This is an AP member Exchange shared by the Houston Chronicle
HOUSTON (AP) — Alexander Hicks sprang from the couch and sprinted up the stairs as soon as he heard the thump. It sounded like a stack of heavy books falling off a shelf. Maybe Alyssa, their 5-year-old, had jumped out of bed? She’d been cuddled up in the master bed with her baby sister and his wife, who was nine months pregnant.
The Houston Chronicle (http://bit.ly/2jN7xSb ) reports Hicks reached the bedroom and saw the girls sleeping peacefully. In the light of the master bathroom, he found his wife, Marlene Dominguez-Hicks, unconscious on the floor. She was 33 and nearly finished with her radiology fellowship at the University of Texas Health Science Center in Houston.
He pulled her into his arms. Her eyes were vacant. She was making a hissing noise. You’re the doctor, Hicks thought. What am I supposed to do?
“Alyssa! Alyssa! Go tell Grandma to call 911!”
The dispatcher said to tilt her up and put her on her left side. Hicks did, but her teeth clenched, and her jaw locked up. Blood started pouring from her nose.
“Stay with me, Mar! Stay with me!”
Peripartum cardiomyopathy, or PPCM, is an uncommon form of heart failure during the last month of pregnancy or up to five months after giving birth, according to the American Heart Association. It weakens and enlarges the heart chambers until, in the most serious cases, the left ventricle can no longer pump enough blood to vital organs.
Doctors are trying to figure out what causes it.
“It happens in women who are young and healthy during what is supposed to be a happy time in their lives,” said Dr. Lili Ayala Barouch, an associate professor of medicine at Johns Hopkins University.
Texas leads the nation with its maternal mortality rate, which spiked from 18.6 deaths per 100,000 live births in 2010 to 35.8 deaths per 100,000 in 2014, according to a recent study in the medical journal Obstetrics and Gynecology.
The state convened a task force in 2013 to investigate why the rates are so high and what can be done to address it.
The task force reported in July that heart diseases were the top killer of pregnant women and new moms in 2011 through 2012, though its latest report did not break down what percentage of those were caused by PPCM.
PPCM is relatively rare in the United States, with an estimated rate of 1 per 3,000 to 4,000 live births. Most mothers with the disease fully recover, but it kills about 6 to 10 percent.
One of its biggest dangers, physicians said, is that its symptoms are deceptively similar to ordinary third-trimester problems: fatigue, swollen ankles and shortness of breath.
If Dominguez-Hicks felt any symptoms, she never mentioned them. A few days before she collapsed, she stole a cookie from her husband and ran up the town home stairs with it.
“Girl, you just ran up the stairs!” Hicks said, impressed.
“Yeah,” she said. “I feel great.”
Dominguez-Hicks had health insurance through her employer. She loved her OB-GYN, who was one of her former teachers. She went to all of her prenatal appointments.
She didn’t meet many of the American Heart Association’s risk factors for PPCM. She was not obese. She did not have a history of heart problems or preeclampsia. She didn’t take medication or smoke or drink. She was not malnourished. She was not African-American.
She did meet one of the risk factors. She’d had two prior births, both healthy baby girls.
Alyssa was born while Dominguez-Hicks was in her fourth year of medical school.
It was a rough pregnancy, with bouts of first-trimester nausea and a long labor with a late epidural. She had little nausea and an early epidural the second time around. Moments after Alana was born, Dominguez-Hicks looked at her husband and said: “Let’s do this again!”
“Are you crazy?” said Hicks, a mechanical engineer. “We got another girl. I’m done. I’m good.”
But she was determined to have a boy.
After they moved to Houston for her fellowship, they found out she was pregnant again.
She was 38 weeks and four days into her pregnancy on Sept. 6. That night, she’d helped Alyssa with her homework. They’d put both girls into pajamas and watched cartoons on the laptop until they realized it was already 9 p.m.
We trust you to know when it’s your bedtime, Hicks said to Alyssa.
Alyssa’s reply caught him off-guard. She said she knew about trust. “My teacher says, ‘Alyssa, when I leave the room and come back, I’m going to ask you who was talking because I trust you.’ “
For Hicks, it was one of those moments. They were doing something right as parents, he said, instilling good values.
“I’m just so thankful for you,” he told his wife. “I love you so much.”
She grinned up at him.
Barouch, with Johns Hopkins, said there is no single test to screen for PPCM, which requires an echocardiogram for diagnosis.
The main symptoms to watch out for, she said, are rapidly worsening swelling in the feet or an unusual amount of shortness of breath, particularly when lying down.
“It’s beyond just uncomfortable,” she added. “You can’t perform normal functions.”
When it is diagnosed early, the recovery rate is pretty good. At least 50 percent of patients have a complete recovery, she said. Another 20 percent to 30 percent will have a partial recovery. The remainder need heart transplants or don’t make it.
Hicks said his wife was always diagnosing herself.
“Ask anybody in medicine — doctors are the worst patients,” Hicks said. “She probably felt something and just brushed it off.”
After he found his wife on the bathroom floor, the paramedics did everything they could for her, he said. They did CPR upstairs, then downstairs, in the ambulance and at the hospital. He broke down and had to be taken into a separate room.
The baby was delivered by emergency C-section. Alexander Hicks Jr. weighed 7 pounds, 14 ounces. But he’d been without oxygen too long. There was no brainstem activity.
They were buried together, mother and son, in one coffin.
Hicks misses his wife’s positivity, her relentless energy. He misses how she looked at the girls.
He’s moving back to Michigan to be closer to family in about a month, but before he goes, he plans to sit down with his wife’s OB-GYN and a copy of the autopsy report. Researchers are trying to figure out if there is a genetic component to PPCM. And Hicks wants to better understand what killed her and their son, he said, so he can prevent this from happening to his daughters.
“I need to know,” he said, “for them.”