The first complicated case was related to extremely low platelet values (thrombocytopenia) in a 36-year-old woman from Veliko Tarnovo.
The woman’s pregnancy was uneventful until blood tests in the seventh month revealed low platelet levels and a bleeding disorder. The woman was hospitalized twice at the hospital in Veliko Tarnovo and referred to the “Maichin Dom”, where she also stayed for a short time. According to the plan, she should have been admitted to the Maternity Home a month before delivery, but due to premature leakage of amniotic fluid, she was admitted as an emergency at 38 y.o.
The mother arrived with a platelet count of 20 g/L, whereas normal values should be between 140-440 g/L. In her case, it was an autoimmune condition related to self-destruction of platelets by the body itself. In this case, due to the inability of blood clotting, one cannot proceed to either delivery or surgical intervention.
“In the given case, the mother and the baby are like docked vessels when she is unwell and she is also at risk. The baby is also prone to low platelet values and is at high risk to start bleeding immediately after birth. And these babies need to be taken out as quickly as possible so that they don’t suffer,” explained Dr. Lyubomir Djerov, the obstetrician who performed the section.
“Thanks to quick actions and good communication with colleagues from Hematology by infusing platelet bioconcentrate and an effective medication regimen, we were able to partially raise the platelets to 69 g/L and ensure safety for the patient and more security for the team.Our hospital is the place where all severe cases from the country are concentrated, but we did it with honor – we delivered a live and healthy baby Daniel”, said Dr. Lyubomir Djerov, Head of the Maternity Ward.
“Absolutely everyone is a great professional and I am extremely grateful that they took care of me and the baby. I had to have a c-section due to a small opening 36 hours after the waters broke because the doctors were worried that an infection might be heading to the baby. All the teams worked like a perfectly oiled machine and had several options for a plan of action,” said 36-year-old Anna Boneva, who is in stable condition with her baby, with gratitude.
The second case was a 26-year-old woman from Berkovitsa who underwent an emergency caesarean section in her 33rd year due to placental abruption (abruptio) from its attachment to the uterus. This is a severe life-threatening condition for both mother and baby, in most cases accompanied by infant mortality. The delivery was performed by the team of Prof. Dr. Ivan Kostov.
The high-risk condition in the young woman occurred as a result of two comorbidities of pregnancy – pre-eclampsia and type 1 diabetes (insulin-dependent). Pre-eclampsia most commonly begins after the age of 20 in women who are in their first pregnancy. It is characterized by hypertension, protein loss, and runoff. At Maternal Home, these conditions are predicted as early as the first trimester by validated risk tests and investigations at 12 yr. Accordingly, these patients are followed regularly by an obstetrician and endocrinologist and are subject to pre-hospitalization.
The baby and mother are stable and the baby is cared for by the neonatologists of the Neonatology Clinic.
The Hospital “Maichin Dom” is a leader in saving such complex high-risk cases with excellent organization, high competence of the teams and uncompromising quality of medical care.