This critically ill pregnant woman was turned away elsewhere; what happened next surprised even doctors

Artemis doctors achieve miracle as 33-week pregnant woman, abandoned by another hospital for her critical medical condition, safely delivers healthy twins The patient was suffering from severe pre-eclampsia, insulin-dependent diabetes, morbid obesity (168 kg and BMI 67), impaired cardiac function, and growth restriction of one twin.

“When all these conditions occur simultaneously in a patient undergoing IVF to become pregnant, a delivery becomes one of the most high-risk and complicated ones that a hospital may face, the treatment team explained.The 33-week pregnant first-time mother had come to the hospitals for delivery and recovery after another tertiary care hospital turned down her request due to her complicated and life-threatening pregnancy, the doctors said.

The medical team provided her with expert care, resulting in the safe birth of two healthy twin baby boys. She was carrying twin fetuses who were diagnosed as having a dichorionic diamniotic twin pregnancy during the treatment for her IVF conceived pregnancy.

She was, unfortunately, not only battling severe preeclampsia but was also insulin-dependent on diabetes, morbidly obese at 168 kg with a BMI of 67, was left with heart function at less than half of normal - with a Left Ventricular Ejection Fraction (LVEF) of between 30 and 35 percent- and also suffering from severe fetal growth restriction in one of the twins.

The treating physicians stated that her combination of conditions posed the highest risk factors they have encountered and that she was a candidate for a massive bleed in the delivery stage. In addition, she ran a high chance of heart failure, and pulmonary embolism; and if the bleed was enormous, a blood transfusion and a life-saving emergency hysterectomy would likely be necessary as other life-saving measures failed.

A plan was made after the mother consults her gynaecologist. Her gynaecologist called a multidisciplinary team. The Gynaecologists were assisted by Anaesthesiologists, Cardiac specialists, ICU doctors, paediatricians, surgeons, and Neonatologists in developing a comprehensive strategy for delivery that included anaesthesia, surgery, care and management of potential cardiac failure, intensive monitoring in the NICU and specialised neonatal care. The mother had a delivery by an elective LSCS, a procedure lasting nearly two hours given the precautions, planning and complexity that needed to be followed. It was to provide all possible care to the babies by taking the mother in intensive care immediately after the delivery. The two baby boys, weighing 1.9 kg and 2 kg respectively, were delivered safe. Both the children, being born pre term at 33 weeks, remained for three days under the observation in the NICU prior to their going back with their mother.

The mother remained in ICU for first 48 hours, however was on soft diet within 24 hours of the delivery. She started on oral feeding the next morning after delivery and mobilized on day one post surgery, blood pressure steadily normalised, and was discharged from the hospital in a stable condition without any adverse event.

Speaking about the case Dr Deepika Aggarwal – Chief, Gynae Laparoscopy & Robotic Surgery, Artemis Hospitals, said, “It was the most challenging of pregnancies for us because there were multiple conditions present that could put both the mother and baby’s lives at risk.

Severe pre-eclampsia, a critically low LVEF, diabetes, morbid obesity and twins make the pregnancy very difficult even individually. Combining all these into one makes it one of the most complex we’ve ever seen.

” “We had to plan every detail in the run up to the delivery. Every team including obstetrics, anaesthesia, cardiac and NICU specialists had to be on standby and prepared for any eventuality. But all our careful planning and preparation paid off, with both the babies and the mother safe and healthy.

This was possible only because the teams came together in a perfectly choreographed manner.”The team included Dr Deepika Aggarwal and Dr Srishti Aggarwal (Obstetrics and Gynaecology), Dr Gaurav Bansal (Anaesthesiology), Dr Indranil Gupta (Cardiology), Dr Rima Dada (Paediatrics), and Dr Sumit Sachdev (Surgery) among other members of the multidisciplinary team at Artemis Hospital Gurugram. Doctors suggested the case highlights the significance of ensuring pregnant mothers with multiple medical conditions and other complexities are referred in time to institutions with appropriate facilities and multi-disciplinary care to improve outcomes.