The Story of the “First Cry”

N. Loganayaki

Assistant Nursing Superintendent, Kauvery Hospital, Hosur

Introduction

“There is no role in life that is more essential than that of motherhood”

              —Elder M. Russell Ballard

“Motherhood is near to divinity. It is the highest, holiest service to be assumed by mankind”

     —Howard W. Hunter

Yes, Motherhood is precious.  Infertility is a major concern all over the world. National Health Survey 5 2019–2021 says that a growing challenge is being posed by primary infertility in India

It affects approximately 8–10% of couples worldwide. Of 60–80 million couples suffering from infertility every year, probably between 15 and 20 million (25%) are in India alone. According to a report by the World Health Organization (WHO), one in every four couples in developing countries is affected by infertility (Indian J Community Med)

Case Presentation

A 32 years aged female came to OPD with complaints of nullipara, in 5 years of marriage life, non-consanguineous marriage. Known to have hypothyroidism. No other comorbidities.

They faced many social stigma issues from relatives and friends. They felt isolation and hopeless.

Our IVF team approached them with all possible treatment plans. IUI was tried but were unable to get expected results with the in IUI,

The IVF team planned for ICSI, In spite of careful implementation of procedure patient’s HCG Was positive.

IVF and ICSI

Techniques that involved manipulation of oocytes outside the body are termed assisted reproductive technology (ART) with in-vitro fertilization (IVF) as the most common form. The term ‘in vitro’ means outside a living organism as oocytes mature in vivo in the ovary and embryos develop into pregnancy in the uterus, but the oocytes are fertilized in a petri dish.

Robert Edwards, Ph.D., and Patrick Steptoe, MD, reported the first live birth from IVF in July 1978 in England. This achievement would later earn Dr. Edwards the Nobel prize in Medicine in 2010.

ICSI

Intracytoplasmic Sperm Injection (ICSI) is a specialized form of In Vitro Fertilization (IVF) that is used primarily for the treatment of severe cases of male fertility. ICSI involves the injection of a single sperm directly in to a mature egg.

During the ANC period, she was followed with all the necessary investigations and immunizations. Mother was normal throughout the ANC visits until 34 weeks with DCDA twins.

A regular 34 weeks checkup showed that patient had a high blood pressure 170/100mmhg and no other symptoms like headache, giddiness and blurred vision.

Pre-Eclampsia

Pre-Eclampsia is a life-threatening complication of pregnancy. It is a condition that typically starts after the 20th week of pregnancy and is related to increased blood pressure (BP more than 140/90mmhg) and protein in the mother’s urine (urinary albumin protein more than 300mg/24hr). The clinical spectrum of pre-eclampsia ranges from mild to severe. Preeclampsia occurs in 5–8% of pregnancies worldwide and is the second leading cause of direct maternal and fetal deaths.

Preeclampsia has remained a significant public health threat in both developed and developing countries contributing to maternal and perinatal morbidity and mortality globally.

 

Patient was admitted in ICU and observed for 4 hr with preeclampsia guidelines and management. Fetal movements were monitored continuously.

In view of babies, obstetrician tried to continue another one or two weeks of pregnancy. But as safety of patient was threatened by eclampsia , hence patient taken for Emergency LSCS.

Eclampsia

Eclampsia is the new onset of seizures or coma in a pregnant woman with preeclampsia. These seizures are not related to an existing brain condition.

 

Few risk Factors

Preeclampsia, Autoimmune disorders, IVF, DM, Kidney diseases, Obesity, Family history of preeclampsia, Early or late pregnancy, Multiple pregnancies, etc.

BP was maintained 150/110mmhg with all the effortive measures. Explained to the patient’s husband that the need of Emergency LSCS in view of eclampsia. High risk consent was received from attenders; both maternal and fetal complications were explained.

Patient was on Labetalol infusion continuously.

Patient was shifted to OT and Emergency LSCS was done. Intraoperatively vitals were stable

Emergency LSCS done at the sunset of the day but it was the sunrise for the Parents. Twin babies were received by the father’s hands with great happiness .

  • Twin I – Birth weight 1.450 kg on 28.06.2024
  • Twin II – Birth weight 1.730kg on 28.06.2024

Both cried at birth. Vit K injection was given. Both babies were anatomically normal and Apgar score was also normal with minimal O2 support.

Mother was shifted to ICU for post op care on Labetol infusion. She was stabilized with medications, close observation was carried out postoperatively and mother was shifted to ward on 2nd postop day.

Babies were shifted to observation unit with O2 and IV Fluids support, On the 2nd day O2 was off; slowly started oro gastric tube feed and followed by Paladai feeding. IV fluids was stopped; babies tolerated oral feeding well on 3rd day.

Mother was kept in ICU for observation with hypertension control measures, once stabilized she was shifted to normal ward. After 4 days babies were given to the mother, one by one.

Mother and both the babies were discharged safely on 3.7.2024 with proper health education.

Health education

We learnt from this case that individualized care will make the impossible possible

Heartfelt appreciation to our dedicated Nurses

Ms. Caroline SN – KHO

Ms. Sathya SN – KHO

Ms. Rupasree SN – KHO


Ms. N. Loganayaki
Assistant Nursing Superintendent

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