Ensuring A Healthy Beginning
A Succesful Delivery of a High-risk Pregnancy
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.
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.
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.