Choosing to have surgery is a major decision for anyone, especially during pregnancy. While advanced techniques and technology have significantly reduced the risks for pregnant patients, we still tend to err on the side of caution.
If a procedure is elective or not urgent, we typically recommend waiting until after delivery to have surgery. But if a condition is life-threatening, the decision usually requires insights from doctors in various specialties at UT Southwestern.
On the Your Pregnancy Matters blog, we've covered the complexities of having various types of procedures while pregnant, including:
Now, after having the opportunity to care for an amazing patient who was facing a stack of pregnancy challenges, we will add brain surgery to this list.
Katie Sturm was pregnant with naturally conceived quadruplets, which occurs in approximately 1 in 700,000 pregnancies. In fact, the Fab Four – all boys – were the first quadruplet delivery at UT Southwestern’s William P. Clements Jr. University Hospital.
Early in the pregnancy, however, Katie was diagnosed with a rare brain tumor. After two seizures related to the tumor, it became clear she would need brain surgery sooner rather than later.
Brain surgery gets even more intense
During Katie's first trimester, she had a seizure at work and was rushed to a hospital, where she was diagnosed with a glioma – a type of rare brain tumor with a tendency to recur.
Gliomas affect patients differently depending on their location.
Katie's tumor was in an area of her brain that caused her to have two generalized tonic-clonic seizures. This type of seizure results in losing consciousness, which increases the risk of environmental injury, such as falls, head trauma, or vehicle accidents. During pregnancy, generalized tonic-clonic seizures can result in oxygen deprivation to the baby and lowered fetal heart rate.
Early intervention is shown to improve quality of life and reduce risks. After the first seizure, my colleague Toral Patel, M.D., from the Peter O'Donnell Jr. Brain Institute, recommended removing the tumor shortly after delivering the babies.
Most multiple pregnancies deliver early, as the growing babies vie for resources and tax the mother's body. So, Katie and we discussed waiting a few more months to remove the tumor after the babies were born.
But Katie’s second seizure occurred approximately two weeks after that discussion. With a toddler at home and four new babies on the way, Katie, Dr. Patel, and I decided the risk of waiting was too great, and we scheduled her surgery for the second trimester.
Timing is key – the second trimester 'sweet spot'
The overall risk of pregnancy loss is generally higher in the first trimester. And in the third trimester, pregnancy-related strains on the patient's blood vessels and respiratory system increase making many surgeries technically challenging. So, we aim to operate in the middle timeframe whenever possible.
Dr. Patel removed the tumor at Zale Lipshy Pavilion at William P. Clements Jr. University Hospital – near our Labor and Delivery unit, where she'd give birth to her sons a few months later. Katie's surgery took four hours, and she was asleep during the procedure. Katie will require routine MRIs to monitor her condition moving forward.
Quadruplets make history
Katie and Chris Sturm talk about the experience of having quadruplets at UT Southwestern's William P. Clements Jr. University Hospital – the first quads ever born at the hospital. Katie's pregnancy was complicated by the pandemic and the fact that Katie was treated for a brain tumor a few months earlier.
Delivering quadruplets – a first at UT Southwestern
As an academic medical center, we're no strangers to delivering twins, triplets, and even quintuplets, as we did in 2012. But the Sturm's babies were our first quadruplet delivery at UT Southwestern.
For triplets and more, most patients have a planned C-section delivery. That way, the patient can feel confident in knowing a robust team of providers is on hand, ready to go, in case she or one of the babies has a health emergency.
On July 3, when Katie was at 32 weeks of the pregnancy, I led a team of 21 doctors, nurses, and health care staff in delivering the quadruplets via C-section. Each of the babies and their specific care team members were assigned a color and a letter from A to D. The NICU doctors and nurses wore caps that identified the baby to which they were assigned.
The NICU also coded the colors and letters to the specific equipment, newborn exam items, and medications each baby would need after birth.
The four boys — Austin, Daniel, Jacob, and Hudson — did well for preemies, who often need extra support after delivery. Becky Ennis, M.D., led the babies' neonatal care, and all four were able to go home within seven weeks.
A few closing thoughts
During pregnancy, our top priority is the health of our patient – the mother. That means we do everything in our power to make sure she has the best outcomes, both personally and for her pregnancy.
In most cases, that means deferring surgery until after delivery. But in unusual and emergency cases such as Katie's, it's important to work with a team of experts. As Katie put it, “The word that comes to mind about care at UT Southwestern is impressive. The care and the doctors have been great.”
UT Southwestern's team approach to care provides a full view of options, in the moment and looking forward. Together, we will help you navigate your options to make the best decision for your health and your family's future.