Lindsey Gillespie, a Dallas nurse and mom of three young boys, was expecting a routine pregnancy to deliver her fourth child. But during a scheduled ultrasound to determine the gender of the baby, the nurse noticed something odd. After being fully evaluated, doctors suspected placenta percreta, the rarest and most severe form of placenta accreta. When Lindsey could not find a group who routinely treated cases like hers in the Dallas/Ft. Worth area, she eventually transferred her care to Texas Children’s Pavilion for Women in Houston.
And she’s not the only one. The Pavilion for Women has the largest and busiest program in the country for this condition, treating more than 60 cases in the last three years.
“What’s unique to others has now become routine to us,” said Dr. Michael A. Belfort, OB/GYN-in-Chief at Texas Children’s Pavilion for Women. “That strengthens the case for having this type of surgery done by a team that does it all the time and knows how to do it.”
Placenta percreta, the rarest and most severe form of placenta accreta, is a potentially life-threatening condition that can affect any neighboring uterine structure. Placenta percreta (5 percent of all placenta accreta cases) happens when the placenta grows entirely through the uterine wall and attaches to another organ like the bladder. When it involves the urinary bladder, a multidisciplinary approach utilizing a team of physicians and surgeons representing urology, radiology, and obstetrics/gynecology is the key to successful management. Moms who have had previous cesarean deliveries are at an increased risk to developing the condition.
According to the American College of Obstetricians and Gynecologists, in the 1980s placenta accreta affected 1 in 4,000 pregnancies. Today the rate has spiked, affecting 1 in 533 pregnancies – in large part due to the increased number of c-section deliveries.
This year alone, Belfort estimates that Texas Children’s Pavilion for Women will treat about 30-40 patients with placenta percreta, including Lindsey Gillespie. Five patients are currently awaiting surgery.
While Lindsey was at first nervous to leave her home and give birth in Houston, her husband reassured her she was making the right choice, saying “Wow, you couldn’t be at a better place. The hospital you are delivering at is connected to a children’s hospital, so if anything goes wrong it is right there. That is phenomenal!”
On March 14, Belfort led a team of physicians and neonatologists who performed an Indicated preterm Classical Cesarean section followed by Modified radical hysterectomy on Lindsey. She gave birth to a healthy baby girl and pulled through the surgeries without needing a blood transfusion. While the risks were high, Belfort and his staff were confident and well prepared, with a room full of high-risk physicians, neonatologists and a huge supply of blood, should she have needed a transfusion.
“The safest place to have this kind of surgery is in a place where they do it all the time, have a protocol, have a well equipped and practiced team and are comfortable with this issue,” said Belfort.