Risky business

The most common cause of maternal death is hemorrhage. Massive bleeding which is uncontrollable and often times the severity of which goes unrecognized until it is too late. I had a close call recently with a situation where the bleeding was uncontrollable.

The patient had a condition call placenta increta. The placenta grew through her old Cesarean section scar. The odds of this increase with the age of the mother and the number of C-sections. In her cause these numbers were 23 and 1. That's right. She is twenty three years old and she has had one other pregnancy, a now two year old.

The other terrible part of this case history is the baby. She has a cardiac abnormality. That fact and the placental problem put both mother and baby at high risk which is why she was transferred to a major medical center for delivery.

Outcomes: The mother lost her uterus. While better than losing her life, a hysterectomy was not the outcome I had hoped for going in to the C-section. Realizing the baby may not live caused me to delay longer trying conservative measures before I began the hysterectomy. This resulted in enough blood loss to warrant the transfusion of several units of blood and blood products.

The baby is very sick. One surgery has been done and another is planned. I know one baby cannot replace another but thoughts of harvesting eggs and IVF with a surrogate donor have already crossed my mind. At best this couple has a long road of treatment for this baby's heart defects.

This is the type of scenario I think of when someone says to me, "Delivering babies, what a wonderful job!" I would agree. I have a wonderful job but most of the people who say that have no idea how dangerous pregnancy can be.