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NUH care turns high-risk pregnancy into miraculous birth


Mother triumphs over end-stage kidney failure, welcoming healthy baby with the help of NUH Team
Issue 1 | June 2023

NUH care turns high-risk pregnancy into miraculous birth

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When couples first learn that they are on the verge of becoming parents, the moment is nothing short of joy. For Madam Nur Fadilah and her husband, Mr Muhammad Farihin Farkhan, the happy occasion was enveloped in a cloud of worry. Mdm Fadilah has end-stage kidney failure, which meant that the pregnancy was high-risk, posing a threat to both soon-to-be mother and yet unborn child.

Confronted by this dilemma, the couple turned to the specialists at the Department of Obstetrics and Gynaecology and the Renal Centre at the National University Hospital (NUH). The multidisciplinary team supported Mdm Fadilah throughout the 35-week pregnancy, closely managing her condition and monitoring the development of her baby. Amidst the risks and complications, such holistic care was the critical factor in the successful birth of Mdm Fadilah's daughter.

Facing the dual challenge of kidney failure and pregnancy

While kidneys are more popularly known for their role in waste and water excretion via urine production, this excretory function is only the tip of the iceberg. Lying beneath is a complex filtration system that removes toxins, regulates blood pressure, and helps maintain salt and pH balance inside the body. Additionally, its hormonal functions are crucial in the production of haemoglobin for red blood cells and the activation of vitamin D for bone integrity.

For individuals like Mdm Fadilah with end-stage kidney disease, kidney function is inadequate to maintain a healthy homeostasis, allowing the accumulation of toxins in the blood and potentially endangering other organs like the heart and brain. As such, some warning signs may not reflect as urinary abnormalities, but instead manifest as shortness of breath, swollen legs, abnormal heart rhythms, lethargy, nausea and confusion.

As end-stage kidney failure is not a reversible condition, patients require long-term dedicated specialty care to enable them to live on. According to the National Kidney Foundation, Singapore has the third highest incidence rate of kidney failure in the world, with more than 300,000 cases of chronic kidney disease and about six new patients diagnosed each day.

Since her diagnosis in 2017, Mdm Fadilah has been receiving dialysis treatment to clean her blood. While her former dialysis schedule only lasted for four hours thrice a week, the treatment increased to an arduous six times a week with over six hours for each session during her pregnancy.

"I thought I'd be used to doing dialysis, but there are times when it's still really tiring. My arms would cramp up from sitting on the dialysis chair for so long. Mentally, this period was tough at times for me, but I kept telling myself 'I must do this for my baby', and that gave me the strength to keep going," says Mdm Fadilah.

Because the kidney plays a key role in maintaining normal blood pressure and haemoglobin, Mdm Fadilah was at increased risk for developing severe hypertension and anaemia. A major reason for elevated blood pressure in dialysis patients is excess water. However, it is challenging to pinpoint how much water to remove in a mother with a growing baby and increasing amniotic fluid during each dialysis session. If not done right, it can harm the mother and fetus.

"We had to be careful in removing the right amount of fluid during dialysis," explains Dr Sabrina Haroon Wong, a senior consultant at the Division of Nephrology, Department of Medicine at NUH. "If too little fluid is removed, Mdm Fadilah's blood pressure would be high, which can sometimes lead to stroke or heart failure, in addition to fetal death. But if too much is removed, this may then result in low blood pressure, reducing blood supply to the placenta and potentially impacting fetal growth."

To keep a close eye, the NUH team would at times measure Mdm Fadilah's blood pressure every 15 minutes, as well as used a special device to estimate her body water levels more accurately. Dr Wong, who is also the Medical Director at the Renal Centre, would personally call to check on Mdm Fadilah almost daily and review her at least twice a week during dialysis sessions throughout the pregnancy.

Holistic healthcare to beat the odds

Associate Professor Chan Shiao-Yng, a senior consultant at the Division of Maternal Fetal Medicine under NUH's Department of Obstetrics and Gynaecology, and her team also served a crucial role in ensuring the safety and success of Mdm Fadilah's pregnancy and delivery.

Women on dialysis have a high risk pregnancy related complications including premature delivery and still birth. "The highest risk pregnancies often need experienced multidisciplinary care across specialties to achieve the best possible outcomes for the mother and baby," says Assoc Prof Chan. From collaborating with the Renal Centre to enlisting an entire crew of nurses and dietitians, the NUH team provided Mdm Fadilah with the best possible care every step of the way.

After many months of regular hospital visits, dialysis treatments and antenatal checkups, Mdm Fadilah welcomed a healthy baby girl weighing 1.9 kg into the world. She was surrounded by family and the NUH team, whose dedication to ensuring the mother and daughter's well-being had never wavered since day one.

"When we heard the cries of our baby for the first time, we were speechless with joy. I never expected that someone like me, who has kidney failure, would be able to give birth to a healthy child," says Mdm Fadilah.

Dr Titus Lau, also a senior consultant at the Division of Nephrology at NUH, hopes that Mdm Fadilah's sensational success can empower other women with kidney disorders who dream of motherhood. "This is a story about a young woman and her determination to start a family, and how she was able to do so with the right medical and social support," he says.

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