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'The whole hospital was involved'

Toronto, July 16, 2014

By Leslie Shepherd

Emerlinda Wania holds her baby Precious in the NICU
Emerlinda Wania holds her baby Precious in the NICU. (Photo by Yuri Markarov)

They say it takes a village to raise a child, and it took nearly that many people recently to bring one child into the world under life-threatening conditions at St. Michael’s Hospital.

In fact, it took four ob-gyns, one neonatologist, two pediatricians, two anesthesiologists, two hematologists, a radiologist and an interventional radiologist, a perfusionist, a trauma surgeon, a vascular surgeon, a urologist, a social worker, an ethicist, a chaplain, perioperative support assistants, unit service workers and respiratory therapists working together in two operating rooms, as well as nurses, clinical managers and educators in the OR, ICU, antepartum ward, post-partum ward, labour and delivery and the NICU, and the hospital’s expertise in blood management.

Emerlinda Wania was pregnant with her fourth child when she developed a condition known as placenta percreta, where the placenta grows through the uterus, generally through a previous C-section scar, and can invade other organs such as the bladder.

She started having some light vaginal bleeding and her water broke at 27 weeks into her pregnancy. She needed another C-section to deliver the baby, a hysterectomy to remove her uterus and additional surgery to repair her bladder and any other damage.

Dr. Andrea Lausman, a specialist in high-risk pregnancies, said she was worried Wania would start bleeding heavily and require emergency surgery, so she assembled a team of two dozen health care specialists to prepare as if it were an elective procedure.

“I felt like we used all of the resources of our hospital to give her truly multi-disciplinary care,” said Dr. Lausman.

Adding to the complexity of the case was the fact that Wania is a Jehovah’s Witness and her religion forbids blood transfusions. The surgeries she was about to undergo carry a high risk of serious bleeding. Doctors knew they could save her life and the baby’s if they could give her blood transfusions, but without that capacity, “we were very concerned she would die,” Dr. Lausman said.

Well before the scheduled surgery date, Wania was under the care of the hospital’s blood management and conservation team who worked to raise her blood hemoglobin levels. They also created a comprehensive blood management plan for the surgery, which included using a big central IV line to ensure adequate fluid replacements and clotting factors, which are accepted by many Jehovah’s Witnesses.

Importantly, the patient also agreed to use the cell salvage process in which her own blood lost during surgery was captured, washed and recirculated in a closed loop so it never left her body.

Precious Jerylle Wania was born on April 1, just short of 30 weeks gestation but close enough that she was allowed to remain in the neo-natal intensive care unit, rather than be transferred to another hospital for more intense care. Both mother and daughter are doing well.

“It was a very big decision for us,” said Emerlinda’s husband, Jerry. “Without blood, she might have died. We put our trust in God.”

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.