WIN October 2019

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Tuberculosis in pregnancy TB in pregnancy is rare in western Europe but as certain patient groups remain vulnerable to it, midwives should recognise the signs NOW AVAILABLE AT https://inmoprofessional.ie Untitled-2 1 10/05/2018 16:45:46

Tuberculosis (TB) continues to be a major health concern around the world. Pregnant women face higher risks of developing TB than the general population because of changes in the immune system during pregnancy, mainly due to T-cell sup- pression and reduced interferon-gamma production. While TB is slowly decreasing in eastern Europe, certain groups (such as those from countries with high rates of TB) remain vulnerable and require better access to prevention measures. This module has been developed to support midwives and their teams in the important role they play in preventing TB. The information is particularly relevant to anyone who is working in an area where there are above average rates of TB. This will usually be in an urban area but TB can occur anywhere with anyone. Learning outcomes On completion of this i-learn module (Study time: 40 minutes) you will: • Be aware of the risks to mother and baby associated with TB in pregnancy and childbirth • Understand your role in the prevention ofTB • Understand key clinical aspects of TB and LTBI relevant to your practice • Be able to identify someone at risk and take appropriate action to prevent TB • Be able to recommend LTBI testing to eli- gible women, organise the test and give them their results • Recognise someone who may be suffering with active TB and ensure the appropriate referral is made. Why are midwives and support workers so important? Midwives and support workers are impor- tant in identifying TB as they are the most likely point of contact that women of childbearing age have with health ser- vices. As such there are a variety of things midwives can integrate into their routine antenatal care. These will be covered in detail as this module progresses. TB is a worrying and often stigmatising disease and midwives and support workers

Think TB! Delay in starting treatment can lead to complications for mother and baby

Losing weight

Unwell

Tired

Fever

Not gaining weight

Delayed foetal growth

Losing weight

Poor appetite

Swollen lymph glands

High risk group

Night sweats

• HIV (HIV/TB co-infection greatly increases the risk of maternal and foetal morbidity and mortality). Very rarely a woman with miliary (wide- spread) TB may give birth to a baby with congenital TB. Hopefully, the woman would already be on treatment and the baby would be started on treatment immediately after birth. If the woman’s condition is not known and she is not on treatment the prognosis would be very poor for both the woman and the baby. Miliary TB is a very serious condition which affects the whole body and symptoms usu- ally include cough, fever, night sweats and weight loss. Course content includes • Why are midwives and support workers so important • What is tuberculosis? • TB worldwide and in the UK • The risks • Treatment of active TB • Prevention of TB in families along the antenatal care pathway • What you can do • Integrating TB care and prevention into an antenatal care pathway. RCM i-learn access for INMO midwife members If you are interested in completing the module, visit www.ilearn.rcm.org.uk Free access is available to all midwife members of the INMO. www.inmoprofessional.ie/RCMAccess

are best placed to offer reassurance to women in their care. Antenatal care is an excellent opportunity for TB screening. This is especially true for women who have limited access to health services such as migrants, who may only approach medical services when pregnant. TB in pregnancy Active TB in pregnancy can result in an increased risk of maternal morbidity, such as anaemia and potentially impacts on foetal health including preterm birth, low birth weight, foetal distress and perinatal death. Outcomes appear to be worse when antituberculous treatment (ATT) is started late. In other words pregnant women with active TB have better outcomes when treat- ment is initiated in the first trimester in comparison to second and third trimester. Diagnosis of TB is more difficult as symptoms might be masked by pregnancy. Weight loss may go unnoticed as it can be offset by pregnancy weight gain. Delayed foetal growth and a woman with a poor appetite may be suggestive of active TB. TB is also often identified in groups who may experience other challenges during pregnancy due to, for example: • Poor access to healthcare • Poor nutrition • Poverty • Late presentation, such as either late booking for midwifery services or delayed recognition of symptoms

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