Doctors at Kamineni Hospitals saved the lives of a twenty five year old woman in an advanced stage of pregnancy and her preterm baby, by performing a complicated caesarean hysterectomy. The Patient, Ms Ramadevi reported with the problem of placenta blocking the cervix. Cervix is the narrow passage for the baby to pass through from the womb, at the time of delivery. The blocking of the cervix impedes the delivery of the baby, thereby risking the lives of both the mother and baby. A multi-disciplinary team led by Dr A Prasanna Latha, Consultant Obstetrician and Gynaecologist and Dr RV Soujanya, Consultant Paediatrician and Neonatologist and comprising of senior specialists from Urology, Anaesthesia and Neonatology, after meticulous planning and diligent work saved both the mother and baby and both have since recovered.
The patient was into her third pregnancy at 36 weeks, with an history of undergoing caesarean sections for the previous two pregnancies. She had come to the hospital with the complaint from the diagnosis done elsewhere of central placenta previa, where in the placenta occupies the lower uterine segment covering the doorway of the womb. However, ultrasound examination and MRI, done at the Hospital revealed her problem to be much more complex due to her suffering from placenta percreta. Wherein the placenta penetrated through the uterus including the left broad ligament, which covers the uterus and further invaded the urinary bladder. This condition could have led to excessive blood loss during caesarean and may have even caused maternal death.
Dr Prasanna Latha speaking about the case said, After an in-depth family counselling, a planned elective surgery with multidisciplinary team approach was opted to save both the mother and the baby. As per the team’s well considered medical advice, a caesarean hysterectomy spanning over three and half hours was performed. The patient was transfused with 3 litres blood to compensate the loss during the procedure. A late preterm female baby weighing 2.59 kgs was delivered safely. The patient recovered within 24 hours and breast fed her baby within 48 hours. Since the uterus has been removed to save the patient, she can’t conceive further.
Due to delayed diagnosis the placenta pervaded across uterus and reached urinary bladder, proving to be fatal for both the mother and the baby. The accomplished team of multidisciplinary specialists ensured the success of the surgery, despite the complications coupled with enormous risk, says Dr Prasanna Latha. Because the mother is just 26 years, we wanted to ensure least complications and damage to the adjoining organs while treating, a well-planned, team approach helped to reduce the morbidity of the patient.
Caesarean sections this patient underwent for earlier two deliveries is the potential cause for placenta blocking the cervix during pregnancy. The incidence of pregnant women suffering from the problem is 1 in 700 pregnancies and off these 1 in 10,000 births see bladder invasion. Off late there is a rise in the incidence due to increased C-Sections. The rate of maternal mortality due to this problem is 9.5% and foetus mortality is as high as 24%.
Dr. Gayatri Kamineni, Dy. COO, Kamineni Hospitals; said, this is a rare case and the chances of survival of the new born was very low. Also the patient had to reconcile with the fact that she at an young age of 26 years had to undergo hysterectomy and lose her child bearing ability permanently. Despite all the challenges and complications, the outcome was positive and well beyond expectations of all involved.
Dr Soujanya said, the moment we came to know of this case, the entire team was alerted to prepare for a critical patient. In such cases we mainly see complication of premature delivery, that is delivery prior to the completion of the gestation period of 9 months. But the expert gynaecology team at the hospital through regular follow up and treatment protocols prolonged the pregnancy till 36th week, much closer to the normal 40 weeks delivery period. This ensured much better outcome of the baby. The other complication we anticipated is low birth weight, this baby was 2.59 kgs at the time of birth, which is considered to be good weight. Both the factors which are of serious concern in such cases were handled very professionally and we could ensure a positive and improved final outcome of the baby being healthy. Normally if there is bleeding at the mother end of the placenta, the baby end also bleeds, we took care on this aspect and there was no blood loss of the baby. We ensured breast feeding of the baby from the second day of her birth, that enabled her to gain good weight. The parents were extremely cooperative and followed the medical advice fully, which also helped to improve on the outcome.
