Karen's story for Preeclampsia Foundation My wife Karen Sclafani, an incredibly vibrant, healthy woman, died

Post On Tuesday, February 08, 2005 By

Karen's story for Preeclampsia Foundation My wife Karen Sclafani, an incredibly vibrant, healthy woman, died
Karen's story for Preeclampsia Foundation My wife Karen Sclafani, an incredibly vibrant, healthy woman, died from hemorrhaging shortly after the Feb. 5, 2004 birth of our first baby, a healthy 5 pound, 15 ounce, at Bozeman Deaconess Hospital in Montana. Karen was diagnosed with pre-eclampsia Feb. 4, four days before our due date. This condition, along with placenta acreta, was the main factor that triggered a cascade of post-delivery complications that culminated in sudden and catastrophic bleeding from her uterus immediately after surgery to remove the placenta. She was 37. Karen's grandmother, an Italian immigrant living in the Bronx, died in 1932 in the same way after giving birth to Karen's mom. We set up a website in Karen's memory, www.karensclafani.com, Here's our story. Twice in 2003, fluky events with Karen's reproductive system necessitated surgery. We conceived that February and learned of the pregnancy when Karen started having abdominal pains on March 24. The pregnancy was ectopic and Karen underwent laproscopic surgery that night to have the right falopian tube removed. We conceived again several weeks later. The pregnancy went very well, with Karen working as a hiking guide all summer. But in late October, after her final trip of the season, Karen again experienced severe abdominal pain on the right side. This time the ovary "torsed," and Karen had to have fairly invasive surgery to have it removed. As with the prior surgery, Karen bounced back quickly and was on Nordic skis by the time the snows hit in December. Near the end of Karen's pregnancy we went every Tuesday to see our midwife, who carefully checked Karen's urine and blood pressure as part of routine prenatal check-ups. Four days before our due date, the midwife found protein in Karen's pee and recorded an elevated blood pressure. I'll never forget that day. Karen picked me up after work on Bozeman's snow-clogged Main Street in the Volvo wagon I had recently bought her for the drive to our midwife's office outside Livingston. On the way, Karen stopped in the historic rail town to pick up this red ceramic utensil holder for the kitchen. It was a day like so many others with work and errands. The midwife insisted Karen go on bed rest. That night two friends made a cast of Karen's belly. It was the last night Karen and I would sleep together at home. The next day, a friend came over to check Karen's blood pressure and this time it was really elevated. The midwife rushed over and drew blood to have a platelet count performed. By the time I got home, the midwife had already called off the idea of a home delivery. When we got word that Karen's platelets were depressed, the midwife instructed me to get packed. We were at the hospital a few minutes later to have our baby delivered, although Karen was not the least bit dilated. The obstetrician on duty decided a vaginal delivery was the safest option given Karen's elevated blood pressure, which had become erratic and put Karen in danger of seizures. An ulcer medication was applied to Karen's cervix to loosen it up and we spent several hours waiting for her to dilate. We snuggled on the bed in the delivery room, talking about how much we loved each other and excited for the future. When the cervix opened enough to manually break the bag of waters, her labor started. Karen wanted no pain medications, but she had to take meds to control her blood pressure and prevent seizures. These drugs made her a little goofy and impaired her ability to push the baby out. The four-hour labor and delivery went fairly smoothly considering the challenges involved. There were a few frightening moments and we had to use this vacuum suction tool on the baby's head to pull her out. Aryana emerged looking like a cone head and a shade bluer than the color of grape juice. "I love you, Babula," Karen kept saying as the delivery nurses worked over the 6-pound little human who was lethargic from the influence of the meds. Meanwhile, the placenta failed to make an appearance. Over the next few hours, the finest day of my life turned into the worst. It was during the post-natal surgery to remove the wayward placenta that Karen suffered a major and ultimately fatal loss of blood. Karen's hemorrhaging practically bankrupted the state's supply of AB blood. High Patrol troopers were delivering blood products from all over on Feb. 5 as surgeons struggled to save Karen's life. More than 20 units of other people's blood were poured into Karen. Doctors performed three more surgeries, but by the next morning a CAT scan revealed that the shocks to her brain rendered survival impossible. Forty-five hours after our daughter was born, a few members of our families gathered around Karen's bed in the ICU as the technicians removed the connections to the life-support machines. After a few minutes we watched her breathe her final breaths. Her death was a shocking loss to Bozeman, a small Montana city Karen moved in the early 1990s a few years after college. The night before she died dozens of her friends crowded the ICU to say goodbye. Her girlfriends painted her toenails red, sang us songs, and decorated her room with her things hastily pilfered from our house. It was clear to hospital staff they had a very beloved person in their care. In hindsight, I wish we exercised greater diligence considering Karen's surgical history. But would it have mattered? Pre-eclampsia just snuck up on us, even though she was under the watchful care of a midwife, as well an OBGYN part of her pregnancy. Karen's fine health may have been masking the signs all along. Maternal deaths are so rare for us that when they do occur they seem like tragedies of archetypal proportions. While our community and families grieve, our daughter has thrived. Aryana's sweet nature, contentedness and energetic playfulness have helped ease me into my new life as a single parent. She just turned a year, took her first step on the anniversary of her mom's death. When I see how many babies are claimed by pre-eclampsia, I realize I have a lot to be thankful for. Brian Maffly Bozeman, Montana brianmaffly@msn.com
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