IN CASE YOU MISSED IT

Happy ending after roller-coaster pregnancy

This story was first published in The Straits Times on Sept 19, 2013

The young mother heard the most frightening news in her life when she was 12 weeks pregnant with her third child.

She was told there was a chance her foetus' bladder could grow so big that it could crush all the other organs in the little body.

Ms Brenda Ho, 34, could not stop thinking what a horrible way it was to die.

"Removing the baby would also be a problem as he would be quite distended," she said.

At the risk assessment ultrasound scan, the obstetrician in private practice said her foetus' bladder was seven times the normal size.

It was a very severe situation and was probably "due to a blockage somewhere", resulting in urine retention in the bladder.

The condition, called foetal megacystis, could be associated with genetic abnormalities.

It was devastating news for Ms Ho, a teacher, and her husband, Mr Sean Goh, also 34, a senior vice-president in corporate planning and regional marketing.

They also have a daughter, aged five, and a son, aged four.

But even at that early stage, when little was known about her baby's condition, she did not want an abortion.

She said: "That was the first thing we told the doctor. My husband and I had discussed it as a couple and we had decided that an abortion was not an option for us."

Their decision was based on personal conviction and religious reasons.

But when the couple found out more about the health risks their unborn baby faced, their resolve was shaken.

Ms Ho's blood test and ultrasound scan also showed there was a one in 10 chance that her baby had chromosomal abnormalities called trisomy 13 and 18, which would have occurred at the time of fertilisation.

Normal egg and sperm cells contribute 23chromosomes each to embryonic cells, but sometimes, errors can occur, and the egg or sperm cell can have an extra chromosome number 13 or number 18.

The extra chromosome can result in many issues, including low birth weight, and brain and heart defects.

The obstetrician said an abortion should be performed before the 15th week of pregnancy.

But before the couple had much time to mourn, around the 13th or 14th week of pregnancy, further scans showed the baby's bladder had shrunk.

Furthermore, the scans showed "tons of amniotic fluid" in her womb. This was a good sign as it showed that the foetus was passing urine.

From its fourth month, the foetus contributes to the fluid by urinating into it. The fluid is important for the lungs to develop and mature as well as give the foetus space to move.

Foetal megacystis usually leads to decreased amniotic fluid in the womb when the foetus is unable to urinate.

The couple decided to stick to their decision to give their baby a chance.

Ms Ho had a further definitive test called chorionic villus sampling, to check the foetus' own genetic material.

"The test, which involved testing the baby's DNA in the placental tissue, showed my baby's chromosomes were all normal, which was a relief," said Ms Ho.

But another setback occurred at 16 weeks, when she found out that her baby's bladder wall was very thick.

This was likely caused by an obstruction to the bladder outlet, either through the narrowing of the urethra - the tube that connects the bladder to the genitals through which urine flows out - or through damaged bladder nerves.

When the bladder is trying to squeeze urine out through a narrowed outlet, over time, the bladder wall will thicken.

It was an unsettling time for Ms Ho, but she soldiered on and hoped for the best.

DIFFICULT BIRTH

At 32 weeks of pregnancy, Ms Ho went to the National University Hospital on the recommendation of a friend whose son was being treated there for kidney problems.

She came under the care of a multidisciplinary team of obstetricians, paediatric surgeons and kidney specialists.

Her fear for her son, Ephraim, peaked at birth when he was born weighing 4.33kg due to the urine retention.

"Ephraim was stuck as his tummy was very swollen. I almost needed an emergency caesarean section," she said.

But doctors managed to get him out with a vacuum suction and whisked him away immediately.

"They switched on some machine to check him. I heard a sharp beep, the kind you hear in medical dramas when someone dies, so for a terrifying minute I thought he didn't make it and I started crying," Ms Ho recalled.

Fortunately, Ephraim was very much alive, though he had many health issues.

These included having a birth defect that caused the spinal cord to be underdeveloped, impaired bladder function and backflow of urine into the kidneys.

He was also born without an opening at the anus.

Three days after birth, he was operated on to create three openings in his abdomen: one for urine and the other two for stool to pass out.

The openings for stool have since been closed, after doctors created an anus for him.

The opening for urine will be permanent, as his urethra is abnormally narrow.

He will have to manually drain urine from his bladder via his Mitrofanoff - the tube created from his own tissue linking his bladder to the hole in his abdomen - using a catheter.

"This gives a much better quality of life compared with wearing a urine bag. The user can drain his urine every three to four hours and it is quite a speedy and easy process," said MsHo.

She does not see Ephraim having any problems with it in future.

"At the hospital, we saw many other children, and some teenagers, who were very adept at using these urine catheters and treated it as a normal part of life," she said.

Despite everything he has gone through, Ephraim is now a happy eight-month-old and will continue to grow up normally.

It was a difficult journey but not a hopeless one because of amazing medical advancements, said Ms Ho.

"We are just so glad to have Ephraim. Our whole family loves and adores him. He has brought us so much joy," she said.

This story was first published in The Straits Times on Sept 19, 2013

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