PRNewswire
Ahmedabad (Gujarat) [India], August 18: India has made real progress on maternal health in recent years with expanding access to healthcare and plummeting maternal mortality ratios. Yet a nation-wide analysis by the ICMR found that nearly half of all pregnancies in India are now classified as high-risk, and the country marks a maternal mortality rate of around 88 maternal deaths every 1 lakh live births. The aim is to lower it to 70 by 2030. In Western India, the department of gynaecology and obstetrics at Zydus Hospitals, Ahmedabad, has been established as a top high-risk pregnancy and IVF centre that manages a massive case load of high-risk pregnancies annually, spanning placenta abnormalities, multiple gestation, pre-existing conditions, preterm complications, and more. With an in-house blood bank, a dedicated Gynec ICU, in-house NICU, and round-the-clock specialists across obstetrics, fetal medicine, anaesthesia, and neonatology, the department is built to handle nearly any gynaecological emergency in the State.
With roughly 3 crore pregnancies and up to 2.7 crore live births annually, more than anywhere else in the world, even a small share of high-risk cases add up to an enormous number of women who need specialised care. A pregnancy is generally classified as high-risk when either the mother or the baby faces a higher-than-usual chance of complications. Common contributors include advanced or very young maternal age, a previous caesarean delivery, obesity, and pre-existing conditions such as diabetes or hypertension.
Dr. Namita Shah, Sr. Obstetrician and High-risk Pregnancy Expert, says, "Several of these factors are becoming more common in India. We handle a lot of high-risk pregnancy cases with such conditions, and recently, a 30-year-old woman in her second pregnancy, came to us for her antenatal check-up in her fifth month. Her first child was born by C-section. During the scans, we could see her placenta had invaded deeply into the uterine wall, and found that she had a rare condition known as placenta accreta spectrum along with placenta previa."
Placenta previa becomes considerably more serious when combined with placenta accreta spectrum (PAS). A prior caesarean delivery is one of the strongest risk factors for PAS, since the placenta can implant over the old scar and burrow in more deeply than it should.
"Our fetal medicine specialist confirmed PAS layered on top of placenta previa. In such a case, we need to deliver the baby in a setup with a strong anaesthesia team, an in-house blood bank and an in-house neonatologist as PAS carries a real risk of catastrophic blood loss during delivery, and if it isn't managed quickly, it can push a patient into haemorrhagic shock or organ injury. Fortunately, all of these facilities are available at Zydus, which also makes it a much safer setup for the patient," says Dr. Namita. An MRI was done ahead of delivery to map the extent of the placenta's attachment, and the team explained the inherent risks of her condition to the family.
The baby was delivered by an upper-segment caesarean section. "As anticipated, her placenta had invaded into the bladder wall, and an obstetric hysterectomy was required to control the bleeding. We had to transfuse 2.5 litres of blood and several units of fresh frozen plasma during the operation," added Dr. Namita.
Given the extent of the bladder involvement, Dr. Kaustubh Patel, Urologist, joined the surgical team. After the delivery of the baby, the placenta was carefully separated from the bladder wall and later a hysterectomy was performed. Post-op, the mother spent two days in intensive care. Both her and the baby's recovery were uneventful, and they were discharged in five days. "They both are doing well now," Dr. Namita said.
Dr. Raman Patel, Sr. Gynecologist, Endoscopic and Robotic Surgeon and IVF specialist, with nearly four decades of experience, met a couple who had been trying to conceive for ten years. The wife, 31, had a history of PMOS and irregular periods; the couple were also facing male-factor infertility and higher BMIs. They had already been through three rounds of intrauterine insemination and one IVF cycle elsewhere, all unsuccessful, before coming to Zydus for a second attempt at IVF, this time under Dr. Raman and Dr. Reitu Patel, IVF and Infertility Specialist and Embryologist.
Keen not to risk another failed cycle, the couple opted to have three embryos transferred. Despite Dr. Reitu explaining to them the potential complications of such a procedure, the couple insisted for the same. Surprisingly, all three embryos implanted. "However, in her first trimester, as she was experiencing multiple episodes of bleeding and spotting, we recommended that they consider reducing the pregnancy to twins," says Dr. Reitu Patel. The reduction was carried out under the guidance of a fetal medicine specialist, and a preventive cervical encerclage (a stitch to reinforce and help support the pregnancy) was done at 16 weeks. The mother had subsequently developed gestational diabetes as the pregnancy progressed.
At 25 weeks and 4 days, considered extremely ultra-preterm, she began experiencing severe pain and leaking so Dr. Raman had to move ahead with a caesarean delivery. "Both twins were born ultra-preterm, weighing just 800 grams and 900 grams. At that stage, babies haven't yet developed the ability to regulate their own body temperature or to breathe and feed without support, so we had to keep them in our in-house neonatal ICU," he said.
"One of the twins developed pulmonary hypoxia and needed ventilator support before recovering. They both spent around three months in the NICU before they were strong enough to be handed over to their mother," said Dr. Anita Srinivasan, Neonatologist.
"I recently spoke to the mother, and I was relieved to hear that the twin babies are doing exceedingly well," Dr. Raman said.
In addition, the team also has state's first MCh in Reproductive Medicine, Dr. Vivek Kakkad, IVF and Reproductive Medicine Specialist.
Though a cervical cerclage was enough to help carry that pregnancy through, for another patient who broke her waters at 4th month of her pregnancy, things took a far more severe turn. She had undergone three miscarriages in her fourth and fifth months, including two where a vaginal cerclage had already been placed. However, in her fourth pregnancy, she came to Dr. Riddhi Shah, Maternity Obstetrician, Gynaecologist and Robotic Surgeon. "Given her history, we had to be very careful. And as she was suffering from chronic cervical insufficiency, this time around, we planned to do a laparoscopic cerclage after the first trimester," she said. Cervical insufficiency is a condition where the cervix begins to open too early in pregnancy without contractions, often leading to second-trimester loss or extremely preterm birth.
"Unfortunately, she began losing amniotic fluid at the 4th month, so we moved straight to a laparoscopic abdominal cerclage," she added. Despite the fluid loss, the patient carried the pregnancy for another 3.5 months, and was admitted for 3 months. "We regularly sent for blood and urine tests and closely monitored her for any infections and also included the infectious diseases team who supported us throughout her stay," said Dr. Riddhi. After long and anxious hospital stay, she delivered successfully, and both the baby and the mother recovered well. Recently she celebrated her baby's first birthday.
Beyond high-risk pregnancies, other complex gynec cases including infertility, endometriosis, ovarian cysts, fibroids, menstrual disorders, and menopause treatment are also carried out here. The department's gynaecology team also includes Dr. Bina Mavani, Dr. Sonali Chauhan, Dr. Foram Vora, Dr. Margi Shah and Dr. Vaishali Patel, Zydus also extends their services in gynec cancer and breast cancer cases with experts like Dr. Ava Desai, Dr. Mona Shah and Dr. Priyanka Chiripal and Dr. Dhara Pandya.
As the quality of care across India remains uneven and a gap is reflected in national data as well as in individual outcomes. Zydus's push to bring advanced infrastructure, in-house specialists and specialised gynec care to its other centres with Dr. Reshmi Banerjee and Dr. Prachi Sabnis at Zydus Vadodara and Dr. Kavya Patel at Zydus Anand, is an effort to close that gap across Western India.
To know more about their services, visit https://zydushospitals.com
(ADVERTORIAL DISCLAIMER: The above press release has been provided by PRNewswire. ANI will not be responsible in any way for the content of the same)
