BREAK THROUGH CASES

I delivered a miracle baby

Dr. Neerja Gupta knew she was dealing with an unusual pregnancy when her patient Mumtaz Shaikh was found to have a double uterus. But at the time of delivery, the gynaecologist discovered she was dealing with a rarer case that of a baby who survived for nine months outside the womb.

Sometimes, even doctors need to believe in miracles. In some medical cases, the best minds alone do not suffice, as was proved in the case of my patient Mumtaz Shaikh’s extremely rare pregnancy. My team of doctors and I fought tooth and nail during the operation. At stake were the lives of Mumtaz and her unborn child. At every step, the case threw new surprises at us.

Mumtaz was in her fifth month of pregnancy when she came to me at Kalsekar Hospital in Mumbra (Mumbai) for a checkup. The ultrasound report said that she had a double uterus with pregnancy in the left uterus. Though clinically there was no sign of anything unusual, her family was concerned. When it was reported that she had a double uterus, I asked her to get an MRI done at around 32 weeks, which confirmed it.

Once the diagnosis of an abnormal pregnancy is made, the foetus is removed if we ascertain that the baby is not going to grow or if the baby has died. Considering how rare Mumtaz’s case was, the radiologists too thought that the baby had no chance of survival. Since a normal delivery was out of the question, Mumtaz was taken for an elective Caesarean surgery. We had two units of blood ready as precaution.

At the operating table, we weren’t prepared for what we witnessed. Once the baby was out, we could see the right uterus but the left side of the abdominal cavity didn’t have the uterus that the reports had confirmed. This meant that the baby had grown in the abdomen instead of the uterus! An embryo swimming freely in the abdominal cavity is like a parasite that has a tendency to grow and invade blood vessels and derive its blood supply from some vital structures in the cavity like the intestine, liver, stomach, spleen—organs that carry good blood. Abdominal pregnancies rarely go beyond four to five months because the blood supply is not sufficient enough to nurture a full-term baby. Also, in a normal pregnancy, once the baby is delivered, the uterus contracts to control the bleeding. If the uterus doesn’t contract, the placenta, which supplies blood and nutrients to the baby, can bleed at the rate of approximately five litres per minute!

In the operating theatre, time was running out. Mumtaz had lost approximately 1.5 litres of blood within a couple of minutes. One of the ways to stop the bleeding was to remove the placenta and the uterus. We decided to do an obstetric hysterectomy, a complicated surgery to remove the uterus. Mumtaz, who is divorced, had already told me that she didn’t want to have any more babies, so she didn’t need the uterus any more. But even after the hysterectomy, the bleeding didn’t stop completely. The danger of losing Mumtaz was very real. The team had almost given up hope. We needed to think fast about how we could control the bleeding, so we decided to use the two units of blood that we had. I kept thinking of Mumtaz’s mother all the time the two are very close. In another attempt to control the bleeding, we decided to perform a rare procedure known as the cold saline haemostatic technique, where towels soaked in ice cold water are packed into the abdominal cavity.

After half an hour, the blood flow had slowed down considerably. Finally, after the abdomen was stitched up, we called in a surgeon to determine any possible damage to the organs, which was expected, given the complexity of the case. Imagine our relief, when we were told that despite the heavy blood loss, no organ had been damaged! We kept Mumtaz in the ICU for almost a day. We were still not sure if she had completely recovered. There were so many unexpected, rare and life-threatening aspects involved in her case. She had to be given 12 units of blood. But Mumtaz was destined to survive. On the second day, she was taken off the ventilator.

“In the midst of all this, the doctors were keeping a close watch on the baby. In most of these cases, the baby is congenitally malformed because the abdomen doesn’t give the baby space to grow and the organs inside exert pressure on her. It is natural to expect facial and limb malformations. But again, fate had something else in store. Fortunately, Farhana was born normal, weighing a healthy 2.75 kg. The entire family was in tears of joy. After several months of uncertainty, the Shaikh family finally heaved a sigh of relief. And so did we.”

A mother’s joy
“I believe this miracle happened because of the doctors’ efforts. Everyone at home had almost given up hope. My parents, my brother and bhabhi prayed very hard. I can never forget the time when everybody was worried. Nobody could sleep or eat well. Farhana and I are perfectly fine now. My baby means everything to me. I hope that I’m able to provide her with a good education so that she becomes a doctor and saves lives, just like Dr Neerja and her team did.” – Mumtaz Shaikh, 32

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