Debora Kimberlin, M.D., Maternal-Fetal Medicine Specialist in the UAB Department of Obstetrics and Gynecology

By Yolanda Heiberger

When Nancy Faulkner and her husband, David, learned they were expecting their third child, they were excited about the prospect of welcoming a new baby into their family of two young boys.

But their excitement was tempered with concern. Because of a pre-existing health condition, Nancy’s first two pregnancies were considered high-risk. And a serious, life-threatening complication—unrelated to her health condition—had followed the delivery of her second child.

Having been a patient of UAB Maternal-Fetal Medicine Specialist Debora Kimberlin, M.D, during her previous two pregnancies, Nancy again sought the care and attention of Dr. Kimberlin and the team of physicians in the UAB Maternal-Fetal Medicine (MFM) Division. “Dr. Kimberlin’s experience, skill, and support were so meaningful during my previous pregnancies, there was no question that I would seek her expertise again for my third pregnancy,” Nancy recalls.

UAB’s MFM Division is the major referral center for complicated obstetrical cases in Alabama and annually receives nearly 500 high-risk obstetrics patients from Alabama and neighboring states. The MFM Division includes 10 board-certified maternal-fetal medicine specialists who collaborate in patient care to ensure the best possible outcome in high-risk cases. For continuity of care in cases requiring specialized treatment for the baby, the division also works closely with the UAB Regional Newborn Intensive Care Unit.

Under the care of Dr. Kimberlin, Nancy experienced a healthy third pregnancy and a delivery that was free of complications. On July 27, 2005, Nancy and David—joyful and relieved—welcomed baby Elizabeth into their family. Today, Elizabeth is a happy, active toddler preparing to take her first, tentative steps.

In this ehealth interview, Nancy shares how the specialized care and attention she received from Dr. Kimberlin gave her reassurance that the most advanced medical safeguards were being used to ensure a healthy outcome. Dr. Kimberlin provides Nancy’s high-risk obstetrical history, explains how her third pregnancy was managed successfully, and discusses the role of UAB’s MFM physicians in providing the most advanced care and treatments based on the latest scientific research.

Dr. Kimberlin: “Nancy’s pregnancies were considered high-risk because of a relatively rare disorder she developed about 10 years ago called essential thrombocytosis. This is a bone marrow disorder that causes an unusually high blood platelet count, placing patients at risk for strokes and other complications caused by the formation of large blood clots in the veins and arteries—including in the heart and brain. During pregnancy, these patients must be monitored very closely to guard against thrombotic complications.”

Nancy: “My hematologist, who was also at UAB, referred me to Dr. Kimberlin during my first pregnancy in 1999. Because I was at risk for complications due to my platelet disorder, I was initially somewhat anxious. But, Dr. Kimberlin was very supportive and monitored me closely every step of the way.”

Dr. Kimberlin: “Nancy did very well during her first pregnancy and experienced no complications. Because there were some indications the baby might be experiencing distress during labor, we elected to do a C-section. But, everything went well.

“However, shortly thereafter Nancy delivered her second baby in 2000. With her second pregnancy, she had a vaginal delivery. She experienced a rare and life-threatening complication known as anaphylactoid syndrome of pregnancy. The condition results from amniotic fluid and fetal cells entering the mother’s bloodstream during delivery, triggering an anaphylactic reaction. Although the cause of the condition is unknown, we do not believe that it was in any way related to Nancy’s platelet disorder. The anaphylactic reaction caused Nancy to go into cardiac arrest, though fortunately she was successfully resuscitated.”

Nancy: “Of course, I had lost consciousness, but I know that Dr. Kimberlin reacted very rapidly. My husband was also in the room, and he believes her quick response helped to save my life that day.”

Dr. Kimberlin: “Nancy was very fortunate to have been at UAB, where we have critical care specialists—including a full anesthesia support team—on duty 24 hours a day. When Nancy’s heart stopped, the anesthesia team was already in the unit and assisted with resuscitation immediately.

“In most reported cases of anaphylactoid syndrome, the outcome is not as good as it was for Nancy. The condition has a mortality rate of 80 percent, and 85 percent of those who survive have some sort of neurological impairment. In Nancy’s case, neither she nor the baby suffered any lasting neurological or other physical problems as a result of the experience.”

Nancy: “We had decided not to have any more children after this. But when I learned I was pregnant nearly five years later, I again turned to Dr. Kimberlin.”

Dr. Kimberlin: “When I saw Nancy and David at the beginning of Nancy’s third pregnancy, I think David, especially, was very concerned. Understandably, he had a vivid recollection of the serious events Nancy experienced after her delivery in 2000. I informed them that we weren’t certain about the risk for recurrence. However, I emphasized that, among women with a history of a prior anaphylactoid syndrome, there does not appear to be an increased risk of recurrence in a subsequent pregnancy.”

Nancy: “Dr. Kimberlin was very supportive and understanding of our concerns, which meant a great deal.”

Dr. Kimberlin: “As with all new cases, Nancy’s pregnancy and obstetrical history were initially reviewed and discussed among the other physicians within the MFM Division. We have a weekly meeting to discuss new patients during which all of our MFM faculty have an opportunity to give an informed opinion and provide input regarding patient care. The patient greatly benefits from this collaboration.”

Nancy: “It was very reassuring to know that so many experts were available to give my case individual consideration.”

Dr. Kimberlin: “Early in her pregnancy, Nancy and I discussed the fact that the most dangerous time for a recurrence of anaphylactoid syndrome is during labor. The prevailing theory is that uterine contractions during labor can sometimes cause fetal cells and amniotic debris to enter the bloodstream, causing the life-threatening reaction. So, we planned to perform a scheduled repeat C-section at 36 weeks, well before the onset of labor.”

Nancy: “I had the chance to speak to members of the anesthesia team a few weeks before my C-section. They were aware of the problems I had experienced after my second delivery and were fully prepared to handle another emergency, which was very reassuring.”

Dr. Kimberlin: “As planned, we performed a scheduled C-section at 36 weeks. Our critical care team was on hand during delivery in the event of an unanticipated problem. Fortunately, the surgery went smoothly, and Nancy delivered a healthy baby girl.”

Nancy: “As in my first two pregnancies, I felt very fortunate that Dr. Kimberlin was my doctor and that I was at UAB. I know many high-risk patients travel to UAB’s MFM Division from surrounding areas or other states. It’s a wonderful advantage to have a world-class medical facility like UAB right here in Birmingham.”

Dr. Kimberlin: “As a physician, I’m honored to be a part of one of the highest ranked OB/GYN departments in the nation. At UAB, we are able to provide our patients with some of the most cutting-edge treatments based on the latest scientific research. It’s very rewarding to be able to provide such an advanced standard of care to patients like Nancy.”