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A 38-year-old woman suffering from dilated cardiomyopathy successfully underwent high-risk caesarean section delivery at Fortis Hospitals, Bannerghatta road. The patient had visited the hospital with a complaint of breathlessness which she was experiencing since for the past three days. The team of doctors who managed her delivery was led by Dr Rajpal Singh, Consultant -Interventional Cardiology, Fortis Hospital, Bannerghatta Road and Dr Anu Sridhar, Consultant- Obstetrician and Gynecology.
The patient was consulting local clinics and visited Fortis Hospitals when she was in an advanced pregnancy stage. Post-diagnosis at Fortis Hospitals, doctors found out that her heart was functioning to only one-fifth of its normal capacity and showed clear signs of heart failure. The woman was on her 33rd week of gestation and the situation was life-threatening to her as well as her baby's life.
The patient had an impaired heart failure and was advised to avoid the pregnancy, and even if she does, she was strongly advised to terminate the pregnancy. With careful risk assessment, a multi-specialty team of doctors managed her condition and performed a C-section in which the baby was delivered successfully and the mother's condition was also stable.
Dr Rajpal, Consultant -Interventional Cardiology, Fortis Hospital, Bannerghatta Road reportedly said that the patient was experiencing impending cardiogenic shock, with a live fetus, so it was imperative that they salvage the live fetus as early as possible and at the same time save the lady's life. We decided to stabilise her heart, reduce the stress on it and improve the coronary perfusion by inserting an intra aortic balloon pump. This novel technique improved the pumping action of her heart and she was able to undergo a caesarian section. Following C-section, the patient started showing early signs of recovery; and within 36 hours she was stabled and started her heart failure medication.
Dr Anu Sridhar, Consultant- Obstetrician and Gynaecology, Fortis Hospital, Bannerghatta Road reportedly said it was a difficult task to perform delivery in this case, as in heart failure; either the life of the mother or the baby is at risk. In order to prepare her for the delivery, they had to first stabilize her heart condition so as to reduce the risk. Dr Rajpal closely monitored her heart rate and blood pressure. When her condition stabilized, they performed C-section on the patient and the baby was surgically removed from the mother's abdomen. Presently, both mother and the baby are doing well and have been discharged from the hospital.
Dr Murali Chakravarthy, Director, Department of Anaesthesia, Critical Care and Pain relief, Fortis Hospitals, Bannerghatta road also said that high-risk pregnancies like this require specialized obstetric and anaesthetic care. In order to prepare for the delivery, they had to put her on the mechanical support that stabilized her heart condition. Administering anaesthesia for patients with mechanical support itself is a challenge. This case highlights the importance of high-risk care in obstetrics, anaesthesia and cardiology to support these high-risk patients.
The patient said that she had consulted several hospitals for the treatment but none of them was ready to handle her case. She feared losing her baby as her heart condition was getting worse day by day. But with the constant support of the doctors, they assured that her heart condition was stable and she delivered her baby.
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