It’s 10 a.m. on a Tuesday morning in a hospital conference room, and this not your average birthday planning committee. Here’s the invitation list for the multidisciplinary meeting to plan this Cesarean section:
- Maternal Fetal Medicine (that’s me), the high-risk obstetrics team
- Gynecologic oncology as the premier surgeons of the female pelvis, because we’re planning on performing a hysterectomy immediately after delivering the baby.
- Interventional radiology, because often we will do a small procedure to temporarily block blood flow to the uterus right before the surgery starts.
- Urology, because the bladder is right next to the uterus, and in this case, right next to the placenta, and may become damaged in the course of the surgery.
- Neonatal intensive care, because we are going to need to deliver this baby early in order to minimize the risks to the mother, and so the baby will be going to the NICU.
- Blood bank, because even with all of the above, we usually need to transfuse enormous amounts of blood products to keep the patient alive.
- Anesthesiology, because they’re in charge of keeping the mom and fetus alive during the surgery.
- Nursing, because they need to know everything we plan on doing, and they need to make sure we have the equipment and manpower to do it.
- Critical care, because these patients almost always need an intensive care unit bed after their surgery.
By the end of the list, it’s a pretty big birthday party. But this is not a normal pregnancy, and not a normal delivery. This patient has a placenta that has grown abnormally, called a placenta accreta. Unless we plan this surgery very carefully, this pregnancy could kill her.
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Placentas are, for the most part, simply amazing. They’re one of the first parts of the pregnancy to form—a whole organ that humans make simply for the purpose of nourishing a new human. The placenta lands in the uterus, and grows downward and outward. Complicated structural and immune changes of pregnancy allow the woman’s body to tolerate what, in other circumstances, we would probably perceive as a parasitic invasion.