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Dr. Pradeep Sharma

Dr. Gayatri Deshpande

Sr. Consultant
Gynaecology
Nanavati Super Speciality
Hospital, Mumbai



Ensuring A Healthy Beginning

A Succesful Delivery of a High-risk Pregnancy

THE CASE

A 30-year-old lady who had been for married for 5 years with a history of recurrent deep vein thrombosis in the lower limb had conceived naturally and was referred to Nanavati Super Speciality Hospital for further pregnancy care. At the time of admission, her initial weight was 103 kgs owing to a sedentary lifestyle and a family history of diabetes with hypertension making her case a ‘high-risk pregnancy’. She was given active treatment including lower molecular weight heparin 60 mg once a day throughout her pregnancy with monitoring of PT, PTT, INR on a regular basis with consultation by Dr. Niranjan Rathod, Associate Director, BMT & Consultant Haematologist. Her routine antenatal profile, as well as the screening for double markers and foetal anomaly scan, was done at 22 weeks which ruled out any abnormality in the foetus. On further follow-up, she showed signs of growth restriction when the foetal weight was only 1400 gms at 33 weeks. However, with high protein diet, protein infusion and other medicines, the weight of the baby improved up to 2700 gms at 39 weeks with the mother’s weight being 116 kgs.

THE PROCEDURE

At 39 weeks of gestation, Obstetric Doppler Sonography showed signs of Oligohydramnios and placental insufficiency; subsequently, the decision for induction of labour was taken. The injection for lower molecular weight heparin was stopped one week before the delivery and the monitoring of PT, PTT and INR were done. The labour process was initiated with vaginal instillation of PG E2 tablets to ripen the cervix followed by augmentation with oxytocin drip. She was monitored for continuous foetal heart rate (CTG) throughout the progress of labour.

THE RESULT

She delivered vaginally a full term female baby weighing 2750 gms with an APGAR score of 7/10 and 10/10. The second stage of the labour was completely uneventful without any complication of postpartum haemorrhage or perineal tear. She could breastfeed the baby immediately and recovered successfully in 48 hours. She was actively mobilised and was given the DVT prevention pump on both the lower limbs to prevent the recurrence of deep vein thrombosis. Further, the lower molecular weight heparin injection was started within 48 hours. Both the baby and the mother are doing well now and are looking forward to a wonderful life ahead.