Kolkata : In a rare and highly complex medical
success, a multidisciplinary team led by Dr. Upal Sengupta, Director – Team
Nephrology & Consultant – Nephrology & Kidney Transplant, and Dr.
Shilpita Banerjee, Consultant – Gynaecology, Obstetrics and Maternal Fetal
Medicine at Manipal Hospital Mukundapur, a unit of one of India’s largest
healthcare providers – Manipal Hospitals Group, successfully managed an
extremely high-risk pregnancy in a renal transplant recipient, ensuring the
safety of both mother and child while preserving graft function.
The patient, 33-year-old Madhabilata Kundu, a
homemaker from Burdwan, had undergone a kidney transplant in December 2023. She
presented at the hospital at 16 weeks of pregnancy while on long-term
immunosuppressive therapy. With a medical history that included a previous
caesarean section, a spontaneous miscarriage, hypertension, hypothyroidism, and
the added risks associated with post-transplant pregnancy, the case required
constant monitoring and meticulous clinical planning. Following extensive
counselling and shared decision-making, the medical team decided to continue
the pregnancy under strict multidisciplinary supervision involving specialists
from Nephrology, Obstetrics, Anaesthesia, Critical Care and Neonatology.
At 21 weeks of gestation, the patient developed multiple
serious complications, including suspected graft dysfunction, severe anaemia,
rising creatinine levels, uncontrolled hypertension and active infections. She
required urgent hospitalisation, blood transfusions, modification of
immunosuppressive therapy and aggressive infection management. Throughout this
critical phase, close fetal surveillance was conducted to ensure fetal
well-being and to rule out abnormalities.
Despite stabilisation, by 28 weeks of pregnancy the patient
showed worsening renal parameters, fluctuating blood pressure, intrauterine
growth restriction and reduced amniotic fluid, raising serious concerns
regarding maternal safety and graft preservation.
After detailed discussions among the Nephrology, Obstetrics,
Anaesthesia and Neonatology teams, the decision was taken to proceed with an
early planned caesarean section at 30 weeks and three days of gestation,
in the best interest of the mother. With strong anaesthetic and neonatal
support, the patient delivered a 1.6 kg baby girl who cried immediately
after birth and was shifted to the Neonatal Intensive Care Unit (NICU),
where she received specialised care for 20 days.
Explaining the obstetric challenges, Dr. Shilpita Banerjee
said, “This pregnancy was medically fragile from the very beginning. The
patient was battling multiple systemic complications, and even small clinical
changes had the potential to significantly impact both maternal and fetal
outcomes. Our responsibility was to carefully balance maternal stabilisation
with continuous fetal monitoring. Coordinated teamwork and vigilant
surveillance allowed us to safely prolong the pregnancy despite repeated
challenges.”
Sharing the nephrology perspective, Dr. Upal Sengupta
said, “Pregnancy following renal transplantation is inherently high-risk as it
places additional physiological stress on the transplanted kidney. Our priority
was to protect graft function while allowing the pregnancy to progress safely.
This required continuous reassessment, careful adjustment of immunosuppressive
therapy and avoidance of invasive procedures. The success of this case
highlights the importance of timely decision-making and multidisciplinary
coordination.”
Post-delivery, the mother experienced hypertension and
urinary infection and required ICU support for three days. With timely
medical intervention, her condition stabilised and renal parameters improved.
She has since been discharged in stable condition. The baby has also been
discharged and is doing well.
Expressing her gratitude, Madhabilata Kundu said, “There
were moments when I feared losing my baby or harming my transplanted kidney.
The doctors stood by me through every complication, explained every step and
gave me confidence. Today, seeing my baby healthy feels nothing short of a
miracle.”
Madhabilata’s husband, Tapas Kundu, who is employed in the
private sector, supported her throughout the prolonged treatment and
recovery.
This case highlights how early counselling, vigilant
monitoring and seamless collaboration across specialties can make even the most
high-risk post-transplant pregnancies successful, offering renewed hope to
women with complex medical histories.