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Team Approach Saves Mother and Baby

Specialist physicians study and train intensively in their areas of expertise, but illnesses do not always fit neatly into one specialized category. Teamwork becomes critical with complex health problems. Such was the situation for Anne Ziegenhorn, from Des Plaines, and her unborn baby.

Ziegenhorn, her husband, Tom, and their 2-year-old son, Kevin, were anxiously awaiting a new addition to their family in the next few months when life took an unexpected turn. Ziegenhorn developed a severe headache, appeared to have a seizure and collapsed. She was rushed to a nearby hospital and diagnosed with a ruptured brain aneurysm. Given the complex and potentially fatal situation for both Ziegenhorn and her baby, the young mother was transported to Loyola University Health System via the Lifestar helicopter.

Ziegenhorn was comatose upon arrival. Emergency physicians and nurses stabilized her vital functions, while neurosurgeons, neuroradiologists, neonatologists and other specialists collaborated closely to assess her situation and plan the best course of treatment. "The aneurysm was difficult to locate by angiogram, but we knew it was there," said Russ Nockels, M.D., neurological surgeon.

With two patients - mother and unborn child - rather than one, a large number of options, risks and conflicting needs had to be carefully considered. Ziegenhorn's husband and family feared the possibility of having to choose between saving the mother or child, or possibly losing them both.

"The big issues were that Anne and the baby could have both succumb to a repeat hemorrhage of the aneurysm while we were trying to save the baby. Delivering the baby could have hurt Anne by causing rehemorrhage, but operating on Anne before the baby was born would have hurt the baby," Nockels said.

Considering all the scenarios, the team worked on delivering the baby first. Maternal-fetal specialists William MacMillan, M.D., and Roberta Karlman, M.D., placed Ziegenhorn on steroids for 24 hours to help the baby's lungs mature more quickly, then successfully delivered a baby boy by Caesarean section. Although four weeks premature, the baby was healthy and received care in Loyola's neonatal intensive care unit. The focus then shifted back to saving the mother's life.

A second angiogram was used to locate the aneurysm and showed that its location and small size would make surgery difficult and increase the possibility of Ziegenhorn suffering a major stroke. After considering several possible surgical procedures, the team of neurosciences specialists - including Nockels, Harish Shownkeen, M.D., a neuroradiologist, and Thomas Origitano, M.D., chairman of the Department of Neurological Surgery - decided the most effective treatment was to seal the blood clot with a small metal clip.

The operation, performed by Nockels, was a success, and three days later the new mother was breastfeeding her baby, Ian. After follow-up care and physical therapy to restore strength and balance, mother and baby went home 23 days after arriving at Loyola.

Today, Ziegenhorn shows no lasting effects from her ordeal, and has gotten back to the joys of everyday life with her family - thanks in no small part to a team of highly skilled health professionals and the collaborative approach they brought to patient care.

"Ultimately, the decisions as to how to proceed from the very beginning were fraught with conflicting 'best' options for Anne and Ian, which is why the teamwork at LUHS really paid off," Nockels said.

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