Evaluation of Pregnant Patient at Risk for TB

Place Tuberculin Skin Test/Interferon Gamma Release Assay and perform symtom screen.

If the patient is Asymptomatic and Tuberculin Skin Test/Interferon Gamma Release Assay negative, then no further evaluation is needed unless the patient is a contact case (Tuberculin Skin Test negative contacts should have Tuberculin Skin Test repeated 3 months after break in contact).

If the patient is Asymptomatic and Tuberculin Skin Test/Interferon Gamma Release Assay Positive and is in the first trimester, then Delay chest x-ray until second trimester unless the patient is a recent contact or HIV positive.

If the patient is in the second or third trimester, take chest x-ray with abdominal shield.

If the chest x-ray is abnormal, collect sputum three times for Acid Fast Bacilli smear and culture. Evaluate the patient for treatment as TB suspect and report to local health department.
Begin therapy with INH, Rifampin, and Ethambutol as a TB suspect.

If the chest x-ray is normal, determine if the patient is a recent contact or HIV positive. If yes, check thir baseline Liver Function Tests. Liver Function Tests should include serum Aspartate Amino Transferase, Alanine Aminotransferase and total Bilirubin. If they are abnormal then seek medical consultation or follow the flow chart: "Assessing and Managing the Risk of Liver Disease
in the Treatment of Latent TB Infection". If the Liver Function Tests are normal then begin therapy for Latent TB Infection during pregnancy and do monthly Liver Function Tests. Complete 9 month treatment for Latent TB Infection with INH.

If the patient is not a recent contact or HIV positive then delay therapy for Latent TB Infection until 3 to 4 months post partum. Check baseline Liver Function Tests prior to start of therapy. Repeat chest x-ray if last chest x-ray was taken more than 6 months earlier. If Liver Function Tests are abnormal, seek medical consultation or follow flow chart: "Assessing and Managing the Risk of Liver Disease in the Treatment of Latent TB Infection". If the Liver Function Tests are normal then begin therapy for Latent TB Infection and complete 9 month treatment for Latent TB Infection with INH.

If the patient is symptomatic after placing the Tuberculin Skin Test/Interferon Gamma Release Assay and test positive. Take chest x-ray with abdominal shield (do not delay until second trimester). If the chest x-ray is normal then seek medical consultation. If the chest x-ray is abnormal then collect 3 sputum for the Acid Fast Bacilli smear and culture. Evaluate for treatment as a TB suspect and report to local health department. Begin therapy with INH, Rifampin, and Ethambutol as a TB suspect.

If the patient is Tuberculin Skin Test negative, then take chest x-ray with abdominal shield (do not delay until second trimester). If chest x-ray is normal then no further evaluation is needed unless patient is a contact of a case (Tuberculin Skin Test negative contacts should have Tuberculin Skin Test repeated 3 months after break in contact) or immunosuppressed or HIV positive (HIV positive persons may have active TB despite a negative chest x-ray and Tuberculin Skin Test. Collect three sputum specimens) and seek consultation.

If the chest x-ray is abnormal then collect 3 sputum for the Acid Fast Bacilli smear and culture. Evaluate for treatment as a TB suspect and report to local health department. Begin therapy with INH, Rifampin, and Ethambutol as a TB suspect.

Produced by Heartland National TB Center. Consultation to healthcare providers at 1-800-TEX-LUNG, www.HeartlandNTBC.org.
This product produced with funds awarded by the Centers for Disease Control & Prevention (CDC).