SA's liver-born baby is a 'medical miracle'

Published May 23, 2003


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

The team, including liver specialist Professor Jake Krige and obstetrics senior specialist Dr Bruce Howard, safely delivered Nhlahla Cwayita on Tuesday 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, life, 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 on Thursday, 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 by Thursday. 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 a part of the body and start growing, called an extrauterine (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 on Monday. 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 on Monday.

"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.

"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.

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