Pregnant Des Moines woman with ruptured cerebral aneurysm survives giving birth, emergency brain surgery

Nine months pregnant and anxious to deliver her second child, 29-year-old Theresa Sawyer had a relatively problem-free pregnancy until August 2, 2001.

While at work, she felt the onset of dizziness so abruptly she leaned forward with head in hands. "That's the last thing I remember from the next five days," she said. "I totally blacked out."

Sawyer's collapse, which occurred during a meeting at her workplace in Ames, Iowa, alarmed her colleagues, who acted quickly.

At first, Sawyer's blackout seemed a likely consequence of her pregnancy and the extreme summer heat. But when her co-workers reported that she had begun experiencing severe headaches in recent days, Michael Miller, M.D. (University of Iowa Roy J. and Lucille A. Carver College of Medicine, 1995), an emergency room physician at Mary Greeley Medical Center in Ames, ordered a CT scan. It showed that Sawyer had suffered a ruptured cerebral aneurysm. A sac had formed in a weakened artery within her brain, and it was leaking.

Fortunately, the blood clotted on its own, stabilizing the damage, but the chances of surviving a ruptured cerebral aneurysm are no better than 50 percent, and far less if the patient is about to deliver a baby. In this case, Sawyer had gone into labor and was having contractions about every four minutes.

"I was worried if she progressed and began pushing, that might cause the aneurysm to re-bleed, so she was given terbutaline to try and arrest her labor until she could be delivered by cesarean section," Miller said. "She really needed specialized care so we had her immediately airlifted to Iowa City."

After arriving at University of Iowa Hospitals and Clinics, a second CT scan showed that the clotted rupture was holding its own. Accordingly, a team of UI specialists--neurosurgeons, obstetricians/gynecologists, and anesthesiologists--developed a strategy for achieving the safest possible outcome for both the baby and the mother. Their carefully considered plans to deliver the baby by cesarean section first (while minimizing the risk from re-bleeding of the aneurysm) paid off when a healthy baby girl, Katy Erin Sawyer, was born at 9:25 p.m.

"It was an unbelievable scene," said husband Doug Sawyer, who was at Theresa's side when Katy was delivered. "I held Katy and brought her over to Theresa. I wanted to make sure she saw her daughter. And although she still was in a great deal of pain, she smiled and said she was beautiful."

Sawyer's brain surgery was scheduled for the next morning. A positive outcome was critical to her survival. The team included Matthew Howard, M.D., director of the Department of Neurosurgery at UI Hospitals and Clinics, and Brad Hindman, M.D., a neurological anesthesiologist who specializes in treating patients with this condition.

The surgery was not without complications. "The aneurysm was so large and full of thrombus that we needed to stop the normal flow of blood to the area in order to remove the thrombus," Howard said. "If you don't do this within five minutes and restore the normal blood flow, the patient can have a stroke. We managed to do it in three."

At first, the recovery was uncertain. After this type of surgery the first 21 days are crucial. Doug traveled between Des Moines and Iowa City during Theresa's stay, helping care for the couple's other child, Hannah, 2. "It was definitely a roller coaster ride. I thought to myself that there's probably a good reason Theresa's scar looked like a question mark. I thought it's because they never know quite how it's going to turn out."

In this case it turned out very well. Sawyer was on the road to recovery. She regained consciousness in the Surgical Intensive Care Unit and returned home nearly three weeks after collapsing at her workplace.

"I thank God every day for hearing everyone's prayers and for giving me the chance to be a mother to my sweet girls," Sawyer said. "I'm still in awe of what everybody did to save my life. I'm very fortunate and grateful to be alive."