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Had miscarriages. Pathology report showed endometritis atypia or granuola. How long should I take akt 3? Chances of pregnancy?

DOCTOR OF THE MONTH - Mar 2013
Mar 2013
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I had two miscarriages in a year both at around 16 weeks, my gynae detected tb in the uterus but surgical pathology report doesnt show evidence of endometritis atypia or granuola , I do not have any other known problems and my menustral cycle also has never missed I m taking akt 3 had taken akt 4 for two months earlier, I want to know how long I have to take akt 3 and what are my chances of a live birth after medication,
Posted Fri, 5 Jul 2013 in Pregnancy
 
 
Answered by Dr. Aarti Abraham 42 minutes later
Hello
Thanks for your query.
Firstly, I do not think that endometrial tuberculosis would cause miscarriages at 16 weeks.
It would cause difficulty in conception .
However, since you have already started AKT, you can continue taking AKT 3 for 4 months ( after 2 months of AKT 4 ), however some practitioners prefer treatment for total of 9 months.
The treatment is started only based on tissue diagnosis of tuberculosis, which was not made in your case.
However, it is not advisable to stop treatment for TB midway, so take it for atleast 6 months totally ( 2 months AKT 4 and 4 months of AKT 3 ).
Regarding your chances of live birth after medication, it depends on the cause.
Ideally the products of conception should have been karyotyped, as genetic causes are the commonest causes of abortion.
Infections such as herpes, rubella, toxoplasmosis, cytomegalovirus, hepatitis etc should be ruled out.
Abnormalities in size and shape of the uterus and tubes should be ruled out by a hysterolaparoscopy, HSG or ultrasound.
Conditions like antiphospholipid antibody syndrome should be ruled out by appropriate testing.
Hormonal imbalance should be ruled out by comprehensive hormonal evaluation.
You should consult a high risk pregnancy Specialist and have detailed evaluation, and take folic acid for 3 months before planning your next pregnancy.
After 2 months of AKT, you can now plan for conception.\

Wish you all the best.
Feel free to discuss further.
Above answer was peer-reviewed by
 
Follow-up: Had miscarriages. Pathology report showed endometritis atypia or granuola. How long should I take akt 3? Chances of pregnancy? 6 minutes later
I'm sorry doctor I forgot to mention that the tb diagnosis was made on the basis of biopsy of the uterus, aps test was also done which yielded negative results, blood tests showed very high tnf alpha and a pregnancy destroying factor, low activity of nk cells were also shown to be a low positive

Infections such as torch and hepatitis have been ruled out and the featl tissue was sent for karyotyping which all showed normal results.
 
 
Answered by Dr. Aarti Abraham 8 hours later
Hi again,
As it was a tissue diagnosis, please complete the regimen of AKT as advised.
I would strongly advise on ruling out abnormality in size and shape of uterus, or in the cervix, by means of ultrasound, HSG and hysterolaparoscopy.
In view of one missed miscarriage and one placental abruption, you should strongly consider taking aspiring and low molecular weight heparin as soon as you conceive.
Please take folic acid supplements.
Since your workup is complete, you can try for conception .
All the best.
Above answer was peer-reviewed by
 
Follow-up: Had miscarriages. Pathology report showed endometritis atypia or granuola. How long should I take akt 3? Chances of pregnancy? 6 hours later
Can itry for conception while I'm taking akt 3 also? What abnormality can be present in the uterus that can cause this can you list it out for me
 
 
Answered by Dr. Aarti Abraham 4 hours later
Hi again,
Yes you can try for conception while on AKT 3.
The abnormalities that could cause the abortions are -
1. Dilatatation ( opening ) of the cervical canal.
2. Septum in the uterus or two cavities in the uterus.
3. Low activity of NK cells and high TNF alpha, also can lead to immunological abnormalities , which can cause such abortions.

Take care.
Above answer was peer-reviewed by
 
Follow-up: Had miscarriages. Pathology report showed endometritis atypia or granuola. How long should I take akt 3? Chances of pregnancy? 4 hours later
Thank you doctor for your time and wisdom, would like to leave you with a XXXXXXX mantra which you can repeat daily as many times as you want , this mantra is beneficial for women for removing any obstacles along the path to happiness and wish fulfilment, the mantra is ( om Tare tu Tare true Soha). Take care
 
 
Answered by Dr. Aarti Abraham 2 hours later
Thank you , its beautiful
God bless you , and I am sure HE will.
Quite soon.
Take care.
Above answer was peer-reviewed by
 
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