SINGAPORE - A miracle.

That was what Madam Yvonne Khoo kept hearing from doctors and nurses after she woke up in the intensive care unit (ICU) at the Singapore General Hospital (SGH) on Nov 1 with tubes sticking out of her face and body.

Hooked up to life support machines, the last thing she remembered was from six days prior, when she was coughing up blood in an ambulance as she was being taken to SGH and was sedated by emergency medical staff.

What Madam Khoo, 37, thought was a long slumber was in fact a close brush with death after what seemed like a mild Covid-19 infection developed into severe respiratory failure.

That she was also 25 weeks pregnant and had an underlying kidney disease made her situation even more precarious.

To save her life, doctors hooked her up to an extracorporeal membrane oxygenation (Ecmo) machine, which is rarely used on pregnant women, especially those so late into their pregnancies.

"They kept telling me it was a miracle (that I survived) but I did not understand," Madam Khoo told The Straits Times on Thursday (Dec 30).

"It was only when I heard that the doctors had told my husband to be mentally prepared to lose me that I was shocked, because to say something like that means it must have been very serious," she said in Mandarin.

This was not Madam Khoo's first brush with Covid-19.

In September, she tested positive for the coronavirus and was hospitalised as her pregnancy put her at higher risk. But Madam Khoo was asymptomatic and discharged after a week of observation and negative tests.

So, when she started to develop symptoms a month later and got a positive result from a self-test kit on Oct 22, she decided to rest at home instead of going to a clinic or hospital as she thought she would recover as quickly as before.

According to the Ministry of Health, reinfection cases are quite rare here. As at August, one-third of the 32 confirmed reinfection cases were dormitory residents, while the rest were imported cases. 

On Oct 26, Madam Khoo noticed that her oximeter reading was at about 80 per cent. A normal blood oxygen reading is typically between 95 and 100 per cent.

So she called for an ambulance and was taken to Changi General Hospital (CGH).

She was then transferred to SGH because she was pregnant while having an underlying medical condition, which made her case complex.

By the time she reached SGH, her oxygen levels were as low as 70 per cent and she was immediately intubated and connected to a breathing machine.

The medical team at SGH considered immediately delivering Madam Khoo's baby so that she would need less oxygen support to survive. But Madam Khoo's condition was deteriorating rapidly, leaving no better alternative than Ecmo life support.

Dr Sewa Duu Wen, a senior consultant at SGH's respiratory and critical care medicine department, said Ecmo, which takes over the function of the heart and lungs, bought precious time for the Covid-19 treatments to take effect on Madam Khoo and for her lungs to recover.

It also bought time for Madam Khoo's then unborn son to develop in her womb while she was being stabilised and treated.

Dr Tan Wei Ching, senior consultant at SGH's obstetrics and gynaecology department, said: "We had to think about whether we could minimise any complications for the baby, who was premature... If there is any prolonged deprivation of oxygen to the mother, the baby will definitely be affected."

Dr Sewa, who is also director for SGH's medical ICU, said Madam Khoo was predisposed to a very severe Covid-19 infection as treatment for an underlying kidney disease had weakened her immune system. She is also unvaccinated, placing her at much higher risk compared with other pregnant women.

Madam Khoo said she wanted to get vaccinated but the timing was never right.

Her gynaecologist had advised her to wait until her second trimester, which was in September, but Madam Khoo tested positive before she could get her jab.

In October, she took a blood test to check if she had antibodies from her earlier infection but while waiting for the result, she tested positive for Covid-19 again.

At SGH, Madam Khoo's condition quickly turned around and she was taken off the Ecmo machine after six days. Shortly after, she was also off the breathing machine.

Madam Khoo was then moved to a high dependency ward and she started to get contractions on Nov 4.

That same day, she got a caesarean section and her son, Yohanne, who was 27 weeks old and weighed just 789g at birth, was immediately whisked away to SGH's neonatal unit.

Madam Khoo said she was wracked with guilt as she blamed herself for what her young infant son had to go through. Choking up, she said it took her almost two weeks to muster up the courage to see her son and to touch him.

"If I had been vaccinated, I think my body would have been able to fight the virus and I wouldn't have dragged my baby down with me," she said.

Fortunately, doctors said Yohanne was not affected by Covid-19 or the ECMO, and is doing well. He is currently at 34 weeks and is being cared for in the neonatal high dependency ward.

Madam Khoo's ordeal with Covid-19 also left behind physical trauma.

She needed physiotherapy and occupational therapy to relearn how to walk and eat. Even now, more than a month after being discharged, Madam Khoo said her body is still weak, her hands tremble and she has some mobility issues.

She also needs to visit the hospital at least thrice a week, but worst of all is worries over the looming medical bill that she will need to pay.

Still, Madam Khoo said she is grateful to friends, family and strangers who have helped her, and that her brush with death has shown her there is love in the world.

Urging other pregnant women to get vaccinated, she said: "I believe nobody wants to go through what I have been through."

SGH's Dr Tan also called on pregnant women to get vaccinated as early as possible.

"Even if it is one dose a few weeks before they deliver, it is better than nothing."