05.04.12 A miracle in Texas
The news story about Gina, the woman in Texas who survived a horrific delivery that required a 35-gallon blood transfusion, is getting a lot of well-deserved attention this week. This young mother had a troubled pregnancy from the start. Pregnant for the third time (she and her husband have a blended family and this is their fifth child), Gina had first trimester bleeding she thought was a miscarriage. Instead, it turned out to be a blood clot behind her placenta and the pregnancy was safe. Month after month, however, she continued having problems. When she was finally wheeled into the operating room for a repeat C-section, her medical team expected complications, but didn’t expect that when she was finally wheeled back out, with a very fragile hold on her life, she would have had a hysterectomy and massive blood transfusions due to almost uncontrollable hemorrhaging. Her baby girl survived the delivery just fine.
Gina had placenta percreta. That means her placenta grew into and through her uterine wall and attached to her bladder. This led to the kind of delivery room nightmare that makes everyone thank his or her lucky stars that it doesn’t happen very often. Amanda French M.D., OB-GYN at Brigham and Women’s Hospital and Children’s Hospital in Boston says, “I read this story and got nauseous just thinking about it.” That’s because what happened to Gina in the O.R. can catch patients and health care teams by surprise, even when they’re prepared for the worst. This is the kind of medical crisis that kills some mothers, even in the best medical facilities. Fortunately, Gina’s situation happens rarely. Unfortunately, incidences of placental complications are on the rise.
In a normal pregnancy, the placenta attaches to the inside of the uterine wall with a web of blood vessels that connect mom’s blood supply to the baby’s. Sometimes, the placenta grows into the uterine wall. Depending on how deep the placenta goes into uterine tissue, the condition is called either placenta accreta, placenta increta or placenta percreta.
- Placenta accreta (which accounts for about 75 percent of cases) means the placenta attaches too deep, but doesn’t penetrate uterine muscle.
- Placenta increta (about 15 percent of cases) means the placenta grows into the uterine wall.
- The worst cases involve placenta percreta (5 percent of cases), where the placenta grows through the uterine wall and attaches to other abdominal organs, like the bladder. Apparently, that’s what happened to Gina.
Dr. French says, “Delivering a mother with placenta percreta is a scary mess. Even when we know that’s what we’ll be facing in a planned delivery, there’s huge risk for massive hemorrhage. Even if we have to do a hysterectomy to stop the bleeding, there’s placental tissue everywhere and it’s so highly vascularized it just bleeds and bleeds. It’s a nightmare.”
Placenta percreta only happens in 1 out of 2500 pregnancies, though the American College of Obstetricians and Gynecologists acknowledges that the incidence has increased 10-fold in the last 50 years. In 1950, placenta accreta only happened in about 1 in 30,000 cases.
Why the increase? Mostly, it’s because we’re doing more C-sections than ever before and more older mothers are having babies. Those are the biggest risk factors. In a relatively young or unscarred uterus (one that’s never been cut into for a C-section or other surgery), the inside uterine wall is smooth and makes the perfect surface for normal placental attachment. In a uterus that’s been cut into or is compromised by fibroids or other issues, the inside surface is lumpy, bumpy and scarred. If the placenta can’t attach evenly to scarred or bumpy tissue, it’ll go deeper to get the maximum ability to circulate blood.
How do you prevent having a problem like Gina’s? If this is your first baby, do what you can to avoid that first C-section. Stay healthy, keep your weight under control and avoid unnecessary inductions. If you’ve already had one C-section your chances for placental problems increases but not a whole lot.
Dr. French says, “It’s really difficult to diagnose placenta accreta and percreta, even with ultrasound or MRI. We know, however, that if a woman has had one C-section and she has placenta previa (where the placenta partially or fully covers the cervix) during her pregnancy, then her risk for accretta or percreta increases 3 percent. That risk rises significantly with each subsequent C-section and if she’s had five previous C-sections, her risk level rises 70 percent. Any health care provider who diagnoses placenta previa in a woman who has had previous C-sections had better be prepared for anything in the O.R. These women need to be delivered under very controlled circumstances at large urban hospitals with all services available like a large blood bank, tertiary care, intensive care…everything. This woman in the news is extremely lucky to have survived this.”
I always like to dial down the fear factor with stories like this, and it’s probably not going to happen to you. That’s why it’s all over the news—it’s rare. My hat is off to the medical team who saved her life. I’m thanking my lucky stars I wasn’t there when it happened. Like Dr. French, it makes me anxious just thinking about it.
Jeanne Faulkner, R.N., lives in Portland, Ore., with her husband and five children. Got a question for Jeanne? Email it to firstname.lastname@example.org and it may be answered in a future blog post.
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