Embryonic Transfer Post-Vaginal Bleeding: Analysis of the Necessity of Tuberculosis Screening

Embryonic Transfer Post-Vaginal Bleeding: Analysis of the Necessity of Tuberculosis Screening | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Embryonic Transfer Post-Vaginal Bleeding: Analysis of the Necessity of Tuberculosis Screening Liu Kexin, Gao Weina, Zhao Xianlan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5389552/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To analyze the clinical manifestations and outcomes of 10 cases of post-transplant tuberculosis and to explore the necessity of screening for tuberculosis in patients with vaginal bleeding after in-vitro fertilization-embryo transfer (IVF-ET). Methods: A retrospective analysis was conducted on 10 clinical cases of active tuberculosis during pregnancy following IVF-ET treated at the First Affiliated Hospital of Zhengzhou University from January 2018 to October 2024. The relationship between vaginal bleeding and active tuberculosis was assessed, and the potential value of tuberculosis screening in such patients was discussed. Results: (1) General situation: Among the 10 pregnant patients with confirmed active tuberculosis after IVF-ET, 3 had a history of tuberculosis before pregnancy (3/10), 6 were diagnosed with tuberculosis for the first time during pregnancy (6/10), and 1 was diagnosed with tuberculosis after termination of pregnancy (1/10); all but one were primiparous (9/10). (2) Clinical symptoms: Among the 10 patients, fever of varying degrees was the main symptom in 9 cases (9/10), accompanied by vaginal bleeding in 8 cases (8/10), with the lung being the main affected organ, and the most common types of pulmonary tuberculosis were acute miliary pulmonary tuberculosis and hematogenous disseminated pulmonary tuberculosis. (3) Maternal and fetal outcomes: It took about 2 weeks from the onset of tuberculosis to diagnosis, and only 4 patients (4/10) had viable fetuses; all live birth cases were terminated by cesarean section, with 1 term live birth and 3 newborns born prematurely and transferred to the neonatal department. Conclusion: Pregnancy outcomes in active tuberculosis after embryo transfer are poor. Screening for tuberculosis in patients with vaginal bleeding after IVF-ET is necessary to some extent. Clinically, it is necessary to be vigilant about the possibility of tuberculosis onset in patients after IVF-ET who are preventing miscarriage. Early diagnosis and regular anti-tuberculosis treatment can improve clinical prognosis. In-vitro fertilization-embryo transfer Tuberculosis Pregnancy Vaginal bleeding Introduction In 2023, the World Health Organization (WHO) noted that China remains one of the countries with a high incidence of tuberculosis [1]. An estimated 748,000 new cases of tuberculosis were reported in China in 2022, ranking it third globally and accounting for 7.1% of the world's total cases, causing significant harm to public health. Most new cases of tuberculosis develop from latent tuberculosis. During pregnancy, the immune system is weakened, and the influence of high levels of estrogen and progesterone [2] further increases the risk of active tuberculosis during pregnancy, complicating the situation. Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, which can affect various organs throughout the body. Genital tuberculosis can lead to female infertility. The most common form of genital tuberculosis is tubal tuberculosis, where the fallopian tubes lose their transport function due to blockage or adhesion to surrounding tissues, leading to infertility. With the advancement of assisted reproductive technologies, in-vitro fertilization-embryo transfer (IVF-ET) has been widely used in the treatment of infertility. Some scholars [3] who have compiled relevant data have found that patients who become pregnant through IVF-ET and develop active tuberculosis during pregnancy often have poor pregnancy outcomes, with only 12.6% successfully delivering, and the maternal mortality rate remains as high as 4.0% even after anti-tuberculosis treatment. The diagnosis of active tuberculosis in pregnancy can be quite complex in clinical practice, as the symptoms are sometimes atypical. According to existing preconception and prenatal care guidelines [4], tuberculosis screening is not a mandatory item for all pregnant women. For pregnant women who are not classified as target populations or high-risk pregnant women, when tuberculosis screening is not conducted before or during pregnancy, symptoms that appear during pregnancy become an important indicator for tuberculosis screening. Common symptoms of tuberculosis include persistent cough, sputum production or hemoptysis, fever, night sweats, and loss of appetite. During pregnancy, especially when symptoms are in the early stages or atypical, it is easy to confuse these symptoms with physiological changes during pregnancy, leading to delayed diagnosis [5]. Therefore, for pregnant women presenting with the above symptoms, tuberculosis screening and diagnosis should also distinguish between physiological changes related to pregnancy and consider the potential adverse effects of tuberculosis on the mother and fetus, such as anemia, miscarriage, preterm birth, and low birth weight, which differ significantly from the screening and diagnosis in non-pregnant patients. Vaginal bleeding is one of the common symptoms of threatened abortion. When encountering patients with vaginal bleeding as the main symptom, after excluding ectopic pregnancy, cervical polyps, placenta previa, and other causes through initial assessment, the possibility of threatened abortion should be considered first by the physician. The treatment for threatened abortion usually includes rest, avoiding sexual intercourse and strenuous exercise, and considering whether progesterone supplementation is needed based on progesterone levels. In some cases, antibiotics may be needed to prevent infection, as well as tocolytic agents to reduce uterine contractions, thereby reducing the risk of miscarriage [6]. In obstetric fetal preservation treatment, the use of antibiotics is for the purpose of preventing infection, not targeting Mycobacterium tuberculosis. The treatment of Mycobacterium tuberculosis infection requires specific anti-tuberculosis drugs, such as isoniazid, rifampin, pyrazinamide, ethambutol, which are not within the scope of routine fetal preservation treatment drugs. Therefore, the fetal preservation effect is often poor in active tuberculosis during pregnancy with vaginal bleeding as the main manifestation. According to data published by Siyuan Dong in Front Cell Infect Microbiol [7], the symptom of vaginal bleeding appears more frequently in patients with active tuberculosis after IVF-ET than in normal pregnant women. Combined with other studies [8], the symptom of vaginal bleeding may occur even earlier than fever and cough. Therefore, this article analyzes the clinical data of 10 cases of patients with active tuberculosis after IVF-ET in our hospital over the past six years, discussing the necessity of tuberculosis screening in patients with vaginal bleeding after IVF-ET, in order to provide a basis for clinical diagnosis and treatment. Materials and Methods 1. Study Subjects A retrospective analysis was conducted on the clinical data of 10 patients with active tuberculosis complicating pregnancy after IVF-ET who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to October 2024. The initial screening criteria included patients diagnosed with active tuberculosis complicating pregnancy at our hospital from October 2014 to October 2024, totaling 41 cases, of which 25 were naturally conceived, and 16 were post-embryo transfer patients. Due to the loss of patient records before 2018, the final analysis included 10 cases of patients who underwent IVF-ET and developed active tuberculosis complicating pregnancy at our hospital from January 2018 to October 2024.The inclusion criteria were: (1) The main clinical data are complete; (2) Clinical symptoms consistent with tuberculosis, such as fever, cough, and weight loss, appeared after IVF-ET, and active tuberculosis was confirmed through necessary examinations. The exclusion criteria were: (1) Pregnant women who became pregnant naturally instead of through IVF-ET; (2) Pregnant women with evidence of tuberculosis infection but without clinical symptoms and signs of active tuberculosis; (3) Pregnant women with other severe systemic diseases. This study was approved by the Medical Ethics Committee of The First Affiliated Hospital of Zhengzhou University (approval number: 2024-KY-1535). 2. Data Collection Data were obtained from the patients' medical records and follow-up telephone calls. Information was collected on three aspects: general data of the patients, clinical characteristics, and treatment and pregnancy outcomes. Results 1. General Data Among the 10 patients, 7 cases (7/10) were infertile due to fallopian tube obstruction, 1 case had primary infertility with patent fallopian tube tests, 1 case had an unknown cause, and 1 case was due to bilateral fallopian tube ligation. The majority of patients had two gestational sacs transferred (8/10), and most of the transferred embryos were blastocysts (7/10). Tuberculosis was detected pre-pregnancy in 3 patients, discovered due to active tuberculosis during pregnancy in 6 patients, and identified retrospectively after pregnancy termination in 1 patient. There were 6 singleton pregnancies and 4 twin pregnancies. The most common complications were anemia (3/10) and liver damage (2/10). See Table 1. 2. Clinical Characteristics Out of the 10 patients, 9 exhibited fever, and 8 had vaginal bleeding. Other symptoms included lower abdominal pain (2/10), headache (2/10), and dry cough (2/10). The primary organs involved in the symptoms of all 10 patients were the lungs, with others being the liver (1/10) and brain (1/10). The T-SPOT test, also known as the gamma-interferon release assay, has high sensitivity and specificity in diagnosing active tuberculosis and latent tuberculosis infection. Among the 10 patients, 7 underwent T-SPOT testing, and all results were positive. Some patients did not have a chest Computed Tomography (CT) during pregnancy due to fetal concerns, and some records were unavailable due to transfer to other hospitals for treatment and loss to follow-up, see Table 2. 3. Treatment and Pregnancy Outcomes Out of the 10 patients, excluding 2 cases with unclear tuberculosis diagnosis, 4 patients had hematogenous disseminated pulmonary tuberculosis, and 4 patients had acute miliary pulmonary tuberculosis. The interval from onset to the confirmation of active tuberculosis ranged from 1 to 5 weeks, mostly around 2 weeks. Among the 10 patients, 4 patients received anti-tuberculosis treatment during pregnancy until they gave birth alive, all by cesarean section; 3 cases were preterm births and were transferred to the neonatal department. Follow-up denied congenital tuberculosis in the newborns. All 4 patients above received anti-tuberculosis treatment from pregnancy until after childbirth. Six patients terminated their pregnancies before 20 weeks of gestation due to tuberculosis condition (2/10) and failure of fetal preservation (4/10), and all received anti-tuberculosis treatment after childbirth. See Table 3. Table 1: General Information of 10 Pregnant Women with Active Tuberculosis Complications after IVF-ET ID Age Reason for IVF-ET Number of Blastocysts Transferred Type of Embryo Gravidity-Parity-Abortion Time of Tuberculosis Diagnosis Number of Fetuses Other Complications 1 37 Bilateral fallopian tube obstruction 2 Blastocyst G2P0A1 1 During pregnancy 1 Hypothyroidism, placenta accreta, moderate anemia 2 35 Unknown 1 Blastocyst G1P0A0 During pregnancy 1 Liver damage, low-lying placenta 3 27 Bilateral fallopian tube obstruction 2 Fresh embryo G1P0A0 After pregnancy 1 None 4 27 Bilateral fallopian tube obstruction 1 Blastocyst G1P0A0 Before pregnancy 1 None 5 28 Right fallopian tube blockage, pelvic adhesion 2 Fresh embryo G1P0A0 During pregnancy 2 None 6 27 Bilateral fallopian tube obstruction 2 Blastocyst G1P0A0 Before pregnancy 2 One intrauterine fetal death in twins 7 34 Unprotected for 10 years without pregnancy 2 Blastocyst G1P0A0 During pregnancy 2 Bilateral ureteral stent placement post-surgery 8 32 Bilateral fallopian tube obstruction 2 Fresh embryo G1P0A0 Before pregnancy 2 Mild anemia, liver damage 9 34 Right fallopian tube blockage, advanced maternal age 2 Blastocyst G1P0A0 During pregnancy 1 Mild anemia 10 41 Bilateral tubal ligation 2 Blastocyst G4P1A2 During pregnancy 1 Methicillin-resistant Staphylococcus aureus infection 1,GxPxAy indicates the number of gravidity (G), parity (P), and abortion (A). For example, G2P0A1 means the patient has been pregnant twice, has not delivered any liveborn child, and has had one abortion. Table 2: Clinical Manifestations of 10 Pregnant Women with Active Tuberculosis Complications after IVF-ET ID Fever Vaginal Bleeding Other Symptoms Main Organs Involved Laboratory Tests Chest CT 2 1 Yes No None Lung Negative Scattered nodules in both lungs 2 Yes Yes Sore throat, headache, palpitations, discomfort in both lower limbs Lung, Liver T-SPOT 1 positive Infectious lesions in both lungs, possible tuberculosis? Calcified nodule in the middle lobe of the right lung. Minimal pleural effusion on the right; local calcification of the left pleura. 3 Yes Yes Lower abdominal pain Lung T-SPOT positive Multiple miliary nodules in both lungs 4 Yes Yes Lower abdominal pain Lung T-SPOT positive Diffuse lung lesions, calcified nodules in the upper lobe of the left lung and the lower lobe of the right lung 5 Yes Yes Dry cough Lung T-SPOT positive Diffuse miliary tuberculosis in both lungs. Calcified subpleural nodule in the right lung 6 Yes Yes None Lung T-SPOT positive Not provided 7 Yes No Headache Lung, Brain Cerebrospinal fluid culture positive for Mycobacterium tuberculosis Not provided 8 Yes Yes None Lung Unknown Unknown 9 No Yes Dry cough Lung T-SPOT positive Miliary high-density lesions in both lungs, slightly enlarged hilar shadows, slightly enlarged lymph nodes in the right cardiophrenic angle and mediastinum, slightly thickened main pulmonary artery, thickened pleura on both sides 10 Yes Yes None Lung T-SPOT Positive Diffuse miliary nodules in both lungs, considering the possibility of infection, tuberculosis? Slight inflammation under both lung pleura. A small amount of pleural effusion on the right side 1,T-SPOT refers to the T-SPOT.TB test, which is a blood test used to detect latent tuberculosis infection by measuring the immune response to specific tuberculosis antigens. A positive result indicates exposure to the bacteria that cause tuberculosis. 2,The "Chest CT" column describes the findings from the computed tomography scans of the patients' chests, which are often used to diagnose and assess the extent of tuberculosis involvement in the lungs. Table 3: Treatment and Outcomes of 10 Pregnant Women with Active Tuberculosis Complications after IVF-ET ID Tuberculosis Diagnosis Anti-tuberculosis treatment Onset Time, Weeks Diagnosis Time, Weeks Termination Time, Weeks Reason for Termination Method of Termination Outcome 1 Hematogenous disseminated pulmonary tuberculosis From week 18 of pregnancy to postpartum 18 / 28 Premature rupture of membranes Cesarean section Live birth, newborn transferred for treatment 2 Hematogenous disseminated pulmonary tuberculosis After induced labor 11 13 14 Tuberculosis condition and liver damage Unknown / 3 Acute miliary pulmonary tuberculosis After induced labor 10 13 13 Premature rupture of membranes Dilation and curettage after failed medical induction / 4 Acute miliary pulmonary tuberculosis After induced labor 10 14 19 Premature rupture of membranes Induction of labor / 5 Acute miliary pulmonary tuberculosis After induced labor 9 11 12 Recurrent bleeding Spontaneous abortion followed by dilation and curettage / 6 Hematogenous disseminated pulmonary tuberculosis Before pregnancy and after induced labor 10 11 12 Tuberculosis condition Dilation and curettage / 7 Unknown From week 23 of pregnancy to postpartum 23 / 32 Preterm labor Cesarean section Live birth, newborn transferred for treatment 8 Unknown After induced labor 11 15 16 Recurrent bleeding Spontaneous abortion / 9 Acute miliary pulmonary tuberculosis From week 24 of pregnancy to postpartum 16 18 38 Low amniotic fluid Cesarean section Live birth 10 Hematogenous disseminated pulmonary tuberculosis From week 21 of pregnancy to postpartum 15 20 27 Premature rupture of membranes Cesarean section Live birth, newborn transferred for treatment Discussion Impact of Active Tuberculosis on Pregnancy Outcomes Active tuberculosis significantly worsens perinatal outcomes for both mother and child compared to pregnancies without active tuberculosis. The risks of adverse outcomes are often heightened by delayed diagnosis and inadequate treatment. Studies indicate that active tuberculosis during pregnancy can triple the risk of anemia, double the risk of cesarean section, increase the risk of miscarriage by nine times, quadruple the risk of perinatal death, and increase the risks of prematurity and acute fetal distress by 1.6 and 2.3 times, respectively, as well as raise the risk of low birth weight by 1.7 times [9]. There is evidence that infertile patients undergoing IVF-ET are prone to active tuberculosis and congenital tuberculosis in infants [10]. Wei's research [11] shows that post-IVF-ET patients with extensive pulmonary tuberculosis have more severe systemic symptoms and poorer outcomes than those who conceive naturally. In this study, out of 10 patients, only 4 had live births, and 3 of these live-born infants were transferred to another department for treatment due to prematurity. Three patients had a history of tuberculosis, and seven patients were infertile due to fallopian tube obstruction, with the possibility that symptomatically hidden genital tuberculosis may have contributed to the obstruction not being ruled out. Diagnosis Challenges and Treatment Principles The most common symptom of tuberculosis is coughing, accompanied by fatigue, low-grade fever, and night sweats. Diagnostic tests such as the T-SPOT test and chest CT are crucial for detecting tuberculosis, with the identification of Mycobacterium tuberculosis in sputum or lesions being confirmatory. In pregnant patients with active tuberculosis, the main clinical manifestations are fever and vaginal bleeding, which may be accompanied by abdominal pain, headache, and dry cough, and can exist without typical symptoms of tuberculosis toxicity. The atypical nature of symptoms and the delay in diagnostic tests like chest CT often lead to late diagnosis. In this study, it took approximately two weeks from the onset of tuberculosis to the confirmation of active tuberculosis. When patients have recurrent, difficult-to-treat vaginal bleeding after embryo transfer, accompanied by fever, cough, headache, and other symptoms, the possibility of tuberculosis should be considered, especially in those with a history of old tuberculosis. The lungs remain the most severely affected organ during pregnancy in tuberculosis cases. Acute miliary pulmonary tuberculosis and hematogenous disseminated pulmonary tuberculosis are common types of active pulmonary tuberculosis during pregnancy, which do not respond well to general antibiotic treatment, leading to frequent hospitalizations for fetal preservation. The treatment of tuberculosis should follow the principles of early, regular, full-course, appropriate dosage, and combined medication [2], typically divided into an intensive phase (2 months of isoniazid, rifampicin, and pyrazinamide) and a consolidation phase (4 months of isoniazid and rifampicin), known as the 2HRZ/4HR regimen. Due to drug resistance, physiological changes during pregnancy, and potential fetal harm, treatment plans during pregnancy are more complex. Ethambutol is a category B drug during pregnancy, while isoniazid, rifampicin, and pyrazinamide are category C drugs but remain first-line anti-tuberculosis medications. Close monitoring of maternal health and fetal development is required during treatment. In our study, the time from symptom onset to pregnancy termination was about 3 weeks (5 out of 10 cases), with the longest fetal preservation time being 22 weeks. Screening and Early Detection Tuberculosis is a major threat to global and public health, being the leading cause of death from a single infectious agent [12]. Many tuberculosis patients do not exhibit typical symptoms, making early case detection challenging. In the special population of pregnant women, tuberculosis symptoms can be even more atypical, leading to delayed diagnosis. Tuberculosis poses a threat not only to the health of pregnant women but may also adversely affect fetal development [2]. Early detection and treatment of tuberculosis are crucial for improving maternal and infant health outcomes. Due to the severe conditions caused by tuberculosis after embryo transfer surgery, some scholars recommend tuberculosis screening before IVF-ET [11]. Screening for tuberculosis in patients with post-embryo transfer vaginal bleeding can lead to early detection and treatment, reducing the risk of tuberculosis transmission and improving the prognosis for pregnant women and fetuses. Current tuberculosis screening is based on high-incidence areas or high-risk groups such as those infected with HIV [13], which is more cost-effective. For patients with vaginal bleeding after IVF-ET, especially those with recurrent, difficult-to-treat vaginal bleeding accompanied by fever, cough, and headache, tuberculosis screening is necessary. This not only aids in early diagnosis and timely treatment but also reduces transmission and improves maternal and fetal outcomes. From a cost-benefit perspective, such screening is also reasonable and economical. Analysis of the Vaginal Bleeding Symptoms in Active Tuberculosis In our study of 10 patients, 17 weeks of pregnancy could be considered an obvious dividing line for vaginal bleeding symptoms, with all patients experiencing bleeding before 17 weeks and none after. The earliest occurrence of vaginal bleeding was in the 9th week of pregnancy. Due to the limited number of cases, we reviewed relevant literature and found that most case reports lack records of vaginal bleeding symptoms or their timing. In Yu's study [8], 4 out of 7 patients had vaginal bleeding, with symptoms recorded at days 102, 20, 50, and 65 post-embryo implantation. In another study [14], 5 out of 7 patients had vaginal bleeding, with timings ranging from 7 to 17 weeks of pregnancy. This indicates that pregnant women with active tuberculosis are more likely to experience vaginal bleeding symptoms within the first four months of pregnancy. The process of embryo implantation involves the late blastocyst implanting into the endometrium through orientation, adhesion, and invasion. During invasion, the trophoblast cells of the embryo penetrate the endometrium, the upper third of the myometrium, and blood vessels [15], causing minor, light red or brown vaginal bleeding in pregnant women between 10 to 14 days post-fertilization, known as implantation bleeding, which generally does not require special treatment. Before the fertilized egg implants, the endometrium thickens under hormonal influence, and after implantation, it begins to transform into the decidual membrane, with the formation of small blood vessels [15]. The main changes in the uterus during the first four months of pregnancy include embryo growth and differentiation, as well as ongoing tissue restructuring of the endometrium, leading to more decidual tissue, a process influenced by embryonic development, hormones, immune regulation, and various external factors [16]. After IVF-ET, significant changes in the endocrine environment and immune function of pregnant women, coupled with the impact of surgical operations, can lead to the reactivation of latent tuberculosis, and even acute hematogenous disseminated pulmonary tuberculosis [17]. The activity of Mycobacterium tuberculosis may lead to immune imbalance, inflammatory damage, and endocrine changes [18], affecting the formation of decidual tissue and causing vaginal bleeding. The rupture of decidual vessels in early pregnancy may also be one of the causes of vaginal bleeding in active tuberculosis, with the spread of Mycobacterium tuberculosis potentially causing genital tuberculosis lesions and damaging decidual and small blood vessels to varying degrees [19], leading to vascular inflammation and injury, and subsequently vaginal bleeding. In addition, fever or other symptoms caused by active tuberculosis may induce stress responses in the uterus [20], such as uterine contractions, leading to bleeding symptoms. While there is a preliminary understanding of the pathological mechanisms behind vaginal bleeding in tuberculosis patients, further research is needed to explore the complex mechanisms behind this phenomenon to provide more accurate diagnostic and treatment strategies for clinical fetal preservation. Conclusion Pregnancies complicated by active tuberculosis after IVF-ET have poor outcomes. Clinically, in patients experiencing vaginal bleeding after IVF-ET, especially when accompanied by symptoms such as fever and cough, and when conventional fetal preservation measures are ineffective, it is necessary to conduct tuberculosis screening to be vigilant for the possibility of active tuberculosis. Early diagnosis and regular anti-tuberculosis treatment can improve clinical prognosis. Abbreviations WHO: World Health Organization IVF-ET: In Vitro Fertilization-Embryo Transfer CT: Computed Tomography Declarations Ethics approval and consent to participate This study was approved by the Medical Ethics Committee of The First Affiliated Hospital of Zhengzhou University (approval number: 2024-KY-1535). Consent for publication N/A Availability of data and materials The datasets used or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding National Science Fund for Distinguished Young Scholars (Approval Number: 82004140) Authors' contributions Conception and design of the research: GWN,ZXL. Acquisition of data: LKX. Analysis and interpretation of the data: LKX,GWN. Statistical analysis: LKX,GWN. Obtaining financing: None. Writing of the manuscript: LKX,GWN. Critical revision of the manuscript for intellectual content: ZXL, GWN. All authors read and approved the final manuscript. Acknowledgements N/A References World Health Organization. Global tuberculosis report 2023 [EB/OL]. (2023-10-16) [Accessed 2024-11-04]. https://www.who.int/publications/i/item/globaltuberculosis-report-2023. HUANG C. Progress in diagnosis and treatment of tuberculosis in pregnancy [J]. China Modern Medicine, 2022, 29(02): 33-37. CHEN Y, CHU YF, ZHANG B, YUE J. Clinical pregnancy outcome of 9 patients complicated with tuberculosis after IVF-ET and literature review [J]. Journal of Reproductive Medicine, 2022, 31(07): 891-898. Obstetrics Group of the Obstetrics and Gynecology Branch of the Chinese Medical Association. Guidelines for preconception and prenatal care (2018) [J]. Chinese Journal of Perinatal Medicine, 2018, 53(1): 7-13. DOI: 10.3760/cma.j.issn.0529-567x.2018.01.003. Miele K, Bamrah-Morris S, Tepper NK. Tuberculosis in Pregnancy. Obstet Gynecol. 2020;135(6):1444-1453. doi: 10.1097/AOG.0000000000003890. Chen J. 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DOI: 10.3760/cma.j.issn.0529-567x.2018.01.003. Adefuye MA, Manjunatha N, Ganduri V, Rajasekaran K, Duraiyarasan S, Adefuye BO. Tuberculosis and Cardiovascular Complications: An Overview. Cureus. 2022 Aug 22;14(8):e28268. doi: 10.7759/cureus.28268. Goetzl L. Maternal fever in labor: etiologies, consequences, and clinical management. Am J Obstet Gynecol. 2023 May;228(5S):S1274-S1282. doi: 10.1016/j.ajog.2022.11.002. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5389552","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":377473267,"identity":"3e776c5a-e9d3-4dcb-b3f7-50c86087890e","order_by":0,"name":"Liu Kexin","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"Liu","middleName":"","lastName":"Kexin","suffix":""},{"id":377473268,"identity":"2a0b13dd-2db0-4301-8985-f826607d495c","order_by":1,"name":"Gao Weina","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"Gao","middleName":"","lastName":"Weina","suffix":""},{"id":377473269,"identity":"acb69018-e528-4565-b09e-435a45c5934c","order_by":2,"name":"Zhao Xianlan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIie3QsW7CMBCA4UOurotJ1qtUha2zEVLUx7GVNZWYkAcEkVKFAUV9A3gFpqojWdzFZWYE9QVggw3vIJxuHfzN9+vOBgiCfwjjstkfNCX4WDY7qcf+JCKTDci+DiJuMrGzxp8kkL9Qt9JqQXn6tH9nLQ4DC0SWOhXkqVYFQjyby/sJq9diqIkhmNFWfT0D2Z+VZ8tGSrcFsVN+bpVFEPTmS3Kx7lbEkUE6VBVrlfQLl7g1Dym0S9wnM3eYQI4ZSWu49y29j/L7fNCT6XL52xxPepzEs/p+coX/bTwIgiC46QK+DUabnVw0oAAAAABJRU5ErkJggg==","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":true,"prefix":"","firstName":"Zhao","middleName":"","lastName":"Xianlan","suffix":""}],"badges":[],"createdAt":"2024-11-04 16:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5389552/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5389552/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101710642,"identity":"c2498a52-4613-4e38-af3a-ee9bcc8bfa93","added_by":"auto","created_at":"2026-02-02 21:39:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":857453,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5389552/v1/3e55db16-8c6a-4cf3-afb1-9b5a6a776d9a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Embryonic Transfer Post-Vaginal Bleeding: Analysis of the Necessity of Tuberculosis Screening","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn 2023, the World Health Organization (WHO) noted that China remains one of the countries with a high incidence of tuberculosis [1]. An estimated 748,000 new cases of tuberculosis were reported in China in 2022, ranking it third globally and accounting for 7.1% of the world\u0026apos;s total cases, causing significant harm to public health. Most new cases of tuberculosis develop from latent tuberculosis. During pregnancy, the immune system is weakened, and the influence of high levels of estrogen and progesterone [2] further increases the risk of active tuberculosis during pregnancy, complicating the situation. Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, which can affect various organs throughout the body. Genital tuberculosis can lead to female infertility. The most common form of genital tuberculosis is tubal tuberculosis, where the fallopian tubes lose their transport function due to blockage or adhesion to surrounding tissues, leading to infertility. With the advancement of assisted reproductive technologies, in-vitro fertilization-embryo transfer (IVF-ET) has been widely used in the treatment of infertility. Some scholars [3] who have compiled relevant data have found that patients who become pregnant through IVF-ET and develop active tuberculosis during pregnancy often have poor pregnancy outcomes, with only 12.6% successfully delivering, and the maternal mortality rate remains as high as 4.0% even after anti-tuberculosis treatment.\u003c/p\u003e\n\u003cp\u003eThe diagnosis of active tuberculosis in pregnancy can be quite complex in clinical practice, as the symptoms are sometimes atypical. According to existing preconception and prenatal care guidelines [4], tuberculosis screening is not a mandatory item for all pregnant women. For pregnant women who are not classified as target populations or high-risk pregnant women, when tuberculosis screening is not conducted before or during pregnancy, symptoms that appear during pregnancy become an important indicator for tuberculosis screening. Common symptoms of tuberculosis include persistent cough, sputum production or hemoptysis, fever, night sweats, and loss of appetite. During pregnancy, especially when symptoms are in the early stages or atypical, it is easy to confuse these symptoms with physiological changes during pregnancy, leading to delayed diagnosis [5]. Therefore, for pregnant women presenting with the above symptoms, tuberculosis screening and diagnosis should also distinguish between physiological changes related to pregnancy and consider the potential adverse effects of tuberculosis on the mother and fetus, such as anemia, miscarriage, preterm birth, and low birth weight, which differ significantly from the screening and diagnosis in non-pregnant patients.\u003c/p\u003e\n\u003cp\u003eVaginal bleeding is one of the common symptoms of threatened abortion. When encountering patients with vaginal bleeding as the main symptom, after excluding ectopic pregnancy, cervical polyps, placenta previa, and other causes through initial assessment, the possibility of threatened abortion should be considered first by the physician. The treatment for threatened abortion usually includes rest, avoiding sexual intercourse and strenuous exercise, and considering whether progesterone supplementation is needed based on progesterone levels. In some cases, antibiotics may be needed to prevent infection, as well as tocolytic agents to reduce uterine contractions, thereby reducing the risk of miscarriage [6]. In obstetric fetal preservation treatment, the use of antibiotics is for the purpose of preventing infection, not targeting Mycobacterium tuberculosis. The treatment of Mycobacterium tuberculosis infection requires specific anti-tuberculosis drugs, such as isoniazid, rifampin, pyrazinamide, ethambutol, which are not within the scope of routine fetal preservation treatment drugs. Therefore, the fetal preservation effect is often poor in active tuberculosis during pregnancy with vaginal bleeding as the main manifestation. According to data published by Siyuan Dong in Front Cell Infect Microbiol [7], the symptom of vaginal bleeding appears more frequently in patients with active tuberculosis after IVF-ET than in normal pregnant women. Combined with other studies [8], the symptom of vaginal bleeding may occur even earlier than fever and cough. Therefore, this article analyzes the clinical data of 10 cases of patients with active tuberculosis after IVF-ET in our hospital over the past six years, discussing the necessity of tuberculosis screening in patients with vaginal bleeding after IVF-ET, in order to provide a basis for clinical diagnosis and treatment.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e1. Study Subjects\u003c/p\u003e\n\u003cp\u003eA retrospective analysis was conducted on the clinical data of 10 patients with active tuberculosis complicating pregnancy after IVF-ET who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to October 2024. The initial screening criteria included patients diagnosed with active tuberculosis complicating pregnancy at our hospital from October 2014 to October 2024, totaling 41 cases, of which 25 were naturally conceived, and 16 were post-embryo transfer patients. Due to the loss of patient records before 2018, the final analysis included 10 cases of patients who underwent IVF-ET and developed active tuberculosis complicating pregnancy at our hospital from January 2018 to October 2024.The inclusion criteria were: (1) The main clinical data are complete; (2) Clinical symptoms consistent with tuberculosis, such as fever, cough, and weight loss, appeared after IVF-ET, and active tuberculosis was confirmed through necessary examinations. The exclusion criteria were: (1) Pregnant women who became pregnant naturally instead of through IVF-ET; (2) Pregnant women with evidence of tuberculosis infection but without clinical symptoms and signs of active tuberculosis; (3) Pregnant women with other severe systemic diseases. This study was approved by the Medical Ethics Committee of The First Affiliated Hospital of Zhengzhou University (approval number: 2024-KY-1535).\u003c/p\u003e\n\u003cp\u003e2. Data Collection\u003c/p\u003e\n\u003cp\u003eData were obtained from the patients\u0026apos; medical records and follow-up telephone calls. Information was collected on three aspects: general data of the patients, clinical characteristics, and treatment and pregnancy outcomes.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e1. General Data\u003c/p\u003e\n\u003cp\u003eAmong the 10 patients, 7 cases (7/10) were infertile due to fallopian tube obstruction, 1 case had primary infertility with patent fallopian tube tests, 1 case had an unknown cause, and 1 case was due to bilateral fallopian tube ligation. The majority of patients had two gestational sacs transferred (8/10), and most of the transferred embryos were blastocysts (7/10). Tuberculosis was detected pre-pregnancy in 3 patients, discovered due to active tuberculosis during pregnancy in 6 patients, and identified retrospectively after pregnancy termination in 1 patient. There were 6 singleton pregnancies and 4 twin pregnancies. The most common complications were anemia (3/10) and liver damage (2/10). See Table 1.\u003c/p\u003e\n\u003cp\u003e2. Clinical Characteristics\u003c/p\u003e\n\u003cp\u003eOut of the 10 patients, 9 exhibited fever, and 8 had vaginal bleeding. Other symptoms included lower abdominal pain (2/10), headache (2/10), and dry cough (2/10). The primary organs involved in the symptoms of all 10 patients were the lungs, with others being the liver (1/10) and brain (1/10). The T-SPOT test, also known as the gamma-interferon release assay, has high sensitivity and specificity in diagnosing active tuberculosis and latent tuberculosis infection. Among the 10 patients, 7 underwent T-SPOT testing, and all results were positive. Some patients did not have a chest Computed Tomography (CT) during pregnancy due to fetal concerns, and some records were unavailable due to transfer to other hospitals for treatment and loss to follow-up, see Table 2.\u003c/p\u003e\n\u003cp\u003e3. Treatment and Pregnancy Outcomes\u003c/p\u003e\n\u003cp\u003eOut of the 10 patients, excluding 2 cases with unclear tuberculosis diagnosis, 4 patients had hematogenous disseminated pulmonary tuberculosis, and 4 patients had acute miliary pulmonary tuberculosis. The interval from onset to the confirmation of active tuberculosis ranged from 1 to 5 weeks, mostly around 2 weeks.\u003c/p\u003e\n\u003cp\u003eAmong the 10 patients, 4 patients received anti-tuberculosis treatment during pregnancy until they gave birth alive, all by cesarean section; 3 cases were preterm births and were transferred to the neonatal department. Follow-up denied congenital tuberculosis in the newborns. All 4 patients above received anti-tuberculosis treatment from pregnancy until after childbirth. Six patients terminated their pregnancies before 20 weeks of gestation due to tuberculosis condition (2/10) and failure of fetal preservation (4/10), and all received anti-tuberculosis treatment after childbirth. See Table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: General Information of 10 Pregnant Women with Active Tuberculosis Complications after IVF-ET\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eID\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eReason for IVF-ET\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Blastocysts Transferred\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eType of Embryo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGravidity-Parity-Abortion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTime of Tuberculosis Diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Fetuses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eOther Complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral fallopian tube obstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBlastocyst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG2P0A1\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDuring pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHypothyroidism, placenta accreta, moderate anemia\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBlastocyst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG1P0A0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDuring pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLiver damage, low-lying placenta\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral fallopian tube obstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFresh embryo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG1P0A0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAfter pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral fallopian tube obstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBlastocyst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG1P0A0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBefore pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRight fallopian tube blockage, pelvic adhesion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFresh embryo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG1P0A0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDuring pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral fallopian tube obstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBlastocyst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG1P0A0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBefore pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOne intrauterine fetal death in twins\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eUnprotected for 10 years without pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBlastocyst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG1P0A0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDuring pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral ureteral stent placement post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral fallopian tube obstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFresh embryo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG1P0A0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBefore pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMild anemia, liver damage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRight fallopian tube blockage, advanced maternal age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBlastocyst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG1P0A0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDuring pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMild anemia\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral tubal ligation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBlastocyst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG4P1A2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDuring pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMethicillin-resistant Staphylococcus aureus infection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e1,GxPxAy indicates the number of gravidity (G), parity (P), and abortion (A). For example, G2P0A1 means the patient has been pregnant twice, has not delivered any liveborn child, and has had one abortion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Clinical Manifestations of 10 Pregnant Women with Active Tuberculosis Complications after IVF-ET\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eID\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFever\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVaginal Bleeding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eOther Symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMain Organs Involved\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eLaboratory Tests\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eChest CT\u003c/strong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eScattered nodules in both lungs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSore throat, headache, palpitations, discomfort in both lower limbs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLung, Liver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eT-SPOT\u003csup\u003e1\u003c/sup\u003e positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eInfectious lesions in both lungs, possible tuberculosis? Calcified nodule in the middle lobe of the right lung. Minimal pleural effusion on the right; local calcification of the left pleura.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLower abdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eT-SPOT positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMultiple miliary nodules in both lungs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLower abdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eT-SPOT positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDiffuse lung lesions, calcified nodules in the upper lobe of the left lung and the lower lobe of the right lung\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDry cough\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eT-SPOT positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDiffuse miliary tuberculosis in both lungs. Calcified subpleural nodule in the right lung\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eT-SPOT positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot provided\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHeadache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLung, Brain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCerebrospinal fluid culture positive for Mycobacterium tuberculosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot provided\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDry cough\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eT-SPOT positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMiliary high-density lesions in both lungs, slightly enlarged hilar shadows, slightly enlarged lymph nodes in the right cardiophrenic angle and mediastinum, slightly thickened main pulmonary artery, thickened pleura on both sides\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eT-SPOT Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDiffuse miliary nodules in both lungs, considering the possibility of infection, tuberculosis? Slight inflammation under both lung pleura. A small amount of pleural effusion on the right side\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e1,T-SPOT refers to the T-SPOT.TB test, which is a blood test used to detect latent tuberculosis infection by measuring the immune response to specific tuberculosis antigens. A positive result indicates exposure to the bacteria that cause tuberculosis. 2,The \u0026quot;Chest CT\u0026quot; column describes the findings from the computed tomography scans of the patients\u0026apos; chests, which are often used to diagnose and assess the extent of tuberculosis involvement in the lungs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Treatment and Outcomes of 10 Pregnant Women with Active Tuberculosis Complications after IVF-ET\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2.08333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eID\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.5833%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTuberculosis Diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.625%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnti-tuberculosis treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOnset Time, Weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.375%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis Time, Weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTermination Time, Weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReason for Termination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMethod of Termination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2.08333%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.5833%;\"\u003e\n \u003cp\u003eHematogenous disseminated pulmonary tuberculosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.625%;\"\u003e\n \u003cp\u003eFrom week 18 of pregnancy to postpartum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.375%;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003ePremature rupture of membranes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003eCesarean section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003eLive birth, newborn transferred for treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2.08333%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.5833%;\"\u003e\n \u003cp\u003eHematogenous disseminated pulmonary tuberculosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.625%;\"\u003e\n \u003cp\u003eAfter induced labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.375%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eTuberculosis condition and liver damage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2.08333%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.5833%;\"\u003e\n \u003cp\u003eAcute miliary pulmonary tuberculosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.625%;\"\u003e\n \u003cp\u003eAfter induced labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.375%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003ePremature rupture of membranes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003eDilation and curettage after failed medical induction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2.08333%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.5833%;\"\u003e\n \u003cp\u003eAcute miliary pulmonary tuberculosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.625%;\"\u003e\n \u003cp\u003eAfter induced labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.375%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003ePremature rupture of membranes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003eInduction of labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2.08333%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.5833%;\"\u003e\n \u003cp\u003eAcute miliary pulmonary tuberculosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.625%;\"\u003e\n \u003cp\u003eAfter induced labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.375%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eRecurrent bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003eSpontaneous abortion followed by dilation and curettage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2.08333%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.5833%;\"\u003e\n \u003cp\u003eHematogenous disseminated pulmonary tuberculosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.625%;\"\u003e\n \u003cp\u003eBefore pregnancy and after induced labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.375%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eTuberculosis condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003eDilation and curettage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2.08333%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.5833%;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.625%;\"\u003e\n \u003cp\u003eFrom week 23 of pregnancy to postpartum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.375%;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003ePreterm labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003eCesarean section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003eLive birth, newborn transferred for treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2.08333%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.5833%;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.625%;\"\u003e\n \u003cp\u003eAfter induced labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.375%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eRecurrent bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003eSpontaneous abortion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2.08333%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.5833%;\"\u003e\n \u003cp\u003eAcute miliary pulmonary tuberculosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.625%;\"\u003e\n \u003cp\u003eFrom week 24 of pregnancy to postpartum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.375%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eLow amniotic fluid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003eCesarean section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003eLive birth\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2.08333%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.5833%;\"\u003e\n \u003cp\u003eHematogenous disseminated pulmonary tuberculosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.625%;\"\u003e\n \u003cp\u003eFrom week 21 of pregnancy to postpartum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.375%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.33333%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003ePremature rupture of membranes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003eCesarean section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.5%;\"\u003e\n \u003cp\u003eLive birth, newborn transferred for treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eImpact of Active Tuberculosis on Pregnancy Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eActive tuberculosis significantly worsens perinatal outcomes for both mother and child compared to pregnancies without active tuberculosis. The risks of adverse outcomes are often heightened by delayed diagnosis and inadequate treatment. Studies indicate that active tuberculosis during pregnancy can triple the risk of anemia, double the risk of cesarean section, increase the risk of miscarriage by nine times, quadruple the risk of perinatal death, and increase the risks of prematurity and acute fetal distress by 1.6 and 2.3 times, respectively, as well as raise the risk of low birth weight by 1.7 times [9]. There is evidence that infertile patients undergoing IVF-ET are prone to active tuberculosis and congenital tuberculosis in infants [10]. Wei\u0026apos;s research [11] shows that post-IVF-ET patients with extensive pulmonary tuberculosis have more severe systemic symptoms and poorer outcomes than those who conceive naturally. In this study, out of 10 patients, only 4 had live births, and 3 of these live-born infants were transferred to another department for treatment due to prematurity. Three patients had a history of tuberculosis, and seven patients were infertile due to fallopian tube obstruction, with the possibility that symptomatically hidden genital tuberculosis may have contributed to the obstruction not being ruled out.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnosis Challenges and Treatment Principles\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most common symptom of tuberculosis is coughing, accompanied by fatigue, low-grade fever, and night sweats. Diagnostic tests such as the T-SPOT test and chest CT are crucial for detecting tuberculosis, with the identification of Mycobacterium tuberculosis in sputum or lesions being confirmatory. In pregnant patients with active tuberculosis, the main clinical manifestations are fever and vaginal bleeding, which may be accompanied by abdominal pain, headache, and dry cough, and can exist without typical symptoms of tuberculosis toxicity. The atypical nature of symptoms and the delay in diagnostic tests like chest CT often lead to late diagnosis. In this study, it took approximately two weeks from the onset of tuberculosis to the confirmation of active tuberculosis. When patients have recurrent, difficult-to-treat vaginal bleeding after embryo transfer, accompanied by fever, cough, headache, and other symptoms, the possibility of tuberculosis should be considered, especially in those with a history of old tuberculosis. The lungs remain the most severely affected organ during pregnancy in tuberculosis cases. Acute miliary pulmonary tuberculosis and hematogenous disseminated pulmonary tuberculosis are common types of active pulmonary tuberculosis during pregnancy, which do not respond well to general antibiotic treatment, leading to frequent hospitalizations for fetal preservation. The treatment of tuberculosis should follow the principles of early, regular, full-course, appropriate dosage, and combined medication [2], typically divided into an intensive phase (2 months of isoniazid, rifampicin, and pyrazinamide) and a consolidation phase (4 months of isoniazid and rifampicin), known as the 2HRZ/4HR regimen. Due to drug resistance, physiological changes during pregnancy, and potential fetal harm, treatment plans during pregnancy are more complex. Ethambutol is a category B drug during pregnancy, while isoniazid, rifampicin, and pyrazinamide are category C drugs but remain first-line anti-tuberculosis medications. Close monitoring of maternal health and fetal development is required during treatment. In our study, the time from symptom onset to pregnancy termination was about 3 weeks (5 out of 10 cases), with the longest fetal preservation time being 22 weeks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eScreening and Early Detection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTuberculosis is a major threat to global and public health, being the leading cause of death from a single infectious agent [12]. Many tuberculosis patients do not exhibit typical symptoms, making early case detection challenging. In the special population of pregnant women, tuberculosis symptoms can be even more atypical, leading to delayed diagnosis. Tuberculosis poses a threat not only to the health of pregnant women but may also adversely affect fetal development [2]. Early detection and treatment of tuberculosis are crucial for improving maternal and infant health outcomes. Due to the severe conditions caused by tuberculosis after embryo transfer surgery, some scholars recommend tuberculosis screening before IVF-ET [11]. Screening for tuberculosis in patients with post-embryo transfer vaginal bleeding can lead to early detection and treatment, reducing the risk of tuberculosis transmission and improving the prognosis for pregnant women and fetuses. Current tuberculosis screening is based on high-incidence areas or high-risk groups such as those infected with HIV [13], which is more cost-effective. For patients with vaginal bleeding after IVF-ET, especially those with recurrent, difficult-to-treat vaginal bleeding accompanied by fever, cough, and headache, tuberculosis screening is necessary. This not only aids in early diagnosis and timely treatment but also reduces transmission and improves maternal and fetal outcomes. From a cost-benefit perspective, such screening is also reasonable and economical.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of the Vaginal Bleeding Symptoms in Active Tuberculosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn our study of 10 patients, 17 weeks of pregnancy could be considered an obvious dividing line for vaginal bleeding symptoms, with all patients experiencing bleeding before 17 weeks and none after. The earliest occurrence of vaginal bleeding was in the 9th week of pregnancy. Due to the limited number of cases, we reviewed relevant literature and found that most case reports lack records of vaginal bleeding symptoms or their timing. In Yu\u0026apos;s study [8], 4 out of 7 patients had vaginal bleeding, with symptoms recorded at days 102, 20, 50, and 65 post-embryo implantation. In another study [14], 5 out of 7 patients had vaginal bleeding, with timings ranging from 7 to 17 weeks of pregnancy. This indicates that pregnant women with active tuberculosis are more likely to experience vaginal bleeding symptoms within the first four months of pregnancy.\u003c/p\u003e\n\u003cp\u003eThe process of embryo implantation involves the late blastocyst implanting into the endometrium through orientation, adhesion, and invasion. During invasion, the trophoblast cells of the embryo penetrate the endometrium, the upper third of the myometrium, and blood vessels [15], causing minor, light red or brown vaginal bleeding in pregnant women between 10 to 14 days post-fertilization, known as implantation bleeding, which generally does not require special treatment. Before the fertilized egg implants, the endometrium thickens under hormonal influence, and after implantation, it begins to transform into the decidual membrane, with the formation of small blood vessels [15]. The main changes in the uterus during the first four months of pregnancy include embryo growth and differentiation, as well as ongoing tissue restructuring of the endometrium, leading to more decidual tissue, a process influenced by embryonic development, hormones, immune regulation, and various external factors [16]. After IVF-ET, significant changes in the endocrine environment and immune function of pregnant women, coupled with the impact of surgical operations, can lead to the reactivation of latent tuberculosis, and even acute hematogenous disseminated pulmonary tuberculosis [17]. The activity of Mycobacterium tuberculosis may lead to immune imbalance, inflammatory damage, and endocrine changes [18], affecting the formation of decidual tissue and causing vaginal bleeding. The rupture of decidual vessels in early pregnancy may also be one of the causes of vaginal bleeding in active tuberculosis, with the spread of Mycobacterium tuberculosis potentially causing genital tuberculosis lesions and damaging decidual and small blood vessels to varying degrees [19], leading to vascular inflammation and injury, and subsequently vaginal bleeding. In addition, fever or other symptoms caused by active tuberculosis may induce stress responses in the uterus [20], such as uterine contractions, leading to bleeding symptoms. While there is a preliminary understanding of the pathological mechanisms behind vaginal bleeding in tuberculosis patients, further research is needed to explore the complex mechanisms behind this phenomenon to provide more accurate diagnostic and treatment strategies for clinical fetal preservation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePregnancies complicated by active tuberculosis after IVF-ET have poor outcomes. Clinically, in patients experiencing vaginal bleeding after IVF-ET, especially when accompanied by symptoms such as fever and cough, and when conventional fetal preservation measures are ineffective, it is necessary to conduct tuberculosis screening to be vigilant for the possibility of active tuberculosis. Early diagnosis and regular anti-tuberculosis treatment can improve clinical prognosis.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eWHO: World Health Organization\u003c/p\u003e\n\u003cp\u003eIVF-ET: In Vitro Fertilization-Embryo Transfer\u003c/p\u003e\n\u003cp\u003eCT: Computed Tomography\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Medical Ethics Committee of The First Affiliated Hospital of Zhengzhou University (approval number: 2024-KY-1535).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNational Science Fund for Distinguished Young Scholars (Approval Number: 82004140)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConception and design of the research: GWN,ZXL. Acquisition of data: LKX. Analysis and interpretation of the data: LKX,GWN. Statistical analysis: LKX,GWN. Obtaining financing: None. Writing of the manuscript: LKX,GWN. Critical revision of the manuscript for intellectual content: ZXL, GWN. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN/A\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWorld Health Organization. Global tuberculosis report 2023 [EB/OL]. (2023-10-16) [Accessed 2024-11-04]. https://www.who.int/publications/i/item/globaltuberculosis-report-2023.\u003c/li\u003e\n \u003cli\u003eHUANG C. Progress in diagnosis and treatment of tuberculosis in pregnancy [J]. China Modern Medicine, 2022, 29(02): 33-37.\u003c/li\u003e\n \u003cli\u003eCHEN Y, CHU YF, ZHANG B, YUE J. Clinical pregnancy outcome of 9 patients complicated with tuberculosis after IVF-ET and literature review [J]. Journal of Reproductive Medicine, 2022, 31(07): 891-898.\u003c/li\u003e\n \u003cli\u003eObstetrics Group of the Obstetrics and Gynecology Branch of the Chinese Medical Association. Guidelines for preconception and prenatal care (2018) [J]. Chinese Journal of Perinatal Medicine, 2018, 53(1): 7-13. DOI: 10.3760/cma.j.issn.0529-567x.2018.01.003.\u003c/li\u003e\n \u003cli\u003eMiele K, Bamrah-Morris S, Tepper NK. Tuberculosis in Pregnancy. Obstet Gynecol. 2020;135(6):1444-1453. doi: 10.1097/AOG.0000000000003890.\u003c/li\u003e\n \u003cli\u003eChen J. Etiology and management of vaginal bleeding in the obstetrics and gynaecology clinic [J]. Journal of Practical Gynecologic Endocrinology, 2023, 10(08): 28-31.\u003c/li\u003e\n \u003cli\u003eDong S, Zhou R, Peng E, He R. Analysis of Clinical Features and Risk Factors in Pregnant Women With Miliary Pulmonary Tuberculosis After In Vitro Fertilization Embryo Transfer. Front Cell Infect Microbiol. 2022 Jul 11;12:885865. doi: 10.3389/fcimb.2022.885865.\u003c/li\u003e\n \u003cli\u003eYU S, XU C, HE K, et al. Central Nervous System Tuberculosis After In Vitro Fertilization and Embryo Transfer: a report of 7 Cases and Literature Analysis [J]. Hebei Medicine, 2019, 25(10): 1695-1700.\u003c/li\u003e\n \u003cli\u003eMiele K, Bamrah-Morris S, Tepper NK. Tuberculosis in Pregnancy. Obstet Gynecol. 2020;135(6):1444-1453. doi: 10.1097/AOG.0000000000003890.\u003c/li\u003e\n \u003cli\u003eYe R, Wang C, Zhao L, Wu X, Gao Y, Liu H. Characteristics of miliary tuberculosis in pregnant women after in vitro fertilisation and embryo transfer. Int J Tuberc Lung Dis. 2019 Feb 1;23(2):136-139. doi: 10.5588/ijtld.18.0223.\u003c/li\u003e\n \u003cli\u003eWei JL, Zhang L, Xu YL, Gan W, Qi M, Fu XW, Li X. Case-controlled study of tuberculosis in in-vitro fertilisation-embryo transfer and natural pregnancy. BMC Pregnancy Childbirth. 2024 Jan 23;24(1):77. doi: 10.1186/s12884-024-06260-1.\u003c/li\u003e\n \u003cli\u003eChinese Anti-Tuberculosis Association Tuberculosis Control Professional Committee, Chinese Anti-Tuberculosis Association Geriatric Tuberculosis Prevention and Treatment Professional Committee, Editorial Board of the Chinese Journal of Tuberculosis and Respiratory Diseases. Evidence-based Guidelines for Active Screening of Pulmonary Tuberculosis in the Community [J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2022, 44(10): 987-997. DOI: 10.19982/j.issn.1000-6621.20220321.\u003c/li\u003e\n \u003cli\u003eHe YC, Jie ZJ. Strategy of early screening for active pulmonary tuberculosis in general hospital [J]. Journal of Tuberculosis and Lung Disease, 2022, 3(4): 334-337. DOI: 10.19983/j.issn.2096-8493.20220078.\u003c/li\u003e\n \u003cli\u003eGai X, Chi H, Cao W, Zeng L, Chen L, Zhang W, Song D, Wang Y, Liu P, Li R, Sun Y. Acute miliary tuberculosis in pregnancy after in vitro fertilization and embryo transfer: a report of seven cases. BMC Infect Dis. 2021 Sep 6;21(1):913. doi: 10.1186/s12879-021-06564-z.\u003c/li\u003e\n \u003cli\u003eKong BH, Ma D, Duan T. Obstetrics and Gynecology (10th Edition) [M]. Beijing: People\u0026apos;s Medical Publishing House, 2024.\u003c/li\u003e\n \u003cli\u003eBao SY, Yu Y, Qiao J. Advances in molecular mechanisms of embryo implantation [J]. Chinese Journal of Reproduction and Contraception, 2015, 35(5): 328-332. DOI: 10.7669/j.issn.0253-357X.2015.05.0328.\u003c/li\u003e\n \u003cli\u003eCheng MP, Guillame BL, Parkes LO, et al. Prevalence of Auto-antibodies in Pulmonary Tuberculosis [J]. Open Forum Infectious Diseases, 2019, 4: ofz114. DOI: 10.1093/ofid/ofz114.\u003c/li\u003e\n \u003cli\u003eObstetrics Group of the Obstetrics and Gynecology Branch of the Chinese Medical Association. Guidelines for Preconception and Antenatal Care (2018) [J]. Chinese Journal of Perinatal Medicine, 2018, 53(1): 7-13. DOI: 10.3760/cma.j.issn.0529-567x.2018.01.003.\u003c/li\u003e\n \u003cli\u003eAdefuye MA, Manjunatha N, Ganduri V, Rajasekaran K, Duraiyarasan S, Adefuye BO. Tuberculosis and Cardiovascular Complications: An Overview. Cureus. 2022 Aug 22;14(8):e28268. doi: 10.7759/cureus.28268.\u003c/li\u003e\n \u003cli\u003eGoetzl L. Maternal fever in labor: etiologies, consequences, and clinical management. Am J Obstet Gynecol. 2023 May;228(5S):S1274-S1282. doi: 10.1016/j.ajog.2022.11.002.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"In-vitro fertilization-embryo transfer, Tuberculosis, Pregnancy, Vaginal bleeding","lastPublishedDoi":"10.21203/rs.3.rs-5389552/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5389552/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective: To analyze the clinical manifestations and outcomes of 10 cases of post-transplant tuberculosis and to explore the necessity of screening for tuberculosis in patients with vaginal bleeding after in-vitro fertilization-embryo transfer (IVF-ET).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: A retrospective analysis was conducted on 10 clinical cases of active tuberculosis during pregnancy following IVF-ET treated at the First Affiliated Hospital of Zhengzhou University from January 2018 to October 2024. The relationship between vaginal bleeding and active tuberculosis was assessed, and the potential value of tuberculosis screening in such patients was discussed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: (1) General situation: Among the 10 pregnant patients with confirmed active tuberculosis after IVF-ET, 3 had a history of tuberculosis before pregnancy (3/10), 6 were diagnosed with tuberculosis for the first time during pregnancy (6/10), and 1 was diagnosed with tuberculosis after termination of pregnancy (1/10); all but one were primiparous (9/10). (2) Clinical symptoms: Among the 10 patients, fever of varying degrees was the main symptom in 9 cases (9/10), accompanied by vaginal bleeding in 8 cases (8/10), with the lung being the main affected organ, and the most common types of pulmonary tuberculosis were acute miliary pulmonary tuberculosis and hematogenous disseminated pulmonary tuberculosis. (3) Maternal and fetal outcomes: It took about 2 weeks from the onset of tuberculosis to diagnosis, and only 4 patients (4/10) had viable fetuses; all live birth cases were terminated by cesarean section, with 1 term live birth and 3 newborns born prematurely and transferred to the neonatal department.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: Pregnancy outcomes in active tuberculosis after embryo transfer are poor. Screening for tuberculosis in patients with vaginal bleeding after IVF-ET is necessary to some extent. Clinically, it is necessary to be vigilant about the possibility of tuberculosis onset in patients after IVF-ET who are preventing miscarriage. Early diagnosis and regular anti-tuberculosis treatment can improve clinical prognosis.\u003c/p\u003e","manuscriptTitle":"Embryonic Transfer Post-Vaginal Bleeding: Analysis of the Necessity of Tuberculosis Screening","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-19 07:30:14","doi":"10.21203/rs.3.rs-5389552/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"10a856ca-940a-469f-b489-9e57fb754d69","owner":[],"postedDate":"November 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-02T21:39:05+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-19 07:30:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5389552","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5389552","identity":"rs-5389552","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}