When Abigail’s mum went for her 20 week mid-pregnancy scan in December 2009, it showed that Abigail was extremely small and was not growing in the womb. Abigail’s mum also had high blood pressure. She was transferred by ambulance to UCLH to see the doctors in the Fetal Medicine Unit. After doing a detailed ultrasound scan of Abigail they diagnosed severe early onset Fetal Growth Restriction. There were not enough nutrients and oxygen going across the placenta to Abigail so she was not growing properly.
The doctors explained that both Abigail and her mum would need regular monitoring. They also said that there was no treatment available to improve Abigail’s growth. Although Abigail was struggling to grow she was still far too small and too premature to survive outside of the womb. The aim was for Abigail to grow inside the womb for at least another 6-8 weeks, by which time she would hopefully weigh 600g or more. At this weight and age there was some hope that Abigail might survive.
Abigail’s mum attended the UCLH Fetal Medicine Unit every 1-2 weeks, having regular ultrasound scans and checks. Abigail continued to grow very slowly, growing less between each scan. On 21st February 2009, when Abigail’s mum was exactly 28 weeks, she went for one of her regular appointments at UCLH. The ultrasound scan showed that Abigail was becoming stressed in the womb, and that she needed to be born urgently otherwise she would suffer permanent damage.
When Abigail’s mum was put on the fetal heart monitor (CTG) it showed that Abigail was distressed and she was delivered by emergency Caesarean section that evening. She weighed just 665g. The average weight of a baby at 28 weeks weighs about 1100g. Abigail was transferred immediately to the Neonatal Intensive Care Unit at UCLH. She needed a tube to help her breathe, drips to give her fluid and medication and an incubator to help her stay warm.
Because she was so small and so premature Abigail faced many challenges. Her lungs were not as developed as a full term baby or even a normally grown preterm baby of 28 weeks, so she struggled with her breathing. This was made even harder because she also had a condition called patent ductus arteriosus (PDA). The ductus arteriosus is a blood vessel which lets most of the blood bypass the lungs while the baby is in the womb, because oxygen is not coming from the lungs but from the umbilical cord. Normally after babies are born and start to breathe it closes, partly because of the higher oxygen levels in their lungs.
Premature babies who have a PDA, like Abigail, face a vicious cycle. Because they struggle to breathe, their oxygen levels are low, which means the ductus doesn’t close, so blood bypasses the lungs and even less oxygen gets into the blood. This means they have to work even harder to breathe. Because she was so small Abigail had very few stores of fat and sugars to provide energy to help her manage with the PDA.');
Even so Abigail struggled through. She needed emergency resuscitation when she was a week old and again when she was four and a half months, which were very difficult times for her and her family. At 3 months old she had to go to Great Ormond Street for surgery to repair a hernia, another complication of being born prematurely. Still she continued to grow and develop and by the time she was 10 months old she was feeding from a bottle and her family were making plans to take her home.
Because she still had problems with her breathing Abigail again went to Great Ormond Street for surgery to insert a tracheostomy: a tube placed into her windpipe to help her breathe better. After she came back to her local hospital she became unwell and developed a high temperature. The doctors treated her with antibiotics but her condition deteriorated and she began to have seizures. Abigail’s health continued to worsen over the next few days and finally her heart stopped beating. This time the doctors were unable to resuscitate her and Abigail died at just 10 ½ months old.
Abigail will always be missed and remembered by her family but her struggle, and that of many other babies, has been an inspiration to the EVERREST project.