Diagnosed in Her Third Trimester, Expectant Mom Required Urgent Delivery

By Susan J. White

The juxtaposition of joy and fear that Ashley Conley felt at once was overpowering. On a fateful February afternoon, she gave birth to a healthy baby girl—and started chemotherapy for a rare and aggressive leukemia.

“It’s kind of a blessing this happened while I was pregnant,” said Conley, of Cary, who has three other children. “I credit the baby with saving my life and me getting help quicker.”

A Sign of Something Wrong

Conley was 32 weeks pregnant when she experienced unusual bruising and nose bleeds. She initially assumed she had low iron, but when her gums began to bleed, she and her husband, Kurt, knew her symptoms should be evaluated. It was a Sunday evening when she had her blood drawn.

Early the next morning, Conley received a call urging her to get to NorthShore Evanston Hospital immediately. Within minutes of her arrival, NorthShore Hematologist-Oncologist Amy Wang, MD, shared the devastating news that Conley had acute promyelocytic leukemia (APL) and that her baby would have to be delivered as soon as possible. NorthShore’s Maternal-Fetal Medicine (MFM) physicians assured her that, though premature, her infant should do well via care in NorthShore’s Infant Special Care Unit.

“Hours matter at this point,” Conley recalled being told as a comprehensive team of oncologists, MFM and critical care specialists began carefully planning her complex treatment and the safe delivery of her baby. Conley’s life-threatening condition put her at risk of severe bleeding and clotting complications while giving birth.

“The good news with APL is that it’s highly curable if we get patients over the hump in the first month or two, when mortality is highest,” said Dr. Wang.

Springing into Action

Conley was given blood products to increase her platelet levels before delivery, and also received her first dose of all-trans retinoic acid (ATRA), an oral medication to treat APL.

But her platelet levels continued to drop, and her care team knew they had to move fast, transferring her to the Intensive Care Unit and preparing for induction and delivery in that unlikely location.

A team of about 30 clinicians—physicians, nurses and anesthesiologists—expertly managed Conley’s care during hours of labor and acute blood loss until she delivered a healthy baby girl. Baby Harlow Rose was quickly whisked away to the Infant Special Care Unit. Within an hour of giving birth, Conley was given her first intravenous chemotherapy treatment.

Erin Tran, MD, an MFM specialist who cared for Ashley and delivered Harlow, said she was optimistic the baby would do well given Ashley’s previously uncomplicated prenatal course, the relatively advanced gestational age, and reassuring fetal monitoring during labor.

In reflecting on the rare case, Dr. Tran said Conley “is a patient I will never forget.”

Critical Care Specialist Todd Dodick MD, said it was clear that the safest place for Conley to deliver would be in the Intensive Care Unit.

“Everybody came together and did whatever it took to ensure a healthy delivery for the mom and baby,” he said.

Road to Recovery

Conley was hospitalized for a month to continue receiving chemotherapy that thankfully put her leukemia in remission. She continues to receive outpatient treatment under Dr. Wang’s direction to keep the APL in remission long enough to be cured.

“My boys are so excited to have a little sister and I’m so thankful for everything,” Conley said. “I couldn’t have had a better care team.”

Proactive, Personalized Care

To learn more about NorthShore’s Maternal Fetal Medicine department. https://www.northshore.org/personalized-medicine/our-services/clinical-expertise/maternal-fetal-medicine/

MFM webpage