Pregnancy

Robotic-assisted surgery helps with high-risk pregnancies

 

Special to the Miami Herald

Qynata Henry-Nairn was getting off the examining table in her doctor’s office almost a decade ago when her water broke. She was 20 weeks pregnant, and she had visited her doctor after she noticed some bleeding.

It was discovered that she had what is known as an “incompetent cervix,” which results in the lower part of the uterus dilating prematurely, resulting in miscarriage or premature birth. The condition affects one out of 100 pregnancies, according to the American Pregnancy Association. Henry-Nairn lost her baby.

An incompetent cervix results in the mother having a high-risk pregnancy, said Dr. Salih Yasin, an obstetrics gynecologist at the University of Miami at Jackson Memorial Hospital. Other conditions can lead to high-risk pregnancies as well, including age — older than 40, younger than 17 — or pre-existing medical conditions such as diabetes, high blood pressure or kidney problems.

Twenty percent of pregnancies are considered high-risk, Yasin said.

When Henry-Nairn became pregnant again five years ago, she saw Dr. Nathan Bruce Hirsch, the senior attending obstetrics gynecologist at South Miami Hospital. Her cervix was stitched closed through vaginal surgery to aid in a successful pregnancy.

But a membrane ruptured, causing her to deliver her baby at 23 ½ weeks. Her son, Juel, remained in the hospital for 4 ½ months. When he came home, oxygen tanks and a monitoring machine were required. Juel suffered from apnea, when breathing temporarily stops, especially while asleep, and he needed to be monitored throughout the night.

Today, Juel no longer has sleep apnea, but he does have asthma.

“We were a little skeptical about getting pregnant again,” said Henry-Nairn, 34, who is married to Wayde Nairn.

But a year ago she became pregnant again. Hirsch recommended that she undergo robotic-assisted cervical procedure called cerclage in which the neck of the uterus, or cervix, is stitched closed. Surgical instruments attached to robotic arms are maneuvered through small incisions in the abdomen, using ultrasound for guidance.

“We put a stitch high up in the cervix which is able to hold in the baby, said Dr. Ricardo Estape, robotic gynecological surgeon and medical director of the Baptist Health Center for Robotic Surgery, who performed the procedure. “The chances for the cervix to open are much lower.”

Henry-Nairn had a full-term pregnancy, and delivered a healthy baby girl named Olivia on March 14 via Cesarean section.

The robotic procedure is recommended before pregnancy, Hirsch said, but Henry-Nairn said she didn’t know she was pregnant until she was 14 weeks along.

“Ideally, the cerclage should be placed when they are not pregnant, but half of cerclages have been done when pregnant,” Estape said.

The cerclage can be placed up to 15 weeks into the pregnancy, said Hirsch. Patients quickly recover, he said.

Henry-Nairn, a second-grade teacher at Florida City Elementary School for almost nine years, worked until two weeks before her delivery when she was placed on bed rest after developing high blood pressure. When she was pregnant with Juel, Henry-Nairn said she was on bed rest in the hospital for a month before delivering.

The cerclage procedure is not common because it is used only for patients who fail to keep a suture in place through vaginal surgery, said Estape, who has performed 60 cerclages in the past six years.

Patients with the cerclage, which remains permanently inside the body, have not suffered any fetal deaths except for one, which had nothing to do with the procedure, Estape said.

Pre-conception counseling is recommended for all women who could experience a high-risk pregnancy, said Yasin, but he noted that most women don’t seek it. Yet a patient’s diet, physical activity, rest and medication have to be tailored to the mother’s needs in such cases, he said.

If a condition such as diabetes is not controlled, a baby can be born with congenital defects from the mother, Yasin said. Pregnant women with diabetes also have a 15 to 20 percent chance of developing hypertension.

Doctors at Memorial Healthcare System in Broward County work collaboratively to identify high-risk patients, said Dr. Laurie Scott, an obstetrics gynecologist and Memorial’s medical director for maternal fetal medicine. A multispecialty group meets monthly to review cases.

Tina Morton was one such patient. The 33-year-old nurse at Memorial Hospital West moved to the Miami area last April from Ocala. While pregnant with her second child, it was discovered that her baby had a low heart rate. When she was 20 weeks pregnant, a scan revealed abnormalities in the fetus’ heart. Doctors referred Morton to a fetal cardiologist.

“We knew there was a chance she wouldn’t make it,” Morton said. “Everyone was involved from the surgeons to cardiologists to the obstetrics gynecologists.

“I didn’t go in blind,” Morton said. “There was a whole team in place.”

After her labor was induced, her baby was immediately attended to by the cardiologist, who performed an echocardiogram, or ultrasound scan of the heart. Her baby suffered from heart problems, including an underdeveloped left ventricle.

“There was no time wasted,” Morton said. “They had a game plan.”

At 10 days old, the baby underwent surgery to place a shunt in her heart so her blood could pump properly, Morton said. The shunt was removed when she was about 6 months old. She will undergo another heart surgery when she is between 2 and 4 years old.

The child, Addison, will be 8 months old on Wednesday, said Morton, whose family includes her husband, Aaron, 35, and 2-year-old daughter Mackenzie.

Morton’s pregnancy was a family affair, with the hospital staff inquiring about Mackenzie and answering the questions of Morton’s parents.

“They truly made it not about just me and Addison but about the family,” Morton said. “It’s important because you need to know you have a support system, and they truly become your family.”

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