In an extremely rare case, a 39-year-old, Srinagar based couple, Nazia and Ayub (name changed owing to confidentiality) were blessed with a baby boy in the tricity’s Cloudnine Hospital, Chandigarh after the couple had undergone recurrent Pregnancy losses due to repeated ventriculomegaly in fetus, a kind of birth defect involving neural tube development in babies. Fetal ventriculomegaly is a condition in which a fetus’s brain ventricles (cavities) are abnormally enlarged. Usually, this condition (ventriculomegaly) in a fetus is first detected during a routine prenatal ultrasound exam during the second trimester (around 18 weeks) and ultrasound can measure the fetal brain’s ventricle size. In case of this couple, their ultrasound in Srinagar again indicated moderate ventriculomegaly and termination was proposed, however, the couple decided to visit the tri-city based hospital for a second opinion.
A team of doctors at Cloudnine Hospital comprising of Dr. Seema Sharma, Associate Director – Department of Gynecology and Obstetrics, Dr. ‘Deepshika Goel, Fetal Medicine specialist, conducted the evaluation of the fetus, it was found that the baby had mild ventriculomegaly and the baby can be delivered under regular monitoring and meticulous antenatal care. Frequent Ultrasound surveillance of the baby was done looking out for progression of the condition and to rule out any other anomalies and fetal growth during the rest of the pregnancy to ensure that the baby will not have future neurodevelopmental issues. The pregnancy continued uneventfully and the baby at term had only mild ventriculomegaly. The patient was delivered on 8th May 2022 a full-term male baby who was neurologically completely normal.
Nazia and Ayub, previously undergoing treatment in Srinagar had 6 miscarriages and had to undergo Medical termination of Pregnancy (MTP) 3 times for Neural tube defects in babies in the form of dilated ventricles in fetuses and one pregnancy loss was a twin pregnancy. Couple was in touch with Dr Seema Sharma, via video consultation owing to pandemic restrictions in view of bad obstetric history and fertility-related issues. With the help of treatment the couple again conceived in 2021 and delivered a healthy baby.
Dr Seema Sharma, Associate Director of Department of Gynecology and Obstetrics at Cloudnine Group of Hospitals, Chandigarh has the credit of managing high risk pregnancies and recurrent pregnancy losses. She emphasized that “Congenital anomalies are the major causes of long term disabilities or deaths in newborn babies. Amongst congenital abnormalities some of the most severe ones are congenital heart defects, neural tube defects and Down syndrome. Although approximately 50% of all congenital abnormalities cannot be linked to a specific cause, there are some known genetic, environmental and other causes or risk factors and most common preventable congenital abnormalities include neural tube defects, which are a challenging problem owing to their causes and consequences Prenatal ultrasound screening of neural tube defects by a highly skilled and trained fetal medicine expert goes a long way in diagnosing and managing such high-risk pregnancies.
Adding further says Dr. Sharma, in case of Nazia and Ayub, folic acid supplementation (4000 mcg) every day was given to the mother in view of her history of repeated NTDs till first twelve weeks of pregnancy. In low risk patients the dose is 400 mcg every day and has positive effect on reduction of birth defects. Also it is very important for any couple planning a conception to manage any pre-existing health conditions before and during pregnancy.
Diabetes for women with type 1 or type 2 diabetes it is essential to control pre conception blood sugars before planning to conceive as high sugars can increase babies’ risk of birth defects (NTD), stillbirths and other complications. Obesity a BMI of 30 or higher before pregnancy can increase complications during pregnancy including serious birth defects. So ideal to reach a healthy weight before getting pregnant. It is important to learn about both parents family health histories gives the baby the best start possible. If either of the baby’s father or mother have a family health history of a birth defect, developmental disability or genetic disease one can find and address potential health problems early.
While, cases related to ventriculomegaly or congenital anomalies in patients have been reported earlier, the successful antenatal care and regular monitoring of the fetus with multiple history of MTP’s and miscarriages stands as a testimony to the clinical expertise of the Gynecology and fetal medicine team and the advanced medical care at Cloudnine Hospital.