His bladder outlet obstruction was caused by posterior urethral valves, where an abnormal fold of tissue in the urethra blocked urine from flowing freely out of the bladder. If not corrected, the blockage would make the urine back up in the bladder, the ureters and the kidneys, threatening kidney development. In severe cases such as Max’s, the backup can lead to too little amniotic fluid which can threaten lung development.
During their visit to the Fetal Care Center from their home in nearby Alexandria, Kentucky, Beth and her husband, Tim, met with a team of caregivers including surgeons, nurses, Social Services, Pastoral Care, Nephrology and Urology. They learned about their treatment options and, guided by the team of fetal specialists, quickly made the decision for Beth to undergo open fetal surgery.
A Complex Surgery
Two weeks after the diagnosis and at 23 weeks gestation, Beth had a procedure where her baby was exposed from the waist down, with the umbilical cord still attached, while surgeons created an opening for the baby to urinate (a fetal vesicostomy). “We were very nervous,” Beth said. “But we focused on the positive. We wanted to give our baby the chance to live.” The vesicostomy allowed urine to properly leave the bladder, thereby restoring amniotic fluid and optimizing development of the lungs. The baby was then put back into the womb for the remainder of Beth’s pregnancy.
Beth spent the next 13 weeks on bed rest. Fetal Care Center specialists monitored her baby’s growth and development during that time, aiming for Beth to carry her baby as long as she safely could. Because of her prior fetal surgery, a C-section was planned. Complications and low fluid levels made it necessary for Beth to deliver during her 35th week of pregnancy. Finally, on May 12, 2008, Max Anthony Livingston was born.
“He had fluid around his lungs, and he was breathing very rapidly. His heart and lungs were working too hard,” Beth said. Max was diagnosed with respiratory distress syndrome, meaning his lungs were immature due to his prematurity. He was transferred to the Newborn Intensive Care Unit (NICU) at Cincinnati Children’s for further treatment.
Beth and Tim knew a lengthy hospitalization for Max was a possibility even before he was born. “The doctors at the Fetal Care Center were good at explaining everything. We felt very prepared,” Beth said.