Jessica already had two children and was feeling great in her third pregnancy, so she had no reason to think anything was wrong when she went in for her 28 week ultrasound.
That’s when they noticed a growth on the placenta.
“I knew it was bad when the doctor said to me, ‘We’ve never really seen anything like this before,’” Jessica said.
She was sent to see Dr. Julia Solomon, a maternal-fetal medicine specialist in Phoenix, AZ, who made a diagnosis: The growth on the placenta was a chorioangioma, a usually benign vascular tumor, but there was more.
“I was watching Dr. Solomon and the ultrasound screen, I could tell that she was looking at the baby’s heart. I could see the chambers and everything,” said Jessica. “I knew that wasn’t good.”
Using GE’s 4D ultrasound technology to see the baby’s heart, Dr. Solomon was able to identify that the heart was markedly enlarged. There was an abnormality to the tricuspid valve and very little flow coming out of the right side of the heart. The diagnosis was consistent with a congenital heart defect called Ebstein’s Anomaly, in which the valve between the chambers on the right side of the heart doesn’t form properly. This defect often results in heart failure before birth because the abnormal valve means only a percentage of the blood that the heart is pumping actually goes to the baby’s body.
“She had the perfect storm,” Dr. Solomon said. “In this case, not only did we have a heart defect, we also had a large placental tumor that was already putting significant stress on the fetus’ heart.”
In the weeks that followed, Jessica spent weeks in the high risk unit of a local hospital, so she and the baby could be consistently monitored. Dr. Solomon would drive an hour each day, from her practice to the hospital, to be able to scan Jessica and check on the baby herself.
“It’s very important to avoid a premature delivery in cases of Ebstein’s Anomaly,” Dr. Solomon said. “This is the kind of situation that really benefited from advanced 3D and 4D ultrasound technology. Vascular modeling enabled us to monitor the chorioangioma. We could track it growing on almost a daily basis. We also monitored measurements of blood velocity to determine whether we could safely continue the pregnancy.”
Two immediate care decisions included in-utero blood transfusions, in which Dr. Solomon went into the umbilical cord using ultrasound guided technology. She obtained a blood sample and calculated how much blood and protein to transfuse to the baby.
“With each transfusion, we gave the baby an extra buffer against the Ebstein’s Anomaly and chorioangioma,” she said. “We were able to buy her an additional three to four weeks to grow in the womb.”
“It was amazing, especially because the only way I knew the baby was alive was from the sound of her heart beating on the ultrasound monitor,” Jessica said. “She wasn’t moving inside me otherwise.”
The other decision came at the end of June.
“The baby wasn’t doing well,” Dr. Solomon said, “The tumor continued to grow quite rapidly, and despite correcting the anemia, it was increasingly clear that the abnormal heart just could not keep up with the size of the chorioangioma. We knew when it was critical to make a decision to deliver.”
Jessica was almost 32 weeks pregnant then, surrounded by the hospital’s entire care team and Dr. Solomon. Many expected the baby to code as soon as she was born.
But the baby girl, Clara, was born, “pink and screaming,” Jessica said, like every other newborn.
Clara did require recovery time in the NICU and advanced heart surgery at the age of two, but today Clara is a happy and healthy 2 ½ year old daughter to Jessica and her husband, and sister to three other siblings, one of whom was born healthy just 13 months after her.
“She is the most active of all my children,” Jessica said of Clara. “She can do a pull up on her own. She makes me crazy every day but I love her and it’s all thanks to Dr. Solomon.”
Looking back on her experience, Jessica advises all moms-to-be to ensure their babies hearts are checked during pregnancy. “Don’t just focus on if it’s a boy or a girl, it’s the heart and organs that matter too,” she said. “Make sure you have a knowledgeable sonographer and physician who can diagnose and understand the anatomy on an ultrasound image.”
That was one of the many decisions that enabled Clara to go from having a shaky prognosis to an active and healthy toddlerhood.
“We were fortunate to have advanced technology available to us to diagnose and care for Clara, and get her to a point where she could be delivered with hope,” said Dr. Solomon.
For Jessica, it was more than just that. “Dr. Solomon saved my daughter’s life. Clara wouldn’t be here today if it weren’t for her.”
Dr. Solomon also teaches peer-to-peer clinician courses for GE Healthcare on the use of 3D/4D ultrasound.