Dr. Michael Maruncic with Sylvie Gaede and baby Daniel
For nine months, the arrival of Sylvie and Stewart Gaede's second child was an eagerly anticipated moment. "My four-year old David thought his brother would never come. Every month of my pregnancy seemed likean eternity for him," says Sylvie.
Sylvie was happy to see her belly grow as the months went by. Having suffered a heartbreaking miscarriage the year before, she was only too pleased to see this pregnancy progress normally.
But once she was 12 days overdue, Sylvie and her obstetrician, LHSC's Dr. Michael Maruncic, decided together that the baby needed to come out.
"It is common procedure to talk to moms about induction after the baby is seven days or more overdue," says Dr. Maruncic. Sylvie and Stewart, a medical physicist at the London Regional Cancer Program, were called in to the hospital at 11 am on June 21, 2007.
The day progressed, but Sylvie did not.At 1 am June 22, Sylvie's water broke, butshe was only dilated two centimetres.
At 6:45 am Stewart left the room to grab a quick coffee. When he came back 10 minutes later, he says, "Everything had changed." Sylviewas in respiratory distress and shaking badly. Her level of consciousness had decreased.
Cardiopulmonary resuscitation was immediately started on Sylvie as she was rushed into the operating room.
The on-call obstetrician, Dr. David Langlois, and his team performed an emergency Caesarean section that saved both Sylvie and her son's lives. Baby Daniel was delivered safely at 7:06 am.
Dr. Maruncic arrived at the hospital and was briefed on what was occurring. He was able to tell Stewart that his son had been delivered, but that Sylvie was still bleeding. Dr. Maruncic told Stewart that all measures were being taken to stop the bleeding, however a hysterectomy was a possibility.
"You have no idea what it is like to be on the outside of those doors. My whole world was crashing around me. Sylvie was slipping away and I could do nothing to help her," Stewart remembers.
Sylvie's heart was revived, but she continued to hemorrhage. Despite all conservative measures, the decision to perform an emergency hysterectomy was made.
"We tried everything. Sylvie had received over 100 units of blood products. Needless to say, the decision to undergo a hysterectomy was not taken lightly but we really had no other choice," says Dr. Maruncic.
The hours and moments after Sylvie's emergency surgery were a blur for theGaede family. Daniel had an ultrasound,an echocardiogram and an MRI. Born weighing 8lbs 2oz, fortunately, he had no complications despite such an urgent arrival.
When Sylvie woke up from sedation she was having problems seeing out of her right eye and her kidneys were not functioning well.
Sylvie was put on dialysis and watched closely by her care team.
While Sylvie was recovering in the Critical Care Trauma Centre (CCTC), her nurses tried to allow as much interaction between mom and baby as possible.
"There wasn't anywhere on my body that the baby could lie that didn't physically hurt," Sylvie remembers. She had bruises all over her body.
Six days passed, and Stewart was allowed to take baby Daniel home. With the support of his parents, Sylvie's parents, Sylvie's brother George and George's fiancée Heather, Stewart was able to travel back and forth between hospital and home. Sylvie had moved to the Gynaecology Unit and continued on dialysis, but she says,"I knew I wasn't getting any better."
Exhausted all the time, but unable to fall asleep, Sylvie was averaging two to three hours of sleep each night. When Stewart brought her flowers to celebrate their anniversary the smell made her physically ill.
On July 4, Sylvie awoke from only a few moments of sleep, panic-stricken.
"I remember screaming, ‘I can't see! Call my husband!'" she says. Sylvie had lost vision in both eyes and her heart was racing.
Stewart rushed to the hospital with Sylvie's parents. They were brought to the CCTC family waiting room while Sylvie completedan MRI exam. Waiting there, the family heard an overhead page.
But Sylvie had not had another cardiac arrest. As the MRI was being finished, Sylvie had a seizure and her pulse was next to impossible to find.
Nephrologist Dr. Bill Clark reviewed Sylvie's MRI, and noticed a series of miniscule strokes throughout her brain that were actually microthrombosis. Upon a quick review of her other symptoms, he determined that Sylvie was suffering from thrombotic thrombocytopenic purpura, (TTP), a platelet-clotting condition that had gone through her entire body.
While Dr. Clark sees 15 to 20 TTP cases each year, Sylvie's case, most likely precipitated by an amniotic fluid embolism during her pregnancy, is very rare. An amniotic fluid embolism is a condition in which the amniotic fluid surrounding the baby enters the mother's bloodstream via the placenta, and triggers an allergic reaction.
"It all started to make sense," Clark said. Sylvie's platelet count had continued to go down after the delivery of Daniel.
"The microthrombosis, or platelet clotting, had caused the vision loss and the aggregation of the healthy cells in the body. This is why Sylvie had started coughing uncontrollably and had bruises develop all over her body, even after Daniel was delivered," says Dr. Clark.
Sylvie started her first course of plasmasphersis immediately to remove, treat and then return donor blood plasma to her circulatory system. She woke up the next morning feeling better than she had in months. Her vision came back in the left eye and her hemoglobin normalized. She continued on that course of treatment for ten days.
Family, friends and neighbours rallied around, preparing to help Stewart and Sylvie get through the next few months of recovery. Stewart's parents took David to their home in Cape Breton and Stewart extended his leave from work at LHSC.
In a situation where they were prepared for the worst, Sylvie's treatment went extremely well. She was discharged the second week of July. "I remember calling Stewart to tell him I was coming home," she says. "He was shocked."
Sylvie returned home to care for her infant son, and herself. "It was tough. Twenty-three days in the hospital had nearly wiped me out. I needed to get back to normal," she says.
Finally, on August 19, Stewart, Sylvie and Daniel flew out to Cape Breton to celebrate David's fifth birthday as a family.
"That was the moment I knew we had turned the corner," says Stewart. "I knew then that the four of us would be fine."
Now Daniel and David are home in London with mom and dad, healthy and happy. Sylvie's parents are back home in St. Thomas and visit often. Stewart's parents are getting ready to come for a visit soon.
David is thrilled. His mom is home. His brother has arrived. And now there is something else he is waiting for that seems like it will never come—his upcoming trip to Disneyland.