Saving a High - Risk pregnancy against the odds: A case Highlighting the importance of trust and timely care
A 33-year-old Bengaluru woman has delivered a healthy baby girl after one of the pregnancies seen at Vasavi Hospital, according to Dr Nisha Buchade, Obstetrician and Gynaecologist. The first-time mother presented with two major complications early in pregnancy. The first was a short and open cervix detected at 16 weeks, indicating that the birth canal had opened in the second trimester. The second complication was severe fetal growth restriction, which began early in pregnancy and was evident by 25 weeks. Severe early-onset fetal growth restriction occurs in a small percentage of pregnancies. The patient also had a single umbilical artery, which may have contributed to this condition. In short, a short and open cervix in the second trimester is a particularly critical finding and, if left untreated, can lead to miscarriage or extremely preterm delivery.

Rapid Action

During a routine examination, doctors found that the cervix had already begun to open and the membranes were bulging. Dr Buchade immediately admitted the patient and performed an emergency cervical cerclage, a stitch placed to support the cervix. She informed the family that there are chances that pregnancy could still be at risk as the birth canal was already open. However, the stitch held, and after two weeks of rest, the patient was able to return to her daily routine.

Growth Challenge

As the pregnancy progressed, fresh complications emerged. By 25 to 26 weeks, the baby's weight began to drop and the amniotic fluid levels also started reducing. Both these conditions can be linked to placental resistance, a single umbilical artery, or constitutional factors. Dr Buchade said, "We monitored the mother using ultrasound and Doppler ultrasound scans, along with medicines and nutritional support, so that we could push the pregnancy as close to term as possible. Luckily for the mother, the baby reached 1.9 kg by 37 weeks and showed stable heart rate patterns."

Safe Delivery

Finally, the day came when an ultrasound showed that the liquor (amniotic fluid) level had dropped very low, making it necessary to plan delivery within one or two days. Steroid injections were administered for fetal lung maturity, and after 48 hours, an elective Lower Segment Caesarean Section (LSCS) was performed as the baby was in a persistent breech position and anhydramnios. The caesarean section was uneventful. The newborn cried immediately after birth, fed well, did not require Neonatal Intensive Care Unit (NICU) care, and both mother and baby were discharged together on the third day.

Doctors say this case stands out because such a combination of risks, including severe fetal growth restriction, low amniotic fluid, cervical incompetence with a short or open cervix, and a single umbilical artery, usually leads to pregnancy loss or extreme prematurity. Detecting cervical changes before symptoms appear is very uncommon, and performing an emergency cerclage at 16 weeks and also introducing medicines right on time helped in maintaining the fetal weight so that the pregnancy could be carried safely up to 37 weeks. Dr Nisha Buchade added, "Without timely diagnosis and stitching, the pregnancy might have ended before 18 weeks. However, continuous monitoring and precise decisions helped balance the mother's safety with the baby's growth."