Even as a little girl, Kearra Cortolillo, 24, of Parkville knew that motherhood was her calling. “I always dreamed about having babies and raising children,” she said.
But at 13 she was diagnosed with Hodgkin’s lymphoma, a cancer of the lymph glands, and her mother, Kathi, recalls how quickly they got the devastating diagnosis. “Thursday, we were at the surgeon’s office, on Friday she was in the hospital having the biopsy, and by Saturday they told us she has cancer.”
At just like that, Cortolillo’s dream of motherhood began to vanish. “They told me [the chemotherapy treatments] could make me sterile, and we were always worried about that,” she said.
And there was a complication. The chemo had damaged her heart muscle, causing a condition known as cardiomyopathy, which can lead to heart failure. This condition is particularly risky for expectant mothers, as pregnancy creates a hyperdynamic state in the body and puts a big strain on the heart.
The placenta and baby add a large and extensive extra network of blood vessels and volume of blood flow that the heart has to pump against. It takes its toll on a young healthy heart, let alone on one with a weakened muscle. Cortolillo had a very real chance of dying if she got pregnant.
“I was completely torn,” said Kathi, when her daughter told her she was expecting. “On one hand, I’ll have a grandchild — how wonderful. But how could I take the chance of losing [my daughter] again.”
It had been almost 10 years since surviving cancer, and even with the cardiomyopathy, Cortolillo — at 22 — was determined to have the baby. Her gynecologist at the time advised against it. “But there was no doubt in my mind,” she said. “I was going to have this baby.”
Cortolillo was referred to Dr. Hugh Mighty, chairman of the department of obstetrics and gynecology at the University of Maryland School of Medicine. Mighty is a board-certified specialist in critical-care medicine and also a board-certified obstetrician and gynecologist.
“It’s the opposite of subspecializing,” Mighty said. “You’re bringing two specialties together to focus on two patients — mother and baby — who are intimately joined together.”
When Cortolillo first went to see Mighty her heart was only pumping out blood at half its capacity. According to Mighty, that’s on the border for complications. “Those with less than a 50-percent ejection fraction have some maternal mortality, and she was right on the cusp,” he said. “I gave her about a 5 percent chance of dying from this pregnancy.”
Mighty’s frank discussions with his patients about potential risks builds a trust in an atmosphere of uncertainty. He describes the three points in a pregnancy that are especially dangerous for women with cardiomyopathy. The first is in the late third trimester, when the placenta and baby are almost full-grown and produce increased pressure — from the increased volume of blood — that the heart has to pump against. The second is during labor because with every contraction of the uterus, extra blood is pushed up against the heart. The third is after delivery of the baby. “[Dying in] the postpartum period usually occurs from an irregular heart rhythm,” Mighty said.
Cortolillo had serious episodes during her third trimester. Twice she had to be hospitalized because of breathing problems.
“I felt like my heart was pounding out of my chest,” she said. “I knew something was wrong.”
Once back home she was so fatigued she barely had the energy to go to the bathroom or even lift her arms to brush her hair or teeth. She concedes she was “worried about dying … or having something happen to my baby.”
“It was a nightmare for me,” her mother said. “It was very difficult, the whole thing.”
Managing her labor was tricky. With each contraction, more blood was pumped to her weakened heart, making it difficult for Cortolillo to breath. When she was supposed to push, she had to be completely passive to minimize the strain on her heart. With an epidural in place, Mighty and an assistant had to manually push from above and pull from below with forceps to deliver the baby. And even with daughter Harper’s birth, Cortolillo wasn’t out of the woods. “I didn’t even look at the baby,” Kathi said. ” I just wanted to make sure Kearra was all right.”
Cortolillo remembers that she was having trouble breathing, that her heart was racing and that all the monitors were going off. It wasn’t until later — after she was stabilized — that she was able to see and hold Harper.
“It’s overwhelming that you can love something so much,” Cortolillo said.
Even Mighty marvels at what women with cardiomyopathy go through to become moms. “[It takes] an incredible stamina and drive … in light of the risks they face,” he said.
And now almost a year later, Cortolillo has no regrets.
“I would do it all over again,” she said. “In a heartbeat.”
