Pune: A resident of Aundh was 29 weeks pregnant. She had 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 a local physician but did not get any relief. The woman was later diagnosed with Tuberculous Meningitis infection, affecting the brain and meninges and delivered her twins at a city-based hospital.
The patient was brought to the hospital in a critical condition. Initial MRI showed features of internal hydrocephalus owing to severe Tuberculous infection affecting the brain and meninges. Given her condition, she was immediately put on ventilator support.
Dr Rohan Purohit, Consultant Gynaecologist at Aditya Birla Memorial Hospital, where the woman was treated, said that given the patient’s pregnancy meant her critical condition could have been fatal for both mother and foetus.
“But we had to first deal with the buildup of fluid in the ventricles deep within the brain,” said Purohit.
Neurosurgeon Dr Rakesh Ranjan was called and immediate drainage of the fluid was carried out using a minimal invasive approach.
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 first line of antitubercular treatment regimen along with steroids to reduce her brain swelling by Neurologist Dr Nilesh Nadkarni. Five days post admission in High Dependency Unit (HDU), her bag of membranes around the first baby which was in breech condition ruptured. Preterm premature rupture of the membranes commonly happens in patients with severe infection.
Dr Rohan Purohit said that 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 Chorioamnionitis and sepsis, which can cause tissue damage, organ failure, and death,” said Purohit. He added that the caesarean section was performed and twin babies, 1.1 kg boy and 1.3 kg girl were
delivered.
“Both the babies were fine and needed minimal support in Neonatal Intensive Care Unit (NICU). Treatment to reduce the risk of TB was given to both twins as per national guidelines. After 35 days, the patient was taken off from ventilator and was discharged home with left sided muscular weakness and 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, most importantly, can carry both babies in her arms,” said Purohit.
The teams of doctors involved in this case were Dr Rohan Purohit - Consultant Gynaecologist /Obstetrician, Dr Rakesh Ranjan- Consultant Neurosurgeon, Dr Nilesh Nadkarni- Consultant Neurophysician, Dr Urvi Shukla- Consultant Critical Care Physician, Dr Sangeeta Thakare- Specialist Critical Care and Dr Pooja Agrawal- Consultant Neonatologist.
