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Beth Livingston had been having a picture-perfect pregnancy until a serious complication was discovered during her 20-week ultrasound. She was referred to the Cincinnati Fetal Center for evaluation where her baby’s diagnosis was confirmed as bladder outlet obstruction. Her unborn son wasn’t able to urinate properly, and his condition was so serious he would not have survived if it went untreated.
In this case, the bladder outlet obstruction was caused by posterior urethral valves, where an abnormal fold of tissue in the urethra blocks urine from flowing freely out of the bladder. If not corrected, this blockage can cause backup of urine in the bladder, the ureters and in the kidneys, and in severe cases, a deficiency of amniotic fluid that can then threaten lung development.
During their visit to the Fetal Center from their home in nearby Alexandria, Kentucky, Beth and husband Tim were made to feel a part of the team. They met with Timothy Crombleholme, MD, FACS, FAAP, Director, and William Polzin, MD, Associate Director, to learn more about their three treatment options. The Livingstons, guided by the team of fetal specialists, quickly made the decision for Beth to undergo open fetal surgery.
Two weeks after the diagnosis and at 23 weeks gestation, Beth had a procedure where her baby was exposed from the waist down, with the umbilical cord still attached, while surgeons created an opening for the baby to urinate (a fetal vesicostomy). “We were very nervous,” Beth said. “But we focused on the positive. We wanted to give our baby the chance to live.” The vesicostomy allowed urine to be properly expelled from the bladder, thereby restoring amniotic fluid and optimizing development of the lungs. The fetus was then put back into the womb for the remainder of the pregnancy.
Beth recuperated in the Fetal Center for five days after her surgery. She spent the next 13 weeks on bed rest – seven at home and then six at Good Samaritan Hospital. The Fetal Center is a collaboration among Good Samaritan, Cincinnati Children’s and University of Cincinnati Medical Center. This combined effort of these organizations means that high-risk expectant mothers can receive comprehensive maternal fetal health services, drawing on the knowledge and skills of experts from all three hospitals. In Beth’s case, her bed rest in the hospital and her baby’s growth and development were monitored by Dr. Polzin, a maternal-fetal specialist at Good Samaritan. At the same time, Dr. Crombleholme of Cincinnati Children’s, who performed Beth’s fetal surgery, maintained awareness of her and her baby’s status. With this closely coordinated care, Beth carried her baby all the way to the 35th week of her pregnancy. Finally, on May 12, 2008, Max Anthony Livingston was born.
“He had fluid around his lungs, and he was breathing very rapidly. His heart and lungs were working too hard,” Beth said. Bladder outlet obstruction can compromise both lung and kidney development. In Max’s case, he was diagnosed with respiratory distress syndrome – his lungs were immature due to his prematurity. He would need to be transferred to the Newborn Intensive Care Unit (NICU) at Cincinnati Children’s for treatment. The unique collaboration among the three leading medical institutions that form the Fetal Center ensured that Max’s transition was a smooth one.
Beth and Tim knew a lengthy hospitalization for Max was a possibility even before he was born. “The doctors at the Fetal Center were good at explaining everything. We felt very prepared,” Beth said. But prepared or not, leaving a newborn in the hospital is a stressful and emotional situation. “At this point, we didn’t know if Max was going to survive,” Beth said.
To help him breathe and give his lungs a chance to mature, Max was intubated (had a tube inserted in his throat) for a week and a half. Recovering from that, he is now doing well breathing room air. But he does face other challenges. He suffers from reflux and began refusing a bottle. To treat this, Max now has a g-tube (gastrostomy tube) to supplement his feedings by mouth. It could be a couple of years before the g-tube is removed. He also has chronic kidney failure and will be on dialysis until he undergoes a kidney transplant, most likely sometime after his first birthday. Despite all this, the Livingstons are happy and hopeful.
“He’s definitely a strong little boy,” Beth said. “He smiles even after a needle prick. He loves to flirt with his nurses, he’s starting to bat at toys and he is beginning to coo. Cognitively, he’s right on track.”
His is a story in which the Cincinnati Fetal Center will forever be a part. And for that, the Livingstons are grateful. “Everyone at the Fetal Care Center was wonderful,” Beth said, “from the receptionist to the chaplain to the nurses to the surgeons.” She says she and her husband know they made the right decision for their son. “Seeing Max smile makes it all worthwhile. He’s proof that miracles do happen.”
If you would like to request an appointment or get more information about the Cincinnati Fetal Center, please call us at 1-888-338-2559 (1-888-FETAL59).
For Tips on Dealing with the Stress, click on image.
Just halfway through her first pregnancy, Beth Livingston faced a major surgery for herself, surgery for her unborn son, and likely hospitalization for her newborn baby. Confronted with this unthinkable situation, she coped by:
While in the Neonatal Intensive Care Unit (NICU), your child will have a primary team of nurses, respiratory therapists and doctors.
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