Unlike many women with placenta accreta who hear the term for the first time when they are diagnosed, I had been warned by my OB that my history of three prior C-sections put me at risk for this condition. Placenta accreta is a serious pregnancy complication where the placenta abnormally attaches to the uterine lining. There are three gradations of abnormal attachment, ranging from accreta (placenta attaches to the uterine lining), increta (placenta invades at least halfway through the uterine wall) to percreta (placenta grows through the uterine wall and often into nearby tissues, like the bladder). Women with placenta accreta are at risk for massive, life-threatening hemorrhage during delivery. According to the American College of Obstetricians and Gynecologists, maternal death occurs in 7 percent of accreta cases (with higher rates for increta and percreta), and may occur despite optimal management and surgical care.
When my OB warned me about the risk of accreta, I thought he was being alarmist. I pulled the latest literature from PubMed and, upon review, concluded my overall risk – after three prior cesareans – was somewhere between 2 and 4 percent. I felt the odds were well in my favor and by September 2015 I was pregnant. In November, we were thrilled to find out we were expecting a girl. With two boys and one girl at home, we felt our family would be complete with the new arrival.
Unfortunately, in December, during a routine ultrasound, I was diagnosed with placenta previa and likely placenta accreta. So much for the 2 to 4 percent! Well, I was no longer in the habit of taking small probabilities lightly, and the possibility of serious morbidity and mortality now seemed quite real. The next few months were spent on bedrest, as I was reading every PubMed article on placenta accreta I could put my hands on. At the same time, I went in for countless ultrasounds and “second” opinions with different doctors. By February, both ultrasounds and an MRI strongly suggested at least a focal increta.
Given that the medical literature often refers to accreta as a growing “epidemic,” I was stunned by how little actual experience most physicians had with this condition. At the large NYC hospital where I was receiving my prenatal care, they saw only about five accreta cases per year. Given the unpredictability of the actual diagnosis until the time of delivery, I felt an accreta center that handles a large volume of accreta cases was the safest place to be. In my reading, I noticed much of the literature on placenta accreta generally, and techniques for minimizing blood loss during accreta deliveries specifically, was being published by Dr. Michael Belfort’s accreta team at Texas Children’s Pavilion for Women. With hundreds of accreta deliveries under its belt (including some of the most challenging percretas), this team was constantly refining its approach to these cases. After talking to Dr. Belfort on the phone, I felt confident that Texas Children’s was the best place for me and my unborn baby. I also felt a sense of calm that I hadn’t experienced in months.
At 33 weeks, my husband and I flew to Houston, leaving our three children with grandparents in New York. My surgery was scheduled for 36 weeks, so we spent two-and-a-half weeks at a hotel next to Texas Children’s. During this time I went in for regular non-stress tests and met with members of the accreta team who would be present at my surgery. Everyone I met was fantastic! I was so impressed with the “system” in place for dealing with accreta cases – a system comforting in its predictability and precision, while still allowing for an individualized approach based on the patient’s symptoms and wishes.
On the morning of my scheduled admission to the hospital (three days prior to my surgery), I started having contractions. I hoped they were temporary Braxton-Hicks contractions, but they did not subside and the decision was made to deliver that evening. Although I have never been more nervous in my life, I felt comforted by the fact that I was in the best possible hands. I met with members of the urology, neonatology and anesthesiology teams before being wheeled into the OR. Seeing some 25 people there, prepared for my surgery, was daunting to say the least. Well, as it turned out all the preparations were not for naught because I actually had a placenta percreta that had invaded my bladder. Thanks to the skill of the accreta team, my surgery was a remarkable success. Unbelievably, I did not even need a blood transfusion. This is almost unheard of in percreta cases! I was discharged on the fourth post-operative day and my daughter spent nine days in the NICU. The same day they told us she was ready for discharge, we flew back to New York as we could not wait to see our other kids.
Today, my daughter is almost 4 months old and is doing great. The road to recovery for me was definitely more difficult than my other C-sections, but I have fully recovered and feel like my old self again. I am forever grateful to the extraordinary team of doctors at Texas Children’s who made this wonderful result possible for both of us, and especially to Dr. Belfort, Dr. Fox, Dr. Ivey and Dr. Diaz-Arrastia. I am equally thankful for the terrific team of nurses who have so caringly and compassionately helped me and my daughter every step of the way during our stay at Texas Children’s. Thanks to Texas Children’s, we will always fondly remember our time in Houston and our little Texan will have quite a story to tell about the journey to her birth and its very happy ending.