关键词: 受精, 体外, 胚胎移植, 结核, 妊娠, 治疗结果

Abstract: Objective To analyze the clinical characteristics of pregnant women complicated with tuberculosis after in vitro fertilization-embryo transfer (IVF-ET). Methods Clinical data, including the clinical manifestation, medical information, laboratory examinations, imaging features, clinical diagnosis, treatment outcome and fetal outcome, of 21 pregnant women complicated with tuberculosis after IVF-ET admitted to the Tuberculosis Department of Hangzhou Chest Hospital, Zhejiang University School of Medicine from January 2013 to December 2020 were retrospectively analyzed. Results Among the 21 patients, 8 were in early pregnancy and 13 were in second trimester, with an average age of (29.57±4.20) years old (ranged from 23 to 42 years old). The most common clinical symptoms were fever (95.2%, 20/21), cough (85.7%, 18/21) and vaginal bleeding (71.4%, 15/21). Patient delay was found in all the 21 patients, the longest delay was 90 days, and the misdiagnosis rate of the first diagnosis was 100.0%, the average diagnosis time was 21 days (ranged from 15 to 30 days). T-SPOT.TB in peripheral blood was positive in 18 patients, sputum/cerebrospinal fluid GeneXpert MTB/RIF was positive in 4 patients; 20 patients had anemia, and 21 patients had hypoproteinemia. Chest CT scan mainly showed miliary nodules in both lungs in 18 cases. Eighteen patients were diagnosed with hematogenous disseminated tuberculosis, of whom two were complicated with tuberculous meningitis, one was complicated with tuberculous peritonitis; one was diagnosed as subacute disseminated tuberculosis; one was diagnosed with tuberculous meningitis; one was diagnosed with tuberculous pleurisy. During the treatment, six patients were transferred to ICU, four were due to respiratory failure, one was due to electrolyte disorder, and one was due to unconsciousness. Threatened abortion, inevitable abortion or incomplete abortion occurred in 9 cases 9-20 weeks after onset; 11 cases underwent induced abortion to terminate pregnancy, including one coma patient; one patient asked for fetal protection and was lost to follow-up. All the 21 patients underwent anti-tuberculosis treatment, 19 were cured after being discharged from hospital, one was still in anti-tuberculosis treatment, and one was in coma due to tuberculous meningitis. Conclusion Hematological disseminated tuberculosis and extra-pulmonary tuberculosis were commonly occurred in pregnant patients with tuberculosis after IVF-ET, and the conditions were always serious. When fever, cough, vaginal bleeding, headache occurred, and the anti-infective treatment effect was not good, tuberculosis related examinations should be carried out in time for pregnant patients.

Key words: Fertilization in vitro, Embryo transfer, Tuberculosis, Pregnancy, Treatment outcome