New Delhi: In an super exemplary case of treating a woman rendered paralyzed in a road accident in the eighth month of pregnancy, the doctors at Indian Spinal Injuries Centre displayed courage, skill and expertise at the highest level. The 30-year old patient, Siddhi Singla, was 31 weeks pregnant and suffered a near-fatal car crash while travelling to her mother’s place on the Delhi-Chandigarh highway. She was travelling in the front seat without using her seat belt. The impact of the accident resulted in a severe cervical injury at the C5 and 6 levels of her spine.
The enormity of the accident was it had paralyzed her completely and increased the chances of endangering her baby’s and her life multifold, as a result of which Siddhi and husband both were very worried. In the circumstances, she was immediately referred to Indian Spinal Injuries Centre, Vasant Kunj for immediate management. Doctors at Indian Spinal Injuries Centre faced multiple challenges and risks in treating her in this very critical condition. The patient could not be placed on her back as the critical injury was in her spine; they could not place her on her stomach as she was carrying a fully developed fetus; she had to be immediately treated, or else she could be rendered paralyzed for her entire life without any scope of revival. The team of doctors closely monitored and took over action to stabilize her condition by putting traction for relieving pressure on cord. The main challenge however was to ensure safety of the baby in her womb which was still doing fine after the accident, say doctors.
Dr. H S Chhabra, Chief of Spine Service & Medical Director, Indian Spinal Injuries Centre says, “Spinal cord compression occurs when owing to pressure on the cord caused by bone fragments, tumors, ruptured discs, or other lesions; a patient is led to medical emergency and decreased sensation below the level of compression. When Siddhi came in to our hospital after the accident, she was suffering from severe cord compression and quadriplegia, a type of paralysis caused by injuries in general that result in partial or total loss of use of all four limbs and torso in an individual. Given the serious nature of her spine injury, immediate surgical intervention was required. However, this would have posed a threat to the baby or precipitated an early labor. With an early delivery, she would land up with all the risks of premature birth of the infant.”
Doctors at the hospital planned to break down the surgical intervention into steps to avoid any risk to the health of the mother and child.
“We planned to first reduce the dislocation in the spine by skeletal traction. This was done by applying increasing weights to pull the dislocated vertebrae. Achieving reduction using traction before surgery simplified the surgery by removing the pressure on the spinal cord, and after that, we waited another 4 days in order to enable Siddhi reach 32 weeks of pregnancy. This ensured a much better prognosis for the child, even in case of premature delivery precipitated by the spine fixation surgery. During the surgery, we could not place the patient on her back or on her stomach; we had to put her laterally during the surgery. The disc between C4 and C5 levels of the spine was removed; a cage and a bone graft were placed in between and fixed with a plate so that the vertebrae are fused with each other. The surgery went uneventful, and post surgery, rehabilitation including physiotherapy and occupational therapy was initiated for Siddhi, following which she recovered from her paralysis in the next two months,” adds Dr. H S Chhabra.
With able guidance and assurance of a team of senior obstetricians at ISIC led by Dr. Rachna Verma, Senior Gynecologist and Obstetrician intensive foetal monitoring was also taken up to deal with the high-risk pregnancy, before and after the spine fixation surgery.
Dr. Rachna Verma, Senior Gynecologist and Obstetrician, ISIC says, “Traumatic life event complicates one in every 12 pregnancies, and is said to be the leading cause of fetal death related to maternal trauma. Motor vehicle accidents are among the commonest traumatic events witnessed in our country, and there are chances of fetal losses even after you have experienced minor injuries. Having said that, the biggest challenge in Siddhi’s case was to maintain a healthy pregnancy, and prevent intrauterine growth restriction, which refers to a condition where the baby is not growing at a normal rate inside the would-be mother’s womb. Periodic feotal monitoring helped ensuring that the cardiovascular rhythm of the foetus was going normal, during and after the spine surgery.”
Every aspect of pre-natal care was monitored and finally the pregnancy reached 36 weeks. A caesarean delivery was planned in the same hospital, and everybody including the pediatric team, surgeons, anesthetists and the OT staffwere geared up to gift a healthy baby to Siddhi, who was now on the path of recovery, after the debilitating and life-threatening road traffic injury experienced only a few weeks back.
“Finally, Siddhi delivered a baby girl few days later, which is also the first baby of ISIC. The entire ISIC family is very proud of this achievement. Given the complications associated with this case, we are happy to announce now that the caesarian went uneventful and the baby girl was born totally healthy. Significant clinical precautions were also taken at the same time to prevent post-partum hemorrhage (PPH) after the child was born,” adds Dr. Rachna Verma.
“We thank doctors at ISIC for gifting us Nayika, our beloved baby girl and the heroine who has indeed made a mark at birth. After the accident, I and my husband had completely lost hope of even giving birth to a child. But, the doctors here made the impossible and unthinkable happen. We owe our bay to them,” says Siddhi, the mother who underwent the intensive treatment.
An automobile accident can happen in different ways, with impact from the front, rear, or side. Most road accidents cause extensive orthopedic or spinal injuries, along with trauma-related mental health problems.Restraints like airbags and seat belts are often able to prevent direct contact of the upper body region during car accidents, but unfortunately in India, many people are not aware about the importance of using these precautionary tools during driving or seating inside the car. A recent research in UK showed that wearing a seat belt reduces risk of minor injuries to front seat passengers by up to 45% and moderate to critical injuries by 50%.
According to the World Health Organization (WHO), road traffic injuries are the leading cause of death among young people (between the ages of 15-29) worldwide. In India, there is one death every four minutes due to a road accident, reveals statistics released by the Ministry of Road Transport &Highways, Government of India. Injuries from road accidents can impact a person’s mobility and other functional abilities, and can turn dangerous for pregnant women in particular, suggests clinical evidence.
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