In January 2024, a 48-year-old woman walked into my clinic, 16 weeks pregnant with her first child. After years of trying and undergoing IVF, this was her long-awaited miracle. But her journey was far from easy.
She entered pregnancy with several risk factors—high blood pressure, a high BMI, pre-diabetes, and advanced maternal age. Each of these increased her chances of complications. At 18 weeks, she experienced light vaginal bleeding. A scan revealed a large subchorionic hematoma with retroplacental extension—an internal bleed near the placenta that can cause it to detach from the uterus, endangering both mother and baby.
Managing her care became a delicate balancing act. She was on blood thinners to prevent clots, but they risked worsening the bleed. We had to temporarily stop them and monitor closely. Our priority was protecting the baby’s growth and preventing pre-eclampsia—a dangerous pregnancy complication marked by high blood pressure, protein in the urine, and organ damage, especially to the kidneys and liver.
Since she lived far from our hospital, we set up remote consultations, local ultrasounds, and home blood pressure monitoring. Tight BP control was crucial. We adjusted her medication, regularly screened for pre-eclampsia, and monitored blood sugar levels, given her pre-diabetic condition and risk for gestational diabetes.
The hematoma remained the biggest concern. It lay right behind the placenta, threatening the baby’s oxygen and nutrient supply. We managed it with strict bed rest, progesterone, and serial ultrasounds. Only once the bleeding resolved did we cautiously resume low-dose aspirin to improve placental blood flow.
Despite our best efforts, by 30 weeks the baby’s growth had slowed dramatically, and the mother’s BP had spiked. At 34 weeks, we made the tough call to deliver. Though premature, 34 weeks is generally safe with preparation. We administered steroid injections to mature the baby’s lungs and gave magnesium sulphate to prevent seizures—a risk in severe pre-eclampsia.
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After a Caesarean delivery, the mother was stabilised in the ICU. She received blood thinners to prevent clots and was shifted to the ward within 24 hours. The baby, though born early, did well and was discharged from the NICU two weeks later. Both mother and child returned home safely.
This case is a reminder of the complexity of pregnancies in women over 40, especially with pre-existing health issues. IVF brings hope, but also added risks. That’s why careful planning, experienced medical teams, and access to full hospital facilities are essential.
Dr Joshi is a gynaecologist at Kokilaben Dhirubhai Ambani Hospital, said, “to women in their late 30s and 40s hoping to conceive: don’t lose hope, but be realistic. Adopt a healthy lifestyle, manage any medical conditions early, and get regular prenatal care. Pre-pregnancy counselling is key. The desire to become a mother should be supported by knowledge, preparation and the right care.
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Source: Times of India
