care. To provide a better
care to lessen the problems to the fetus.
 SEXUALLY
TRANSMITTED
DISEASES
IN PREGNANCY
STDs and ■ It is important for pregnant women to be checked for
STDs

Pregnancy ■ They can cause women to go into labor too early and
may complicate delivery.
■ Many STDs can be passed from mother to baby
during pregnancy, childbirth, or after the baby is born.
■ STDs effects on babies can include stillbirth, low
birth weight, neurologic problems, blindness, liver
disease, and serious infection.
■ But there are treatments to minimize these risks.
Treatment during pregnancy can cure some STDs and
lower the risk of passing the infection to your baby.
Objectives:

■ To identify the risks involved with getting STD.

■ Classify a number of STDs, the symptoms and prenatal effects.

■ Learn how to prevent getting STD and obtain its treatment options.
What are sexually transmitted
diseases (STDs)?
 Sexually transmitted diseases, commonly called STDs, are infections
that are spread by having sex with someone who has an STD.
Sexually transmitted diseases are passed on from sexual activity that
involves the mouth, anus, or vagina.

 The consequences of an STD can be significantly more serious, even

life threatening, for a woman and her baby if the woman becomes
infected with an STD while pregnant.
 Chlamydia
Genital herpes
Gonorrhea
Hepatitis B
STDs HIV/AIDS
include: HPV
Genital warts
Syphilis
Trichomoniasis
Chlamydia

■ Chlamydia is a common sexually

transmitted disease. It is caused by
bacteria called Chlamydia
trachomatis.

■ It can infect both men and women.

Women can get chlamydia in the
cervix, rectum, or throat. Men can
get chlamydia in the urethra (inside
the penis), rectum, or throat.
Genital
Herpes
■ Genital herpes is a common
sexually transmitted
infection caused by the
herpes simplex virus
(HSV).
■ Sexual contact is the
primary way that the virus
spreads. After the initial
infection, the virus lies
dormant in your body and
can reactivate several times
a year.
Gonorrhea

■ A sexually transmitted disease

(STD) caused by infection
with the Neisseria
gonorrhoeae bacterium.
■ N. gonorrhoeae infects the
mucous membranes of the
reproductive tract, including
the cervix, uterus, and
fallopian tubes in women, and
the urethra in women and men.
Hepatitis B

■ Hepatitis B is a vaccine-
preventable liver infection
caused by the hepatitis B
virus (HBV).
■ Hepatitis B is spread
when blood, semen, or
other body fluids from a
person infected with the
virus enters the body of
someone who is not
infected.
HIV/AIDS

■ Human immunodeficiency
virus (HIV) is the causative
agent for AIDS. The most
common type is known as
HIV-1 and is the infectious
agent that has led to the
worldwide AIDS epidemic.
There is also an HIV-2 that is
much less common and less
virulent, but eventually
produces clinical findings
similar to HIV-1.
HPV

■ The virus that causes HPV

infection is transmitted
through skin-to-skin
contact. Most people get
a genital HPV infection
through direct sexual
contact, including vaginal,
anal, and oral sex.
Because HPV is a skin-to-
skin infection, intercourse
isn't required for
transmission to occur.
Genital Warts

■ caused by a virus called

Human Papilloma Virus
(HPV). This virus is
passed on through direct
skin-to-skin contact with
someone who has HPV on
their skin.
Syphilis

■ The cause of syphilis is a

bacterium called
Treponema pallidum. The
most common way
syphilis is spread is
through contact with an
infected person's sore
during sexual activity. The
bacteria enter the body
through minor cuts or
abrasions in the skin or
mucous membranes. 
Trichomoniasis

■ Trichomoniasis (or “trich”)

is a very common sexually
transmitted disease (STD).
It is caused by infection
with a protozoan parasite
called Trichomonas
vaginalis.
 Anyone who is sexually active risks some degree
of exposure to an STD or STI. Factors that may
increase that risk include.
 Having unprotected sex.
 Having sexual contact with multiple partners.

Risk Factors 

Having a history of STIs.
Injecting drugs. Needle sharing spreads many
serious infections, including HIV, hepatitis B
and hepatitis C.
 Being young. Half the new STIs occur in
people between the ages of 15 and 24.
CLINICAL
MANIFESTATIO
NS
Sometimes, there are no symptoms. If symptoms are present, they might include:

• Bumps, sores, or warts near the mouth, anus, penis, or vagina

• Swelling or redness near the penis or vagina

• Skin rash

• Painful urination

• Weight loss, loose stools, night sweats

• Aches, pains, fever, and chills

• Yellowing of the skin (jaundice)

• Discharge from the penis or vagina (vaginal discharge might have an odor )

• Bleeding from the vagina other than during a monthly period

• Painful sex

• Severe itching near the penis or vagina

PATHOPHYSIOLOG
Y
Sexually transmitted diseases (STDs) are transmitted via the mucous membranes of the
vagina, penis, urethra or rectum, during sexual contact with an infected individual.
Transmission can also occur via membranes of the throat, respiratory tract, mouth and eyes.
The mucous membranes are thinner than skin and allow microbes to cross them into the
body. In addition, minor breaks in the skin and mucous membranes due to abrasions or cuts
further increase the risk of infection. The microbes are often present in fluids secreted from
the penis, vagina, saliva, faeces, urine and sweat. Sometimes, only a small amount of the
microbes can lead to transmission of an STD.
Any sexual contact including oral sex and deep kissing can lead to the transmission of certain
infections, although the concentration of the microbes is often lower in saliva than in the
genital fluids. Non-sexual contact such as hugging and shaking hands is not usually
responsible for transmitting infection.
HOW CAN SEXUALLY
TRANSMITTED DISEASE
(STDS) AFFECT
PREGNANCY AND IT’S
TREATMENT?
■ Chlamydia: Pregnancy seems to be unaffected by
chlamydia infection. However, infants exposed to the
infection at birth can develop severe eye infections or
pneumonia.
■ Treatment: Mothers with chlamydia are treated with
antibiotics and all newborn babies are given
antibiotic eye ointment after birth to prevent
infections.
■ Genital herpes: Herpes infection in
pregnant women is relatively safe until she
gets ready to deliver. Active herpes lesions
on the genitals are contagious and can
infect the infant during childbirth. Thus,
many women are delivered via cesarean
section.
■ Treatment: Antiviral medications can be
given. Cesarean section if indicated.
■ Gonorrhea: If contracted during pregnancy, the
infection can cause mouth sores, fever and blood
stream infections. The baby is usually unaffected,
but if the baby is born while the mother has an
active infection, the baby may develop an eye
infection or blindness, joint infections, or blood
infections.
■ Treatment: Mothers with gonorrhea are treated
with antibiotics and all newborn babies are given
antibiotic eye ointment after birth to prevent
infections.
■ Hepatitis B: This is a liver infection caused by the hepatitis B virus. If a pregnant
woman is infected with hepatitis B, she can transmit the infection to the fetus through
the placenta, infecting the newborn baby. In addition, women with hepatitis B are more
likely to have premature birth delivery. However, early screening and vaccination can
prevent the worst outcomes of this infection.

■ Treatment: If you have hepatitis B, your doctor will give your newborn baby an
injection of antibodies and a vaccine to prevent the baby from becoming infected.
■ HIV/AIDS: Thanks to the advent of powerful medication combinations, transmission of
HIV infection to the infant is almost completely preventable. However, if the disease is
passed on, the baby may develop the HIV infection.

■ Treatment: Although HIV/AIDS is an incurable disease, you can prevent transmitting

the virus to your baby by taking various medications.
■ HPV/genital warts: It is a common STD that can present with lesions or may have no
symptoms at all.

■ Treatment: If you contract genital warts during pregnancy, treatment may be delayed
until after you deliver. Delivery is only affected if large genital warts are present, and
your healthcare provider will discuss delivery options with you.
■ Syphilis: Syphilis is easily passed on to the unborn child and is likely to cause fatal
infections. Untreated infants can be born premature or develop problems in multiple
organs, including eyes, ears, heart, skin, and bones.

■ Treatment: Your healthcare provider will likely prescribe antibiotics to you during
pregnancy to reduce the risk of transmission to the baby.
■ Trichomoniasis: This is a parasite that causes vaginal discharge. If left untreated, babies
can be premature and have low birth weight.

■ Treatment: This infection is easily treatable with antibiotics.

■ If you are given an antibiotic to treat an STD, it's important that you take all of your
medicine, even if the symptoms go away. Also, never take someone else's medicine to
treat your illness. By doing so, you might make it more difficult to treat the infection.
Likewise, you should not share your medicine with others.
Preventing STDs

■ The best way to avoid getting an STD, is to abstain from any sexual
contact and be in a monogamous, long-term relationship with an
uninfected partner. To reduce your odds of getting STDs
■ Ask your partner to be tested before sexual activity.
■ Use condoms.
■ Avoid sexual activity if your partner has signs of STD.
■ Be aware of symptoms and get regular check ups with your health
care provider.
MIDWIFERY
ROLE
Independent ■ The midwife has a role in the detection of all STDs
and has an excellent opportunity to fully assess the
patient’s psychological as well as physical status.
■ When assessing the patient, gather data about social
behavior, sexual attitudes, and attitudes concerning
pregnancy. Assessing the potential impact of the STD
on the pregnancy and its outcome is important.
■ A careful social history must be taken. Data about
age, address, employment, education, and sexual
contacts are important sources of information for
identifying possible disease spread.
■ Plan to teach the patient about female anatomy and
effects of pregnancy when discussing the disease with
the patient.
Dependent

■ Screening for STIs or STDs such as human immunodeficiency virus (HIV), hepatitis B, chlamydia and
syphilis, generally takes place at the first prenatal visit for all pregnant women. Gonorrhea and hepatitis C
screening tests are recommended atleast once during pregnancy for women at high risk of these infections.

Screening for STDs can include tests such as:

• Pelvic and physical exam. Your doctor will look for signs of infection, such as warts, rashes or discharge.
• Blood test. A blood sample is checked for signs of STDs.
• Urine test. A urine sample is tested for signs of STDs.
• Fluid or tissue sample tests. A sample of fluid or discharge from an infected area of your body is viewed
under a microscope or sent to a lab for testing.
Collaborative

• Identify societal issues (e.g., access to quality health care) that contribute to disparities
and develop interventions to address those societal issues;

• promote personal health; and

• advance community wellness.

• safer sex/risk-reduction counselling, condom promotion;

References

■ https://www.slideshare.net/sangita8/uberculosis-and-its-effect-in-pregnancy?fbclid=IwAR3MbHFqlMAE0mq
dMPhPdSaDkUO3YxHXFXFaJ0mBBKTnEs77s5vxXn40R-c
■ https://www.slideshare.net/miniebliss/presentation2-pregnancy-and-tuberculosis?fbclid=IwAR1nklZobdlLkHf
4aLWLG7uuCSNT-uNM5riDcwkUp_tJNOFcHzo-vUjF8dw
■ https://www.slideshare.net/munivenkatesh420/std-43851804
■ https://my.clevelandclinic.org/health/articles/10246-pregnancy--sexually-transmitted-diseases
■ https://www.mayoclinic.org/diseases-conditions/sexually-transmitted-diseases-stds/symptoms-causes/syc-2035
1240
■ https://www.news-medical.net/health/STD-Pathophysiology.aspx
Members
TORRES, Cyrelle Jen

TULAB, Jesabel

TUMAMAO, Princess

VALDEZ, Joyce Ann

VIERNES, Jireh Faith