Pregnant Pause: How a Specialist’s Caution Saved Haylie’s Life

Haylie’s pregnancy was challenging and the delivery of her twins was complicated, but the initial result appeared positive.
20 fingers
20 toes
Just what everyone hoped for.
But after delivering the babies by cesarian section, stitching Haylie up and checking for bleeding, Johns Hopkins All Children’s maternal-fetal medicine specialist Brad Sipe’s instinct was to be cautious: “Five more minutes,” he says.
Haylie credits those five minutes with saving her life. They revealed bleeding that in the coming hours cost her two-thirds of the blood in her body, they resulted in the rapid assembly of a team from two hospitals that saved both her life and her uterus, and they rewarded her with a future with her family.
“Here I sit today thankful for ALL the blessings in my life … and most of all for those five more minutes!” she wrote in an email to Johns Hopkins All Children’s Hospital in St. Petersburg, Florida.
A Challenging Pregnancy
Haylie had many risk factors in her pregnancy.
Haylie was carrying monochorionic diamniotic (MCDA) twins, which are identical twins that share a placenta but have separate amniotic sacs, increasing the risks associated with multiple fetuses. She also had an anomaly called uterine didelphys — known as a double uterus — a rare congenital condition where a female is born with effectively two uteruses instead of one.
In the course of her pregnancy, Haylie developed preeclampsia, a serious condition where the woman develops high blood pressure and protein in her urine. She was admitted to the hospital toward the end of her second trimester, seeing a rotation of specialists in the Johns Hopkins All Children’s maternal-fetal medicine practice.
After Haylie had been in the hospital about two months, she was just past 33 weeks gestation when Sipe was on duty. He visited her about 11 a.m. “You don't look like you,” he remembers saying. “What's going on?”
Haylie was in preterm labor. By 2 p.m., they were in the operating room.
“It was not planned,” Sipe says. “It was a surprise.”
An Experienced Specialist
Sipe was attracted to obstetrics and gynecology because in one specialty it combined medically diagnosing the patient, performing surgical procedures, emergency medicine and following the patient longer term. He realized during his training that he was invigorated by the most challenging cases, so he trained further in high-risk pregnancies to become a maternal-fetal medicine specialist, also known as a perinatologist.
Many maternal-fetal medicine specialists act as consultants to high-risk pregnancies while others perform the delivery, but Johns Hopkins All Children’s specialists often deliver the babies themselves. Sipe estimates he has delivered more than 1,000 babies over the past 10 years.
His experience and familiarity with Haylie’s risks caused Sipe to be on guard for what was to come.
“She just had a perfect setup to be at risk for bleeding,” Sipe says. “So, we had blood in the room before we even went in. We had all of the medications ready. Everybody was ready and prepared.”
Detour After Delivery
Haylie’s twins were not in the optimal position for delivery. They were in a transverse position, meaning they were horizontal in the uterus rather than vertical. Because of her anomaly, the uterus was smaller than average and it was swollen because of the twins. All of this along with her preeclampsia added to Haylie’s risk of bleeding.
Despite the obstacles, the delivery itself went well.
“It was challenging getting the newborns,” Sipe says. “They were in a position that's hard for delivery, so getting them out was a little tough, but that went fine.”
As Sipe closed the opening from her C section and performed a standard check that involves massaging the uterus to check for excessive bleeding, Haylie prepared to go to the recovery room. There was no excessive bleeding initially, but that’s when Sipe said:
“Five more minutes.”
When he rechecked the uterus, it started to hemorrhage. It was hard to stop.
Sipe explained to Haylie that he would need to put her under general anesthesia for more extensive efforts to stop the bleeding. Her uterus was at risk. She asked him to call her husband, Steven.
She would not be going to the recovery room anytime soon.
“I go to one hospital and I’m supposed to be so excited for 20 fingers and toes only to walk across to the other hospital not knowing if my wife is going to make it,” Steven recalls.
Teamwork
A flurry of activity ensued. Sipe performed compression sutures, which artificially clamp down on the uterus. He inserted a uterine balloon tamponade, which inflates in the vagina to put pressure on the uterus and tamp down the bleeding much like a bandage would.
Sipe collaborated with many — including consulting another OB-GYN on duty — as he assembled a team in hopes of avoiding a hysterectomy. He arranged for interventional radiologists to be ready to treat Haylie. They performed a uterine artery embolization, a minimally invasive procedure that reduces blood flow to the uterus to help ease the bleeding.
In all, Sipe was with Haylie from in the delivery room through the interventional radiology suite in the Bayboro Building across the street and into the intensive care unit at Orlando Health Bayfront Hospital across another street.
But they stopped Haylie’s bleeding and saved her uterus. She spent the night in a medically induced coma. She is home now with her husband and her twins. She followed up with Sipe regularly until her risk of further bleeding or infection was minimal.
Sipe insists he’s not a hero, pointing to collaboration among nurses, anesthesiologists, the interventional radiologists and other specialists.
“We don’t operate in silos,” he says. “There were a lot of different specialties that were involved, and it was the combination and teamwork that let this be a good outcome.”
But Haylie knows where it all started.
“In those five minutes, so many fast-acting decisions were made by such an incredible doctor who I will forever be grateful for,” Haylie says. “Thank you for those five minutes. Now, I get to spend a lifetime with my husband and the girls.”