Diagnosis: Cancerous tumors threatening pregnancy
Sometimes it takes an entire hospital to save a mother and her baby. In Kelly McClure’s case, it took EvergreenHealth specialists from maternal-fetal medicine, oncology, endocrinology, hematology and cardiology to solve her medical mystery.
At 33 weeks into her pregnancy, McClure’s blood pressure began shooting between extreme highs and lows.
She was carefully monitored, then admitted to the Critical Care unit at EvergreenHealth Medical Center at 35 weeks with an initial diagnosis of preeclampsia – a potentially life-threatening condition that causes high blood pressure.
But that didn’t explain the fluctuation between high and low blood pressure.
Dr. Carolyn Kline, a maternal-fetal medicine specialist, was part of the team that found the answer – two tumors – a cancerous one in McClure’s intestinal tract, and a rare and very dangerous one called a pheochromocytoma (pheo), which was sitting directly on top of McClure’s uterus.
The cancerous tumor would have to be dealt with, but it was the pheo tumor causing McClure’s immediate health crisis.
“When pushed upon, the pheo tumor secretes a powerful hormone that acts like adrenaline on the body, causing the spikes in blood pressure,” Dr. Kline explains.
“In cases of preeclampsia, the right thing to do is deliver the baby early to relieve the high blood pressure,” Dr. Kline continues. “Had we not diagnosed the pheo tumor, the pressure of a normal C-section on the tumor would have triggered a massive release of adrenaline that likely would have killed Kelly.”
While the tumor had nothing to do with her pregnancy, the two were intertwined. Every time the baby would move and press on the tumor, the resulting adrenaline rush would send Kelly's heart rate racing.
But there was one piece of good luck. Instead of being in the normal vertical position in the uterus, Kelly's baby was lying in a horizontal, or transverse, position. “That saved their lives,” Dr. Kline says, “because it reduced the amount of contact the baby had with the tumor.”
To prepare her for surgery, Kelly was put on medication to block the receptors to the hormone secreted by the tumor. She was observed by a team of specialists who monitored her pregnancy, her blood pressure fluctuations and her cancer, and she received 24-hour nursing care.
At 37 weeks, she was finally ready for a very delicate C-section using a full abdominal incision.
Dr. Kline and surgeon Michael Towbin cradled the uterus during delivery so it wouldn’t touch the tumor. After obstetrician Theresa Tsang delivered the baby, Dr. Towbin took over and removed both tumors.
Remarkably, baby Ashtyn was unharmed throughout the grueling ordeal. “She was perfectly healthy,” Kelly McClure remembers. “She was never affected by anything – sometimes my heart rate was up and my BP was down and sometimes my BP was up and my heart rate was down – but she was a trooper.”
“The baby did unbelievably well,” Dr. Kline agrees, “and Kelly did beautifully. Things could easily have gone badly, but it was a real team effort across many hospital departments. All of us were involved to keep them safe around the clock, and it probably saved their lives.”
For more information on Women’s and Children’s Services at EvergreenHealth, visit our Web site at www.evergreenhealth.com.