| Objective:The clinical data and reproductive outcomes of patients with pelvic tuberculosis were summarized retrospectively,and the related factors affecting pregnancy and live births as well as their predictive values were analyzed,which can provide a theoretical basis for pre-pregnancy risk assessment and comprehensive management of patients with pelvic tuberculosis in clinical work.Methods:From January 2013 to January 2023,a total of 113 patients with pelvic tuberculosis who visited the department of obstetrics and gynecology of the first hospital of shanxi medical university and had a previous history of pelvic surgery,were selected as the research object.The age,body mass index(BMI),premenstrual volume(according to the menstrual blood loss assessment chart,PBAC),tuberculosis history or tuberculosis contact history,anti-tuberculosis treatment time,history of tuberculosis or contact with tuberculosis,previous operation history(pelvic adhesion during operation,tubal lesion,and whether or not salpingectomy was performed),pelvic tuberculosis type,diagnosis method,and other factors were correlated with the pregnancy and live birth.The independent influencing factors of the reproductive outcome were analyzed by difference analysis and multivariate Logistic regression,and the predictive value was analyzed by receiver operating characteristic curve(ROC).Results:1.A total of 113 patients were included in the retrospective summary of general clinical data of patients,including 62 cases of infertility,25 cases of live births,17 cases of ectopic pregnancy and 9 cases of abortion.According to whether the patients were pregnant or not,they were divided into nonpregnant group 62 cases(54.87%)and pregnant group 51 cases(45.13%).The pregnancy group was further divided into the live birth group 25 cases(49.02%)and the non-live birth group(50.98%).2.Seen from pregnancy or not,the results of difference analysis showed that there were significant differences between the pregnant group and non-pregnant group in BMI before pregnancy,PBAC score before pregnancy,anti-tuberculosis treatment time,degree of pelvic adhesion,tubal lesion and tubal resection,etc.(P<0.05),and no significant differences in age,tuberculosis history(or tuberculosis contact history)(P>0.05).Multivariate Logistic regression analysis showed pre-pregnancy BMI[P=0.001,odds ratio(OR)=1.360,95%confidence interval(CI):1.130–1.637],anti-tuberculosis treatment time(P=0.004,OR=1.135,The differences between the 95%CI:1.041–1.239)and the pre-pregnancy PBAC score(P=0.035,OR=1.016,and 95%CI:1.001–1.031)in the binary Logistic regression model were significant.Through ROC curve analysis,pre-pregnancy BMI(P<0.001),anti-tuberculosis treatment duration(P<0.001)and pre-pregnancy PBAC score(P=0.024)have significant prediction effect on the occurrence of pregnancy in patients with pelvic tuberculosis.The area under curve(AUC)for predicting the occurrence of pregnancy in patients with pelvic tuberculosis were 0.7,0.736,and 0.624,respectively.The sensitivity,specificity,and specificity were 74.5%,68.6%,and 43.1%,respectively.Among them,the critical value of pre-pregnancy BMI for predicting the occurrence of pregnancy in patients with pelvic tuberculosis was21.375kg/m~2,the PBAC score was 80.5 points,and the anti-tuberculosis treatment duration was 10.5 months.3.Seen from the live birth or not,the difference analysis showed that there were significant differences in age and anti-tuberculosis treatment time between the live birth group and the non-live birth group(P<0.05),and there were no significant differences in pre-pregnancy BMI,pre-pregnancy PBAC score,tuberculosis history(or tuberculosis contact history)and tubal resection(P>0.05).Binary Logistic regression analysis showed that the difference of anti-tuberculosis treatment duration was significant in the binary Logistic regression model(P<0.001,OR value was 1.368,95%CI:1.150–1.627).According to ROC curve analysis,the duration of anti-tuberculosis treatment(P<0.001)had a significant prediction effect on the life and labor costs of patients with pelvic tuberculosis pregnancy.Its AUC for predicting the outcome of live births in pregnant patients with pelvic tuberculosis was 0.862,with a sensitivity of 76%and specificity of88.5%.The critical value of duration of antituberculosis therapy in predicting the live birth outcome of a patient with pelvic tuberculosis pregnancy is 10.5 months.Conclusion:1.Pre-pregnancy BMI,anti-tuberculosis treatment duration and pre-pregnancy PBAC score are the risk factors for pregnancy in patients with pelvic tuberculosis.Pregnancy rates were significantly increased in patients with pelvic tuberculosis when the pre-pregnancy BMI was>21.375 kg/m~2,the pre-pregnancy PBAC score was>80.5points,and the anti-tuberculosis treatment duration was>10.5 months.2.The duration of anti-tuberculosis treatment is a risk factor for the live birth outcome of pelvic tuberculosis pregnancy patients.Pelvic tuberculosis pregnancy patients with antituberculosis therapy lasting more than 10.5 months had significantly increased live birth outcomes.3.In clinical work,we should strengthen the management of patients with pelvic tuberculosis from pregnancy preparation to perinatal period,evaluate and adjust the body state of patients as early as possible before pregnancy,and inform the relevant situation of the reproductive outcome and the adverse risks of perinatal outcome in detail at the same time,especially need to pay more attention to the problem of placenta previa and placenta accreta.In addition,dynamic monitoring during pregnancy,pre-delivery evaluation and preparation should be strengthened to ensure the safety of mother and child during childbirth. |
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