Mother who was declared 'brain-dead' delivers healthy baby

 Karla Perez was a young, vibrant 22-year-old. This mother of one, pregnant with her second child, loved to dance and was a good friend to anyone she met.

What happened on February 8 changed her life and the lives of those who cared for Karla at Methodist Hospital and Methodist Women's Hospital.

A brain bleed took Karla Perez's life that day, but little did she know she would become the first person on record in the United States, since 1999, to be kept on somatic support and her pregnancy maintained – for 54 days –  at Methodist Women's Hospital.

"Our team took a giant leap of faith," said Sue Korth, vice president and COO of Methodist Women's Hospital. "We were attempting something that not many before us have been able to do. I couldn't be more proud of our medical team and the more than 100 staff who were a part of her care. Karla's loss of life was difficult, but the legacy she has left behind is remarkable."

Perez, who had been diagnosed with juvenile rheumatoid arthritis at a young age, was told that she might not be able to have children. Certainly through the years the arthritis resulted in challenges for Karla – but not being a mom wasn't an option. Her first pregnancy, which resulted in a beautiful baby girl, was monitored but no issues arose.

"Women with juvenile arthritis are usually counseled not to get pregnant," said Dr. Tifany Somer-Shely, Karla's OB physician at Methodist Physician's Clinic Women's Center. "But pregnancy was so important to her and her partner that she went off all meds to get pregnant. They really wanted this baby. A healthy pregnancy was more important than her own comfort."

The same held true with her second pregnancy – until the night of February 8. She had been battling a bad headache that simply would not get better. She collapsed at her home in Waterloo, Neb., and was transported by ambulance to Methodist Women's Hospital. Evaluation by medical staff revealed a catastrophic intracranial hemorrhage.

A transfer to Methodist Hospital for neurosurgical evaluation and ICU admission ensued and a tube was placed to decrease the pressure on her brain. Continued evaluation revealed absence of brain stem reflexes and clinical brain death.

"It was then that we had decisions to make," said Dr. Andrew Robertson, maternal-fetal medicine, Methodist Women's Hospital Perinatal Center. "Karla's baby was fine, but its gestational age was too young to consider delivery. That's when the team and Karla's family agreed to attempt to provide somatic support and maintain Karla's pregnancy until her baby reached a viable gestational age."

Karla was transferred back to Women's Hospital when the baby reached 24 weeks gestational age to be under closer supervision by Dr. Robertson and the perinatal team. Around the clock care was provided to Karla and her baby with the hope a 32 week delivery could be achieved.

"There is nothing in the books about how to provide medical care in this situation," said Dr. Todd Lovgren, also a maternal-fetal medicine specialist. "That's why our team approach was so important. We needed everyone on board with what we were trying to accomplish."

On April 4, Karla's status was declining and it was then the team made the decision to deliver via C-section. Baby Angel arrived at 11:47 a.m. at 30 weeks and 3 days. He weighed 2 pounds 12.6 ounces.

"Angel's condition remains very stable," said Dr. Brady Kerr, neonatologist at Methodist Women's Hospital Neonatal Intensive Care Unit. "He has no severe complications. At this time he is still in an incubator and has a feeding tube – he is not yet feeding by mouth.  It's hard for us to know the long-term outcome due to the rarity of the situation, but we are cautiously optimistic."

Angel's first cry was bittersweet – it meant he was alive, but Karla was gone. Her brain death was confirmed on April 6 and organ donation took place on April 9. Not only does Karla's legacy live on through Angel, but also through the four individuals who benefited from her liver, two kidneys and her heart.

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