Dubai: An Indian expat woman aged 31 has beaten all odds to save a high-risk, unplanned pregnancy that was confirmed following a road accident in the UAE.
“My heart could have stopped and I could have died anytime,” recalls Sumbul Anak Khan, a mother of three, in an interview with Gulf News one-and-half months after delivering the child.
Sumbul got to know about her third pregnancy during tests when she was rushed to the hospital with head injuries after a car accident in November 2022.
Head injuries, rheumatic heart disease
She received 11 stitches for head injuries. But, what worried doctors more was the condition of her heart.
“I was diagnosed with Rheumatic Heart Disease a year ago. So, doctors from two hospitals here and in India advised for medical termination of the pregnancy,” Sumbul told Gulf News.
I was diagnosed with Rheumatic Heart Disease a year ago. So, doctors from two hospitals here and in India advised for medical termination of the pregnancy.
During pregnancy, an increased pressure on the damaged heart valve of a patient with Rheumatic Heart Disease (RHD) leads to increased risks to the mother and child though many women with RHD have had healthy pregnancies and healthy babies with the right medical care.
She delivered her youngest, a healthy baby, one-and-a-half months ago.
Sumbul said she and her husband, Danish Anwar Khan, did not want to lose the child.
They decided to go ahead with the pregnancy after they received supportive assurance from Aster Hospital in Sharjah.
The medical team conducted a thorough clinical evaluation under the expert care of Dr. Danu Chandradas, specialist obstetrician and gynecologist, and Dr. Yogeeswari Vellore Satyanarayanan, specialist cardiologist.
The patient was diagnosed as a high-risk pregnancy case, with previous two Lower Segment C-sections, Rh-negative pregnancy, hypertension, and complex heart disease.
Sumbul said she had difficulty breathing and suffered from joint pains and heavy sweating.
Further assessments revealed mixed mitral valve disease (MMVD), including moderate to severe mitral stenosis and moderate mitral regurgitation. In MMVD, the combination of aortic regurgitation and aortic stenosis (AS), are common causes of congestive heart failure.
Due to the significant risks involved, including the possibility of acute heart failure, abnormal heart rhythms, stroke, and — in rare cases, death — a multidisciplinary team was formed.
The patient was under constant surveillance by multidisciplinary team which included obstetrician, foetal medicine unit, cardiologist and intensivist.
It meant close and frequent monitoring throughout the pregnancy.
“The doctors made me feel comfortable and I went for checkups every two weeks.”
Sumbul also followed the doctors’ advice — go for a walk every day, light yoga and breathing exercises. She completely avoided coffee and reduced the use of oil.
Medications were optimised. Dr Yogeeswari decided to opt for smart device monitoring to constantly monitor Sumbul’s heart rhythms.
“The doctor advised me to get an Apple Watch. It really helped with the constant monitoring of my heart’s condition.”
She said she used the smartwatch to check her heart rate, take ECG and detect heart arrhythmias such as atrial fibrillation (AFib).
“The doctors were in touch with me on WhatsApp also. I used to send the reports from the smartwatch to Dr Yogeeswari. I regularly updated my BP reading also.”
Meanwhile, she was also advised to seek the help of a foetal medicine specialist. “I consulted Dr Ali Hussein Al Ibrahim, consultant in maternal foetal medicine at Medcare Hospital Sharjah, who also works at the Mother and Fetuses Clinic in Sharjah. He was a great help in the whole process. He kept monitoring the baby monthly for the last five months by regular 3D scans which took away a lot of our worries about the baby's well being,” she said.
As the gestation progressed, however, Sumbul experienced worsening breathlessness, especially at night, dizziness, and extreme fatigue.
Her medications were adjusted accordingly and doctors decided to opt for a preterm C-section. Sumbul said she was aware of the grave nature of her condition. “I was a bit nervous when doctors said we will go for preterm surgery. But, the doctors comforted me and I just decided to trust them and trust in God.”
On May 24, she underwent a C-section under general anaesthesia, under the close watch of Dr. Karthik Nallu, specialist anaesthetist.
Sumbul said she had received epidural anaesthesia to delivery her two older children, now aged eight and seven.
“I knew what was happening during the delivery. This time, I just did not know what happened. But I am so grateful the surgery was successful.”
Heart rate fluctuations
During the delivery, Sumbul underwent close haemodynamic monitoring. Dr Yogeeswari said: “She had fluctuations in her heart rate and BP which were managed appropriately.”
The mother remained in the Intensive Care Unit (ICU) for a day while her newborn son, Huzaifa, was in the neonatal ICU as “he did not cry after coming out and had breathing issues.”
“Our union happened on the second day and I can’t explain how emotional I was. I didn’t know how to thank my doctors.”
The mother and child were discharged after five days. The doctors said the first two weeks post-delivery were also critical, as there was an increased risk of heart failure during this period.
Mother of three
However, Sumbul has defied all odds and is now a happy mother of three. “I still have breathing difficulties when I walk fast or climb steps. But I am pulling through and continuing to follow the doctors’ advice.”
Meanwhile, Sumbul was also advised to seek the help of a foetal medicine specialist. “I consulted Dr Ali Hussein Al Ibrahim, consultant in maternal foetal medicine at Medcare Hospital Sharjah, who also works at the Mother and Fetuses Clinic in Sharjah. He was a great help in the whole process. He kept monitoring the baby monthly for the last five months by regular 3D scans which took away a lot of our worries about the baby's well being,” she said.
She urged women with high-risk pregnancies to put their faith in capable doctors and not to take the stress and complicate things further. “I am also very grateful for the immense support I got from my husband,” she added.
According to the World Heart Foundation, rheumatic heart disease affects 40 million people worldwide.
Every year, it claims more than 300,000 lives —about two per cent of all deaths from cardiovascular disease — the top cause of death globally.
Dr. Danu Chandradas said cardiac disease during pregnancy is a significant cause of maternal morbidity and mortality. It is found in only one to four per cent of all pregnancies.
“The highest prevalence of RHS has been reported in India, China, Pakistan, Indonesia, and Congo. Among the pregnant women with heart disease, RHD was found in 70.25 per cent. Cardiovascular disease is one of the most frequent leading cause of maternal mortality reaching up to 15 per cent,” she said quoting previous studies.
“The patient is of Indian origin and she had multiple valvular disease. The risk of maternal mortality in rheumatic heart disease with multiple valve involvement is as high as 30 per cent.It also causes morbidity and mortality for the growing foetus.
Studies show that, the rates of prematurity in foetus of women with rheumatic heart diseases are 20 to 30 per cent, foetal growth restriction 5 to 20 per cent, and stillbirth one to three per cent,” she added.