TAG: "Women’s health"

Statewide public cord blood collection begins

UC Davis Health System administers the state-funded program.

Mothers of newborns can now donate their babies’ umbilical cord blood at UC Davis Medical Center and other hospitals throughout the state as part of California’s first comprehensive public system of collecting cord blood for lifesaving transplantations and medical research.

“This program enables new mothers to be both life-givers and lifesavers,” said Laurel Finta, medical director for Maternity Services at UC Davis Medical Center. “Parents now have the opportunity to donate to a publicly funded cord blood collection program that costs them nothing and can provide benefits to so many others.”

Created by state legislation in 2010, California’s Umbilical Cord Blood Collection Program (UCBCP) is a unique, state-funded system designed to broaden the diversity of umbilical cord blood units for public banking and use in unrelated transplants as well as provide a source of high-quality cord blood units for qualified researchers. UC Davis Health System administers the program, which is funded by a $2 dollar fee on birth certificate copies.

“The main goal of this program is to expand the diversity of publicly available cord blood by making it easy and convenient for new mothers to donate,” said Suzanne Pontow, co-director of the program and a scientist at the UC Davis Institute for Regenerative Cures in Sacramento. “Only a tiny fraction of cord blood is collected and preserved right now, so this is the beginning of an important effort to enable parents around the state to voluntarily and easily donate cord blood at no cost.”

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Young mother delivers baby, develops heart disease

UC San Diego Sulpizio Cardiovascular Center among first in region to implant cardiac device.

Amanda and her husband, Nathan, doting on their beautiful daughter, Kassidy, minutes after her arrival.

Three weeks after delivering her first child, Amanda began to suffer from extreme fatigue, headaches, a tight chest and stomach pain. An initial diagnosis of pneumonia changed for the worse: Amanda was experiencing heart failure. The 28-year-old’s life was at risk. She was quickly transferred to UC San Diego Sulpizio Cardiovascular Center (SCVC) where a multidisciplinary team implanted a novel cardiac device under her skin, leaving the heart untouched, to prevent sudden cardiac arrest.

“When Amanda first arrived at SCVC, she was in critical condition. It became clear within 24 hours that she needed emergency surgery or she would not survive,” said Eric Adler, M.D., director of cardiac transplant and mechanical circulatory support at UC San Diego Health System.

The new mother was diagnosed with peripartum cardiomyopathy, a rare disorder in which a woman develops heart disease within the final month of pregnancy or within five months after delivery. Adler adds that one in 2,000 women suffers from the condition, the cause is not exactly known and it can be hard to correctly diagnosis.

“I knew I had to fight for my daughter,” said Amanda. “I am not a quitter and always strive for success. I wasn’t going to let heart failure beat me.”

A left ventricular assist device (LVAD) – a mechanical heart of sorts that helps pump oxygen-rich blood throughout the body – was first implanted in Amanda.

“The patient’s heart was failing. She was in a dire situation and needed the LVAD device immediately implanted to support her heart function and restore blood circulation,” said Victor Pretorius, M.B.Ch.B., cardiothoracic surgeon at UC San Diego Health System, who implanted the LVAD in Amanda.

Amanda was also a candidate for the new Boston Scientific Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) System. The device is used for the treatment of patients at risk for sudden cardiac arrest. To date, more than 3,000 devices have been implanted in patients around the world.

The S-ICD System monitors cardiac activity and shocks the heart when it goes into a dangerous rhythm, a function not performed by the LVAD. The S-ICD does not use traditional wires, called “leads,” threaded to the heart through blood vessels. Rather, the device is implanted just under the skin near the breastbone, and heart patients who require an ICD may be candidates.

“Leads in standard ICDs have been known to fracture or disconnect at times. The S-ICD has fewer long-term complications, an easier removal process and puts the patient at less risk for infection,” said Ulrika Birgersdotter-Green, M.D., director of pacemaker and ICD services at UC San Diego Health System, who implanted the device in Amanda. “It is an advancement in defibrillation technology that is simple to implant and can be life-saving.”

Amanda was the first patient at UC San Diego Health System to receive the S-ICD. The procedure took about an hour, and she was able to walk around the next day. As she continues to heal, she will be closely monitored to see if her heart function improves. If not, she will be placed on a heart transplant list.

“As part of the region’s only academic hospital, we are dedicated to using a team approach to treat high risk patients, who five to ten years ago, may not have survived,” said Adler.

Amanda is now sharing her story to raise awareness about heart disease.

“Knowledge and early detection for heart disease, especially peripartum cardiomyopathy, are key. I hope my story helps others to understand the warning signs and the technology available for treatment,” said Amanda. “The first time I was able to hold my daughter after the procedure, I became very emotional after the journey I had just been through. Because of the team at SCVC, I am able to embrace my family every day.”

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Researchers one step closer to ovarian cancer marker

UC Davis researchers verify that glycans can be used to detect ovarian cancer.

Gary Leiserowitz, UC Davis

The hunt is on to find biomarkers that detect cancer, but it’s a challenging process. Early successes often are followed by heartbreaking failures. But now, researchers at UC Davis have verified that glycans (sugars attached to proteins) can be used to detect ovarian cancer. The study was published online in the journal Cancer Epidemiology, Biomarkers & Prevention.

“This is one of many papers we’ve done to see if glycans can distinguish between women who have ovarian cancer and those who don’t,” said senior author Gary Leiserowitz, chief of the Division of Gynecologic Oncology. “So far, the results have been consistent and promising.”

Creating a diagnostic tool that identifies ovarian cancer early through analysis of a blood sample would be an enormous benefit. Because the disease produces indistinct symptoms, such as bloating, ovarian cancer is often diagnosed late, making it difficult to treat.

The answer may be glycans, which are attached to over 50 percent of all proteins and often are altered when patients have cancer. By measuring these changes, the UC Davis team hopes to create a blood test that will find these cancers early.

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Know the risks: Kawasaki disease and pregnant women

UC San Diego researchers say risks are manageable, provided doctors recognize them.

Jane Burns, UC San Diego

In the first study of its type, researchers at the UC San Diego School of Medicine have looked at the health threat to pregnant women with a history of Kawasaki disease (KD), concluding that the risks are low with informed management and care.

The findings are published in today’s (March 6) online edition of the British Journal of Obstetrics and Gynaecology.

KD is a childhood condition affecting the coronary arteries. It is the most common cause of acquired heart disease in children. First recognized in Japan following World War II, KD diagnoses are rising among children in Asia, the United States and Western Europe. Predictive models estimate that by 2020 one in every 1,600 American adults will be affected by KD.

“A growing number of women with a history of KD are reaching child-bearing age, but there is little information available to guide their obstetrical care,” said study author Jane C. Burns, M.D., professor and director of the Kawasaki Disease Research Center at UC San Diego and Rady Children’s Hospital-San Diego. “By and large, KD is virtually unknown among working obstetricians.”

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Acetaminophen use during pregnancy linked to ADHD in children

UCLA study raises concerns about use of acetaminophen during pregnancy.

Beate Ritz, UCLA

Acetaminophen, found in over-the-counter products such as Excedrin and Tylenol, provides many people with relief from headaches and sore muscles. When used appropriately, it is considered mostly harmless. Over recent decades, the drug, which has been marketed since the 1950s, has become the medication most commonly used by pregnant women for fevers and pain.

Now, a long-term study by UCLA, in collaboration with the University of Aarhus in Denmark, has raised concerns about the use of acetaminophen during pregnancy.

In a report in the current online edition of JAMA Pediatrics, researchers from the UCLA Fielding School of Public Health show that taking acetaminophen during pregnancy is associated with a higher risk in children of attention-deficit/hyperactivity disorder and hyperkinetic disorder. The data raises the question of whether the drug should be considered safe for use by pregnant women.

ADHD, one of the most common neurobehavioral disorders worldwide, is characterized by inattention, hyperactivity, increased impulsivity, and motivational and emotional dysregulation. Hyperkinetic disorder is a particularly severe form of ADHD.

“The causes of ADHD and hyperkinetic disorder are not well understood, but both environmental and genetic factors clearly contribute,” said Dr. Beate Ritz, professor and chair of the department of epidemiology at the Fielding School and one of the senior authors of the paper. “We know there has been a rapid increase in childhood neurodevelopmental disorders, including ADHD, over the past decades, and it’s likely that the rise is not solely attributable to better diagnoses or parental awareness. It’s likely there are environmental components as well.”

“That gave us the motivation to search for environmental causes that are avoidable,” said the University of Aarhus’ Dr. Jørn Olsen, another senior author and former chair of the UCLA Fielding School’s epidemiology department. “Part of the neuropathology may already be present at birth, making exposures during pregnancy and/or infancy of particular interest. Because acetaminophen is the most commonly used medication for pain and fever during pregnancy, it was something we thought we should look at.”

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Drug prolongs survival in advanced cervical cancer, study finds

Results of UC Irvine-led trial already have changed treatment guidelines.

Krishnansu Tewari, UC Irvine

Women with advanced cervical cancer now have a new treatment option that could lengthen their lives. A trial led by UC Irvine gynecologic oncologist Dr. Krishnansu S. Tewari found that combining chemotherapy with bevacizumab, also known as Avastin, extended median survival to 17 months, compared to 13.3 months for those receiving chemotherapy without bevacizumab.

Furthermore, treatment with the anti-angiogenesis drug – which inhibits a tumor’s ability to form new blood vessels – caused no significant deterioration in quality of life. The results of the phase 3 randomized trial conducted by the Gynecological Oncology Group appear in today’s (Feb. 20) issue of The New England Journal of Medicine.

“This trial showed for the first time that a targeted agent could improve overall survival in a gynecologic cancer,” said Tewari, a professor of obstetrics & gynecology at the University of California, Irvine. “Women with metastatic or recurrent cervical cancer don’t have many options, and now we finally have a therapy that helps them live longer.”

Although a difference of 3.7 months may not seem like a long time, he said, it’s important to understand that this patient population responds very poorly to even one line of therapy and that those minimal responses tend to be short-lived.

“We do not have the luxury of treating women who have advanced cervical cancer with multiple lines of therapy over many years, as we do with more chemosensitive malignancies such as ovarian or breast cancer,” Tewari said. “However, these findings show that we may be on the cusp of converting this disease from a terminal to a chronic condition where the 3.7 months provides a window of opportunity in which patients might benefit from new therapies, including other anti-angiogenesis drugs and immunotherapies that are now being studied.”

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UCSF receives $50M gift for women’s health

Women’s hospital at Mission Bay named in honor of quality, safety leader Betty Irene Moore.

This rendering of the new UCSF Medical Center at Mission Bay shows the entrance to the women's hospital, which will be named in honor of Betty Irene Moore, a patient safety pioneer and advocate.

This rendering of the new UCSF Medical Center at Mission Bay shows the entrance to the women's hospital, which will be named in honor of Betty Irene Moore, a patient safety pioneer and advocate.

UCSF Medical Center will name its new women’s hospital at Mission Bay in honor of Betty Irene Moore, a patient safety pioneer and advocate.

The hospital has received a $50 million gift from Bay Area residents Gordon and Betty Moore to help fund the region’s first women’s hospital and to advance the innovative initiatives of the UCSF National Center of Excellence in Women’s Health. The gift is a private donation from the Moores, whose leadership and philanthropy have profoundly influenced health care practices in the United States.

Gordon Moore is a co-founder of Intel Corp. In 2000, he and his wife Betty established the Gordon and Betty Moore Foundation to support progress in science, nursing and patient care, as well as environmental conservation.

By bringing attention to such issues as medication safety, central line-associated bloodstream infections and ICU care, the Moore Foundation has helped patients avoid hundreds of thousands of hospital days, improved patient experiences and saved lives. And, thanks in large part to continued support from the Moore Foundation, UCSF has established itself as a national leader in patient safety and satisfaction.

“Gordon and Betty Moore have been amazing visionaries and philanthropists in so many fields, including health care, and we are so grateful for their support at UCSF. We are delighted to have Betty Irene Moore’s name permanently associated with our new women’s hospital,” said Chancellor Susan Desmond-Hellmann, M.D., M.P.H.

In recognition of the Moores’ outstanding generosity, UCSF will name its new women’s hospital the UCSF Betty Irene Moore Women’s Hospital. The specialty hospital is part of the new UCSF Medical Center at Mission Bay, a 289-bed state-of-the-art hospital complex for children, women and cancer patients that will open in February 2015.

“It is a privilege to have the Moore name associated with our women’s hospital. Betty is an icon, and her longstanding work as a patient advocate is inspiring,” said Mark Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospital. “The Moores are national leaders in improving the quality and safety of health care, and we are thrilled to partner with them as we work to better the lives of our patients at the UCSF Betty Irene Moore Women’s Hospital.”

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Reducing premature births

UCSF team wins $2.7M grant for innovative project.

Larry Rand, UC San Francisco

Larry Rand, UC San Francisco

UC San Francisco has been awarded a Bill & Melinda Gates Foundation grant of $2.7 million over three years for a collaborative project aimed at reducing premature births.

The funding will allow the UCSF team to continue to pursue development of the Smart Diaphragm, a wireless monitoring and warning system for early signs of preterm birth.

Globally, about 15 million babies are born prematurely, according to the World Health Organization, leading to death or lifetime disabilities. It is the leading cause of infant mortality worldwide, amounting to more than one million deaths annually. Preterm birth also poses an enormous medical cost to society, exceeding $26 billion annually in the United States alone, according to estimates from the Institute of Medicine.

Yet, when detected early and treated, preterm labor can be prevented or delayed.

“Labor is a long and mostly silent cascade of events that culminates with the uterus trying to expel the fetus,” said principal investigator Larry Rand, M.D., who holds the Lynne and Marc Benioff Endowed Chair in Maternal Fetal Medicine at UCSF.

“One key silent event is the transformation of the cervix,” Rand said. “Throughout most of pregnancy it is a long, tough, protective barrier at the opening of the uterus. When labor approaches, the cervix begins to soften, shorten and thin out, before becoming an open gateway for the baby to enter our world.”

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Hospital charges vary widely for women giving birth

UCSF study examines charges for uncomplicated deliveries.

Renee Hsia, UC San Francisco

Renee Hsia, UC San Francisco

Women giving birth in California can face a huge cost difference in their hospital bills, according to a new UC San Francisco study.

The study found that California women giving birth were charged from $3,296 to $37,227 for an uncomplicated vaginal delivery, depending on which hospital they visited. For a C-section, women were billed between $8,312 and nearly $71,000. Few of the women in the study had serious health issues and most were discharged within six days of admission.

For the more than half million women who give birth at California hospitals every year, medical costs are difficult to predict and can result in differences of thousands of dollars among facilities even in the same geographic area, the researchers said.

“Unlike other industries, the way health care is priced and paid for is notoriously opaque, making it difficult for patients to act as educated, price-comparing consumers,” the authors wrote.

The study was released online Jan. 16 in BMJ Open.

“This is unfortunately the appalling state of affairs of health care in the United States,” said lead author Renee Y. Hsia, M.D., an associate professor of emergency medicine at UCSF. She is also an attending physician in the emergency department at the UCSF-affiliated San Francisco General Hospital & Trauma Center and a faculty member of the UCSF Institute for Health Policy Studies.

“Childbirth is the most common reason for hospitalization, and even for an uncomplicated childbirth, we see a staggering difference in what hospitals charge, even for the same, average patient,” Hsia said. “These charges affect not only the uninsured, but also the fee-for-service reimbursements by some private insurers, which can translate to out of pocket costs for patients.”

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UCSF, Quest Diagnostics launch collaboration to advance precision medicine

Areas of focus will include autism, oncology, neurology and women’s health.

June Lee, UC San Francisco

June Lee, UC San Francisco

UC San Francisco and Quest Diagnostics, the world’s leading provider of diagnostic information services, have formed a collaboration to accelerate the translation of biomedical research into advanced diagnostics in the field of precision medicine, for improved patient care, treatment and outcomes.

Initial clinical areas of focus include autism, oncology, neurology and women’s health.

The collaboration, which combines the research discoveries and capabilities of UCSF with the national testing database and technical and clinical development capability of Quest Diagnostics, has an overarching aim of enabling holistic and integrated diagnostic solutions that close gaps in care or enable new clinical value.

Under the terms of the agreement, scientists will jointly research, develop and validate diagnostic innovations to solve specific clinical problems and provide actionable information to improve patient care. The organizations will focus on diagnostics to advance precision medicine, an emerging field of medical science that aims to integrate the most informative data from molecular, clinical, population and other research to create predictive, preventive and precise medical solutions for patients. Quest Diagnostics would independently develop and validate any lab-developed tests for clinical use that emerge from the collaboration’s research.

Researchers will utilize laboratory-based diagnostics, imaging procedures and population analysis based on Quest’s national Health Trends database, the largest private clinical database in the U.S., based on more than 1.5 billion patient encounters, to advance precision medicine.

The alliance is the first master agreement that UCSF’s Office of Innovation, Technology and Alliances has signed with a clinical laboratory testing company and augments the university’s efforts to translate laboratory research into new therapies. The broad agreement lays the groundwork for multiple projects between the two organizations.

“Advances in technology and science have identified many promising opportunities to improve outcomes through insights revealed by novel diagnostic solutions, yet fulfilling the full potential of these opportunities often hinges on translational clinical studies which validate their value,” said Jay Wohlgemuth, M.D., senior vice president, science and innovation, Quest Diagnostics. “This unique collaboration between UCSF and Quest brings together the finest researchers and clinicians in the country to accelerate the development of a ‘product pipeline’ of scientific discoveries as clinically valuable diagnostic solutions that enable precision medicine for improved outcomes.”

The collaboration is launching with two specific projects already under way. One project involves Quest’s national database of molecular testing data to facilitate participation in research and development efforts related to genetic variations of autism, based on Quest’s CGH microarray ClariSure technology, which can help identify genetic mutations associated with autism and other developmental disorders. While there currently is no treatment for autism, a test that aids its diagnosis could help identify individuals who might be appropriate candidates for research studies that could lead to future therapies.

The second project aims to identify biomarkers to determine which children with glioma brain tumors may benefit from a drug that is currently available to treat the disease. That project will integrate molecular biomarker testing with advanced MRI imaging technologies. This project is the first phase of larger collaborative studies to develop and validate integrated care pathways, which would include laboratory diagnostics, imaging data and other clinical information to be used in the management of patients with brain cancer and neurological diseases.

UCSF has been at the forefront of the movement toward precision medicine, for which UCSF Chancellor Susan Desmond-Hellmann, M.D., M.P.H., co-authored the initial National Academy of Sciences paper that defined the new field. That paper set the vision of harnessing the vast amounts of genetic, environmental and health data worldwide to make health care more predictive, precise and targeted.

“There are many diagnostics projects underway at UCSF for which Quest could partner and contribute a great deal of value in turning an isolated research project into a diagnostic service or other technology that directly benefits patients,” said June Lee, M.D., F.A.C.C.P., director of early translational research at the UCSF Clinical and Translational Science Institute, which initiated the collaboration with Quest after several scientists from both organizations had formed isolated, but successful, research collaborations. “This agreement will give UCSF researchers access to Quest expertise in developing diagnostics, as well as in understanding the market conditions for projects on campus.”

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UCSF nurse-midwives collaborate with doctors for high-quality maternity care

Changing the culture of childbirth.

Students practice delivery both with "standardized patients" (live actors), as shown above at San Francisco General Hospital, and with robotic "simulated patients" at UCSF's Kanbar Center. (Photo by Elisabeth Fall)

Students practice delivery both with "standardized patients" (live actors), as shown above at San Francisco General Hospital, and with robotic "simulated patients" at UCSF's Kanbar Center.

In the early 1970s, a group of obstetricians at San Francisco General Hospital began discussions with certified nurse-midwives in the local community about starting what would become the first hospital-based midwifery practice in San Francisco. “They recognized that there was an untapped market for women who wanted midwifery care but didn’t want or couldn’t afford out-of-hospital birth,” says CNM Margaret Hutchison, a clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the UC San Francisco School of Medicine, who also chairs the leadership council of the nurse-midwives of SFGH.

It was a time when attitudes toward childbirth were shifting. The enormous safety gains of the previous half century – a product of medical innovations like antibiotics, safer anesthetics and better diagnostic tools – had made survival of the mother and baby seem almost a given, but it moved maternity care into a more “medicalized” model, which sometimes ignored the fact that childbirth is a normal physiological experience for most women. In-hospital midwifery care strikes a balance between preserving the normal aspects of birth and providing rapid access to technology and advanced care when it’s needed.

The midwifery service at SFGH began in 1975 with the opening of an alternative birth center within the hospital, which offered a more homey environment than the traditional labor and delivery unit. Although births at the hospital increased by 50 percent in the first year, maintaining a separate unit proved financially unviable, and midwifery patients were eventually moved to the regular labor and delivery unit, where 46 percent of women now select a midwife for their care.

The move proved fortuitous. Nurse-midwives and obstetricians began working side by side, and over time, a collaborative atmosphere developed.

“I think the early presence of midwifery at SFGH has influenced the culture of childbearing for everybody in our labor and delivery unit,” says Hutchison. Obstetrician Rebecca Jackson, chief of the SFGH division of the Department of Obstetrics, Gynecology and Reproductive Sciences, agrees. “[The midwives] push us [obstetricians] to think more carefully about why we do certain things,” she says.

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A miracle baby

Dialysis couldn’t stop one woman’s dream of motherhood.

Growing up, Elizabeth Hill had her entire life planned. She would be her family’s first college graduate, a successful professional and, above all, a mother. “I always knew I was born to be a mom,” she says.

At 17, however, she was diagnosed with lupus, a disease that can attack almost any part of the body. “At first I fell into a deep depression,” the Yorba Linda resident explains. “But then I decided I was going to live a normal life.”

She did just that, earning her degree and later working as a human resources manager — a job she loved.

Hill was still living with lupus, though. By 2008, her kidneys were irreparably damaged by the disease. She received a kidney transplant, but it failed after just two years.

Seriously ill, Hill began dialysis treatments to cleanse her blood of the impurities normally eliminated by the kidneys. The treatments were lifesaving, but being on dialysis meant she would probably never have children.

“Dialysis patients rarely become pregnant,” says Dr. Carol Major, a UC Irvine Health maternal-fetal medicine specialist. And if they do, they usually miscarry.

This is because “a developing fetus is extremely vulnerable to metabolic changes that take place during dialysis,” explains Dr. Kamyar Kalantar-Zadeh, chief of the UC Irvine School of Medicine’s Division of Nephrology & Hypertension.

Then — against the odds — Hill learned she was pregnant. “I had a million emotions,” she says. “I’d been told this would never happen, but now it had.”

The 34-year-old Hill was immediately referred to UC Irvine Health, one of the nation’s leading centers for treating kidney disease and managing high-risk pregnancies. UC Irvine Health kidney and obstetric-gynecologic specialty services both have been ranked among the best in the country by U.S. News & World Report.

Hill’s treatment team included nephrologists as well as obstetricians with expertise in managing complex, high-risk pregnancies. “We coordinated her treatment across all specialties on a daily basis,” says Major, who cared for Elizabeth throughout her pregnancy.

“To better maintain the delicate balance so critical for mother and baby,” says Kalantar, “Elizabeth underwent dialysis six times a week instead of the usual three.”

During dialysis, the fluid removed had to be carefully measured and analyzed to ensure that the developing fetus was still receiving enough fluid volume. And after each dialysis session, Hill underwent fetal heart rate monitoring for more than an hour to make sure the baby was doing well. On Sundays — the one day Hill didn’t make the trek to UC Irvine Medical Center — she and Major texted each other.

“Dr. Major and I have this amazing bond,” Hill explains. “She’s so incredibly wonderful and caring. I’ve never met a doctor like her.”

Even with the unprecedented care she received, Hill’s pregnancy was extremely difficult — jeopardized by anemia and a liver condition that caused intolerable itching.

“When Elizabeth developed liver problems, we called in our liver disease experts,” Kalantar says. “We tailored treatment to her unique needs, using all our expertise and resources to deal with each setback.”

Hill braved all the complications, risks and discomfort, having faith that her baby would be healthy. Her determination paid off.

Baby Audrey was born in November 2012, just four weeks short of full-term. “It was the most unbelievable feeling in the world,” recalls Hill. “Dr. Major kept telling me, ‘We did it. She’s perfect.’”

Hill is back on dialysis three days a week, and mom and baby are thriving, thanks to Hill’s extraordinary strength and determination, her faith, her husband, Sean, and her UC Irvine Health doctors.

“Elizabeth is an amazing woman and mother,” says Major. “She was told she would never get pregnant, yet she got the proper care and had a completely successful pregnancy. Her story is a source of hope for other women who are facing the same challenges.”

To learn more about kidney disease and dialysis services, visit ucirvinehealth.org/dialysis. For more information about high-risk pregnancy care, visit ucirvinehealth.org/high-risk or call (714) 456-2911.

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