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The arrival of Niki Hoppe’s second child is more dramatic than most birth stories. Thanks, in part, to the expertise of the Froedtert & the Medical College of Wisconsin health network, it’s a story with a happy ending.

On April 24, 2019, Niki, then 33, was working as an athletic trainer at St. Francis High School. She was 29 weeks along in a pregnancy that had been uneventful. She had commented to colleagues that she was having a little trouble breathing, but breathlessness can be common in pregnancy, so she wasn’t concerned. School had ended for the day and students from the track team stopped by Niki’s office to get ice for an injury. Niki was standing by the ice machine, making an ice pack, when she suddenly collapsed.

Her skin turned blue and she wasn’t breathing. The students acted quickly; one dialed 911 while another ran to get the athletic director and an assistant principal who was nearby. They began CPR immediately. A custodian grabbed an automated external defibrillator device mounted on a wall. When two police officers arrived, they took over the CPR and administered two shocks to Niki’s chest, restarting her heart.

Niki was rushed by ambulance to a local hospital, and her husband met her there. Doctors worked to stabilize her but determined they could not provide the level of care she and her baby needed. The medical team called Froedtert Hospital, activating a special protocol for patients in heart failure. Within minutes, Froedtert & MCW cardiac specialists gathered by phone to discuss Niki’s situation. They agreed to have her transported to Froedtert Hospital for treatment and alerted the obstetrics team that she was on her way.

Critical Care for Mom and Baby

When she arrived at Froedtert Hospital, Niki was taken immediately to an operating room. Her heart was pumping at only a fraction of its normal ability. Lucian “Buck” Durham III, MD, PhD, cardiothoracic surgeon and MCW faculty member, began surgery to place Niki on extracorporeal membrane oxygenation (ECMO) support, a system that temporarily pumps and oxygenates blood when the heart and lungs can’t do that work.

Garrett Fitzgerald, MD, an obstetrician/gynecologist and MCW faculty member who specializes in high-risk pregnancy, was also on hand with a team to monitor the heart rate and blood oxygen level of Niki’s baby.

“We know that when mom’s heart isn’t pumping blood well, we can’t expect it to get to the fetus,” Dr. Fitzgerald said.

At first, ECMO appeared to pump sufficient blood and oxygen for both Niki and her baby, which was good news. Given that Niki was only 29 weeks along and still had about three months remaining in her pregnancy, Dr. Fitzgerald hoped to keep the baby in utero a while longer. But within about five minutes, the baby’s heart rate declined dramatically.

“Dr. Durham wasn’t even finished with the ECMO procedure and I told him, ‘We need to go ahead and deliver,’” Dr. Fitzgerald said.

Niki’s daughter was delivered safely by cesarean section minutes later, weighing just 2 pounds, 9 ounces. She was quickly transferred to the neonatal intensive care unit (NICU) at Children’s Wisconsin.

After the baby was born, Niki’s heart and lungs began to recover. She regained consciousness, and a few days later, Dr. Durham was able to safely remove her from the ECMO system. Niki said one of her treasured memories from that period is when her nurse set up a video call from her hospital bed to Niki’s husband and their baby in the NICU. It allowed her to see her tiny daughter for the first time. Within a few days, she was healthy enough to visit in person.

Niki was discharged from the hospital two weeks after her cardiac arrest, while her daughter remained in the NICU for 11 weeks.

“I am grateful that she is now a completely healthy, normal toddler,” Niki said.

Continuing Heart Care

Doctors suspected an arrhythmia was the cause of Niki’s sudden cardiac arrest. Before she left Froedtert Hospital, her medical team implanted a defibrillator in her chest in case her heart stops in the future. Since then, she has had two ablation procedures designed to address abnormal heartbeats known as premature ventricular contractions. She also has regular checkups with Sarah Thordsen, MD, cardiologist and MCW faculty member, and Marcie Berger, MD, electrophysiologist and MCW faculty member.

Given its expertise with ECMO and high-risk maternal fetal medicine, the Froedtert and MCW team is particularly equipped to help pregnant women who need an extremely high level of care.

“If you’re having any sort of issues where you or your baby are at higher risk, it’s the perfect place to be,” Niki said.

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