A baby boy was delivered at 29 weeks recently. Doctors at a city hospital described it as a rare and miraculous case.
The baby’s mother had her amniotic fluid completely drained out at just 19 weeks of her pregnancy, a condition that could have caused septicemia and multiorgan failure.
The amniotic sac in the mother’s womb protects and supports the development of the baby. But 36-year-old Lisa Rao, a native of Kolkata, who has been in Bangalore for 10 years, had a premature rupture of membrane of the sac causing her amniotic fluid to completely drain out. Lisa was immediately hospitalised. She had earlier suffered a subchorionic haemorrhage that caused her placenta to tear during the 14th week of her pregnancy.
“My pregnancy was traumatic from the 14th week. After the sac ruptured, I had no hope as it was mentally and physically taxing,” she said. Dr Anita Balakrishna, consultant obstetrician and gynaecologist at Motherhood Hospital, said the breach in the barrier between Lisa’s womb and the environment had exposed her to a lot of infection as nearly 75 percent of the membrane had been separated.
“The baby was just around 300 to 400 grams heavy and between 19 and 28 weeks. It was not possible to deliver the baby. The patient had already developed chorioamnionitis where the foetal membrane swells due to infection,” she said.
Even as the amniotic fluid was completely dry, Lisa’s baby was wrapped in the membrane with no space left for growth and movement of limbs. However, ultrasound parameters indicated that the baby was developing and there was no bad prognosis, Dr Anita said.
Lisa continued to leak amniotic fluid sporadically and doctors feared her baby would develop thoracic rib cage deformities and pulmonary hypoplasia leading to incomplete development of lungs.
“There was no medium or space left for the baby to grow and despite hormone injections, the level of amniotic fluid remained abysmally low. Instead of the normal amniotic fluid index (AFI) of 12 to 13, Lisa was at 2 to 3,” Dr Anita said.
“Miraculously, my baby was developing normally and we did not see abnormalities. He was growing despite the very low AFI. It must have been hard for him but I managed to pull it off,” said Lisa who delivered the baby via Caesarean section.
Dr Jagannath Pairu, assistant professor at the department of obstetrics and gynaecology at Bangalore Medical College and Research Institute, said,”This is a rare case. Typically in the case of an amniotic membrane rupture, the body automatically produces liquor amnii to protect the baby. But if the baby has grown in a completely dry sac, its a rare and interesting case.”
In fact, according to a report Delivered Too Soon released by the Indian Foundation for Premature Babies, nearly half of the babies born at 32 weeks die due to lack of basic care. “Babies born at 32 weeks make up 16 per cent of all pre-term births. Of the 27 million babies born in India annually, 3.6 million are born prematurely of which at least 3 lakh do not survive due to complications,” the report said.
The World Health Organisation (WHO) stated that India with 23.6 per cent, topped the list of ten countries that account for 60 percent of the world’s pre-term births.
Awareness levels are very low when it comes to early rupture of the amniotic sac and need for intervention, according to Dr Swarna Rekha Bhat, professor and head, department of neonatology, St John’s Medical College and Hospital.
“When the amniotic sac ruptures prior to term, at any time earlier than 20 weeks, pregnant women should consult a doctor immediately. It could be of very high risk to the mother and the foetus,” she said. While the baby’s lung development will be poor, the mother may suffer from chorioamnionitis.
“If at any term during the pregnancy, the ultrasound indicates low amniotic fluid levels, the patient should immediately get it checked,” Dr Bhat added.