Patient Story
From ICU to the Delivery Room: How Innovative AVM Surgery Saved a Pregnant Mother
At 26 weeks pregnant, Melanie Hart suffered a ruptured brain arteriovenous malformation. What followed was a carefully coordinated treatment plan, a difficult recovery—and the safe arrival of her baby girl.
The night everything changed
At 26 weeks pregnant, Melanie knew something was wrong
The fall of 2024 was going well for Melanie Hart. She loved teaching third grade and life at home with her husband, their energetic preschooler and another daughter on the way.
Then, after attending a school function and going to bed as usual, Melanie woke in the middle of the night knowing something was different.
Her left side felt heavy and frozen. Her arm and leg no longer felt like part of her body, and her head throbbed unlike anything she had experienced before. Melanie slid to the floor as her husband called 911.
The diagnosis
A ruptured arteriovenous malformation
Emergency imaging at Overlook Medical Center revealed bleeding in Melanie’s brain caused by a ruptured arteriovenous malformation, or AVM. Although she had likely been born with the AVM, the physical stress of pregnancy may have contributed to its rupture.
Facing the unknown
One patient. Two lives. A carefully coordinated plan.
In the days after the rupture, Melanie drifted in and out of awareness while her family gathered at her bedside. They were frightened for Melanie, her unborn baby and the future they had imagined.
Kyle T. Chapple, MD, an Atlantic Brain and Spine neurosurgeon with expertise in both open and endovascular surgery, met with the family and explained how the team could treat the AVM while managing the added risks of pregnancy.
Dr. Chapple’s approach immediately gave our family confidence. Everyone thought he was personable and knowledgeable.Melanie’s family
The team’s immediate priorities
Stabilize Melanie
Relieve the dangerous pressure caused by bleeding in the brain and prevent additional neurological injury.
Treat the ruptured AVM
Address the abnormal blood vessels responsible for the bleed and reduce the risk of another rupture.
Protect Melanie’s pregnancy
Coordinate neurosurgical, critical-care and maternal-fetal care around the needs of both Melanie and her unborn baby.
If complications required the baby to be delivered early, the plan included transfer to the neonatal intensive care unit at Morristown Medical Center while Melanie continued recovering at Overlook.
A novel procedure with promising results
Two techniques. One coordinated operation.
Dr. Chapple’s training in both endovascular and open neurosurgery allowed him to perform each part of Melanie’s treatment as one carefully planned procedure.
Endovascular embolization
Reduce blood flow to the AVM
Dr. Chapple first navigated a catheter through Melanie’s blood vessels and delivered embolic material to block abnormal vessels feeding the malformation.
Open neurosurgery
Remove the AVM and relieve pressure
He then performed a craniotomy to remove the malformation and evacuate the blood clot, relieving dangerous pressure on Melanie’s brain and reducing the risk of another bleed.
The turning point
The procedure went smoothly
The bleeding was treated, pressure on Melanie’s brain was relieved and her pregnancy remained stable. But the work of recovery was only beginning.
“Hi, my name is Melanie. I’m the patient and I’m here for surgery.” Melanie, introducing herself to the surgical team
The long road to recovery
Recovery came one small victory at a time
Surgery had treated the immediate danger, but Melanie still had to relearn how to use the left side of her body. She spent two weeks in the intensive care unit at Overlook before beginning rehabilitation.
At first, she could not stand or walk without assistance. Progress came gradually as Melanie worked to regain her balance, coordination and strength while her pregnancy continued.
“It felt like my leg wasn’t working in unison with the rest of my body. I had to consciously tell myself, ‘Okay, left foot, heel to toe.’”Melanie Hart
Regaining movement
Melanie worked to reconnect with the left side of her body and rebuild the movements that had once felt automatic.
Relearning to walk
Physical rehabilitation helped her rebuild balance, strength and coordination one deliberate step at a time.
Returning home
With support from her family and care team, Melanie was eventually able to return home and continue recovering.
Support beyond surgery
A familiar face throughout recovery
Lauren Eschuker, an advanced practice nurse at Atlantic Brain and Spine, visited Melanie daily to monitor her progress, answer questions and support her recovery.
Post-surgery milestones
Back home—and moving forward
In January, Melanie and her family welcomed a healthy baby girl, Kylie Charlotte. Dr. Chapple and Lauren joined the family to celebrate the arrival they had all worked so hard to make possible.
Nearly a year after the night that changed everything, Melanie reached another major milestone: returning to the third-grade classroom she loved.
Baby Kylie arrived
Melanie safely welcomed her second daughter.
Home with her family
She continued healing with Steve and both daughters beside her.
Back in the classroom
Melanie returned to teaching third grade.
I have nothing but gratitude and appreciation for everything Dr. Chapple and his team did. All the people surrounding me were angels.Melanie Hart
Recovery is still a process
Melanie continues to experience some light sensitivity, occasional brain fog and headaches. Her progress reflects both how far she has come and the ongoing work that can follow a serious brain injury.
Expertise when it matters most
Complex neurovascular care built around the patient
Melanie’s story shows why access to both endovascular and open cerebrovascular expertise matters. The right treatment is not one technique—it is the approach that best fits the patient and the situation.
Understand the condition
Learn more about brain AVMs
Explore how arteriovenous malformations develop, how they are diagnosed and the treatment options that may be considered.
Explore AVMsMeet the surgeon
Kyle T. Chapple, MD
Meet the cerebrovascular and neurointerventional specialist who directed Melanie’s surgical care.
View Dr. Chapple’s profileExplore the program
Advanced neurovascular care
Learn how ABS specialists combine open surgery, embolization and other advanced approaches for complex vascular conditions.
Visit ABS NeurovascularYour next step
Talk with a neurovascular specialist
If you have been diagnosed with an AVM, experienced a brain bleed or want another opinion about your treatment options, our team can review your situation and help you understand what comes next.
