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Patient:
Sandra

Age Diagnosed:
19 weeks pregnant

Treatment:
Draining fluid from the baby's chest

Category:
Prenatal Diagnosis Center

Organization:
Women &Infants

Miraculous Occurrences at Women & Infants’ Prenatal Diagnosis Center

Dr. Stephen Carr and the Guzmans When Sandra Guzman was 19 weeks pregnant, she underwent a routine ultrasound. The parents of a healthy 6-year-old son, Camilo, she and her husband, Carlos Betancur, expected to find that everything was progressing smoothly. But when they were told that the baby had excess fluid in his chest and abdomen, their world turned upside down.

Their baby might not survive and, even if he did, he might have significant health problems, cautioned their obstetrician. But Sandra and Carlos held onto hope. They were referred to Women & Infants’ Prenatal Diagnosis Center (PDC) for further evaluation.

The PDC is staffed by a multidisciplinary team which is led by maternal-fetal medicine specialists, obstetrician/gynecologists with further training in high-risk pregnancy. The Center offers comprehensive screening, diagnostic and counseling services aimed at helping the patient and her physicians better understand a high-risk pregnancy. Referred by their own health care provider for further evaluation, patients may be seen for a number of reasons, including a family history of health issues that may affect an unborn baby, women who have taken medications that may have unpredictable effects on fetal development, women who have been exposed to a communicable disease, women who have undergone a routine ultrasound that revealed a possible problem, or women with an abnormal AFP screening test.

As is generally the case, Sandra and Carlos’ first encounter at the Prenatal Diagnosis Center was with one of the masters degree-trained genetic counselors. “During these visits, the patients learn more about their risks, what abnormal test results might mean, and the different techniques available that might help answer their questions,” explained Dr. Stephen Carr, director of the Prenatal Diagnosis Center and a maternal-fetal medicine specialist.

Following the visit with the genetic counselor, and depending on the nature of the problem, many patients undergo a more extensive ultrasound. Dr. Carr said, “We do a detailed exam of the fetal anatomy and then, if necessary and desired, we do more invasive genetic testing.” Those tests may include amniocentisis (taking a sample of the amniotic fluid in which the developing fetus floats) at approximately 16 weeks gestation, or chorionic villus sampling (extracting tissue samples from what will develop into the placenta) at 10 to 12 weeks gestation.

“We always hope that all is well,” stated Dr. Carr. “But when something is wrong, the PDC staff helps put together a comprehensive and coordinated plan that is unique to that woman and that fetus. Within a short period of time, the mother has a broad-based, comprehensive care plan that outlines who will work with them before the baby is born, what tests will be done before the baby is born, and what will be done after the baby is born.”

At Sandra’s first ultrasound at the PDC with Dr. Marshall Carpenter, director of Maternal-Fetal Medicine at Women & Infants, it could not be determined exactly what was happening with her baby. Perhaps it was an infection. Or perhaps this tiny baby’s heart was not working correctly. “Dr. Carpenter was wonderful,” commented Sandra. “He held my hand and was so kind in trying to explain things in a way that we could understand.”

A few days later, Sandra went back to the Prenatal Diagnosis Center and met with Dr. Carr and a pediatric cardiologist. They said that the baby’s heart looked good, but perhaps it could be Down Syndrome. The only way to find out for sure was to perform an amniocentisis. “I didn’t need to know if it was Down Syndrome, I just wanted to help my baby,” explained Sandra.

So she asked Dr. Carr the most logical question - is there any way to simply drain the fluid from the baby’s chest?

Dr. Carr explained that the procedure - which involved inserting a needle directly into the baby’s chest - could help the pregnancy, but it could also result in miscarriage. But if Sandra and Carlos wanted to try it, Dr. Carr was willing to give it a try. At 21 weeks, Sandra underwent the procedure. The procedure went well, but it didn’t take much time for the fluid in the baby’s chest to build up again.

Sandra and her family were desperate to save their baby and they spent countless hours on the internet researching possibilities. Ultimately, they found a similar case in Atlanta, where they actually put a chest tube - a drain, of sorts - into the developing baby. Although Dr. Carr and his colleagues had performed a procedure like this on a baby’s bladder, he and the other surgeons who comprise the Program in Fetal Medicine (a Women & Infants, Hasbro Children’s Hospital and Brown Medical School program) had never performed it on a baby’s chest.

“It was very scary,” said Sandra. “Before the surgery, they explained all of the things that could go wrong. I didn’t stop crying the whole time, but we all knew it was the only chance my baby had to survive.”

During the procedure - which was performed by Dr. Carr, pediatric cardiologist Dr. Lloyd Feit and pediatric surgeon Dr. Francois Luks - they inserted a needle four times through Sandra’s abdomen and into the baby’s chest wall, leaving behind a tiny chest tube that would drain the fluid from the chest.

It worked. After just two days in the hospital, Sandra went home, but she required additional monitoring to ensure that the fluid was not accumulating again.

On March 6, 2002, just three weeks shy of her expected due date, Sandra delivered baby Carlos, weighing in at a whopping 8 lbs. 10 oz.! There was a large team of pediatricians and specialists in the delivery room, all waiting for baby Carlos’ arrival, and all anxious to be sure that he was healthy.

“Two weeks before I delivered, Dr. Carr did an ultrasound and could still see the drain in place,” explained Sandra, incredulously. “But when I delivered, it wasn’t in the baby’s chest. We figure that it must have fallen out about a week before I delivered.”

Baby Carlos spent one day in Women & Infants’ Neonatal Intensive Care Unit as a precaution, undergoing special tests and additional x-rays, all of which were normal.

At one month of age, Carlos is developing normally and growing beautifully. Sandra smiled, “We call him our miracle baby. Every day I see my baby, I thank God for having him.”

Sandra and Carlos have a special place in their heart for Dr. Carr and the rest of the staff at the Prenatal Diagnosis Center and the Program in Fetal Medicine. On a recent follow-up visit, they presented Dr. Carr with a plaque that reads:

God has blessed us in so many ways, but putting you in our path was his greatest blessing of all. We will never forget your determination and dedication in helping us. Each time we look into our son’s eyes and see his smile we will always know that your hands, guided by our Lord, made this miracle happen.         From - The Betancur Family 3/6/02