Background <p>Research on pregnant patients with rifampicin-resistant tuberculosis remains limited. This study aims to retrospectively analyze the clinical characteristics and outcomes of pregnant patients with rifampicin-resistant tuberculosis, providing valuable insights for the management and treatment of such cases.</p> Methods <p>This retrospective study reviewed the electronic medical records of pregnant patients with rifampicin-resistant tuberculosis admitted to the Public Health Clinical Center of Chengdu between July 2017 and April 2025. The clinical characteristics and outcomes of these patients were analyzed.</p> Results <p>A total of 21 pregnant patients with rifampicin-resistant tuberculosis were included in the study, with a mean age of 28.8 years. Among them, 14 patients (66.7%) had no prior history of tuberculosis treatment, and 18 patients (85.7%) conceived naturally. The majority (90.5%) were carrying a singleton pregnancy. Regarding treatment outcomes (referring to maternal tuberculosis treatment outcomes), 11 patients (52.4%) were cured, 8 patients (38.1%) completed treatment, and 2 patients (9.5%) died. Adverse reactions occurred in 12 patients (57.1%) during treatment. Pregnancy outcomes (two twins) included 6 live births (26.1%), 5 miscarriages (21.7%), 1 died (4.3%) and 11 pregnancy terminations (47.8%).</p> Conclusion <p>The findings suggest that pregnant patients with rifampicin-resistant tuberculosis can achieve favorable maternal treatment outcomes with appropriate treatment. However, nearly half of the patients (52.4%) opted for pregnancy termination.</p>