Cayman doctors save mom and baby in ‘rare and challenging’ surgery

A Cayman mom and her baby are alive today thanks to the efforts of a surgical team at the Cayman Islands Health Services Authority that successfully performed a rare and challenging surgery, one of only two in recorded medical history.

Dr. Peter Sipos, consultant obstetrician/gynaecologist, led the complex caesarean section, which not only saved mom and baby, but also ensured the woman could have more children.

“The motivation of healthcare workers is to… improve people’s lives and we actually did that on that night,” Sipos said in a recent interview with the Cayman Compass on the surgery, in which uterine fibroids had created a dangerous situation for the mother and baby.

Though Sipos was modest about the procedure, mom, identified only as M. Brown, called what the doctors did for her and her newborn divine intervention.

“I knew the pregnancy was high risk but was not aware of the true level of how serious things were until after my c-section. Dr. Sipos was very kind and gentle. He was professional and I had confidence that he was able to take care of my operation as I already prayed that God would choose the right person for the job,” she said.

Both mom and baby are recovering well after undergoing the recent five-hour procedure.

“We are doing great. I am still undergoing recovery, but I am strong enough to overcome,” she said through an HSA statement.

Complex case

Brown’s case was complicated from the start as she had been suffering from uterine fibroids which resulted in her uterus being bent in a complete U-shape.

This was unique in itself, Sipos, head of the Women’s Health Clinic, said, as with most cases the uterus, with the fibroid on top of it, normally resides in the lower pelvis or true pelvis.

“As the pregnancy grew, the rest of the womb grew out of the pelvis and turned around in a U shape. So, therefore, the body of the womb, which normally contains the baby, was upside down behind the front of the uterus,” he said.

Going into the surgery, Sipos and his team, which included Dr. Christina McLean and anaesthetist Dr. Rachel Gooden, knew the surgery would be complicated.

However, it was only when he commenced the procedure that the true scale was revealed of what was required to save the mom, her baby and her fertility.

“We thought this is going to be a difficult caesarean section with large fibroids on the uterus, expecting a lot of bleeding. But during the surgery, we discovered that it’s actually a lot more complicated than that… We were in kind of disbelief,” he said.

He said the original plan for the procedure had to change.

“We did not fully understand what was going on and that’s probably the scariest thing for any doctor, especially during a surgery when you are not in control completely, as in you don’t know what’s happening and until you know that, it’s a stressful position to be in,” he said.

Sipos, in explaining the procedure, said he had to cross through the lower part of the uterus, essentially detaching it completely from the vagina.

Then, he said, they had to access the baby from the back of the body of the uterus, adding it was “obviously a relief” when they delivered the infant.

Following that, he said, the team had to fix the wounds and reattach the bottom of the uterus to the vagina.

He said this was something that could only be understood once they began the procedure.

Sipos said he then tag-teamed with obstetrician/gynaecologist Dr. Iulia Irimia to finish.

“It was quite a challenge to understand what the situation was. Delivering the baby was probably the easier part, but then finishing the surgery in a way that she could preserve her fertility and preserve her uterus that was a more challenging and difficult situation,” he said.

There was an additional layer of concern as the mom suffered from a number of underlying conditions, some of them quite severe.

“She has some challenges in her life, which made particularly the recovery time more challenging… and prolonged for her,” he said.

Sipos said there was a lot at stake as Brown was a first-time mom who wanted more children.

Being able to perform such a procedure without loss of life or having to resort to a hysterectomy, he said, was “a good feeling”.

Inspired by surgery

Young Caymanian physician Dr. Christina McLean, a medical registrar at Women’s Health, who was on the surgical team, said being able to work on such a rare and complex case was inspiring.

“I want to do obstetrics and gynaecology. It really started during medical school with the exposure in the field. It’s something that I really feel very passionate about, women’s health in general, certain diseases, screening processes, so forth,” she said.

McLean said being in the room and part of the surgery was a bit nerve-racking, especially when the magnitude of the medical procedure became apparent.

“It was pretty scary in the moment, but you do have those situations that you want to know what to do and what steps to take. So seeing Dr. Sifos and Dr. Irimia staying calm and composed did keep me calm and composed,” she said.

She added she would like to see more Caymanians join the medical field and work with consultants like Sipos to acquire such skills.

McLean said she is currently waiting to do her entry exams to the United Kingdom for her specialisation.

Advice before pregnancy

Sipos said though Brown’s case is rare, he is urging would-be mothers to do the necessary checks to ensure they are in good health before becoming pregnant.

“Before becoming pregnant one would want to achieve the best possible health in any way. This may refer to medical conditions such as diabetes, high blood pressure, thyroid functions, and so forth, but also surgical conditions such as the fibroids, for example, in this situation,” he said.

Women who are preparing for pregnancy, he said, should start taking folic acid.

“So that somebody who is planning to be pregnant should start as healthy as they can possibly be. With this they can assure the highest chance for a successful and problem-free pregnancy,” Sipos added.