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Amniotic Fluid Embolism: Harmony’s Story

March 27, 2018

Harmony and Ian VanGundy were anxiously awaiting the birth of their third child in September 2017. Like their other two children, Allistair, age 3, and Gannon, 15, they were going to deliver at WakeMed, but this time they were going closer to home to the new WakeMed North Hospital in North Raleigh.

Harmony was nine days late when she finally began having sporadic contractions. And while it was still early in her labor, her OB/GYN recommended that she be admitted to the hospital since her blood pressure was on the higher end of normal. They gave her Pitocin to move labor along, and her and Ian settled in for what they knew would be a long night of labor.

The following morning, Harmony had still not progressed much. Matthew Zerden, MD, WakeMed Physician Practices – OB/GYN, was on-call. He broke her water, she received a little nitrous for pain…and that is the last thing Harmony remembers from her birthing experience.

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Charlie’s Arrival

Ian and Harmony’s mom could instantly tell something had changed as they watched Harmony’s feet and lips turn blue and saw her collapse. The baby’s heart rate also dropped, and at that point Dr. Zerden immediately took Harmony back for an emergency C-section, while the staff performed CPR on her the entire time.  Baby Charlie Enright VanGundy was born at 10:49 am weighing in at 8 lbs. 9 oz.

Harmony’s Journey

After reviewing Harmony’s symptoms, the medical team identified that Harmony had an Amniotic Fluid Embolism (AFE), a rare complication of pregnancy that causes an allergic-like reaction when amniotic fluid enters the mother’s circulatory system, according to the AFE Foundation. It causes rapid respiratory failure and cardiac arrest, followed by excessive bleeding where the placenta attached or at the cesarean incision.

Following the C-Section, Harmony went into Disseminated Intravascular Coagulation (DIC), which causes excessive bleeding. The medical team continued to give Harmony blood, and once she was stable enough, they transferred her to the WakeMed Raleigh Campus. She was met by her OB/GYN, Lauren Wheeler, MD, with Kamm McKenzie OB/GYN, and Christopher Long, MD, PhD, Raleigh Radiology, a interventional radiologist, who performed a two-hour surgery to stop the bleeding. In all, Harmony received almost 28 units of blood.

Harmony remained in the Surgical Intensive Care Unit for two days, and then stayed in the hospital for 10 additional days while they monitored her for organ failure, infections and other setbacks. During this time, Harmony said she was given constant updates on Charlie, and was able to see him as soon as possible.

Charlie’s First Days

When Charlie first arrived, he did not breathe for 12 minutes. But thanks to the experienced neonatal team at WakeMed North, he was immediately intubated and given hypothermia therapy to prevent brain issues. They decided to transfer him to the Level IV Neonatal Intensive Care Unit at the WakeMed Raleigh Campus, where he could receive the highest level of care. The NICU team from the Raleigh Campus, lead by neonatologist Stephen Kicklighter, oversaw his transfer to the NICU, where he stayed for 18 days.

Charlie is now a healthy 6-month-old who is army crawling everywhere, loves pears, playing with his brother, pat a cake, and his exersaucer. He shows no signs of developmental delays.

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Outstanding Medical Team

AFEs are unpreventable and unpredictable, as in Harmony’s case. But having the medical team that she did, saved her life and Charlie’s, and she is forever grateful.

“There are so many unknowns with this, but the best thing the medical team could have done was act quickly – and that’s what they did,” Harmony says.

It took this team of doctors and nurses working together to make this happen. There was something else, like spiritual beings, too. But I give them a lot of credit. They are the ones who are in the rooms making this happen.  And the number of people who jumped in and took time away from their families to save me was just amazing.

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AFE Awareness Day

March 27 is AFE Awareness Day. AFE occurs 1 in 40,000 births in North America and is the leading cause of maternal death globally. To learn more about AFE and the AFE Foundation, visit www.afesupport.org.

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