Doctors at Apollo Cradle, Chennai, the flagship hospital of the Apollo Group, for the first time in India, have used a combination of blood thinners and intravenous immunoglobulin at appropriate frequencies to prevent foetal death and ensured successful child birth in a woman suffering from rheumatological complications.

In yet another example of clinical excellence by Apollo Hospitals, Apollo Cradle, the premier birthing centre, showcased its expertise in handling high-risk pregnancies by helping a woman with not one but two rheumatological complications deliver a healthy baby boy.

Shyamala approached senior rheumatologist Dr S Ramakrishnan with a history of previous foetal loss in her first pregnancy. Examination of her records revealed that she had a combination of two rheumatic diseases, generally associated with bad pregnancy outcomes. The two diseases were Primary Antiphospholipid Antibody Syndrome and Neonatal Lupus, which have always been a challenge to rheumatologists in terms of management.

Primary Antiphospholipid Antibody Syndrome: A medical condition where there in increased risk of blood clotting, due to substances in maternal blood named as Antiphospholipid antibodies. A pregnant woman with primary Shyamala resents as recurrent abortion or repeated intrauterine foetal demise.

This syndrome leads to blockage of maternal blood vessels resulting in inadequate blood supply to the foetus leading to foetal demise. Occasionally new born in Neonatal Lupus is born with congenital heart block which may result in death or necessitate permanent pace maker implantation.

Neonatal Lupus is a disease associated with increased risk of heart block in the foetus resulting in foetal demise. Occasionally new born in Neonatal Lupus is born with congenital heart block which may result in death or necessitate permanent pace maker implantation.
 
Speaking about the condition, Dr S R Ramakrishnan said, "Some women during pregnancy have substances called Anti-Ro and Anti-La antibodies in the maternal blood, which cross the placenta and damage foetal conduction system and heart muscles. This damage results in complete heart block or heart failure ultimately leading to foetal death. This condition is called neonatal lupus"

Shyamala had another coexistent rheumatological disease named Primary Antiphospholipid Antibody Syndrome, which is also associated with increased risk of foetal demise, due to risk of blood clot during pregnancy. The blockade of blood supply to the foetus results in foetal demise.

“We have seen that administering a combination of blood thinners and intravenous immunoglobulin at appropriate frequencies can prevent foetal death and ensure successful delivery. Shyamala was administered intravenous immunoglobulin on the 12th, 15th, 18th, 21st and 24th week of pregnancy and underwent frequent echocardiography to detect foetal heart block and there was no evidence of heart block in the test done,” Dr Ramakrishnan added.