关键词:

妊娠, 结核, 妊娠结局, 重症, 试管婴儿

Abstract:

Objective To investigate the deficient diagnosis and treatment of pregnant patients with tuber⁃ culosis and the clinical characteristics of high⁃risk patients so as to provide references for early screening and whole pregnancy management of the patients. Methods The clinical data and case characteristics of 112 pregnant wom⁃ en with tuberculosis treated in the eight hospital of Guangzhou Medical University from January 1，2011 to Decem⁃ ber 31，2019 were retrospectively analysed. The patients with intrauterine pregnancy were divided into natural con⁃ ception group and post⁃IVF⁃ET group. The two groups were compared in terms of the severe disease rate，pregnancy outcome，prognosis and follow⁃up. The categories of severe high⁃risk groups were identified. Results The main onset symptoms were nonspecific，and the median time from onset to diagnosis was 30 days. All the cases with early pregnancy continued，a total of 12 cases（20.0%）of second trimester pregnancy went on to the third trimester. Hematogenous disseminated pulmonary tuberculosis was the main cause of premature birth，and low birth weight infants accounted for 46%（14/30）. Severe cases accounted for 14%（16/112），mainly with hematogenous dissemi⁃ nated pulmonary tuberculosis and/or tuberculous meningitis. There were 4 cases of death and 6 cases with neurologi⁃ cal sequelae. The incidence of hematogenous disseminated pulmonary tuberculosis and tuberculous meningitis in the post⁃IVF⁃ET group was 94.1%（16/17），which was significantly higher than that in the natural conception group. The childless rate of the post⁃IVF⁃ET patients was 50% after 2 to 9 years follow⁃up（all P < 0.05）. Conclusion Pregnancy complicated with tuberculosis is concealed and easily misdiagnosed. Patients with immunosuppressive or immune disorders are prone to severe cases. Screening for latent tuberculosis and tuberculosis should be carried out before in vitro fertilization and embryo transfer. We should strengthen the informed consent about tuberculosis in the early and middle stages of pregnancy，and make use of molecular biological diagnostic techniques for early diag⁃ nosis so that the pregnant women with tuberculosis as well as their infants can both get a good outcome.

Key words:

pregnancy, tuberculosis, pregnancy outcome, severe case, IVF?ET