Glad tidings they bring in these bleak times
A team of doctors from De Soysa Hospital for Women come to the fore for safely delivering quadruplets from a COVID-19 infected mother through a Caesarian section (C-section)
They managed the pregnancy for nearly one long month because it was too early for the babes to be born – but then came the day when they could delay no longer, for the condition of the young mother was deteriorating.
They also pored over medical literature from all over the world to get some guidance on how to manage this pregnancy and deliver the babies, but could not find any.
Are they the pioneers who have shown the way? Most probably they are.
The team which has come to the fore for safely delivering quadruplets through a Caesarian section (C-section) in this new normal of the COVID- 19 pandemic are from the ‘grand matriarch’ of maternity care in Sri Lanka – the De Soysa Hospital for Women, down Kynsey Road, Colombo.
“We just couldn’t wait any longer and so we did the C- section on Thursday (December 17) and delivered the four babies at around 11.15 a.m.,” says Consultant Obstetrician & Gynaecologist, Dr. S. A. Ruwanpathirana, explaining with a smile that since that time of birth when the babies were whisked off to the Neonatology Unit he has not seen them.
Mother and babies, two boys and two girls, are fine – good news in these bleak times of COVID-19.
The 25- year- old mother from Dematagoda had been very conscientious the moment she was with child, her first pregnancy, attending the antenatal clinic. The scan at eight weeks found her to be carrying quadruplets. Twelve weeks into the pregnancy, the first signs of trouble came in the form of bleeding, but the obstetric team treated her and she went on for 28 weeks without issue.
However, on November 30, she arrived at the hospital with breathing difficulty and was in the COVID19 isolation unit awaiting an RT-PCR test result. Her blood pressure had risen as also her liver enzymes.She was also positive for COVID-19.
Dr. Ruwanpathirana explains the team’s dilemma – they were not a COVID-19 Treatment Centre and she would have to be transferred to the Colombo East ( Mulleriyawa) Hospital.The mother needed special care in a maternity setting.
“We decided to keep her at the De
Soysa Hospital after teams from all disciplines discussed the matter at the COVID- 19 meeting,” he says, explaining that one and all were in agreement that “we will manage”.
Then followed the ironing out of the details of logistics, for this mother who was COVID-19 positive could not be kept with others who were suspected of having the disease in the isolation unit.
All teams put their heads together and with the support of the Matron demarcated an area near the Outpatients Department ( OPD) for her, with medical and nursing teams rotating so that a majority of the staff would be safeguarded, as otherwise a COVID-19 spread within the hospital would spell disaster.
For a few more weeks they managed the pregnancy, keeping the mother’s pressure and liver enzymes down but then her haemoglobin and platelets began to drop. Assuming that she would have got over her COVID-19 infection two weeks into the disease, they were disappointed as both the Rapid Antigen and RT-PCR Tests continued to be positive.
By December 17, they could wait no longer – her platelets were still dropping and her renal functions were also getting affected. The mother’s life was in danger and the babies had to be delivered. Ideally, they would have preferred if the babies were 34 weeks, but with no option they went ahead at 30 weeks.
Dr. Ruwanpathirana describes how the teams, 30 members in all, donned the unwieldy and uncomfortable Personal Protective Equipment ( PPE) and squeezed into the Operating Theatre to deliver these premature babies.
The C-section took just one hour, he says, but the donning and doffing of the PPE took a long time……. while the little ones, weighing 1.6kg, 1.4kg, 1.3kg and 1.1kg had been rushed to the Neonatal Unit isolation section. One baby is on the ventilator.
The Rapid Antigen Tests done on them have been negative and RT-PCR Test results are awaited.
Dr. Ruwanpathirana pays tribute to all those who helped to look after the mother and the babies, without shying away from their duty but also going that extra mile beyond the call of duty. He adds a special word of thanks to hospital Director, Dr. SagariKiriwandeniya, for her unstinting support.
The teams involved in this major feat are:
The obstetric team headed by Dr. Ruwanpathirana and comprising Resident O&G Dr. Diluk Senadeera; Senior Registrar Dr.Deshan Udana; Registrars Dr. Srisubaskaran, Dr. S. Visagan & Dr. Anusitha Bandara; and House Officers Dr. Thimal Sumanasekera & D r. ChamariLiyanage.
The anaesthesiology team headed by Consultant Anaesthesiologist Dr.Saroja Jayasinghe and comprising Consultant Anaesthesiologist Dr. Harshani Liyanage; Senior Registrar Dr. Chamindu Weerasinghe; and Medical Officer Dr. Krishna Arachchige.
The medical team comprising Consultant Physician Dr. Priyankara J ayaw a rd a n e ; C o n s u l t a n t Haematologist Dr. G. P. Anoma D. Weerawardhana; and Consultant M i c r o b i o l o g i s t D r. S av i n i Athukorala.
The neonatology team headed by Consultant Neonatologist Dr. Nalin Gamaathige and comprising Senior Re g i s t r a r D r. S a n g e e t h a Wickramarathna; Registrars in Paediatrics Dr. Drukshan Palihena & Dr.Sajini Herath; Medical Officer – Neonat a l o g y Dr . Sankalpa Marasinghe; and Relief House Officers of the Nenonatal ICU Dr. Iwonthi Wijegunarathna, Dr. Thanshayan Balasubramaniyam & Dr.Dinesha Lakmali.