Katie Cochran remembers all the “what if’s” circling through her head during a harrowing 45-minute nighttime drive to the hospital. She was just 33 weeks into her third pregnancy and bleeding heavily. She kept feeling her stomach to make sure her baby was moving and kicking.
“It came out of absolutely nowhere,” she describes. “I was absolutely terrified. I didn’t know if my placenta had ruptured, because I had never experienced that type of bleeding. Never. It was awful.”
Cochran understood that a placenta rupture was a real possibility after being diagnosed with a rare condition called percreta where the placenta grows through the uterus and into other organs in the abdomen. “Mine actually went completely through my uterus and attached itself to my bladder,” she explains.
One in 14 women in the U.S. with placenta accreta or placenta percreta bled to death during childbirth in 2017, the last year national statistics are available. Overall pregnancy-related deaths have steadily risen in the U.S. since 1987 when the Centers for Disease Control and Prevention began tracking it. Now there are 17.3 deaths per 100,000 childbirths, a 240% increase over the last two decades. That’s about 700 women a year who die during childbirth or from complications afterwards.
In California — which has made a concerted effort to reduce the risks of childbirth and the conditions that increase the incidence of accreta or percreta — maternal mortality rates are much lower. And in the Fresno area, no mothers with this condition have died since Community Regional assembled a multi-specialty surgical team five years ago to handle such complex deliveries, says Pamela Emeney, medical director of University Obstetrics & Gynecology Center. She leads the effort and trains UCSF Fresno residents in these kinds of OB surgeries.
The accreta surgical team involves several specialists in case the placenta has reached vital organs. Dr. Emeney ticks off the list: “We have general surgery, radiology, anesthesia, interventional radiologists, colorectal surgeons, trauma surgeons, a urologist, NICU [neonatal intensive care], lactation specialists and social work.”
Having multiple specialties working together is the key to safer outcomes in such complex surgeries; it makes the procedure quicker as each expert steps in to do their part.