Nhlahla - rahim dışında doğan bebek

Monday Paper archives

Volume 22.15 2 June 2003

back to archived volume

Zygote's Homeric journey secures life for baby Nhlahla


Miracle baby Nhlahla's story and picture have been splashed across the
world's media: the BBC, CBS Canada, Radio Asia, and even the front page
of The Times in London. HELEN THERON of the Monday Paper paid a recent
visit to Groote Schuur Hospital to see how mother and baby were doing,
and to get the behind-the-scenes story which features both staff and a
student of the UCT's Faculty of Health Sciences.


It was a journey of Homeric proportions, liver surgeon Professor Jake Krige said of baby Nhlahla Ncise's beginnings.


The subject of intense media interest, Nhlahla made world headlines
recently after senior obstetrician Dr Bruce Howard gently extracted her,
at 39 weeks, from behind her mother's liver, putting paid to some
formidable survival odds.


What were the chances that the zygote (fertilised egg), smaller than a
pinhead, would slip from 20-year old Cwayita Ncise's fallopian tube,
survive and then embark on a miraculous upward odyssey, via abdominal
fluid and between the convolutions of intestines and internal organs, to
fortuitously implant itself on her mothers' liver, an organ with
sufficient blood supply to nurture the embryo to full term?





Dubbed "the liver baby", little Nhlahla presented the UCT medical
fraternity at Groote Schuur Hospital (GSH) with some anxious moments,
however. Only 14 other such extra-uterine cases had been reported. As a
result of bleeding complications, only three babies survived.


Extra-uterine pregnancies, which can develop on the outside of the
uterus, or even get their blood supply from the bowel, are always
difficult cases. But Nhlahla's location in her mother's abdomen
initially had the UCT and GSH medics, registrars and specialists
scratching their heads.


One week short of full-term, her mother had been referred to Somerset
Hospital with high blood pressure. On duty in the labour ward that night
was sixth-year medical student Lindsay Bick, who completed Ncise's
clerk sheet (which includes patient details, etc).


"She looked like a normal pregnant woman," Bick recalled. However, on
examining her, Bick couldn't find the baby's head, usually easy to
detect in the pelvis at 39 weeks. "The baby's bottom was also very high
in the abdomen," she reported. Puzzled, she alerted her supervisor,
registrar Dr Saadiqa Allie. Allie conducted an ultrasound scan and
confirmed Bick's misgivings; she could not locate the baby's head either
- and the uterus was empty.


Transferred to GSH, Ncise was examined by senior registrar Dr Howard
Manyonga and consultant Dr Silke Dyer. Subsequent scans confirmed an
advanced extra-uterine pregnancy and the location of the placenta in the
upper abdomen.


"We see about five or six cases of extra-uterine pregnancy a year,"
noted Howard, a specialist in gynaecological cancers and difficult
surgery. As these cases are rare, he remembers looking forward to the
operation.





Inside the theatre, the drama deepened. The Caesarean section revealed a
further puzzle; all Ncise's organs were in place (even the empty
uterus), but there was no baby. Flanked by an enthralled cluster of 30
or so doctors and fifth- and sixth-year medics (the news had spread
quickly), Howard described the moment as "very frightening". Instead of a
foetus, he found a "massively enlarged" liver and placenta.


"It was a time bomb waiting to explode."


Krige was at a liver clinic nearby when he received a distress call at
11h00; a cryptic message from the obstetrics theatre to deliver a baby,
not his usual line of work. He rushed to a scene of "enormous anxiety".


"The placenta in its amniotic sac, lined the liver. Its removal would
have resulted in catastrophic bleeding," he elaborated. In highly
complex situations like these, he said, "there are no rules of
engagement".


"These cases require on-the-spot improvisation and every situation will be different. But it was clear we had to find a way in."


The team mobilised the liver, working quickly to free it from its
attachments. And providence is always kind. At the bottom of the large
organ Krige and Howard found a 5 cm diameter "window", a small area
where the placenta and amniotic sac weren't attached. It offered the
sole entry point. An incision was made and Nhlahla's delivery began,
feet first.


"It was extraordinary," Krige remarked. "A breach delivery from the liver."


There was initially little time for euphoria, however. The baby was
distressed and needed resuscitation. The placenta had also started to
bleed and the bleeders had to be tied off. Krige and the team were also
left with a crucial decision: how to manage the remaining placenta.


"The trick was to leave the placenta attached to the liver," Krige said.
The extraneous tissue would be absorbed in two months or so and the
organ would return to its normal size. "The liver has phenomenal
regenerative capacity," he confirmed.


The news of Nhlahla's birth spread like proverbial wildfire. Within
hours, news hounds, armed with large cameras and even larger lenses,
thronged the corridors of GSH.
"It has been unbelievable," Howard remarked. "My phone has not stopped
ringing."


Baby Nhlahla's story and picture have been splashed across the world's
media: the BBC, CBS Canada, Radio Asia, and even the front page of The
Times in London. Now, Ripley's believe it or not want the story, the
latter raising more than a few eyebrows in the medical streets of GSH.


The remarkable success story has thrust GSH into the spotlight. Both
Krige and Howard are full of praise for the multidisciplinary team's
efforts and the sterling obstetrics services available in the province.
However, there is an irony that has not been lost on them.


"If Cwayita had had access to ultrasound from the beginning, as is the
case in first world countries, the pregnancy would have been
terminated," Howard commented. "Now we have a healthy mother and baby,"
he beamed. The case will be well documented as he and Manyonga plan to
write a report for submission to a respected medical journal.


Nhlahla, by the way, is the Zulu name for "lucky". One feels she could
as easily have been named Umlingo, or "miracle". And though some may be
tempted to follow her life's path, just to see why fate was so
determined she should be counted among the world's populace, her mother
has it all worked out: Nhlahla is going to be a doctor, she says
emphatically.


http://www.uct.ac.za/print/mondaypaper/archives/?id=3799

Miracle baby 'grew in liver'

The baby developed outside the womb

A healthy baby has been born after developing in its mother's liver instead of in the womb.
Reports from South Africa say Nhlahla, whose name means
"luck" in Zulu, is only the fourth baby ever to survive such a
pregnancy.
In all, there have only been 14 documented cases of a child developing in this way.
Nhlahla was born after specialists performed a difficult operation to deliver her on Tuesday.

The mother is at a huge risk Professor James Walker, Ectopic Pregnancy Trust,

She had to be put on oxygen after her birth, where she weighed a healthy 2.8kg, but was breathing without aid by Thursday. Doctors said Nhlahla and her mother Ncise Cwayita, 20 - whose first baby was born normally - were both doing well.
Liver specialist Professor Jack Krige, who helped deliver
the baby, told a South African newspaper: "She is the real thing. She
is truly a miracle baby."

Risks

When an egg is fertilised, it normally travels down the fallopian tube to the womb, where it implants and grows.

But sometimes, the embryo implants in the fallopian tube, a standard ectopic pregnancy.

In some cases - around one in 100,000 pregnancies - it falls out of the fallopian tube and can implant anywhere in the abdomen.

In extremely rare cases, such as this one, the embryo attaches itself to the liver, a very rich source of blood.

The baby is protected because it is within the placenta -but it does not have the usual protection of the womb - and is at more risk in the abdominal cavity.

Most babies in extrauterine (out of the uterus) pregnancies die within a few weeks.

Window

In this case, doctors only discovered the baby was growing in the liver when they performed a scan this week.

Her womb was found to be empty, even though her baby was due in a week.

Ms Cwayita was transferred to the Groote Schuur Hospital in Cape Town.

Dr Bruce Howard told the Cape Argus newspaper said: "We knew it was an extrauterine pregnancy but we didn't know it was in the liver until we started the operation on Tuesday morning."

Doctors found a small "window" where the amniotic sac
connected with the outside of the liver where they were able to go in to
deliver the baby.

Doctors had to leave the placenta and amniotic sac in the liver, because the mother's life would have been at risk.

It is expected they will be absorbed back into her body.

Professor James Walker, president of the British Ectopic
Pregnancy Trust, told BBC News Online abdominal pregnancies could be
very dangerous.

"The mother is at a huge risk. One in 200 women die before we can do anything to help them.

"The main problem for the baby is that it is not protected by the muscular wall of the womb."


http://news.bbc.co.uk/2/hi/health/2932608.stm

Lucky baby born from mom's liver

Thanks
to a rare surgical achievement by Groote Schuur specialists, a perfect
baby is sleeping soundly after growing to full term in her mother's
liver.

The Cape Town team, including liver specialist Professor
Jake Krige and obstetrics senior specialist Dr Bruce Howard, safely
delivered Nhlahla Cwayita in an extremely tricky and risky operation.

Fast
asleep, with the drip in her arm the only evidence of her dramatic
entry into the world, Nhlahla - her Zulu name means "luck" in English -
has been only the fourth such baby to survive.

Krige said a
search of medical publications showed there had been only 14 documented
cases of a baby growing in its mother's liver.

"She is the real thing. She is truly a miracle baby," he said.

Two of the other births were in the United States, and the third in France.

Nhlahla's
mother, Ncise Cwayita, 20, of Philippi, was not available to comment,
but doctors said both mother and baby were doing well.

This is Cwayita's second child. The first was born normally.

Although
Nhlahla was on oxygen after the birth, she was breathing without aid
two days after delivery. She weighed in at a healthy 2,8kg.

Krige
explained how such a birth is even possible: "Usually, the egg is
fertilised in the Fallopian tube and then moves down into the uterus.
But sometimes the fertilised egg travels the wrong way, falls out of the
fallopian tube and disappears.

"Sometimes this fertilised egg
can attach itself to part of the body and start growing, called an
extra-uterine (out of the uterus) pregnancy, but this is very rare and
usually it'll grow for a couple of weeks, and then die."

Krige
explained that in Nhlahla's case, the fertilised egg had nestled on the
surface of the liver, a rich source of blood, then grew into the liver,
complete with placenta, amniotic sac and amniotic fluid to keep the baby
safe.

As Nhlahla grew, her mother's liver cells were pushed aside.

Some months into her pregnancy Cwayita was checked at a clinic and was pronounced fine.

Last week she visited the clinic again, and they found her blood pressure was up.

She
was referred to Somerset Hospital, where a scan was done. Startled
staff saw Cwayita's womb was empty, although she was just a week off
full term.

She was rapidly transferred to Groote Schuur.

Howard
first attended to her when she was referred there. "We knew it was an
extra-uterine pregnancy but we didn't know it was in the liver until we
started the operation. That's when we called in Professor Krige," Howard
said.

Krige found a small "window" where the amniotic sac
connected with the outside of the liver, and Howard entered there to
deliver Nhlahla.

She came out slowly and carefully, first her
left foot, then her right, then her body, followed by her arms and
finally her head.

The liver, about the size of a rugby ball
usually, is a highly dangerous organ on which to operate, because it is
rich in blood vessels and bleeds easily. Although there was "some
bleeding" in Cwayita's case, the specialists controlled it.

The
placenta and amniotic sac were left in the liver, because these would be
too much of a threat to the mother's life to remove, and are expected
to be absorbed back into her body.

Although Cwayita is doing
well, Krige said she would remain at Groote Schuur for 10 days to two
weeks to monitor her liver, and see what happens to the placenta.

He was full of praise for the efficiency of the obstetric service in the province and hospital.

"They did everything right. They saved this woman's life," he said.

• This article was originally published on page 1 of The Cape Argus on May 23, 2003
  

http://www.kwik-p.co.za/IssueOfTheWeek/Lucky-baby-born-from-mom%27s-liver