“I remember feeling a little bloated, even though I had been working out and eating well,” Anh recalls. “So, I took a pregnancy test, and that’s when I found out I was pregnant. I showed it to Timothy, and at first, he didn’t believe it! I took another test just to be sure. We were beyond excited.”
Early Pregnancy
Anh began seeing her OB/GYN, Sidra Yunas, MD, affiliated with Children’s Memorial Hermann Hospital. At first, the baby’s ultrasounds looked great, filling Anh and Timothy with excitement. But early in the pregnancy, that excitement took an unexpected turn.
At 13 weeks, Anh chose to undergo a Non-Invasive Prenatal Test (NIPT) to screen for genetic conditions. The results showed she was a carrier of Alpha Thalassemia Major, a serious hemoglobin disorder that could affect their baby’s health. When Timothy was tested, they learned he was also a carrier. Dr. Yunas explained there was a significant risk that Milan could inherit the condition.
“This news hit us hard,” Anh says. “But we tried to stay positive, praying that our baby would be like us—carrying the gene but not affected by the disease.” Following this, Dr. Yunas recommended that Anh see the team affiliated with The Fetal Center at Children’s Memorial Hermann Hospital for further evaluation.
Complications in the Pregnancy
Around 20 weeks, affiliated maternal-fetal medicine physicians at The Fetal Center noticed that Milan had an enlarged heart, a condition called cardiomegaly. “I was scared, but they reassured me her heart anatomy was normal and that sometimes babies with enlarged hearts grow into it,” Anh explains.
But at 28 weeks, things took a turn. The ultrasound monitoring revealed that Milan was accumulating fluid in her face and stomach, which was consistent with findings of fetal anemia. Anh was subsequently admitted to the Women’s Center at Children’s Memorial Hermann Hospital that night.
While in the hospital, Anh received a magnesium infusion to reduce the risk for adverse neurological outcomes for the baby, along with a steroid shot to boost lung development in case that delivery was required for fetal or maternal reasons. Following diagnostic fetal blood sampling, fetal blood was sent for hemoglobin electrophoresis analysis which confirmed that Milan had Alpha Thalassemia Major. The decision to proceed with fetal blood sampling came after the baby exhibited serious signs of anemia, had an enlarged heart and both parents were carriers.
In-Utero Treatment: Transfusing Hope for Baby Milan
Given the seriousness of Milan’s anemia, doctors decided to perform intrauterine blood transfusions to treat her while still in the womb.
“Intrauterine transfusion is the most effective in-utero treatment for Alpha Thalassemia Major,” said Jimmy Espinoza, MD, who was Anh’s primary fetal interventionalist at The Fetal Center during her pregnancy. “Treating this condition in utero is crucial because it helps prevent severe anemia and its complications, which can significantly impact the baby's growth and development. In this procedure, our team transfused healthy red blood cells directly into the fetus’s bloodstream through the umbilical vein.”
“Shortly after the intrauterine blood transfusions, the anemia symptoms started to clear up, and her lungs were developing,” said Anh. “It was amazing! She was even hiccupping, which was a great sign.”
Anh continued to have intrauterine infusions every three weeks until Milan was born. These intrauterine transfusions were performed by team of affiliated fetal intervention specialists at The Fetal Center, including Dr. Espinoza and Anthony Johnson, DO, co-director of The Fetal Center.
Milan’s birth
Despite the improvements, the journey to delivery was still filled with uncertainty.
Milan continued to be closely monitored through ultrasounds twice a week. “Her heart was still enlarged, but the doctors were hopeful it was something that could be managed after birth,” Anh remembers.
At 37 weeks, her doctors made the decision to induce labor because babies with Alpha Thalassemia Major can potentially develop more complications after 37 weeks in utero.
Milan was born on March 27, 2024, via emergency C-section due to signs of fetal deceleration. After Milan was transferred to the Level IV neonatal intensive care unit (NICU) at Children’s Memorial Hermann Hospital, Anh faced her own life-threatening health crisis.
A Mother’s Crisis: Anh’s Battle with Amniotic Fluid Embolism
Shortly after Milan’s birth, Anh experienced a rare and severe complication called an amniotic fluid embolism (AFE), a condition where amniotic fluid or fetal material enters the mother’s bloodstream, causing an extreme reaction. “I just remember waking up in the ICU with a foggy brain. They told me I must have had a seizure, and my heart had stopped as soon as they delivered Milan,” Anh shares. “They had to do CPR, and I was intubated. It was terrifying to learn that I had an amniotic fluid embolism.”
Anh woke up not knowing if Milan survived but the Labor and Delivery team placed a picture of Milan on her bedside table to reassure her.
Jerrie Refuerzo, MD, Director of the Maternal Care Program in The Fetal Center, performed Anh’s cesarean section and directed the management of care for her AFE. The Maternal Fetal Medicine specialists affiliated with Children’s Memorial Hermann Hospital are well-equipped to handle such life-threatening emergencies in high-risk pregnancies and deliveries. With a multidisciplinary team of specialists and access to advanced medical technology, the hospital is uniquely prepared to respond quickly to rare complications like AFE. Their specialized experience in maternal-fetal medicine, critical care, and neonatal care helps to provide comprehensive, lifesaving treatment for both mother and baby when every second counts.
AFE is a medical emergency that can lead to respiratory failure and cardiac arrest, as it did in Anh’s case. In addition to the embolism, Anh also suffered from disseminated intravascular coagulation (DIC), where the body’s clotting system goes into overdrive, causing both excessive clotting and severe bleeding. “I lost a lot of blood and needed transfusions. It was a scary time,” Anh recalls. She remained in the hospital for seven days after her emergency, gradually recovering with the help of the medical team.
"I was very weak and had trouble walking," said Anh. "The nurses helped me get out of bed so I could move around, but it was still hard for me to walk long distances. Dr. Refuerzo took care of my C-section incision and advised me not to drive for a month. I continue to see Dr. Refuerzo for my post-care."
Meanwhile, Milan was receiving the care she needed in the NICU. Though her anemia symptoms had improved before birth, she was still being closely monitored for her heart condition and development. She received three transfusions while in the NICU. Upon discharge, she no longer had an enlarged heart. “It was hard not being able to be with her right away,” Anh says, “but I knew she was in good hands.”
Milan spent 21 days in the hospital–seven days in the NICU and 14 days in the Intermediate Medical Unit (IMU) before she was ready to head home.
Anh and Milan Today
Today, both Anh and Milan are doing remarkably well. Milan, now 7 months old, continues to grow stronger each day, and Anh is regaining her strength after her ordeal. Reflecting on her experience, Anh is filled with gratitude for the team at Children’s Memorial Hermann Hospital.
"I don’t know how we would have gotten through this without them," she says. "They were with us every step of the way, from Milan’s transfusions and birth to my emergency medical situation after delivery. We’re so grateful for the care we received—from the nurses and doctors to the lactation consultant and all the other specialists involved. This is truly the best place for maternal care."
As part of her follow-up care, Milan has regular visits with Neethu Menon, MD, her affiliated pediatric hematologist, and receives blood transfusions every four to five weeks, with her hemoglobin levels, abnormal hemoglobin percentage and iron levels closely monitored at the Infusion Center at Children’s Memorial Hermann Hospital. The only way to cure Alpha Thalassemia is with a stem cell transplant, and the plan is to do it when she turns two, once her liver is fully mature.
Milan’s journey may have started with uncertainty, but with the support of her family and medical team, she continues to thrive. She loves to eat, talk, smile and play. She is very observant and is meeting all of her milestones.
As Anh reflects on her and her baby’s journey, she has a message for families facing similar challenges:
“Like our daughter Milan, I want people to know babies with Alpha Thalassemia Major can survive and defy the odds. There is hope out there; you have to hold on to it and trust your doctors. I am immensely grateful to the labor, delivery and maternal team for saving my life, allowing me to be a mom to Milan.”
Learn more about The Women’s Center, The Fetal Center, High-Risk Pregnancy Care, and NICU & Neonatal Care at Children’s Memorial Hermann Hospital.