Media Release

Udupi, October 12: Doctors at Kasturba Hospital, Manipal, have safely delivered a baby and preserved the uterus of a 32-year-old woman whose pregnancy was complicated by a serious heart condition and two very large fibroids, a combination that placed her at high risk of life-threatening bleeding and possible removal of the uterus.

The woman, who was 37 weeks pregnant, had coarctation of the aorta, a narrowing of the body's main artery that had previously been treated with a stent. She also had a bicuspid aortic valve, a heart valve with two flaps instead of the usual three, and long-standing high blood pressure. She had lost two previous pregnancies to ectopic gestation, in which a pregnancy develops outside the uterus, and had undergone surgery to remove one fallopian tube.

Adding to the risks were two large fibroids, non-cancerous growths in the wall of the uterus. Fibroids of this size have a rich blood supply and can cause severe bleeding during childbirth, often leaving surgeons with no choice but to remove the uterus to save the mother's life.

“In a mother with a treated heart condition, heavy blood loss is dangerous not only for the uterus but for the heart itself. We knew the risks well in advance, so every step of this delivery was planned together with our anaesthesia and interventional radiology colleagues. Having the interventional radiology team ready inside the operating theatre allowed us to control the bleeding, remove both fibroids, and preserve her uterus, which matters greatly for a young woman,” said Dr Jyothi Shetty, unit chief, Department of Obstetrics & Gynaecology, Kasturba Medical College, Manipal.

Before surgery, the interventional radiology team, led by Dr Harshith Kramadhari, placed small balloon catheters in both internal iliac arteries, the major blood vessels supplying the uterus, to enable rapid control of blood flow if required.

The Caesarean section was then performed under general anaesthesia by Dr Rekha, associate professor, along with Dr Prateeksha and Dr Divya C. A healthy baby girl weighing 2.6 kilos was delivered, crying at birth.

As feared, heavy bleeding followed. The initial attempt to block the blood supply to the fibroids using Gelfoam, a material that temporarily seals blood vessels, failed to stop the bleeding because the fibroids had an unusually rich network of large feeding vessels. The interventional radiologists then sealed the vessels supplying the fibroids from the left uterine artery using cyanoacrylate glue, a medical-grade adhesive, bringing the bleeding under control.

With the bleeding controlled, the surgeons removed both fibroids during the same operation. One measured approximately 15 × 14 cm and weighed 960 grams, while the other measured approximately 14 × 12 cm and weighed 740 grams, bringing their combined weight to nearly 1.7 kilos. Although the woman lost about two litres of blood, timely intervention meant she did not require a massive blood transfusion, and her uterus was preserved. She was closely monitored after surgery.

“This case shows what a teaching hospital can offer a patient: specialists from different disciplines working as one team, supported by advanced interventional radiology facilities on site. Our commitment at MAHE Teaching Hospitals is to ensure that families in coastal Karnataka and neighbouring regions can access this level of complex care close to home, without having to travel to a metro city,” said Dr Sudhakar Kantipudi, chief operating officer, MAHE Teaching Hospitals.

Doctors said the case highlighted the importance of early antenatal check-ups and planned delivery at a well-equipped centre for women with heart disease, large fibroids or other high-risk conditions during pregnancy.