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A special delivery
Pregnancy is rarely easy, but Mayra Beato had no idea just how hard it would be.
Pregnant with her first child, Mayra had a normal first trimester. But late in her second trimester, the problems began. On July 14, 2019, severe abdominal pain sent her to the hospital, where she was found to have an ovarian torsion – a condition in which the ovary twists, cutting off blood supply to the ovary and fallopian tube. Mayra had urgent surgery at Tufts Medical Center to remove her right ovary, but two weeks after she went home, she was forced to return to the hospital with swelling in her lower leg. Mayra's blood pressure was elevated and she was diagnosed with preeclampsia at 25 weeks gestation. She was admitted to Tufts MC for the remainder of her pregnancy.
But worries about Mayra’s health and that of her unborn child would only increase four weeks later, when symptoms of chest discomfort convinced her doctors to send her for an x-ray and CT scan on August 28, 2019. The imaging showed an enlarged heart and a pulmonary embolism – a blood clot in her lung. Medication helped stabilize the blood clot, but there was significant concern about her heart. A normal heart pumps at around 60 percent; Mayra's heart was working at about 20 percent and fluid was developing around her heart.
“These symptoms can happen in pregnancy – with or without preeclampsia,” said Maternal-Fetal Medicine Physician
Mohak Mhatre, MD
, who first met Mayra when she was being treated for the ovarian torsion. “While heart failure can occur spontaneously during pregnancy, based on her imaging, it is more likely that Mayra had pre-existing cardiac disease that was exacerbated by her pregnancy.”
Mayra met with a team of heart failure experts. The doctors were concerned how her heart would handle the additional stress of pregnancy, especially in the third trimester. In addition, the fetus was beginning to become growth-restricted due to the preeclampsia.
“Six weeks earlier, I had been a completely healthy 25-year-old,” said Mayra. “This was all really hard for me to accept.”
Developing a plan
Given Mayra’s health concerns, her
care team decided the best and safest time for her to deliver would be in the 31st week of her pregnancy. In order to ensure optimal outcomes for both mother and baby, experts from a wide variety of specialties - Maternal-Fetal Medicine,
- were brought together to develop a plan.
The team prepared for all possible scenarios, discussed the safest place for Mayra to deliver and determined who and what was needed on-hand for the delivery. They decided the best option was in the inpatient Cardiac Care Unit (CCU) so Mayra was transferred there in anticipation of being induced for a vaginal birth. However, on the day of induction, Mayra began contracting spontaneously after receiving an epidural. The fetal heart rate slowed multiple times and Dr. Mhatre was concerned that the baby might not be able to tolerate the labor. So the team swiftly pivoted to a c-section in the cardiac catheterization laboratory.
A successful delivery
Typically used for a procedure to unclog blocked arteries, the cardiac cath lab was in close proximity to the CCU and convenient for interventional cardiologists to assist with any cardiac issues that might arise. The procedure was quick and easy, with no complications. The baby boy was small (2 pounds, 8 ounces), but healthy and breathing on his own. Mayra named him William Emilio Pichardo. She calls him Emilio.
“This was our second time delivering a baby in the cath lab with multidisciplinary involvement, so we already had an excellent plan in place and everything went extremely smoothly,” said Director of the Interventional Cardiology Center
Carey Kimmelstiel, MD
. “The team worked quickly and seamlessly together and it proved to be a safe and effective option for Mayra’s delivery.”
“Navigating the multiple complex issues and caring for two patients – the mother and the fetus – simultaneously, is what I love about my work,” said Dr. Mhatre. “It’s very fulfilling to have a large group of individuals, each contributing their own expertise, create a collaborative and thorough approach in order to manage a tough case and ensure the best possible outcome. I am proud that our planning and preparation worked out so well and I am very glad we could help Mayra and Emilio.”
Two excellent outcomes
Both Mayra and Emilio are doing very well. Mayra’s Tufts MC cardiologists are developing a plan to help her monitor her heart condition at home. Emilio was expected to remain in the
Neonatal Intensive Care Unit (NICU)
at Tufts Children's Hospital until his November 6, 2019 due date, but he did so well that he was discharged home more than three weeks early, on October 14, 2019. Beato looks forward to bringing him back periodically to visit the doctors, nurses and other staff members who helped them both.
“The Tufts MC staff was amazing and the support they provided throughout this experience has been so important to me. I am also beyond grateful for my boyfriend, close friends and family who took time out of their busy schedules to visit me at the hospital,” said Mayra. “So many members of my care team are like extended family at this point. They always made me feel comfortable and assured me that everything would turn out great. And it did!”