A nosebleed. A pregnancy. A team effort - Cape Cod Healthcare

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Published on April 02, 2018

A nosebleed. A pregnancy. A team effortA nosebleed. A pregnancy. A team effort

Megan Brown

Megan Brown and Paul DeMeo, MD

It took a team of dedicated and skilled medical professionals at Falmouth Hospital to bring Harper Borofski into the world on Friday, March 9.

Her unusual delivery started earlier in the week when her mother, Megan Brown, who was 39 weeks pregnant at the time, had a nosebleed. When her nose started bleeding on Tuesday of that week, she wasn’t overly concerned. But the bleeding didn’t stop.

On Wednesday, the 24-year-old Sagamore resident went to Stoneman Urgent Care in Sandwich, where they referred her to otolaryngologist Douglas Mann, MD, at Upper Cape Ear, Nose & Throat in Falmouth.

“Dr. Mann saw me immediately which was amazing,” Brown said. “He was great.”

Nosebleed are common enough that Dr. Mann sees them almost every day, he explained. But Brown’s nosebleed was out of the ordinary.

“I would say that 95 percent of the time you look in the nose and you can see exactly where the bleeding is coming from and you can control it fairly easily,” he said. “But Megan was in the five percent group where we didn’t see anything as an obvious source.”

Part of the difficulty was that Brown had a deviated septum. The wall between her nostrils was crooked and it was deviated on the left side, which is the side that was bleeding. Any time Dr. Mann did any kind of manipulation of her nose, it bled profusely. He thought that Brown would probably need surgery but, as a first line of defense, he put significant packing in her nose to apply pressure and hopefully stop the bleeding.

He then called Brown’s obstetrician, Paul DeMeo, MD, at Cape Obstetrics & Gynecology PC in Falmouth and Bourne to see if it was okay for Brown to have surgery, if necessary. He also wanted to share his concern that if Brown went into labor the exertion of pushing could cause her nose to start bleeding excessively again.

“I got involved at that point because Dr. Mann wanted her admitted to maternity overnight for pain control because of the packing she had placed,” Dr. DeMeo said.

Bleeding Started Again

When Brown returned to see Dr. Mann on Friday to have the packing removed, she immediately started bleeding again. He knew surgery was the only option and sent her back to Falmouth Hospital.

Luckily, Dr. DeMeo was already at the hospital that day. Dr. Mann consulted with Dr. DeMeo and his colleagues, obstetricians Phillip McCrary, MD, and Elizabeth Murray, MD, along with anesthesiologist Nina Zachariah, MD, about how to proceed in the safest way for both mother and child.

The options were either to do general anesthesia to fix her nose and then do a caesarian section a few days later, or to do both the nose repair and the C-section at the same time.

“I didn’t want to subject my child to anesthesia twice,” Brown said. “I didn’t want her to go through my nose surgery and then four days later have to have a spinal to take her out. That didn’t seem fair to her and it was scary to me to think that she was going to be inside of me during surgery.”

Her doctors agreed and moved forward with the plan. Falmouth Hospital Chief Medical Officer, Alexander Heard, MD, who is also a pediatrician at Cape Cod Pediatrics in Forestdale, joined them, along with pediatrician Giannina Tierney, MD, from Bramblebush Pediatrics & Adolescents in Falmouth.

“We decided to do it in the main operating room because of the availability of all of Dr. Mann’s special instruments that he needs,” Dr. DeMeo said. “It made sense to do it there rather than try to bring all of those instruments up to maternity. If there was something else that they needed that they didn’t have, someone would have to run down and get it so, logistically it was easier to do it in the main OR. We just had to coordinate that with the maternity staff, and they came down and brought all the instrumentation and the things that we needed to do the Caesarean to the main OR.”

The maternity and pediatric team was set up in an adjoining operating room, along with Brown’s fiancé, Dylan Borofski. Four minutes after Dr. Zachariah administered anesthesia to Brown, Harper was born. She was then whisked off to the second operating room to meet her father.

A Great Outcome

“What they did was beautiful,” Dr. Mann said. “I watched the C-section, which I have not done in my entire career since medical school. It was exciting to watch and to see how expertly and quickly they got it all done.”

When Dr. DeMeo and Dr. McCrary finished their surgery, Dr. Mann began the repair on Brown’s nose. First, he straightened her septum so his vision wasn’t obstructed. Once he did that, he could see that she had a hemangioma, which is a benign growth of a collection of abnormal blood vessels.

“Hemangiomas bleed easily and they bleed impressively,” said Dr. Mann.

He removed the hemangioma and sent it to pathology to be checked out, and cauterized the base of it to prevent it from bleeding again.

“Everything turned out well and now she’s breathing better afterwards,” Dr. Mann said. “That’s a little plus.”

Brown couldn’t be happier about the care she received from the entire team.

“It was kind of like I got the Boston experience at Falmouth Hospital, which was amazing,” she said. “It was just the greatest experience from start to finish, even though I had to have surgery.”