Doctors at Wockhardt hospital, Mumbai, not only managed to save the life of a serious Covid positive pregnant woman, but also helped her deliver a premature baby by performing lifesaving procedures, including emergency labour in ICU.
Fortunately, both the mother and the baby are doing well and have been discharged after spending 21 days in ICU, including 14 days on the ventilator.
Hethal Gandhi, 35, a resident of Mira Road, with 7 months of pregnancy, was referred to Wockhardt Hospital as she complained of fever for 2 days, which was followed by a relatively asymptomatic phase of probable corona infection for the patient. After 5 days, the patient started feeling breathless. This was followed by desaturation.
A CT scan performed at a private hospital showed 70-80% of lung involvement. On further tests, she tested Covid positive. Since she was very breathless and was not maintaining saturation with high flow oxygen of 15 litres per minute, she was shifted to the hospital for further management.
Dr Bipin Jibhkate, Consultant and Head Critical Care Medicine, Wockhardt Hospital, said, “On admission the patient was having low oxygen level, so she 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.”
Dr Jibhkate pointed out that pregnant women 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.
“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,” added the doctor.
Dr Jibhkate said that on ventilator initially, she was requiring very high oxygen and pressure support, even with that, the 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,” said Dr Jibhkate.
“ICU team performed 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,” added.
Dr Mangala Patil, Consultant Obstetrician, Wockhardt Hospital, said: “Considering that the 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 life-threatening condition to the patient, as well as anaesthesia related complications, it was decided that labour should be conducted in ICU in the supervision of Intensivists and neonatologists.”
Ultimately labour was conducted successfully and both mother and baby were fine after that.