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Complicated Delivery a Success for Sandy Hook Woman with Dangerous Heart Condition

Thursday, November 18, 2010 - Danbury, CT

Integrated medical team from Danbury Hospital manages high-risk pregnancy

Laura Tashjian is a mom. It’s a role she has relished since the birth of her first two children, both boys. Despite having a recently diagnosed heart condition, the Sandy Hook resident’s first two deliveries at Danbury Hospital occurred without incident or complications. However, to Tashjian’s surprise, her decision to expand her family once again, posed very dangerous risks.

A Recent Heart Condition

In 2003, Tashjian suffered heart palpitations, shortness of breath and a tingling sensation in her left arm after a negative reaction to medication she was taking. Upon investigating the situation further, doctors diagnosed Tashjian with a subaortic membrane and a leaky mitral valve. This can sometimes lead to blood leaking backward into the left atrium, a condition called mitral valve regurgitation. When pregnant, this condition can pose significant risk to both the baby and the mother.

“While reviewing Laura’s most recent echocardiogram, we became very concerned about this pregnancy. There was a risk that she might go into congestive heart failure at some point during the remainder of the pregnancy, or especially during delivery,” said Dr. Brian Pollack, a Danbury Hospital Cardiologist.

A Pregnancy Risk

Tashjian was fortunate to deliver two healthy babies without complications. However, a third pregnancy posed new risks. Physicians from a cross section of departments at Danbury Hospital joined forces to ensure this pregnancy and delivery went as smoothly as the first two.

“In pregnancy, the blood volume increases by 40-45 percent from non-pregnant levels. This is associated with an increase in the cardiac output. In Laura’s case, her heart's capability to compensate for this increased cardiac work was limited, and could cause her to retain fluid in her lungs,” said Dr. Patricia Whitcombe, a Danbury Hospital Obstetrician-Gynecologist.

Danbury Hospital Forms Specialized Multidisciplinary Team

Tashjian progressed through the remainder of her pregnancy with close monitoring from her obstetrician Dr. Whitcombe, her cardiologist Dr. Pollack, her perinatologist Dr.Gouyang Luo and her neonatologist Dr. Alicia Perez. In addition, a multidisciplinary team of specialists, including a perinataologist, anesthesiologist, intensive care unit (ICU) nurses, and labor and delivery nurses was formed in anticipation of the big event - the delivery.

Although initial conversations of the team focused around Tashjian having a C-section to reduce the strain on her heart from pushing, it was Dr. Luo, Director of Prenatal Diagnosis at Danbury Hospital, who recommended that a natural, vaginal birth, like Tashjian’s other two deliveries, would be a safer option in this delicate case.

“A C-section is a major surgery and should be reserved for true obstetric indications,” said Dr. Luo. “In Laura’s case, at Danbury Hospital, where a multidisciplinary team of specialists is available, vaginal delivery is better off for her than having cesarean delivery, which may further compromise her cardiac function secondary to excessive bleeding from surgery. This is the perfect example of team work involving a multidisciplinary team of specialists. With a cardiologist monitoring her cardiac status, an anesthesiologist controlling her labor pain, and an obstetrician managing her labor and delivery, she had an uneventful delivery.”

In addition to Tashjian’s specific heart condition, Danbury Hospital offers perinatology care for women who are considered high-risk because of other existing medical conditions, family history, or previous complications, including those with:

  • High blood pressure
  • Diabetes
  • Lupus
  • Preeclampsia during the pregnancy
  • Other medical conditions that may be affected by the pregnancy or that may affect the pregnancy

Other candidates include women expecting multiple births, women experiencing premature labor or those with concerns about the developing fetus.

The Delivery

Tashjian’s team of doctor specialists made the call to induce her labor three weeks early, setting the date for May 12, 2010.

“Clearly, the most dangerous part of Laura’s labor was her pushing. The effort of pushing could have resulted in the patient's inability to have blood flow out of her heart and could have resulted in her death,” said Dr. Whitcombe.

To avoid the risks associated with pushing, doctors performed an assisted delivery. A pressure monitoring catheter was also inserted into her heart to allow doctors to precisely monitor her heart activity during the delivery. In addition, Dr. Luo directed the team to administer an epidural early on in the delivery process.

“If Laura experienced any type of pain as she progressed through the stages of her delivery, she could have lost her life,” adds Luo.

“It was amazing how the entire team worked simultaneously to ensure the health and well-being of both myself and my baby girl,” adds Tashjian. “In fact, everyone to my right - my cardiologist and ICU nurses - was monitoring me, while everyone to my left, the neonatologist and perinatologist, was keeping tabs on my baby’s development.”

A Happy Ending

All went smoothly and now Tashjian has a beautiful and healthy baby girl. “I can’t say enough about the care I received at Danbury Hospital. Everyone knew what their role was and the team had a great plan of action,” said Tashjian. “It’s for that reason that Danbury Hospital has always been, and will always be, my hospital of choice. I’m here today enjoying my little girl because of the dedicated team of doctors and nurses who made sure we were both safe.”

About Danbury Hospital

Danbury Hospital is a 371-bed regional medical center and university teaching hospital associated with New York Medical College, the Yale University School of Medicine, the Connecticut School of Medicine, and Columbia University Medical Center. The hospital provides centers of excellence in cardiovascular services, cancer, weight loss surgery, orthopedics, digestive disorders, and radiology. It also offers specialized programs for sleep disorders and asthma management. Medical staff members are board certified in their specialties.

Besides managing low and high risk pregnancies like Tashjian’s, Danbury Hospital’s Family Birthing Center is equipped to handle all types of personalized birth experiences including:

  • The type of delivery from natural to vaginal to C-section to water
  • Whether the mother would like a midwife to be involved in the delivery
  • Personalizing the atmosphere with music or displaying items from home
  • Determining who should be present during labor and delivery
  • Preferred labor positions
  • The preferred medications
  • Father and family involvement

The Praxair Regional Heart and Vascular Center at Danbury Hospital is Western Connecticut’s most comprehensive, full-service cardiac and vascular care program that includes diagnostic testing, medical treatment, interventional and non-interventional cardiac and vascular procedure, electrophysiology, and minimally invasive and open-surgical procedures to evaluate and treat cardiovascular diseases. The Praxair Regional Heart and Vascular Center is accredited as a Chest Pain Center by the Society of Chest Pain Centers; one of only two hospitals in the state to carry this designation.

Its Nuclear Medicine Laboratory is accredited by the Intersocietal Commission for the Accreditation of Laboratories, one of the first 50 Echocardiography Labs in the United States, Canada and Puerto Rico to receive this recognition.

For more information, visit our website at DanburyHospital.org.




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