Diagnosis: Bilateral Pleural Effusion during Pregnancy
Treated by: Maternal-Fetal Medicine
Lindsay Kendall was at a routine 20 week ultrasound appointment in Seattle, and the moment she took notice of the switch in the ultrasound tech’s tone and expression, everything changed in her world.
It was clear that the images were concerning her – and Lindsay's heart sunk.
"They told me that the baby had fluid around her lungs – causing them to be compressed and therefore restricting lung growth and development," Lindsay recalls. "They didn't know what was causing it and said the baby had made it this far and good luck with the remaining weeks of my pregnancy."
Lindsay and her husband Bill were stunned; her two previous pregnancies were smooth sailing - why should they think this one would be any different?
The ultrasound results were sent to Lindsay's OB/GYN, who referred them to a perinatologist to perform an amniocentesis and discuss the baby's condition.
The amnio was done to rule out chromosomal abnormality. The test was done on a Friday and they wouldn't get the results until Monday.
It was at the appointment the Kendall's discovered a name for this fluid-surrounding-her-prenatal-lungs condition: Bilateral Pleural Effusion.
Over the longest weekend on record, they waited to hear if there might be hope that they could do something and fight for the baby to live.
"I think it's critical to always be an advocate for myself and my family and it wasn’t a time to just sit by and wait, we had to do something to help her if we could. I had to find someone to help us," Lindsay says.
"Researching led me to discover this condition is often fatal and I also learned of a possible solution – a fetal shunt procedure. My fingers couldn’t type in the search-box fast enough…I had to know where I could go to get our baby the help she so desperately needed."
After researching a host of specialists who perform fetal shunt procedures across the country, Lindsay discovered the help she needed was right in her backyard: EvergreenHealth’s Maternal Fetal Medicine Program.
"My vision of packing a bag and flying elsewhere turned into a simple drive across the lake," she said, smiling.
On Monday morning came the encouraging news that the baby's amnio was normal.
Another ultrasound confirmed that, other than the effusion, the baby was looking great.
At the appointment Lindsay made a recommendation to the perinatologist that they look into EvergreenHealth’s Maternal Fetal Medicine Therapy Program (MFM).
The perinatologist was already acquainted with Dr. Bettina Paek at MFM – and made a call.
Six days after discovering the baby's bilateral pleural effusion, MFM colleague Dr. Martin Walker “held the baby in place” while Dr. Paek inserted a shunt so that the fluid could drain away from the baby's lungs.
The Kendall's also learned their baby was a girl.
Lindsay visited MFM weekly for 10 weeks – just to be sure the one side of the baby's lungs continued to drain and the other side wasn’t accumulating more fluid.
"Those weeks were full of uncertainty. Yet everyone at MFM was so caring and supportive and added to my bank of hope by keeping me calm and assuring me along week by week," she recalls.
"I actually began to look forward to my visits because the staff was so invested in my unborn child and me and each week brought us closer to meeting my baby girl."
When the baby was 30 weeks along, the doctors noticed the fluid on the drained lung was back – and it was even worse on the other lung.
A condition called ‘hydrops’ was developing – where fluid builds around other organs while in utero.
Dr. Paek inserted a second shunt on the baby's other lung. Both lungs were draining and the hydrops resolved.
Lindsay knew that the second shunt procedure would create a risk of preterm labor.
An ultrasound showed that membrane tissues were separated and two weeks after the second shunt procedure, her amniotic fluid began slowly leaking.
She was admitted to the Antepartum Care Unit to be monitored and make sure she wasn't going into labor.
After 10 days in antepartum care, the baby's heart rate showed extreme distress during contractions and baby Ruby was delivered via C-section. She weighted 4 lbs. 7 oz.
"To both mine and Bill's eyes, tears followed our immediate concern for her ability to breathe. It was overwhelming and all I could do was cry and then instantly began to worry about her," Lindsay explains.
Ruby's shunts were removed right after delivery – and the fluid around her lungs was no longer accumulating and eventually went away.
Ruby spent two weeks in the NICU because of her small size – but the time sped by quickly and she made a beautiful full recovery.
During this time, Lindsay spent her days with at the NICU with Ruby, and went home to her boys at night. "I felt so at peace knowing that she was in excellent hands," Lindsay says. "The nurses in the NICU were absolutely wonderful and provided the best care for my little miracle."
Ruby is a healthy little girl, and when she gets older her parents will tell her about the scar on her back and what an absolute miracle she is and who helped her live.
"We are all forever grateful for Dr. Paek and Dr. Walker, the whole team at MFM and the NICU team who gave Ruby the best care possible and a chance to live and thrive," she says. "During the hardest days, hours and minutes, the staff at MFM made everything feel like whatever was presented to them, they could handle it.
They were instrumental in guiding us through some very tough emotional points in the pregnancy and will never forget how they brought this miracle into our lives."