There were multiple challenges in managing this patient in ICU as her immunity was low
MUMBAI: Pregnancy is bliss but sometimes things can go awry. A team headed by Dr Pritam Moon (consultant physician), Dr Bipin Jibhkate (Consultant and Head Critical Care Medicine), Dr Mangala Patil (Consultant Obstetrician), Dr Samir Shaikh (Consultant Neonatologist), helped a 35 years old woman beat Covid-19, and deliver a second baby at 31st week, after performing the emergency labour in ICU at Wockhardt Hospital, Mira Road.
The mother and baby both are doing well and have been discharged after spending 21 days at the in ICU, 14 days on ventilator, and a total 25 days of hospital stay.
Pregnancy is considered one of the critical phases of a woman’s life. A woman goes through emotional, physical, and mental challenges while she carries on with her journey of becoming a mother. Hethal Gandhi, a 35 years old housewife, a resident of Mira Road, Would-be-mother with 7 months of pregnancy, was referred to Wockhardt Hospital, Mira Road, as she complained of fever of 2 days, which was followed by relatively asymptomatic phase for the patient. Then after 5 days patient started feeling breathless. This was followed by desaturation. Patient was taken to a private practitioner for above complaints. There the woman underwent CT scan of chest, showing 70-80% of lung involvement, as well she was tested positive for Coronavirus by RT PCR method. Since she was very breathless and was not maintaining saturation with high flow oxygen of 15 litres per minutes, she was shifted to Wockhardt Hospital Mira Road, for further management.
Dr Jibhkate said, “RT PCR test was performed on admission to confirm COVID. On admission patient was having low Oxygen level, so was admitted to ICU and started on HFNC (high flow nasal cannula). There were multiple challenges in managing this patient in ICU as her immunity was low; her physiological needs were different from normal women. Pregnant females have higher tendency for clotting, their abdominal pressures are high, their carbon dioxide levels are low, they have higher tendency to vomit, and they are carrying a baby in their tummy. So in such situation if their oxygen level is not maintaining the options are very limited. Considering all these things initially HFNC was tried but she could not maintain her oxygenation even with highest settings of HFNC. So, we decided to put a tube through her mouth to her chest and put the patient on ventilator. On ventilator initially she was requiring very high oxygen and pressure support, even with that patient’s oxygen level was low. In such situation, generally normal patients are managed in prone position ventilation, but due to pregnancy that was not possible with this patient, so we decided to put her in right lateral position. Along with this she was started on standard treatment of COVID, like anti-viral, antibiotics, steroids, and anticoagulation. She also had decreased urine, alternate hypotension and hypertension, very high heart rate of around 150/minute. Slowly she responded to the treatment and her ventilator requirement went down. But even after 7 days of ventilation she was requiring significant level of ventilator and hence it was decided that, we will have to remove her tube from mouth and put it through throat, a procedure called as tracheostomy. ICU team performed a procedure called percutaneous tracheostomy. In this procedure, a hole is made in the front of the neck into the patient’s windpipe that is the trachea. We at this stage also repeated her COVID test, which turned out to be negative. So, this patient was shifted to non COVID ICU and slowly was taken out of ventilator after 14 days.”
But because of all this stress of disease and ICU stay patient went into labour at 31st week of her pregnancy. Patient got premature rupture of membrane and went into labour.
Dr Patil explained “Considering that patient was having tracheostomy, still requiring small amount of Oxygen, had higher chances of clot forming which may go into lungs during operation and cause life threatening condition to the patient, as well anaesthesia related complication, it was decided that labour should be conducted in ICU in supervision of Intensivists and neonatologists. This was very risky and unusual as labour is normally conducted in labour rooms.”
Ultimately labour was conducted successfully and both mother and baby were fine after that.
"Baby weight was 1560 grams. It was a baby boy. After that baby was shifted to NICU and was treated there. Initially baby was unstable but after few days it started improving and was ultimately discharged in stable condition,” Dr Shaikh said.
Dr Moon said “The tracheotomy tube was closed, when patient was maintaining saturation without Oxygen support. Then patient was shifted towards after 21 days of ICU care. Then ultimately, she was discharged in stable condition after 25 days of hospitalization. The patient is back on track and can walk without support. She can breastfeed the baby too.”
“I am elated and fortunate about the treatment I have received at Wockhardt Hospital, Mira Road. Our world came crashing down when I was tested positive for Covid. But, the doctors made sure that I deliver my baby safely, and now, my baby’s health has also improved,” said patient Hethal Gandhi.