How a ‘miracle’ pregnancy at 48 got a happy ending

Byline: Dr Vaishali JoshiIn Jan 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 already 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 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 work 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 worry. 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 ultrasounds. 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 usually safe if we prepare well. We gave her steroid injections to mature the baby’s lungs. Before surgery, we started magnesium sulfate 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 moved to a regular ward. The baby, though early, did well. After two weeks in the NICU, she was discharged home 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 such pregnancies need careful planning, experienced doctors and a hospital with full facilities. To women in their late 30s or 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.Dr Joshi is a gynaecologist at Mumbai’s Kokilaben Dhirubhai Ambani Hospital. She spoke to Sharmila Ganesan Ram Quote: 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. To women in their late 30s or 40s: don’t lose hope but be realistic