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Bianca Chavarria was 28 weeks pregnant with her second child when something didn’t feel right. She felt extreme pressure and an unusual pain in her abdomen, something she hadn’t experienced during her first pregnancy. A sonogram showed an unusual pattern of blood vessels in her placenta.
Her OB-GYN knew Bianca, 21, had placenta previa, a condition that could result in the placenta blocking the baby’s path during delivery. While the doctor told her the condition would probably disappear before the baby arrived, Bianca wanted greater reassurance.
“They couldn’t explain what was happening, so I just Googled it,” she recalled. “That’s when I found placenta accreta.”
What makes placenta accreta so dangerous?
Placenta accreta is a serious and increasingly common condition affecting as many as 1 in 272 pregnancies. Studies estimate a maternal death rate as high as 7%.
Dr. Patrick Ramsey, maternal fetal medicine specialist and vice chair of obstetrics at University Health and UT Health San Antonio, said that during a normal pregnancy the placenta attaches like Velcro to the side of the uterus, and detaches during delivery. With placenta accreta it digs deeper than normal into the uterus and does not separate from the uterus during delivery. That can lead to catastrophic bleeding, and in the worst cases, death.
“It’s like peeling off a scab and it just keeps bleeding, bleeding, bleeding,” explained Ramsey. “You have to be ready to manage that patient including preparing for a hysterectomy, and most importantly, transfusion.”
Risk factors and the need for blood
Following her online Google searches and conversations, Bianca approached her OB-GYN with her suspicions. She had two of the most common risk factors linked to placenta accreta: placenta previa and a previous Cesarean birth.
Her OB-GYN told her that if she had placenta accreta the hospital where she was planning to deliver would not have enough blood to treat her. So, the doctor referred her to University Hospital, home to South Texas’ only civilian Level I trauma center. It maintains a large supply of blood to treat mass casualties and serious, life-threatening injuries. It also operates its own blood bank and is a leading center for the development of whole blood which has proven to more quickly stop excessive bleeding than individual blood components like red blood cells or plasma.
While many hospitals do not have a constant supply of whole blood, its 24/7 availability at University Hospital has become an essential element in strengthening a placenta accreta program that can successfully respond to emergency deliveries where women have massive bleeding.
Launching the program
The event that launched University Health’s first-of-its-kind placenta accreta program dates back to 2012 when Gina Walker began bleeding uncontrollably during and after the Caesarean section birth of her daughter. She was losing blood so rapidly that an emergency call went out to all hospital staff to rush to the blood bank and donate. It took more than 33 gallons of blood during a 24-hour period to save Walker’s life — an unheard-of amount.
An alarmed resident in training was watching and decided more targeted prevention and care was needed.
“It made me say, ‘Can we do this better?’” recalled Dr. Kayla Ireland, now chief of maternal fetal medicine with University Health and UT Health San Antonio. “It inspired me to help coordinate our team.”
A network of specialists
The team organized by Ireland and others in 2015 has grown into a vast network of specialists who contribute to a patient’s prenatal care and delivery. It includes labor and delivery nurses, a blood bank team, OB-GYNs, maternal fetal medicine physicians, gynecology oncologists, trauma doctors, radiologists, anesthesiologists, neonatologists, urologists and pathologists. More than 140 medical professionals are invited to join a meeting twice a month to plan for the risky deliveries.
It was members of that team that quickly evaluated Bianca at University Health.
“She had one of the most severe forms of placenta accreta spectrum disorder,” said Ireland, also director of the placenta accreta program. “Her placenta was growing all the way through her uterus and touching the back of her bladder, which significantly increases the amount of bleeding.”
She said Bianca was at increased risk for serious complications or death at the time of delivery.
A case study for managing placenta accreta
Bianca was an hour’s drive from the hospital when her water broke early and she began to bleed.
“They tell you right before you go in to say goodbye to your loved ones. And that is scary. But I felt very safe with the team,” Bianca said.
Her team was ready with an ample supply of whole blood and a surgical team that would perform a hysterectomy and remove Bianca’s uterus following her son’s birth.
“She lost about five liters of blood, which is almost the entire blood volume of a pregnant woman,” said Ireland. “We were able to replace that and appropriately best take care of her.”
Developing a model program
The success of University Health’s program has led to the team advising other maternity centers and helping the State of Texas draft guidelines for treating placenta accreta patients.
In 2021, Ramsey chaired a subcommittee of the Texas Perinatal Advisory Council that helped draft requirements for Texas hospitals providing maternal care. Now all hospitals must be prepared to manage placenta accreta and have protocols for screening and referring patients to properly equipped centers when they are not able to safely deliver their babies.
At University Health, the team’s approach and its use of whole blood has led to fewer women being admitted to the ICU, a reduction in the amount of blood needed and surgical techniques that improve outcomes.
Most importantly, all of the 170 women treated during the past five years have survived their life-threatening deliveries and experienced fewer complications.
Bianca’s message
Bianca’s son, Daven Martin, is now a healthy four-year-old. She credits her dedicated placenta accreta team for their survival.
“I believe that if I hadn’t come to University Health, I wouldn’t be here today and neither would my son,” she said.
She urges other women to learn about pregnancy risks and to question their OB-GYNs about placenta accreta if they’ve had a previous Cesarean section.
“Be your own advocate,” she said. “Get a second opinion.”
To learn more about specialized care for placenta accreta contact the maternal-fetal team at University Health Women’s & Children’s Hospital.
