Nagpur– Mrs Sarita (name changed)comes to the OPD with pain and fullness of abdomen. Ultrasound shows a pregnancy of 9 months! Mrs Sarita is married for 17 years, living with her husband who is 47-48 years old and their first reaction is CHAMATKAR ( Miracle ).Sarita had her husband had given up hope of ever having a child of their own after their first experience almost 17 years ago when the pregnancy ended at 5 months. In fact Mrs Sarita had undergone a heart bypass surgery ( CABG) 4 years ago, was on treatment for chronic hypertension and diabetes. But she never had a doubt that she was pregnant and so never had any prenatal care.
The team at AIIMS Nagpur provided a multi-disciplinary care with everyone pitching in cardiologist, anaesthesiologist, neonatologist and of course the obstetrician!
The team of obstetricians at AIIMS which included Dr Shuchita Mundle, Dr. Anita Yadav, Dr. Neha Gangane offered care and counselling to the patient and her husband. She underwent tests and investigations done during routine prenatal care as well assessment for the cardiac status in consultation with the cardiologist, Dr Gunjan Ghodeshwar who provided support throughout the course of the patient’s hospital stay.
An elective cesarean was done on 27th October 2021, and a healthy girl child (3.2kg) was born. The happy and grateful mother and baby were discharged with advice to follow up. It was a wonderful experience to provide care to a mother with so many high risk factors and giving the couple “the joy of life” in their fourth decade of life. It was indeed a team effort under the able guidance, support and encouragement of the Honourable Director Maj Gen (Dr) Vibha Dutta.
According to the neonatologist Dr Nishant Banait, from the baby’s point of view lots of things were unknown. Throughout the pregnancy, mother was taking medications ( for her heart condition and diabetes), which are known to be harmful for growing fetus. Fortunately, baby was born good size and without any malformations. However, there was a hick up when baby dropped its sugar levels within the first 24 hours, which was taken care of swiftly by NICU team. One of the challenges was around continuing mother’s medications whilst she continues to breast feed her baby. The team discussed with parents, the benefits of continuing breast feeding for baby versus the chance of harm caused by medications (although, very low probability) which mother is receiving. Parents took an informed decision and the baby was allowed to breast feed.
Dr Avinash Prakash (Assistant Professor, Department of Anaesthesiology) – This was a was quite challenging : hypertension, diabetes, post Percutaneous transluminal coronary angioplasty ( PTCA) followed by CABG on antiplatelet, statins etc. She had also had a history of lumbar spine surgery some 8 years back. Antiplatelet drugs were stopped 5 days before surgery, after discussion with colleagues and seniors decided to go with combined spinal and epidural anaesthesia with lower dose of spinal aesthetic agent but as a back-up general anaesthesia drug, cardiac medications and life-saving/ emergency drugs were kept ready. Epidural catheter secured at L1- L2 level and spinal given in the same space with low dose. Case underwent uneventful and post op proper analgesia was maintained for 48 hours with epidural infusion.
