Dr. Bettina Paek likely saved a life after flying more than 3,200 miles to preform the first ultrasound-guided intrauterine transfusion in Jamaica in late July.
Paek, 49, is an attending physician for maternal fetal medicine at EvergreenHealth in Kirkland, chair of the obstetrics and gynecology department and co-director of the fetal therapy program at EvergreenHealth. She’s been working for EvergreenHealth for 10 years.
On July 20, Paek performed the transfusion on an expecting Jamaican mother of four at Victoria Jubilee Hospital in Jamaica.
The mother, who was 29 weeks pregnant with her fifth child, had been diagnosed with Rh-Isoimmunization early in her pregnancy. At 29 weeks, she found out the baby was anemic.
Rh-Isoimmunization is potentially life-threatening for the fetus. It occurs when the mother has an Rh-negative blood type and the baby has an Rh-positive blood type. In this case, the mother begins to make antibodies that are absorbed by the fetus through the placenta. The baby then becomes anemic.
Only about 10-15 percent of the human population has an Rh-negative blood type. It’s not that common to have Rh-Isoimmunization, but it’s not rare either, Paek said. Additionally, there are only about 15 centers in the United States that have a fetal therapy program that specializes in dealing with high-risk pregnancy complications; EvergreenHealth is one such center.
No one at Victoria Jubilee Hospital had the expertise or experience to perform the necessary transfusion. The closest facility that could perform the transfusion was in Miami.
But the Jamaican family didn’t have insurance that would work in the United States. It would cost $10,000 for the procedure, assuming there were no complications, and that was not including travel and living expenses to get to the states.
The family’s other option was delivering the baby prematurely, but since Jamaican facility did not have a neonatal intensive care unit, which specializes in caring for premature newborns, the chances of the baby’s survival was less than 50 percent, Paek said.
Luckily, Dr. Clayton Kelly, based at the Jamaican hospital, knew who to call.
Kelly had trained with Paek last fall and knew Paek was an expert in this field.
“They couldn’t come to the U.S., so I decided, well, I’m going to donate my time and my expertise and fly out to Jamaica,” Paek said. “It was unusual, but I felt it was the best thing for the family.”
Paek took an eight- to nine-hour flight July 18 and landed in Jamaica on July 19. She met with the family July 19 to talk about the procedure, potential risks and complications and she and the Jamaica medical team prepared for the procedure that afternoon. On July 20, she performed the ultrasound-guided intrauterine transfusion, which Paek has performed at least a hundred times, she said.
“We do this on a regular basis (at EvergreenHealth),” Paek said. “I’ve been doing this for 15 years.”
The procedure causes no pain to the fetus, as it requires going through the umbilical cord, which has no nerve endings. For the mother, it’s the equivalent to a blood draw.
Paek used a local numbing medicine on the mother’s stomach and gave the fetus medicine that stops the baby from moving during the procedure.
Paek uses the ultrasound to guide her to the umbilical cord, which involves penetrating the mother’s stomach and the umbilical cord to administer blood to the baby.
“It’s pretty tricky to do,” Paek said, but she felt pretty comfortable in her abilities.
The real trick was doing it by herself. Normally there are a couple other experts in the room helping her, but in Jamaica the team assisting was completely new to the procedure.
“It was a little tricky doing it all by myself, but we got it done,” Paek said.
Paek hopes that the Jamaican medical team will set up a simulation so they can practice the transfusion so in the future, “they’ll be able to fly solo,” Paek said.