A 19-year-old woman who suffered from acute liver failure during pregnancy was saved after a 12-hour transplant surgery here. The child was also delivered successfully which is rare, claim doctors.
The surgery took place at Sir Ganga Ram hospital(SGRH).The patient, Swati Kumari, suffered from acute liver failure in the 38th week of pregnancy due to hepatitis E infection, said the doctors. She was admitted to a hospital in her hometown Patna with severe jaundice and referred to SGRH later.
“The problem in her case was that she required urgent liver transplantation as a life-saving procedure, however, that could put the unborn child at risk of anaesthesia and death. If we had decided to conduct the delivery then the patient would have been at risk of severe uncontrolled bleeding because of thinning blood,” said Dr Naimish Mehta, the liver transplant surgeon.
The woman went into spontaneous labour on the second day of her admission and gave birth to the child. But then went into deep coma which could lead to death.
“A healthy person’s brain activity measures greater than 90 on Bi-Index Spectrography (BIS). In patients who are under anaesthesia it reduces to 40-60. But, when BIS shows reading of less than 40, then tests for brain death are advised. In Swati’s case, the BIS reading was 17-18 which is very low. We were in a quandary whether to perform a transplant to save her or not.
Finally, on the family’s permission, a 12-hour long transplant procedure was conducted. The girl’s mother donated part of her liver,” said Mehta.
Dr Jayshree Sood, head of the department of anaesthesia said the patient regained consciousness within 48 hours of surgery. “The first thing she asked after gaining consciousness was about the child. It’s her first baby,” said Reena Devi, the patient’s mother. Both the child and the mother are doing fine post-surgery, said the doctors.
Health experts say hepatitis E infection is the most common cause of liver failure in pregnancy and is dangerous for both mother and child with a mortality rate from 60 to 100%. “We received four similar cases in the last three years. In three cases, only the mother survived,” said Dr Mehta.
He added that hepatitis E virus is transmitted through contaminated food and water. “During pregnancy, the immunity levels are low and chances of infection causing severe complications such as liver failure increase. One must take precautions such as drinking clean water, avoiding food from outside and not having fruits without washing them properly. Maintaining hygienic practices such as hand washing , particularly before handling food is helpful,” said a senior gastroenterologist.