18 January 2012
Richa Nangia’s previous three pregnancies ended abruptly in tragedy. This was the last chance the thirty–yearold had of becoming a mother.
Nangia, who suffers from an inherent inability to retain pregnancybeyond 24 weeks, delivered a girl weighing 700 grams at 27 weeks of pregnancy at the Aditya Birla Memorial Hospital in Chinchwad recently. High–end life support measures and clinical expertise of a team of doctors made it possible for her. “My doctors had told me that I would never be able to conceive after this, not even through assisted reproductive techniques like IVF (in–vitro fertilisation),” said Nangia.
Her first pregnancy had not matured beyond 24 weeks and the baby died in–utero due to placental insufficiency, amniotic fluid and intra uterine growth retardation (IUGR). The second time round, doctors at the hospital where Nangia was being treated tried infusing fluid, but in vain. After two miscarriages and failure in getting pregnant the third time, Nangia was referred to the Aditya Birla Memorial Hospital under the treatment of IVF specialist Anil Chitake.
“On investigations it was revealed that she had high levels of Thyroid antibodies in her system and her uterus had obliterated because of adhesions,” explained Chitake, who then conducted hysteroscopic fertility enhancement surgery after which she conceived again, but had a miscarriage the third time.
Nangia became pregnant for the fourth time naturally. Her obstetrician made it clear that this was her last chance of bearing a child. “We were very careful with her as this was her last chance. We monitored her regularly. We noticed her blood pressure had increased during the 5th month of pregnancy. We continued the pregnancy till 6–6.5 months on medications. But, regular sonography showed that the blood supply to the fetus was deteriorating and the fluid was drying up,” said Chitake. “The only chance of saving the baby was an emergency lower segment caesarean section, which was carried out and she delivered on August 11, 2011,” he added. The baby was only 700 gms at birth and her chances of survival were remote. All the organs, such as lungs, digestive system, brain, were underdeveloped and the baby had severe difficulty in breathing.
Neonatologist Sachin Shah, director, paediatrics and neonatology at Aditya Birla Hospital, immediately shifted the baby to the advanced Neo–natal Intensive Care Unit and put her on ventilator support. “Emphasis was given on creation of an environment similar to mother’s womb so that baby would be able to grow in a natural way,” Shah said.
There were many ups and downs during the stay in the hospital since this was a very rare case. “The baby suffered a setback on the 22nd day in the form of a suspected infection and needed higher antibiotic and again the help of the ventilator to breathe,” said Shah.
All vital parameters and body functions were closely monitored by a trained team of doctors and nurses. The ventilator–assisted breathing continued for 10 more days. After being removed from CPAP, the baby still needed supplemental oxygen till the 35th day. She made good progress with proper growth and development of full fortified feeds. “The most important fact was that her brain growth continued normally. It was confirmed with regular ultrasound scans of the brain and her eyes remained only mildly affected by retinopathy of prematurity, indicating a normal vision later,” Shah said.
The team comprising neonatal intensivists Amita kaul, Priya Mankare, Pushkar Bhide, Rahul Kallianpur, Suhas Chowghule, Ajay Walimbe and Sachin Admuthe, headed by Shah saw their efforts bear fruit, when the baby was discharged after 82 days. At the time of discharge on October 31, 2011, the baby weighed 1.87 kg and all her organs had matured normally. “We could not express our happiness in words,” smiled Nangia.
“There is lot of ignorance about the outcome of such babies. Many people think that it is futile to treat such babies since they will not survive. That is a myth. If treated properly (in the right place by the right people) the chances of such babies surviving are very high. Not only do they survive, but they grow up to become healthy children,” said Shah. The baby girl with her parents