Specialized Care for Special Pregnancy: Part 1

Specialized Care for Special Pregnancy: Part 1

As it is with many couples, the road to parenthood for my wife, Abby, and I was not an easy one. It took us four years, two rounds of IUI, and three rounds of IVF to become pregnant. It was a difficult, arduous process, full of a lot of dashed hopes and tears, but in the end we were blessed to find out we were pregnant with twins, a baby boy and a baby girl.

Because of the fact that we were having twins as well as other factors, the pregnancy was considered “high risk,” so the fertility clinic referred us to Maternal-Fetal Medicine at Woman’s Hospital to monitor the pregnancy. Dr. St. Amant and all of the nurses at MFM were extremely helpful and caring and, initially, the pregnancy progressed normally; in fact, in comparison to the emotional and physical rigors of three rounds of IVF, the pregnancy was initially something of a breeze. When week 25 hit, however, all of this changed.

At the week 25 check-up, one of the sonogram technicians spotted something concerning with our baby girl. The sonogram technician spotted, and Dr. St. Amant confirmed, the presence of fluid in her chest cavity (what we would later learn was called a “pleural effusion,” meaning our baby girl had a build-up of fluid in her pleural space, this being the space between the lungs and the inner chest wall). Initially, the pleural effusion was very small, so the decision was made to wait two weeks to see if the condition spontaneously resolved itself as such conditions sometimes do. Unfortunately, this would not be the case in our situation.

When we returned in two weeks, the sonogram revealed that the effusion had grown in size and become bilateral, meaning there was now fluid on both sides of our little girl’s chest cavity. At this point, Dr. St. Amant brought in Dr. Moore, the fetal surgeon, to consult.

After consultation, it was decided that the fluid should be drained from our daughter’s chest cavity. This was done for the dual purpose of sending out the fluid for testing (to both determine its composition and to determine if there were any chromosomal abnormalities with the baby) and because, in some cases, draining the fluid causes the condition to resolve itself spontaneously. Again, despite our hopes and prayers, this did not occur in our case.

The next sonogram after the fluid was removed revealed that it had accumulated. On top of that, the sonogram also revealed the presence of fluid, or edema, in our little girl’s scalp. The presence of this edema, along with the fluid in the chest cavity, lead to a diagnosis of hydrops. This was a very scary diagnosis as hydrops is a condition which can be fatal to a growing fetus, often occurring incidentally to fetal heart failure. After this diagnosis, things moved very quickly. In order to relieve the pressure in the chest cavity and allow our little girl’s lungs to expand and grow, the decision was made to perform surgery.

During this whole time, my wife and I were beside ourselves with fear and worry. After the initial diagnosis of the pleural effusion, we read everything we could get our hands on about pleural effusions, hydrops, fetal surgery and more. So we were very aware of the risks to our baby of both surgery and delaying surgery. Additionally, through all of this we were deeply concerned about our son who was sharing the womb with our little girl and progressing normally. As much as we wanted to help our little girl, we also did not want to risk hurting our son.

Luckily, we had the team at Woman’s to save the day. Dr. Moore was able to perform surgery on our daughter by inserting a pigtail catheter in one side of our daughter’s chest cavity without bothering or endangering our son in the slightest. The pig tail catheter allowed most of the fluid in the chest to drain out into the amniotic fluid and allowed our daughter’s lungs to expand and grow. Additionally, and much to our great relief, an analysis of the fluid showed no chromosomal abnormalities. The fetal cardiologist at Woman’s examined our daughter’s heart and found no structural defects. Drs. Moore and St. Amant also did a great job of explaining what would need to happen after birth to address the issue and the possible outcomes.

Although we were not quite entirely out of the woods yet (there was still the issue of the hydrops and some fluid in the chest), we were able to breathe a little sigh relief, or at least we thought we were able to. Little did we know that some of the most difficult times were yet to come…. click here continue the story.

To learn more about high-risk pregnancy, click here.

For more information about Woman’s Maternal Fetal Medicine, click here.

For more information about Woman’s Maternal Fetal Surgery, click here.