Department of Obstetrics & Gynecology
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Protocols

 

Subject:      Tuberculosis         

 
Screening /Diagnosis:
 
All patients should be considered for tuberculosis screening on the initial visit.  At increased risk are the following patients:
 
1.       Signs and symptoms suggestive of TB
2.       Close contact with persons known or suspected to have TB
3.       Alcoholics and IV drug users
4.       Persons infected with the HIV virus
5.       Foreign-born from countries with high TB prevalence that have been in the United States less than 5 years 
6.       Medically under served populations, including high risk racial/ethic minority
populations.
7.       Medical risk factors ie renal treatment, gastrectomy, HIV
8.       Health care workers 
 
 
Recommendations:
 
DO NOT test women who have a history of a positive TB test or active TB (See North Carolina TB control PPD Procedure)
 
If the woman is tested and has a positive reaction to the PPD, or a history of positive PPD or history of active TB, the following management is recommended:
 
1.  Shielded chest X-ray
 
  • If chest x-ray is negative and timing of conversion is remote or unknown, the patient will be referred to the TB clinic after delivery.
 
  • If chest x-ray is negative and the patient has a known conversion in the last two years, please refer to Duke High Risk for consideration of INH/Vitamin B6 prophylaxis or refer to the local communicable disease program.
 
  • If chest x-ray is positive, refer to HD TB Clinic for multi-agent treatment.
 
Prepared in conjunction with the
Division of Maternal-Fetal Medicine
Duke University Medical Center
 
 
____________________________
Director
 
____________________________
Date
1/16/07
 
 
 
 
 
 
References
 
Tuberculosis
 
 
 
  1. Samuels P.  Pulmonary Disease in:  Obstetrics, Normal and problem pregnancies.  Gabbe SC, Niebyl JR, Simpson JL, eds, 1996.  Pages 1013-1014.
 
  1. ACOG Technical Bulletin:  Pulmonary disease in pregnancy.  Number 224, June 1996.
 
  1. CDC Fact Sheet.  Tuberculosis and Pregnancy, Last updated May 3, 2000.
 
 
 
The Clinical Care Guidelines Development Committee of the Perinatal Improvement Board of Duke University Health System has developed a series of multi-disciplinary protocols to offer guidance to health care providers who are caring for pregnant women with high risk conditions.
 
These protocols are designed to assist health care providers in the management of a variety of problems that occur in pregnancy and the time of delivery. They should not be interpreted as standard of care, but instead represent only general guidelines for the care of pregnant women with high risk conditions.  We recognize that services offered by individual providers depend not only on their training, experience and institutional resources, but on the medical facts and circumstances of the specific care situation.
The protocols remain the intellectual property of the Duke University Health System.  They cannot be reproduced in whole or part without the expressed permission of the Health System.
 
These protocols are reviewed by the Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, the Department of Pediatrics Division of Neonatology and the Department of Anesthesiology Division of Women’s Anesthesia.  Please contact Andra H. James (andra.james@duke.edu), Chair, Clinical Care Guidelines Development Committee of the Perinatal Improvement Board with ideas for additional protocols.
 
 
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