Doctors at Aditya Birla Memorial Hospital successfully deliver a twin in a complicated pregnancy case of the female suffering from Tuberculous Meningitis

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8 July 2019 : Doctors of Aditya Birla Memorial Hospital, Maharashtra’s first Joint Commission International (JCI), USA and NABH Accredited Hospital successfully solves a rare and complicated case of a female who was 29 weeks (IVF)pregnant and was suffering from Tuberculous Meningitis.

Shweta(name changed), a resident of Aundh was 29 weeks pregnant, conceived by IVF with twin pregnancy after 12 years of her marriage. She faced difficulties in concentrating in her day to day activities, had severe headache, evening fever and irregular sleep cycle. She even consulted local physician but had no relief.

Shweta was brought to hospital in a critical condition. Initial MRI showed features of internal hydrocephalus (buildup of fluid in the ventricles deep within the brain owing to severe Tuberculous infection affecting the brain and meninges). Given her deteriorating clinical condition and her 29 weeks pregnancy, she was immediately put on ventilator support.

“Given the patient was pregnant her critical condition could have been fatal for both mother and fetus. But we had to first deal with the buildup of fluid in the ventricles deep within the brain”, shared Dr. Rohan S Purohit, Consultant Gynecologist at Aditya Birla Memorial Hospital.

Being a multi-specialty hospital, Neurosurgeon Dr. Rakesh Ranjan was called and immediate drainage of the fluid was doneusing a minimal invasive approach rather than traditional approach of Ventriculoperitoneal shunt (a medical device that relieves pressure on the brain caused by fluid accumulation) and External Ventricular drain to avoid the risk associated with pregnant condition.

Further, multiple tubercles were seen in the patient during Endoscopic ventriculostomy raising high suspicion of Tuberculous meningitis. Without any further delay, the patient was given 1st line of antitubercular treatment regimen along with steroids to reduce her brain swelling by Neurologist Dr Nilesh Nadkarni.5 days post admission in High Dependency Unit (HDU), her bag of membranes around the 1st baby which was in a breech condition ruptured. The Preterm premature rupture of the membranes (PPROM) commonly happens in patients with severe infection.

“The case had further complicated due to the rupture, hence post meeting with multidisciplinary team and taking the consent from relatives, we decided to deliver the babies to reduce the risk of bacterial infection that occurs before or during labor called Chorioamnionitisand Sepsiswhich canlead to tissue damage, organ failure, and death” said Dr. Rohan S Purohit, Consultant Gynecologist at Aditya Birla Memorial Hospital.

“Caesarean section was performed andtwin babies, 1.1kg boy and 1.3kg girl were delivered. Both the babies were fine and needed minimal support inNeonatal Intensive Care Unit (NICU).INH chemoprophylaxis to reduce the risk of TB was given to both twins as per RNTCP guidelines. After 35 days, the patient was taken off from ventilator and was discharged home with left sided muscular weakness and aphasia (inability to speak). Gradually, the patient responded to anti tubercular treatment and physiotherapy along with nutrition. The patient has now completely recovered and can walk independently, talk clearly, no memory loss, most importantly can carry both babies in her arms”, he further added.

The teams of doctors involved in this case were Dr Rohan Purohit – Consultant Gynecologist /Obstetrician, Dr Rakesh Ranjan- Consultant Neurosurgeon, Dr Nilesh Nadkarni- Consultant Neurophysician, DrUrvi Shukla- Consultant Critical Care Physician, Dr Sangeeta Thakare- Specialist Critical Care and Dr Pooja Agrawal- Consultant Neonatologist.

“Tuberculosis is rampant in India, and TB meningitis consists of only 1% of all cases. Complicated TB meningitis in pregnancy is a very rare and serious condition with mortality to the tune of 40-50% for both mother and baby. Such cases are always managed in a tertiary care institute with multi-disciplinary team”, shared Ms. Rekha Dubey CEO Aditya Birla Memorial Hospital “It feels great when our team of expert doctors solves such complicated case which is now selected for presentation at the prestigious RCOG (Royal College of Obstetricians/Gynecologists) World Congress in London, UK from 17th to 19th June 2019”, she further added.

At the end of the ordeal, Shweta expresses that the few months have been a roller coaster ride with highs and lows. But now holding her children in her arms makes everything perfect and worth the pain. “My journey would not have been possible without the support from my family members who stood by me and the wonderful team of doctors of Aditya Birla Hospital,” said Shweta