By Dr. Shaheen Akhtar, Consultant – Obstetrics and Gynaecology, Manipal Hospital, Mysuru

Pregnancy is a remarkable journey, often filled with joy, anticipation and sometimes, uncertainty, particularly in the case of medically assisted pregnancies.  At Manipal Hospital, Mysuru, patients facing such adversity find hope through expert care and advanced medical interventions. One such case was that of Prerana (name changed), a 37-year-old woman who conceived through IVF after facing two ectopic pregnancies and multiple surgeries.

Prerana’s pregnancy, however, was complicated by several serious conditions, which required meticulous planning and expert care. Her journey began when she conceived through IVF in Bengaluru, after years of trying to become a mother. She followed up at Manipal Hospital, Mysuru, at 10 weeks of pregnancy.

However, by 20 weeks, she was referred to Dr. Shaheen Akhtar, Consultant – Obstetrics and Gynaecology, at Manipal Hospital, Mysuru, with an anomaly scan revealing placenta previa (a condition where the placenta covers the cervix, creating potential risks for both mother and baby).

Her situation was further complicated by other risk factors, including her advanced age and history of two laparotomy surgeries and the removal of fibroids. This combination of factors raised her risk of placenta attaching too deep into the uterine wall medically called placenta accreta.

Prerana experienced heavy bleeding at 26 weeks, which was controlled with medication and hospitalisation. However, as the pregnancy progressed, she began experiencing spotting and reduced foetal movements from 31 weeks. An MRI scan revealed a dangerous condition called placenta percreta, where the placenta had invaded the bladder.

A multidisciplinary team comprising Obstetricians, Cardiologists, Urologists, Neonatologists, Intensivists and Paediatricians began formulating a complex treatment plan. After counselling Prerana and her family, the medical team decided to proceed with surgery. A urethric stent was placed, followed by a pre-surgical procedure in the Cath lab, where a balloon was inserted into the arteries supplying the uterus to help control bleeding.

The surgery itself was a delicate and high-risk procedure. Under general anaesthesia, a midline incision was made and the baby was safely delivered. Given the risks of massive blood loss, a hysterectomy was performed, with the balloons in the arteries inflated at the critical moment to reduce bleeding by up to 50 percent. Fortunately, there were no bladder injuries and the surgery was successful.

Though the recovery has been challenging, both mother and baby are showing positive signs. The baby, who weighs 1.6 kg and is on a ventilator, is coping well, and plans for extubation are progressing.

Regarding the complexity of the case, “Women with a history of multiple uterine surgeries, such as myomectomy, caesarean sections or other uterine procedures, face a higher risk of complications like placenta previa, where the placenta attaches in the lower uterine segment. This condition significantly increases the chances of severe bleeding and requires expert care. Managing such high-risk pregnancies calls for a multidisciplinary approach.”

With the support of a highly skilled, multidisciplinary team and the advanced medical infrastructure available at Manipal Hospital, Mysuru, Prerana received the best possible care to manage these risks and bring her baby safely into the world.