Mediastinal Teratoma and Fetal Surgery: Grace's Story

When Laura Srinivasan was three months pregnant, she and her husband, Reuben, decided on a name for their daughter: Grace.

“As it turns out,” says Laura, “that name would be appropriate.”

Grace was indeed a blessing, considering doctors originally didn’t expect her to survive.

After a routine ultrasound performed at 19 weeks at her Michigan doctor’s office, Laura was told her baby had a mediastinal chest mass — a solid growth developing between the baby’s heart and lung.

The doctor told Reuben and Laura “it is a fatal thing” and their options were to abort the fetus or wait for the baby to die in utero, and then deliver her.

Finding another option

Laura and Reuben knew in their hearts there had to be another option, and sought a second opinion. Fortunately, the second doctor they spoke with suggested they travel to The Children’s Hospital of Philadelphia (CHOP) to meet with Holly Hedrick, MD, and the fetal surgery team at CHOP's Center for Fetal Diagnosis and Treatment.

“We were totally distraught. She hadn’t been born yet; we didn’t even know her, yet we had all these high hopes for her. Everyone was saying it was fatal. We had to do everything we could, we had to exhaust all possibilities,” says Laura.

Just days later, they boarded a plane for Philadelphia.

Fetal surgery to remove the mass

At Children's Hospital, Laura went through a battery of tests, which included gathering 3-dimensional images of the baby’s heart. A meeting with Dr. Hedrick and the team determined that the outcome of any attempt to save Grace would be “unknown.”

“The odds weren’t good,” says Laura, “But we were all willing to try — us and the doctor.

On June 14, at 23 weeks gestation, doctors operated in utero to remove the mass. The surgery was a complete success — the mass was taken out, and Grace was left to continue growing in her mother’s womb. However, just days later, Laura went into labor. Grace was born on June 25 weighing in at approximately 1 pound 8 ounces.

“We knew premature delivery was a risk,” says Laura. “But we didn’t have a choice.”

Grace was in a Catch-22 situation. The surgery is what triggered the premature delivery; but without the surgery to remove the mass, Grace would have died in utero.

Making a turnaround in the N/IICU

For weeks, Laura and Reuben “waited to exhale” as they watched their baby struggle to survive in the Newborn/Infant Intensive Care Unit (N/IICU).

“The doctors in the N/IICU said she was one of the sickest babies they had ever seen,” recalls Laura.

Even though Laura thought her baby’s problems were “insurmountable” and had her doubts Grace would live, Reuben saw the positive side of things: there was no bleeding in the brain.

Then, one “golden weekend” Grace turned things around, says Reuben.

“She decided to live,” adds Laura.

By the end of August, even though she was still on a ventilator, Grace was stable enough to be discharged to a children’s hospital in her home state of Michigan.

On Oct. 12, Reuben and Laura brought their baby home for good. Although she was still hooked up to a ventilator and feeding tube, Grace continued to steadily improve.

Growing and thriving

Today, 2½ -year-old Grace is developing normally, and doing everything she can to keep up with her three big brothers. All the concerns about the consequences of having a mediastinal chest mass and having been born premature are in the past, say her parents.

“We’re just so grateful to have found Children’s Hospital when we did,” says Laura, adding, “But I don’t think it was a coincidence. We were meant to find (the Hospital); Grace was meant to be here.”

Originally posted: June 2009