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Twin pregnancy, TB medication taken during conception, concerned about the fetal safety - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Pregnancy
Answered by

General & Family Physician
Practicing since : 2008
Answered : 3180 Questions
User :   hello doctorThis is regarding my wife. She is 28 yrs old and 5.3" my wife is 8 weeks pregnant now. she was using AKT4 at the time of conception and then was moved on to AKT3 till a day back (08.04.2011). We would like to know, if it is advisable to go ahead with the pregnancy. is it going to cause any disability of any kind (hearing, eye, etc.) for the babies (she is conceived with twins) to be born. kindly advise in detail as we are getting different words from many of our offline doctors. We are really concerned and the verge of thinking to terminate.
Doctor :   Hi
User :   hello doctor
Doctor :   Please give me a couple of mins to read your questions
User :   sure
Doctor :   I will help you now , thanks for your patience
User :   thank you doctor
Doctor :   may i know when was she diagnosed with TB ?
User :   she was not diagnosed of TB, it was inconclusive
User :   she was diagnosed with granulumatous lymphadenitis
Doctor :   ok
Doctor :   when was this ?
User :   for which the doctors could not find any dead or live bacteria
User :   this was in october 2010
Doctor :   ok
Doctor :   when did she start the medicines
User :   november 2010
Doctor :   ok
Doctor :   was she on AKT4 regularly ?
User :   then she had stopped for sometime
Doctor :   ok
Doctor :   when was the conception exactly diagnosed ?
User :   yes continuously for three months starting december
User :   yes we have done a scan and also a blood test too.
Doctor :   ok , when was the pregnancy confirmed?
Doctor :   can you give me the dates
User :   07/04/2011
User :   we didn't know that she was pregnant before that
Doctor :   ok
User :   when it was diagnosed it was already 7.5 weeks
Doctor :   have you taken an opinion about this from a consultant gynecologist ?
User :   one fetus and another 7.6 weeks
User :   yes
Doctor :   what did the doctor opine ?
User :   she is not able to ascertain if there would be any effect on the fetus or not
User :   so she is suggesting termination
User :   we also consulted a pediatrician, he is in the opinion that the child might have problem with the hearing
Doctor :   ok
Doctor :   let me explain it to you
Doctor :   the drugs for TB include isoniazid , pyrizinamide , ethambutol and rifamipicin
Doctor :   all of them are grouped under CATEGORY C
Doctor :   under the pregnancy and lactation drugs list
User :   what does the category c mean doctor
Doctor :   We have something called FDA categories in pregnancy which we follow
Doctor :   i will tell uoi
Doctor :   you*
Doctor :   for example : we have 5 categories called A,B,C,D,X
User :   ok
Doctor :   Controlled studies show no risk. Adequate, well-controlled studies in pregnant women have failed to demonstrate risk to the fetus this is for category A
Doctor :   No evidence of risk in humans. Either animal findings show risk, but human findings do not; or if no adequate human studies have been done, animal findings are negative this is for CAT B
Doctor :   Risk cannot be ruled out. Human studies are lacking, and animal studies are either positive for fetal risk or lacking. However, potential benefits may justify the potential risks THIS IS FOR CAT C which the drugs taken fall under
Doctor :   since this says risks cannot be ruled out
Doctor :   but human studies have not shown risks so far
Doctor :   i would give 60 /40 chances
Doctor :   many doctors do not ask to terminate the pregnancy
Doctor :   but some doctors do suggest for termination if it is stillin early weeks
Doctor :   this is a situation of weighing risk over benifits
User :   is this going to be the case even in the case of twins
Doctor :   yes , it includes same for twins as well
Doctor :   may i know if it is the first child ?
User :   yes this is our first
User :   we are unable to make a strong decision
Doctor :   i know this is a situation which needs a lot of thinking
Doctor :   it may or may not harm the child
Doctor :   there is no significant evidence so far that there will be problems in the child
Doctor :   with the medicines she is on
Doctor :   if she had taken STREPTOMYCIN
Doctor :   there were possibilities of having a hearing defect
Doctor :   as I told you the classification also
Doctor :   it does not rule out chances of risk , but also says it can be given in pregnancy
Doctor :   it is upto you to make the decision
Doctor :   I suggest you take a second opinion
User :   what are the possible defects that we can expect, if there would be any
Doctor :   from a good obstretician
Doctor :   with these drugs , there are not much which has been reported , but very rarely one can see vision problems in the child like color defects
Doctor :   and also bleeding problems at birth
User :   ok doctor
Doctor :   so i recommend a second opinion
User :   could those defects if treated if needed
Doctor :   you can compare and contrast
Doctor :   it depends on the level of damage to the eye and other organs
User :   will the bleeding affect the mother badly during pregnancy
Doctor :   it would be difficult for me to say upto what level it causes a damage
Doctor :   the bleeding can be pevented with supplement vitamins called pyridoxine in pregnancy
Doctor :   it will not be so severe also
User :   whats the percentage of complication in pregnancy
Doctor :   very rarely limb malformation , kidney malformation , hip dislocation have been reported in some cases , very very few cases so far
Doctor :   it will not affect the mother
Doctor :   as such taking AKT4 in pregnancy will notcomplicate the pregnancy if taken under guidance of a good speciailist
User :   ok doctor
User :   do we get to talk to a obstretician on this website
Doctor :   probabaly a second opinion
Doctor :   yes , you have a phone service as well as mail service for seeking a specialist opinion
Doctor :   do you want to avail it
User :   i will try that doctor
Doctor :   she is in our panel
Doctor :   you can call our customer team
Doctor :   or mail us
User :   sure thanks
Doctor :   seeking a specialist opinion
User :   we appreciate your help.
Doctor :   you can talk through phone with her or other gynecologist or mail them
Doctor :   you will get a reply with in 48 hrs
Doctor :   i hope i was of some help to you
Doctor :   thanks for consulting me
Doctor :   you can mail us or chat with us again for further details
User :   we are happy with you doc. thanks once again
Doctor :   thank you
Doctor :   take care
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