Fetal expert brings rare care to Guam
HAGATNA (AP) - Junisha M. Doyle, emergency medical dispatcher, gave birth to a healthy baby boy despite chronic high blood pressure.
Pregnant women with high blood pressure can develop risks for themselves as well as the baby, says Dr. Thomas Shieh, a board-certified obstetrics and gynecologist.
These patients need to be monitored closely.
High blood pressure strains the heart and blood vessels. It puts a pregnant woman at risk for heart failure, heart attacks and strokes. There are other more serious complications as well, Shieh says.
Throughout the pregnancy, the doctor will look for spikes in protein levels in her urine or changes in her blood work. This can indicate whether an immediate delivery is needed or if the mom needs to be flown out, he continues.
The baby needs to be monitored as well. In a mother with high blood pressure, her heart is struggling and blood isn’t circulating efficiently. The baby doesn’t get enough oxygen, nutrition or circulation into the placenta, Doyle says.
The placenta is also where the baby’s waste is taken away. With circulation and waste disposal not working properly, the baby is at risk for intrauterine growth restrictions resulting in premature or stillbirth, says Shieh.
Additionally, an abrupt separation of the placenta from the uterine wall, called “placenta abruptio,” causes profuse bleeding, creating the risk of losing the mom as well as the baby. They would need immediate medical attention, says Shieh.
Due to the possibility of growth restrictions, monitoring the growth of the baby is very important, he continues.
This is where Dr. Greigh I. Hirata comes in. He is double board-certified in maternal fetal medicine and genetics. He rotates through Shieh’s clinic in Tamuning every 4 to 6 weeks throughout the year. Shieh asked Hirata to visit Guam more frequently because he saw the need for it.
“Dr. Hirata’s presence in our clinic over the years has elevated the standard of care for pregnant moms on Guam. I am extremely pleased,” says Shieh.
A maternal fetal medicine specialist concentrates on women with medical conditions in pregnancy, and looks for any birth defects in the fetus and offers treatment, says Hirata. For example, as far as medical treatment for fetal heart defects, there are times when certain medications are given to keep the valves open so the fetus doesn’t go into heart failure.
In addition, Hirata can perform procedures such as chorionic villus sampling, taking samples from the placenta, and amniocentesis, taking samples from the fluid holding the baby. The samples are used to diagnose genetic disorders, infections and other abnormalities, says Shieh.
Because of his specialty, Hirata can offer genetic consultation. He looks at family history and can rule out or confirm the risks of any known genetic diseases, says Shieh.
With all the thoughts of the above in an already concerned pregnant mother, he brings comfort, says Doyle.
“Dr. Hirata has helped reassure us. He’s thorough. He is able to give me dimensions and size. He even tells me the number of spines and number of toes and fingers while he’s doing the ultrasound,” says Doyle.
“Sometimes when he gets too detailed it’s hard to follow,” she says, laughing, “But it’s really comforting to me because it lets me know he knows what he’s doing and he cares about my concerns.”
Financially, it’s helped the couple as well. Doyle is glad she can stay home and not stress about flying out and having the baby away from family.
Age, multiple fetuses, diabetes or hypertension can increase the chances of pregnant mothers having a baby with birth defects. However, that’s not always the case, says Hirata.
“You don’t have to be a high-risk patient. You never know. About 50 percent of the normal pregnant mothers were getting a routine exam when I found a birth defect,” says Hirata.
The other key is that a normal pregnancy can turn abnormal at the last moment, says Shieh.
“I had a patient that came into the office wanting a 4D ultrasound print of her baby. We always do a routine exam because really, the 4D is more for the parents to have something great to look at,” says Hirata.
The doctors were viewing the fetus via ultrasound when they noticed the lung area looked abnormal. The mother was soon flown out to Los Angeles. A stent was surgically placed to drain the baby’s lungs. The baby progressed well and was born at 36 weeks without any other complications.
The baby would have died without that procedure, says Hirata.
Early detection is important, especially for a place like Guam where patients have to be flown out, says Dr. Shieh.
The population in Guam isn’t large enough to support specialized practices like a fetal cardiac center. Even Hawaii has to send patients to Los Angeles, says Hirata. It’s crucial to have obstetric doctors with his specialty.
“It makes a difference flying out a pregnant mother versus a struggling newborn. The womb is the best incubator. Keep the mom pregnant with medication; then transport the mother to a major center where a surgeon awaits,” says Shieh.
Photo: Dr. Greigh I. Hirata performs an ultrasound exam as James B. Doyle, right, and Dr, Thomas Shieh look on at Shieh’s clinic in Tamuning on Sept. 6. Photo by Frank San Nicolas, Pacific Daily News via AP
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