Risk Factors Associated With the Case Fatality Rate of Pulmonary Tuberculosis in Pregnancy: A Five-Year Retrospective Study From a Developing Country

Abstract Background Tuberculosis is a leading cause of maternal and fetal mortality in women of reproductive age. Tuberculosis is frequently misdiagnosed and treated inadequately during pregnancy. Although the global case fatality rate of tuberculosis is decreasing annually, the trend of tuberculosis mortality in Indonesia remains relatively high. Most tuberculosis reports do not include pregnancy status because most countries do not routinely screen for tuberculosis in pregnant women and do not report pregnancy status in female cases. In Southeast Asia, there is currently insufficient data regarding the risk factors associated with maternal mortality due to tuberculosis. This study aimed to identify the risk factors associated with tuberculosis-related mortality during pregnancy. Methodology This retrospective study was conducted at Dr. Soetomo General Hospital, Surabaya. Data were collected from patients’ medical records. The samples were all pulmonary tuberculosis cases in pregnancy (suspected, bacteriological, and radiologically confirmed cases) from 2014 to 2018. Data on maternal characteristics, underlying risk factors, and maternal outcomes in pregnant women with tuberculosis were collected from medical records. A total of 77 cases of pulmonary tuberculosis in pregnancy were obtained and analyzed using the chi-square test for differences between pregnant women with tuberculosis who survived and those who did not. Results In total, 77 cases of pulmonary tuberculosis out of 7,242 deliveries were found during the past five years (incidence per year was 1.07), of whom 20.8% (16/77) died. Eight patients died before the gestational age reached 28 weeks. Most of the non-surviving women were aged <35 years (93.8%; 15/16). More than 30% (5/16) of the patients had human immunodeficiency virus co-infection, and the highest risk factors were pneumonia and miliary tuberculosis. Miliary tuberculosis was significantly associated with maternal mortality in pulmonary tuberculosis (p = 0.004) with a relative risk of 3.43. Conclusions According to the findings of this study, miliary tuberculosis is a significant risk factor for maternal mortality during pregnancy