Mumbai: When the world is fighting against Covid-19 during this time delivery of a child has become very challenging for the frontline health workers and Pregnant woman. A team of doctors in Mumbai hospital headed by Dr Pritam Moon (consultant physician), Dr Bipin Jibhkate (Consultant and Head Critical Care Medicine), Dr Mangala Patil (Consultant Obstetrician), Dr Samir Shaikh (Consultant Neonatologist), helped a 35 years old woman who was Covid-19 positive and delivered a second baby at 31st week, after performing the emergency labour in ICU. The mother and baby both are doing well and have been discharged after spending 21 days in ICU, 14 days on the ventilator, and a total of 25 days of Hospital stay.
A 35-year-old Hethal Gandhi is a housewife and resident of Mira Road was tested positive for Covid-19 during her pregnancy. She was referred to Wockhardt Hospital but having no symptoms of Covid-19 that means she was an asymptomatic patient. But she was having mild fever and after 5days she started complaining about breathlessness. and couldn’t maintain saturation with a high flow of oxygen.
According to Dr. Bipin Jibhkate who is Consultant and Head Critical Care Medicine, Wockhardt Hospital, Mira Road said, “RT PCR test was performed on admission to confirm COVID. On admission the patient was having a low Oxygen level, so was admitted to ICU and started on HFNC (high flow nasal cannula). There were multiple challenges in managing this patient in ICU as her immunity was low; her physiological needs were different from normal women. Pregnant females have a higher tendency for clotting, their abdominal pressures are high, their carbon dioxide levels are low, they have a higher tendency to vomit, and they are carrying a baby in their tummy. So in such a situation, if their oxygen level is not maintaining the options are very limited. Considering all these things initially HFNC was tried but she could not maintain her oxygenation even with the highest settings of HFNC. So, we decided to put a tube through her mouth to her chest and put the patient on a ventilator. On ventilator initially, she was requiring very high oxygen and pressure support, even with that patient’s oxygen level was low. In such a situation, generally normal patients are managed in prone position ventilation, but due to pregnancy that was not possible with this patient, so we decided to put her in right lateral position. Along with this, she was started on standard treatment of COVID, like anti-viral, antibiotics, steroids, and anticoagulation. She also had decreased urine, alternate hypotension and hypertension, very high heart rate of around 150/minute. Slowly she responded to the treatment and her ventilator requirement went down. But even after 7 days of ventilation she was requiring a significant level of the ventilator and hence it was decided that we will have to remove her tube from the mouth and put it through the throat, a procedure called as a tracheostomy. “
“ICU team performed a procedure called a percutaneous tracheostomy. In this procedure, a hole is made in the front of the neck into the patient’s windpipe that is the trachea. We at this stage also repeated her COVID test, which turned out to be negative and patient was free from COVID. So, this patient was shifted to non-COVID ICU and slowly was taken out of ventilator after 14 days of ventilation.” he added
The patient went into the labour pain due to stress after which delivery has to be performed in ICU itself where she deliver a child.
“Considering that patient was having tracheostomy, still requiring a small amount of Oxygen, had higher chances of clot-forming which may go into lungs during operation and cause the life-threatening condition to the patient, as well anesthesia-related complication, it was decided that labour should be conducted in ICU in the supervision of Intensivists and neonatologists. This was very risky and unusual as labour is normally conducted in labour rooms.” said Dr. Mangala Patil, Consultant Obstetrician, Wockhardt Hospital Mira Road
Ultimately labour was conducted successfully and both mother and baby were fine after that.
