Marlene Dominguez-Hicks was less than two weeks away from her due date.
The 33-year-old doctor and her family had recently moved to Houston from California for her to do a radiology fellowship at the University of Texas Health Science Center.
But at 38 weeks pregnant, Marlene collapsed at the home she shared with her husband Alexander and their two girls, Alyssa, five, and Alana, one.
By the time she arrived at the hospital, Marlene was dead from peripartum cardiomyopathy – an uncommon form of heart failure that can hit some women during the last month of pregnancy.
The baby was delivered via emergency C-section, but had been without oxygen for too long. There was no brain stem activity.
Tragic: Marlene Dominguez-Hicks, 33, (pictured with husband Alexander and daughters Alana and Alyssa) collapsed at her home in Houston due to an undiagnosed heart condition PPCM
The condition know as PPCM can occur up to five months after giving birth, according to the American Heart Association.
It weakens and enlarges the heart chambers until, in the most serious cases, the left ventricle can no longer pump enough blood to vital organs.
PPCM is relatively rare in the United States with about 1,000 to 1,300 women developing the condition each year. Most mothers with the disease fully recover, but it kills between six and 10 percent.
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Doctors are trying to figure out what causes it.
Dr Lili Ayala Barouch, an associate professor of medicine at Johns Hopkins University, said: ‘It happens in women who are young and healthy during what is supposed to be a happy time in their lives.’
Physicians say one of PPCM’s biggest dangers is that the symptoms are deceptively similar to ordinary third-trimester problems such as fatigue, swollen ankles and shortness of breath.
Marlene (pictured here with Alexander) did not have most of the risk factors for PPCM. She wasn’t obese, didn’t drink or smoke, and wasn’t of African American descent – all key factors
Marlene’s only symptom off PPCM was the fact that she’d had multiple pregnancies. The California native already had two healthy daughters: Alyssa, five, and Alana, one
Alexander told the Houston Chronicle that Marlene never mentioned any symptoms if she felt them. In fact, just a few days before her collapse, she had run up the stairs after stealing a cookie from her husband.
He recalled jokingly shouting up to her: ‘Girl, you just ran up the stairs!’
‘Yeah, I feel great,’ Marlene replied.
Marlene had been going to all her prenatal appointments and she didn’t meet any of the American Heart Association’s risk factors. She wasn’t obese and didn’t smoke or drink. There was no history of cardiac disorders in her family and she was not African-American.
She did, however, meet one of the risk factors: multiple pregnancies
The couple’s oldest daughter, Alyssa, was born during Marlene’s last year of medical school.
The pregnancy was rough. Marlene experienced first-trimester nausea and a long labor. The second pregnancy with their daughter Alana was much easier.
Alexander said that not long after their second daughter was born, Marlene wanted to try again – for a boy.
After the couple moved to Houston for her fellowship, they found out she was pregnant again. This time it was a boy, whom they had planned to name Alexander Jr.
Texas leads the nation in maternal mortality rates.
The number has climbed from 18.6 deaths per 100,000 live births in 2010 to 35.8 deaths per 100,000 in 2014, according to a recent study in the medical journal Obstetrics and Gynecology.
Dr Barouch from Johns Hopkins says there is no singular test that diagnoses PPCM.
Besides an echocardiogram, which is required for diagnosis, she says the main symptoms to watch out for are rapidly worsening swelling in the feet or an unusual amount of shortness of breath, when lying down in particular.
‘It’s beyond just uncomfortable. You can’t perform normal functions,’ she added.
When diagnosed early, the recovery rate from PPCM is high. At least 50 percent of patients have a complete recovery.
Another 20 to 30 percent will have a partial recovery.
The remainder need heart transplants or don’t make it.
Alexander says its likely his wife felt something and brushed it off, as she was always diagnosing herself.
Alexander said that his wife didn’t have any symptoms. PPCM’s symptoms are deceptively similar to ordinary third-trimester problems like fatigue, swollen ankles or shortness of breath
Researchers are studying if there is a genetic link to PPCM. Alexander says he’s determined to know what caused Marlene’s heart failure to prevent it from happening to his daughters
He and his daughters, in the next month, will be moving to Michigan to be closer to family.
The Meharry Medical College School of Medicine, of which Marlene was a graduate, has created a GoFundMe account on behalf of the family to help raise funds for their immediate and long-term needs.
Researchers are currently trying to figure out if there is a genetic component to PPCM.
And before Alexander leaves, he’s determined to better understand what killed Marlene and their son so he can prevent it from happening to his daughters.
‘I need to know, for them,’ he said.