You Saved My Baby’s Life

As Preeclampsia Awareness Month comes to a close, I want to share a blog post I wrote on 2/28/2011 that provides a better description of my former patient’s birth that resulted in her amazing son. If nothing else, please pay attention to what her blood pressures were and how the resident physicians had a false sense of security that almost led to her baby’s death. 

I was greeted by those words during a patient’s recent postpartum exam and was both gratified and humbled.  A potential disaster was avoided and her pregnancy had a happy ending.

Katina* (name changed) had registered for prenatal care early so when her blood pressure was a little “different” at 32 weeks, the change was duly noted. She wasn’t complaining of a headache, her feet weren’t swollen but this was her first pregnancy which placed her at an increased risk of developing pre-eclampsia.  A blood pressure of 120/82 would seem normal to most people but in Katina’s case it wasn’t. She was sent to the hospital and then discharged home with instructions to monitor her blood pressure daily and I asked her to return in one week for closer scrutiny.

Upon Katina’s return, her blood pressure was 140/90 so off she went to the hospital’s labor and delivery triage department for further evaluation. Upon her arrival, her blood pressure appeared to have improved. The resident physicians on duty made snide remarks, insinuating that she was referred inappropriately.  As she was about to be discharged, the baby’s heartbeat dropped precipitously. Before Katina could blink, a team of physicians and nurses descended upon her with full force. They shoved papers in her face requesting a signature for an emergency c/section and informed her that it was possible she could die as well as her baby. Her blood pressure had escalated through the roof and her heart raced dramatically. She was quickly put to sleep, a “stat” c. section was done,  and her baby was born alive. For the next four days, the hospital staff had difficulty controlling her blood pressure and her heart continued to pound at rates above 150 beats per minute. It was one of the most harrowing experiences of her life however, in the end, both mother and baby were discharged home and are now fine. Katina experienced what we in medicine call a “diagnostic save.” A life was saved because the proper diagnosis was made in a timely manner. How often does that happen? Not often enough. If you can “see it” then you can treat it. Pregnant moms must be empowered to help their healthcare providers “see” the problem before it spins out of control.

 

Soulmates Left Behind on Mothers’ Day

Charles Spurgeon Johnson, Anthony Wallace, Juwan Lopez, and Bruce McIntyre III.

On this Mother’s Day, I honor the soulmates of mothers who left before their time on earth based on clinical incompetence, arrogance, and, yes, that dreaded word no one wants to discuss but is ever apparent racism.

Here are some examples of why Sha-Asia Washington, Amber Rose Isaac, Kira Johnson, and Dr. Chaniece Wallace are no longer with us:

Dr. Dmitry A. Shelchkov, a foreign medical school graduate, failed to provide adequate oxygen or monitor three previous patients before finally killing Sha-Asia Washington. He did not give her oxygen when she became short of breath and placed her epidural catheter incorrectly. His mistakes had been known for years, but it took the death of a 26-year-old first-time mother before the New York Medical Board suspended his medical license.

The obstetrician who performed a 17-minute elective C-Section led to a postpartum hemorrhage and the preventable death probably of Kira Johnson. Unfortunately, he probably still has privileges at the infamous Cedar Sinai Hospital.

The ob-gyn residents and their attending physicians at Montefiore Hospital who missed Amber Rose Isaac’s dropping platelets are probably still practicing without any accountability except providing a pathetic apology that will not bring her back to life.

And then there’s the case that keeps me up at night involving my fellow physician colleague and sorority sister, Dr. Chaniece Wallace. The horrific two-hour delay of starting an intravenous line in the setting of her hypertensive crisis is chilling. Yet, St. Vincent’s Hospital in Indiana purports to have given her the best care.

Yet, amid this madness, four remarkable men have turned their pain into action on behalf of their departed soulmates. Their comments and posts on social media platforms demonstrate a palpable love. They speak about their beloved in the present tense. They not only continue to love these women but remain IN love with them despite their physical absence of 6 years for Charles Spurgeon Johnson IV and two years for Anthony Wallace, Juwan Lopez, and Bruce McIntyre III.

These brothers teach us that love continues to win, even in death, and has created beautiful children that represent their legacy.

Today, I salute the soulmates of Kira, Sha-Asia, Amber, and Chaniece, who continue to teach all of us that death has no real power over love, just as it had no power over Jesus, the Christ.

May my sisters continue to rest in Power, and may their memory continue to be a blessing.

 

The U.K. Approves an Early Preeclampsia Diagnostic Test. Will the U.S. Follow?

A decision made by the British version of our NIH, the National Institute of Care and Excellence (NICE), sheds a flicker of light onto a very dark landscape regarding maternal mortality. They are authorizing the use of a blood test that will diagnose preeclampsia as early as 20 weeks. This decision is groundbreaking news and will change the landscape of how preeclampsia is currently diagnosed, treated, and hopefully save lives.

NICE is developing a draft of clinical guidelines and believes that African, Caribbean, and Asian women will benefit the most based on their history of adverse birth outcomes.

Here’s what you need to know in plain English about the test:

  • It measures Placenta Growth Factor (PIGF), which is a protein that plays a role in the development of blood vessels in the placenta
  • Women who have preeclampsia have low levels of PIGF. Low levels of PIGF means that the placenta blood vessels do not grow well

Can these tests diagnose as well as exclude preeclampsia?

Yes, according to published literature cited in the article.

Who makes these tests?

Four independent labs: one in San Diego, two in Germany, and a lab in Finland

What are the benefits of using this test for pregnant women?

The tests will make it easier for healthcare providers to diagnose preeclampsia and make fewer mistakes regarding clinical management.

Are there any economic benefits of using this test?

According to NICE literature, the saving was between 26 pounds ($34.06) to 2,896 pounds ($3,793.76) per patient.

Are there any other early diagnostic tests for preeclampsia?

Yes, there is a test using different technology that measures cell-free RNA as a means of early preeclampsia detection, according to an article published by Nature.com. However, healthcare providers do not currently use this test because it has not been approved as part of clinical guidelines.

I anxiously await the use of PIGF in mainstream obstetrics. We once thought that the adverse effects of preeclampsia stopped when the baby and placenta were delivered. However, we now know that reasoning was wrong based on the number of women who died during the postpartum period. Hopefully, with the future use of this test, women will no longer be discharged from hospitals or emergency departments prematurely. Anything that decreases maternal mortality gives me a glimmer of hope.