SPRING 2011 - Baptist Health South Florida

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Doctors fix rare pregnancy problem
Dozens of doctors and nurses assisted at the birth of Lila Male at
Baptist Cardiac & Vascular Institute.
The most common cause
of maternal death during
childbirth is severe
bleeding. But doctors at
Baptist Cardiac & Vascular
Institute are using a relatively
new procedure —
inserting and inflating tiny
balloons in the arteries that
supply blood to the uterus
and placenta to decrease the
bleeding and potential hemorrhage
that can occur with
some pregnancy complications.
In this case, it was
placenta accreta.
On November 19, Katrina
Male, 27, became the
first patient to receive the
lifesaving treatment at Baptist
Cardiac & Vascular Institute. And her
daughter, Lila, was the first baby born in a
procedure room at the Institute rather
than the Family Birth Place at Baptist Hospital.
“An ultrasound showed that I had a
problem with the placenta,” Ms. Male said.
“I was amazed to learn about the technology
that was available so that my baby and
I would be safe and healthy.”
Ms. Male had the most dangerous, and
rarest, form of placenta accreta, called placenta
percreta. It occurs when the placenta
penetrates the uterine wall, sometimes
attaching to the bladder or other internal
organs, said Lucia Gaitan, M.D., her obstetrician.
The finding led Dr. Gaitan to interventional
radiologist Constantino Peña,
M.D., medical director of vascular imaging
at the Institute.
A multidisciplinary team pulled
together by the Labor and Delivery staff
consisted of anesthesiologists, interventional
radiologists, obstetricians, neonatologists,
a gynecological oncologist, urologist,
perinatologist, hematologist, and
blood bank, labor room, surgery and Institute
staff. They coordinated Ms. Male’s care
when she was 30 weeks into her pregnancy.
At 35 weeks, after some premature
contractions, doctors decided it was time
to deliver little Lila via C-section, and some
30 healthcare professionals gathered in the
procedure room.
“We threaded a small catheter through
the femoral artery in the leg, visualizing
our way using X-ray,” Dr. Peña said. “When
the catheter reached the proper place, we
inflated the small balloons, which blocked
the blood flow.”
The technology is the same that is used
during less-invasive treatments to open
blocked blood vessels throughout the
body. To open blood vessels, the balloons
are inflated to leave an open path for blood
flow. In this case, the balloons are left
inflated, to stop blood flow.
“This is such an exciting time in a
woman’s life, and it’s wonderful to know
that with advance planning and a team
PHOTO: BETH ANN ROBERTS, R.N.
approach that included
doctors and specialists who
don’t normally work together
we prevented a potentially
life-threatening situation,”
Dr. Peña said.
Dr. Gaitan performed a
C-section after the balloons
were inflated. Although the
balloon procedure alone
can be done under light
sedation, Ms. Male had general
anesthesia because, like
many women who have placenta
accreta, she required a
hysterectomy when her
daughter was born. In addition,
the placenta had
attached to the bladder,
which required repair.
“Even with the balloons, she lost eight
liters of blood,” said Dr. Gaitan. “We prefer
to avoid a hysterectomy, but in her case
we had no choice. Fortunately, we had an
amazing team, and baby and mom were
fine. They went home after nine days.”
Ms. Male said she had been told going
into the procedure that it was possible she
would need a hysterectomy. “My first
daughter, Leilani, was born in 2009,” she
said. “Even though I had thought about
trying for a boy, I was prepared and OK
with the hysterectomy.” There should be
no long-term health issues due to her
complications, but Ms. Male’s bladder is
still continuing to heal.
Doctors aren’t sure what causes placenta
accreta, but they believe scar tissue
from previous C-sections increases the
chances of developing the problem. Ms.
Male had a C-section when her first child
was born. A form of placenta accreta is
present in one in about 2,500 pregnancies,
according to the American Pregnancy
Association.
— Adrienne Sylver
16 RESOURCE