A Dramatic Delivery Showcases Inova’s Teamwork Approach

When 8-months-pregnant Jihye Ha needed emergency care, the situation turned critical for her and the baby.

Throughout her first pregnancy, Jihye Ha seemed to be sailing through it without much difficulty or discomfort — but then in February, at 32 weeks, she began noticing a strange development. Her fingernails were turning blue.

Ha also started feeling shortness of breath, sometimes so severe she had to sleep in a chair because lying down made it worse. When she went in for a prenatal checkup, it turned out her oxygen levels were alarmingly low, resulting in an immediate trip to the ER, where she was diagnosed with severe pulmonary hypertension and right heart failure. This was caused by a hole in her heart that hadn’t been detected before.

Immediately, the staff at Inova Fairfax Medical Campus put together a team to decide on the best course of action, bringing together specialists from the pulmonary hypertension team, cardiac surgery, cardiovascular ICU nursing, critical care, interventional radiology, labor and delivery, obstetrics, congenital cardiology and respiratory therapy.

“It does not get any more serious than this,” says Oksana Shlobin, MD, Director of Inova’s Pulmonary Vascular Disease Program. “Women who are diagnosed with the kind of condition that Jihye has are usually advised not to get pregnant because there can be a 50 percent mortality rate for mother and baby. We all knew this needed to be handled with a lot of care because the risks were incredibly high.”

Going on ECMO

The Inova team decided that the baby needed to be delivered immediately, but Ha’s heart was so weak they feared she wouldn’t survive it, even doing a Caesarian procedure. That’s when they proposed placing Ha on extracorporeal membrane oxygenation (ECMO) as a way to support her heart and lungs, and significantly lower the risk of going into cardiac arrest during delivery. This would be the first time the team had ever placed a pregnant woman on ECMO to safely deliver a baby.

ECMO uses a pump to circulate blood out of the body and into an artificial lung, where the blood is oxygenated and pumped back into the patient. Basically, it provides a way to replicate heart and lung function for people like Ha, whose own organs can’t work properly to get enough oxygen into the bloodstream.

Although she was partially sedated, Ha remembers feeling the tube in her mouth, and could hear the concern of everyone around her, including her husband, J.D. The events of that day were such a whirlwind she barely registered what was happening, she recalls, but one moment stood out clearly.

“I thought I was going to die,” she remembers. “I prayed for God to give me just one more day to see my baby.”

Dramatic Delivery

Working quickly, the Inova team delivered a healthy baby boy, Noah, and the relief felt by family and everyone involved was incredible, says Mehul Desai, MD, one of the Critical Care team members and Medical Co-Director for Adult ECMO.

“It was definitely a very special moment for all of us to see the baby delivered safely,” Dr. Desai says, but “we knew Jihye still needed a great deal of care before we felt that kind of relief about her health.”

Ha went through weeks of difficulty, including bleeding in her lungs, severe pneumonia and resistance to all but the strongest antibiotics. Her respiratory system took longer to heal due to the bleeding and infections, says Erik Osborn, MD, a Pulmonary Critical Care physician and Medical Director of Adult ECMO.

“It seemed like one life-threatening issue after another,” Dr. Osborn says. “And when we would take her off the breathing machine, her oxygen levels would drop back down, but putting her back on sedation and a breathing machine risked causing her heart to stop. It was very tricky and complex. Jihye was able to text complex sentences on her iPhone despite incredibly low oxygen levels which helped reassure us that she was getting enough oxygen from ECMO.

On the Road to Recovery

Little by little, Ha improved, and baby Noah thrived during the two months Ha remained in the hospital. Everyone rallied around them — the nurses even threw her a baby shower — all the time, Ha maintained her positive attitude and composure, which was so admirable, according to Dr. Shlobin.

“She’s extraordinary, and we all marveled at how she always maintained a great attitude and greeted everyone with a smile, no matter what she was going through,” Dr. Shlobin says. “This was a remarkable situation made even more notable because Jihye has a remarkable spirit.”

The delivery also showcased how adept Inova is at bringing in multiple specialists and departments to handle complicated cases like Ha’s.

“Every ECMO requires significant collaboration,” says Dr. Desai. “Every decision has to be made as a group, and the goal is always to get the patient headed toward recovery. We knew that despite a successful delivery, Ha still needed a great deal of support before her heart could fully support her.”

After leaving the hospital at the end of April, Ha headed back home with Noah, but she still needs a special pump that continuously administers to her heart and lungs. Fortunately, it’s small enough that she can remain mobile — and that allows her to visit her friends back at Inova.

“When I went back to see them, some of the doctors and nurses cried when they saw me,” Ha says. “I feel lucky and happy to have them, and they all worked so hard for me and Noah. We are all so deeply grateful.”

Learn more about Inova’s Extracorporeal Membrane Oxygenation (ECMO) Program and Inova’s Pulmonary Hypertension Program.

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