When Sarah Blackwell had her second sonogram at 20 weeks, her ultrasonographer Maxine Aguilar, spotted a tiny irregularity — a miniscule spot on the baby’s neck — a cystic hygroma.

“It was something to be very concerned about,” says Garrett Blackwell, Sarah’s husband. “We were really scared. We learned that in 60 percent of the cases where something like this is pinpointed, the baby will have a chromosomal abnormality.”

Sarah and Garrett were devastated by the news. Sarah went through amniocentesis at UTMB. The couple waited for the results. Garrett said he tried to remain strong and calm throughout the whole ordeal so he could be a comfort and support to his wife.

“But secretly I would go to the garage and cry,” he said.

The amniocentesis showed the baby did not have a chromosomal disorder. Everyone breathed a sigh of relief. All that could be done then was watch and wait. Sarah had weekly sonograms at the UTMB Women’s Specialty Care Clinic at Bay Colony. She and Aguilar became dear friends as they watched the growth on the baby’s neck swell to enormous proportions week after week on the ultrasound screen.

“Sarah was always so calm and collected during this whole ordeal,” said Aguilar. “She and Garrett did so much research. They understood all the risks and everything that could happen and they just dealt with all of it quietly as everyone on their UTMB team watched the case carefully and kept the couple abreast of what needed to happen next.”

When Sarah learned that because of the massive size of her baby’s neck malformation, the baby would have to be delivered by EXIT c-section and she was petrified.

In an EXIT (Ex-Utero Intra Partum) Procedure c-section, the baby is only partially removed from the mother’s body so that it can remain attached by placenta and umbilical cord while the doctors perform surgery on the baby to open an obstructed airway. Surgeries of 30 minutes to one hour can be performed while the infant continues to receive oxygen from its attachment to the mother. But it’s a difficult procedure with many risks to the mother.

On Friday, April 20 at 10:47 p.m., baby Lola Blackwell was delivered using the EXIT method. There were some 30 physicians, nurses and technicians in the UTMB operating room. OB/Gyn Dr. Perry Fulcher performed the Cesarean section. Maternal/Fetal specialist Dr. Mary Munn assisted with ultrasound.

UTMB Drs. Russell, Gleinser, Patton, Pine, Coughlin, Venkatesan and Pernas, comprised the ENT team that opened Lola's airway.

Pediatric Ear, Nose and Throat specialist Dr. Harold Pine performed the procedure to open Lola’s airway. Pine’s team of seven resident physicians was close by. Dr.  Jeffrey Richards did anesthesia for Sarah. Dr. Joaquin Cortiella was the anesthesiologist for baby Lola. Dr. Joan Richardson, chairwoman of UTMB’s department of pediatrics, along with her neonatology fellow, was there to attend to the baby immediately upon its birth. Many other physicians were in the operating room for support and others were outside the OR doors in case they were needed.

By 5 a.m. Saturday, mother and baby were resting peacefully and Garrett was able to visit his daughter for the first time in UTMB’s neonatal intensive care unit. The lymphatic malformation on her neck was as large as her head.

“To me, I didn’t even see it. She was so beautiful and I was so grateful that she was breathing and that Sarah was OK,” said Garrett.

On Wednesday, April 25, UTMB’s Chief of Pediatric Surgery, Dr. Ravi Radhakrishnan, successfully removed the 10.5cm x 11cm neck mass, carefully separating it from the major nerves and vessels in the neck. Lola is still in UTMB’s NICU recovering. She’ll probably go home within the next two weeks. 

While there could have been a host of problems with the removal of a mass that size, the surgery went very well.  She is currently off the ventilator and breathing on her own.Her parents have been right there by her side every moment.

“We’ve done nothing but pray,” said Sarah, “and we couldn’t be happier right now.”