A mum-to-be who suffered a potentially catastrophic stroke when she was 39 weeks pregnant had her life and that of her unborn child saved by a procedure to mechanically remove a blood clot from her brain within three hours of collapsing at home.
Jana Smith, 29, is only the third known case in the UK of a pregnant woman undergoing undergo a mechanical thrombectomy – a procedure to physically remove the clot from the brain using a catheter inserted in the groin and fed up through the blood vessels.
She made a full recovery following the procedure and had a healthy baby delivered by caesarean section three days later, with both mum and baby able to return home the same week.
Jana, of Stradbrook, Sheffield, said: “It was very scary and emotionally difficult for me and my husband because we’ve been waiting for this baby for some time. I had a miscarriage last year so little Jonny is our much wanted rainbow baby.
“The fact they saved me so quickly and I made a full recovery means the world to us.”
Sheffield Teaching Hospitals has offered the mechanical thrombectomy service for almost two years, but it is the first time it has been performed on a pregnant woman at the Trust.
Stroke Consultant Dr Aaizza Naqvi said: “This was a challenging case and without the timely decision making that enabled the procedure to be undertaken quickly, it would have been very likely that Jana would have been left severely disabled and unable to look after her baby.
“It could have been a dire outcome. There is only a four to six hour time window for the treatment to be effective – when somebody suffers a stroke like this, time is brain. A person loses nearly two million brain cells in a minute, therefore it is crucial to call 999.
“Only 25% of strokes occur in young people, and although the risk of stroke is higher in pregnant women, it is still uncommon. Stroke is even more devastating when it occurs in a young woman trying to start a family.
“It is very satisfying to see Jana is doing so well now.”
Jana was in the bathroom at home when she suddenly slid to the floor and was unable to get up.
She said: “I tried to grab onto different things like the edge of the bath to try and pull myself up, but I had no strength.
“Luckily I was in middle of an online chat conversation with my husband Tom who got worried when I stopped responding. I managed to pick up my phone and message him to ask for help.
“He only works ten minutes away so he came quickly to my rescue.”
Tom phoned an ambulance and Jana was assessed as being suitable for the ‘straight to scan’ service, where the patient is taken directly to radiology at the Royal Hallamshire Hospital for a quick initial assessment by the stroke team and a CT scan.
Jana had lost movement in the left side of her body, could not move her left arm or leg and her speech was very slurred.
“I was very scared for the baby and didn’t care much about myself but kept hands on my belly trying to monitor baby’s movements,” Jana said. “It still makes me very emotional.”
The scan confirmed a clot in Jana’s brain, and it was decided that a mechanical thrombectomy would be the best treatment.
Some strokes are treated using thrombolysis, where clot-busting drugs are administered, but this was not suitable in Jana’s case due to the size of the clot and because she had a very low platelet count and a clotting factor deficiency in her blood, which meant she was at high risk of bleeding. There was also a risk of placental abruption (the separation of the placenta from the uterus), which would have harmed the baby and resulted in the team having to deliver it there and then. Therefore the decision was made to use the mechanical method.
The procedure was carried out by Consultant Interventional Neuroradiologist Sanjoy Nagaraja, supported by Consultant Interventional Neuroradiologist Dr Richard Dyde. A catheter was inserted in Jana’s groin and fed it up to the brain, using x-rays to guide it. The clot was removed using suction and the procedure was complete within about 20 minutes, and less than three hours after Jana initially collapsed.
Because Jana was pregnant, a consultant obstetrician (Dr Shehnaaz Nivraj) provided continuous monitoring of the baby and a theatre was kept on standby in case an emergency caesarean was necessary. A consultant anaesthetist (Dr David Turnbull), radiology nurses and specialist radiographers in imaging blood vessels also supported the operation.
Dr Nagaraja said: “The mechanical method enabled us to save Jana without using drugs which could have harmed her baby, and enabled it to remain in the uterus.
“Within hours of the procedure, Jana had recovered significantly and regained most of her function.
“Stroke team, radiology team, obstetrics and anaesthetists all sprang into action extremely quickly for this lady, and it is that team effort which has produced a great outcome.”
A caesarean section was planned for Jana’s due date, to mitigate the risks that the strains of a natural birth could have caused following the stroke.
Jana said: “Although we had been hoping for a natural birth, we agreed because my health was a priority.
“My husband was allowed to stay with me until the caesarean, a bed was found for him and I am very grateful for that because I couldn’t imagine not having him there with me.
“I had my baby without any complications. We named him Jonathan and we’re both doing really well now.
“He’s a healthy beautiful little boy with a big appetite and I’m able to fully take care of him. My left side is fully recovered now and I keep practicing my fine motor skills (dexterity with fingers and toes) on the baby clothes every day.
“When he’s old enough to understand it, we will tell him the story of what happened when he was born.”
Jana has been followed up by the specialist community stroke team and in clinic to ensure she had the support she needs, but thanks to the speedy response to her stroke she has made a fantastic recovery and is fully independent.
She said she wanted to raise awareness of how important is to act fast if you think someone is having a stroke.
“When I heard how rare what I had been through was, my first thought was ‘why me?’ she said.
“But I want to share my story and hopefully spread awareness about strokes. Without Tom acting so fast, I’d surely be bedbound or disabled.”
If you suspect someone is having a stroke, remember to act FAST.
Face – has their face fallen on one side? Can they smile?
Arms – can they raise both arms and keep them there?
Speech – is their speech slurred?
Time to call 999 if you see any single one of these signs of a stroke.