MIRACLE PREGNANCY AT 48

HOW A 'MIRACLE' PREGNANCY AT 48  ENDED HAPPILY

Dr. Vaishali Joshi, Gynaecologist, Kokilaben Dhirubbai Ambani Hospital, reports her most interesting case in The Times of India of 28 May 2025, through Sharmila Ganesan Ram

"In January 2024, a 48 year old woman walked into my clinic, 16 weeks into her first pregnancy. After years of trying and undergoing IVF, this was her long awaited miracle. But she alraedy had high blood pressure, a high Body Mass Index (BMI), pre diabetes before pregnancy and her advanced age to reckon with. Such a pregnancy is itself high risk, so we had to be extra cautious

.At 18 weeks she had light vaginal spotting and a scan showed a large internal bleed near the placenta., known as a subchorionic hematoma with retroplacental extension. This can lead to the placenta separating from the uterus, risking both mother and baby's lives.

The tough part was balancing treatment options. She was on blood thinners to prevent other complications., but those very drugs could worsen the bleeding. We had to temporarily stop them and monitor closely to protect the baby's growth and prevent pre-eclampsia in the mother, which is a serious pregnancy complication characterised mainly by high blood pressure, protein in urine and signs of damage to other organs, most often the liver and the kidneys.

She lived far from our hospital, which made regular check ups harder. So, we arranged for remote consultations, local sonographies and home BP monitoring. Tight blood pressure control was essential. We adjusted her medicines and screened regularly for protein in her urine and blood to pick up pre-eclampsia signs. We also watched for gestational diabetes, a risk due to her age and pre-diabetic history.

The hematoma was the biggest wory. It sat right behind the placenta, threatening to block the baby's oxygen and nutrients. We managed it with strict bed rest, progesterone  support and ultra sounds. Only once the bleeding stopped did we cautiously resume low dose aspirin to maintain blood flow to the baby. But the baby's growth slowed down greatly after 30 weeks and the mother's blood pressure soared. At 34 weeks, we made the difficult decision to  deliver the baby. While still premature, 34 weeks is safe if we prepare well. We gave her steroid injections to mature the baby's lungs. Before surgery we started magnesium sulphate to prevent seizures, a known risk in severe pre-eclampsia. after the Caesarean, the mother was moved to the ICU. Her BP was stabilised and she received  blood thinners to prevent clots.  After 24 hours, she was moved to a regular ward.  The baby, though early, did well. After two weeks in the NICU, she was discharged  with the mother.

This case highlights how complex pregnancies can be for women in their 40s, especially with pre- existing health conditions. While IVF offers hope, it also brings added risks. That's why scuh pregnancies need careful planning, experienced doctors and a hospital with full facilities. To women in their 30s and 40s thinking about pregnancy, don't lose hope  but be realistic. Follow a healthy lifestyle, get regular checkups and manage blood pressure or diabetes early on. Regular prenatal care is key as is pre-pregnancy counselling. The desire to become a mother must be backed by knowledge, preparation and the right care. That's what gave this mother and her baby the happy ending they deserved."

Reading this article, my wife, a mother of two grown ups, quietly said she never knew pregnancy was this complicated.