Baby and mom safe at home after emergency C-section in ICU

Posted on 26 February 2021

A Mediclinic Kimberley mom met her baby girl, Thembile, one month after she gave birth – while she was in a coma.

“The mom was intubated, in intensive care, for a month. Looking back I think you can safely say she was one of the most severely sick moms who made it.”

Dr Peet Potgieter, a gynaecologist and obstetrician at Mediclinic Kimberley, looks back at one recent patient with a lingering sense of surprise, and a hint of pride.

When Thuli Ndzunga came to Dr Potgieter at the beginning of her pregnancy, she showed signs of chronic high blood pressure and early-onset diabetes – both risk factors that warned of a challenging pregnancy and potentially complex delivery. Months later, she came in for an unscheduled visit, and she looked terrible, he says.

“We admitted her, and she tested positive for COVID-19,” he explains. “From there her condition got progressively worse.”

When patients arrive at Mediclinic hospitals, they are tested for coronavirus disease upon admission. This test empowers physicians to treat them accordingly; whereas negative patients may be streamed into COVID-free areas and grouped with other confirmed negative patients, positive patients are guided into a different direction of treatment.

Patients with a positive COVID-19 result are examined by physicians early after admission and triaged into treatment protocols in either a general ward, high care or intensive care unit, depending on several criteria, including the severity of their condition. Patients in ICU may, if necessary, be placed in an induced coma leaving them, unaware of the treatment they receive.

Thuli’s case was so severe, Dr Potgieter says, that doctors faced a challenging choice: if they did not deliver the baby soon, she could pass away.

“From the evidence we have seen, pregnant women don’t battle too much when they have COVID-19, on average,” he says. “But in a small number of severe cases, the problem comes in when they need to be ventilated. Pregnancy has an effect on a mom’s ventilation capacity – which means the lungs, blood pressure, a wide range of factors are affected.”

Pregnancy alters a woman’s physiology in subtle but important ways, from hormone production to blood supply, and this creates a delicate balance designed to support the foetus’ development while ensuring the mom has what she needs to thrive.

COVID-19 puts that balance under strain. Thuli started to show signs of preeclampsia, a dangerous complication characterised by high blood pressure and signs of damage to other organs, such as the kidneys.

“We could see she was getting worse, and quickly. As a team, we decided the best thing to do would be to perform a Caesarean section, as we could then ensure the health of the baby and really give the ventilation option our best shot.”

It worked. Thuli was in an induced coma, unresponsive, while doctors maintained her respiration and blood flow levels, throughout the C-section procedure.

Delivering the baby, Dr Potgieter says, changes the cardiovascular system of a mom. “The best way I can explain it is to say, you put the blood back into the system, and that circulates better, and ventilation better. The baby was big enough to come out safely, so this decision was more about mom.”

From the moment the baby was born, Thuli started to turn around, says Dr Potgieter. “She was in ICU for another four weeks, in an induced coma, which just shows you how sick she really was. Only in the last few days of her stay were we able to move her over to high-flow oxygen and her normal oxygen levels started to normalise, and that’s where she started to come out of it.”

Today, Thuli is home and happy with her new, healthy family. While staff at the hospital nicknamed the little girl Thembile, which means hope in Xhosa, the family chose Asiphile, which means, a gift from heaven.

Published in Patients