February 17, 2015

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Due to our success in treating the most severe cases of morbidly adherent placenta, Texas Children’s Pavilion for Women continues to attract numerous patients from across the country. With the rise of caesarean births in the U.S., this potentially life-threatening condition is becoming more common among pregnant women.

Morbidly adherent placenta – known as placenta accreta, increta or percreta, depending on the depth of uterine invasion – occurs when the placenta and its blood vessels grow deeply into the wall of the uterus and is unable to detach after childbirth. Women who have had prior caesarean sections (C-sections) or other uterine surgeries are more at risk for this pregnancy complication since the placenta latches on to the surgical scar too firmly. About 5 to 7 percent of women die due to massive hemorrhage.

“The number of women with morbidly adherent placenta that we care for is rapidly escalating as our outcomes continue to attract a growing number of referrals,” said Texas Children’s OB-GYN Chief Dr. Michael Belfort, a world-renowned placenta accreta expert and founder of the Morbidly Adherent Placenta Program at Baylor College of Medicine. “Our success is rooted in our ability to work as a team.”

Women with morbidly adherent placenta receive multidisciplinary care from a diverse group of specialists representing maternal-fetal medicine, gynecologic oncology, anesthesiology, urology, neonatology, radiology and blood bank services.

“Our multidisciplinary team works closely with the hospital’s blood bank to ensure adequate supply of blood products is available for surgery and to help manage transfusions,” said Texas Children’s Maternal-Fetal Medicine specialist Dr. Karin Fox. “We rely on our anesthesiology team to administer blood and draw labs to ensure electrolytes remain stable in addition to keeping the patient comfortable. Urologists provide expertise when the placenta embeds itself into the urinary system.”

The approach that gynecologic oncology surgeons use to remove uterine cancer inspired the technique used to treat placenta percreta since the abnormal placenta acts like a cancer invading the outside of where it is supposed to be growing.

“We take a wider approach when we perform a hysterectomy to reduce the potential for blood loss,” said Texas Children’s gynecologic oncologist and surgeon Dr. Concepcion Diaz-Arrastia. “We remove the uterus and cervix in a modified radical hysterectomy along with a small amount of the tissue that attaches the uterus to the pelvis as if it were cancerous.”

Khadajah Winchester credits the Pavilion for Women’s highly skilled team of physicians who meticulously prepared and planned for her emergency surgery. She was airlifted from a hospital in Alexandria, Louisiana to the Pavilion for Women.

Winchester – who had two previous caesarean deliveries – had placenta percreta where the placenta invaded part of her bladder. Physicians made an incision high on Winchester’s uterus to avoid touching her placenta. Despite minimal bleeding during the actual delivery of her 6-pound 7-ounce baby girl Brooklyn, Winchester began bleeding profusely from the numerous vessels that had fed her invasive placenta and required a 25-pint massive blood transfusion.

“I hardly had blood pumping through my veins and if I had not gone to the Pavilion for Women, I would have died,” Winchester said. “Hospitals in smaller communities don’t carry the large volume of blood that I needed to survive.”

The Pavilion for Women – world renowned for its comprehensive, multidisciplinary care and focus on high-risk pregnancies – has treated 27 cases of placenta accreta in the last 12 months.

“Patients with risk factors for placenta accreta should consult with specialists early – ideally by 24 to 28 weeks of pregnancy,” said Texas Children’s Maternal-Fetal specialist Dr. Alireza Shamshirsaz. “Early diagnosis prior to delivery is crucial to allow time for planning and preparation to enhance the best possible outcomes for mother and baby.”

Click here for more information about Baylor’s Morbidly Adherent Placenta Program at the Pavilion for Women.

February 10, 2015

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Living with pelvic health issues isn’t easy. Many women are too embarrassed to talk about it. Some simply don’t know where to turn, while others struggle to find a physician who will listen to them.

Texas Children’s Pavilion for Women is changing that, and the lives of our patients.

In partnership with Baylor College of Medicine Department of Obstetrics and Gynecology, Texas Children’s Pavilion for Women recently launched the Pelvic Health and Wellness Program to improve the quality of life for women suffering from pelvic disorders and sexual dysfunction.

While incontinence, overactive bladder, pelvic organ prolapse and low libido are more common in women over 50, these conditions affect women of all ages. Studies estimate more than 40 percent of women will experience symptoms related to incontinence, prolapse, or pain with intercourse in their lifetime.

“We understand the toll these disorders can take on a woman’s physical and emotional well-being,” said Dr. Anuja Vyas, a Texas Children’s gynecologist and obstetrician who specializes in the diagnosis and treatment of vulvovaginal disorders. “Our team takes the time to listen to our patients’ needs and tailor a customized treatment plan for every patient to achieve the best possible outcomes.”

Many patients who are referred to the Pavilion for Women have already seen countless physicians who have unsuccessfully treated their condition. When they come to our facility, they receive comprehensive care from a multidisciplinary team of specialists representing diverse areas of expertise:

  • Urogynecology
  • Vulvovaginal health
  • Menopause health care
  • Reproductive psychiatry
  • Obstetrics and gynecology
  • Physical therapy
  • Surgery (cutting-edge technology)

The Pelvic Health and Wellness team also includes nurse practitioners, licensed biofeedback therapists, massage therapists and sexual counselors, all collaborating to improve the health of women during every stage of their reproductive lives.

From diagnosis to treatment – whether it is physical therapy, mental health, or minimally invasive surgery – women receive the full complement of services in one centralized location.

“We know what our patients are going through and we want to help them,” said Texas Children’s surgeon Dr. Francisco Orejuela, a urogynecologist who is board certified in female pelvic medicine and reproductive surgery, and specializes in treating women with pelvic floor disorders. “The sooner they come to us, the greater our success in treating them, and the faster they can return to their normal lifestyle.”

For more information about the Pelvic Health and Wellness program, click here.

Click here to watch a video spotlighting the world-class, gynecologic care provided to women of all ages at the Pavilion for Women.

September 3, 2014

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On April 11, identical conjoined twin girls were born at Texas Children’s Pavilion for Women, each weighing about 3 pounds, 7 ounces. Born via Caesarean-section at 31 weeks gestation, Knatalye Hope and Adeline Faith share a liver, diaphragm, pericardial sac (the lining of the heart) and intestines. They were welcomed by their parents, Elysse and John Mata and their older brother Azariah.

Now estimated to weigh 10 pounds, 4 ounces each, the girls are being cared for by a team of specialists at Texas Children’s Newborn Center.

“The twins still require some respiratory support but they are doing well, and we don’t expect them to have any significant setbacks,” said Chief of Neonatology Dr. Stephen Welty.

Plans for surgical separation are being discussed among a team of multidisciplinary specialists. The Mata family and the care team’s goal right now is for the babies to continue to grow and gain weight.

“I expect it to go well,” Welty said in an interview with KHOU on Tuesday. “Will it be easy? No. The best thing to do is to do the safest thing, which is grow them up, get them bigger and healthier with great nutrition and great developmental care and then separate them at a time which is as safe as possible.”

Waiting a few months after the babies’ birth before proceeding with separation helps optimize the lung and organ function, which can minimize the risk of complications.

“Although other facilities have reported early separations, each case is different with regard to the number of organs that needs to be separated,” said Dr. Darrell Cass, co-director of Texas Children’s Fetal Center. “Also, in some instances those cases have experienced complications due to the early separation, which I believe can be avoided.”

Doctors anticipate beginning the twins’ separation process between the ages of 6 months and 8 months. First, our plastic surgery team will place tissue expanders to help induce the growth of additional skin that will be needed once the two babies are separated. The process of tissue expansion is six to eight weeks. Afterward, a multidisciplinary team of specialists will proceed with separation of the twins. The separation will involve many surgeons, including those from Pediatric General Surgery, Urology, Plastic Surgery, Orthopedic Surgery, Cardiac Surgery and Gynecology.

“There will be two surgical teams,” Cass said. “One team will start, and then once the babies are separated, the teams will separate to work on each infant and finish the reconstruction.”

The surgical teams include:

  • Anesthesiology: Dr. Helena Karlberg and Dr. Steve Stayer
  • Pediatric General Surgery: Dr. Darrell Cass (team lead) and Dr. Oluyinka Olutoye
  • Pediatric Urology: Dr. Patricio Gargollo and Dr. Chester Koh
  • Pediatric Plastic Surgery: Dr. Ed Buchanan and Dr. Larry Hollier
  • Pediatric Orthopedic Surgery: Dr. David Antekeir and Dr. Frank Gerow
  • Pediatric Gynecology surgery: Dr. Jennifer Dietrich

Cass said the surgery is risky, as there always is the risk of death for one or both children. However, he believes the risk is small and the team is anticipating an excellent outcome.

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Hormonal changes during and after pregnancy may trigger depression in some women. In fact, between 10 and 15 percent of pregnant women and new mothers may experience some symptoms of depression. But their condition can be far more than simply feeling “blue” or “down.” For many, it can have a debilitating effect on their health, their family, their careers and their relationships.

To address the need for earlier screening and treatment of maternal depression, the Texas Children’s Pavilion for Women launched a pilot program in May to screen patients multiple times throughout their pregnancy and postpartum period. The effort is part of the Women’s Mental Health Delivery System Reform Incentive Payments (DSRIP) program, focusing on expanded access to health care services.

“Our goal is to identify women with maternal depression as soon as possible and get them into care because maternal depression is treatable,” said Dr. Lucy Puryear, medical director of The Women’s Place – Center for Reproductive Psychiatry and Baylor College of Medicine psychiatrist, who oversees the program. “How we deal with this can have a profound impact not only on the physical and emotional well-being of the mother, but on the life of the child and the family overall.”

As part of the program, women are screened for maternal depression using the Edinburgh Postnatal Depression Scale multiple times throughout their pregnancy (during the first and third trimesters) and postpartum (at two weeks in the pediatrician’s office and at six weeks by their obstetrician), and those requiring follow-up mental health services are referred for care.

“Our overriding goal is to learn from the patients we’re currently screening in order to develop a model for the early diagnosis and treatment of maternal depression using several combined strategies,” said Dr. Puryear. “Texas Children’s Pavilion for Women is uniquely positioned to oversee this project because of the unique Reproductive Psychiatry program and faculty at Baylor College of Medicine.”

Dr. Lisa Valentine, a Baylor College of Medicine psychiatrist hired to treat patients as part of this program, practices at The Women’s Place at the Pavilion for Women, The Center for Children and Women at Greenspoint and at Pearland Ob-Gyn. Two Texas Children’s Pediatrics practices, Pearland and Shadow Creek Ranch, are serving as pilot sites for the project. Providers and staff at these pilot sites have been trained to implement standardized screening and referral.

At Texas Children’s Pediatrics Pearland, every new mother is screened for postpartum depression at the initial well-child visit, which occurs approximately two weeks postpartum, referring those needing services. Referrals are processed quickly and most patients are seen within seven days of being screened. Select providers at Texas Children’s Pediatrics Shadow Creek Ranch have also begun standardized screening.

Future plans focus on educating and training staff at obstetric clinics and additional pediatric clinics to implement standardized screening and referral; adding additional providers, including a psychiatrist, therapist and social worker; and expanding to additional sites with the intent of integrating maternal mental health services where women are already seeking treatment.

August 19, 2014

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By Amber Jacques

Recently, we celebrated our daughter’s first birthday. It’s so amazing how fast time flies! Fourteen months ago, I remember my husband, Sam, and I, rushing to Texas Children’s Pavilion for Women for the birth of our beautiful daughter, Sydney. The contractions were getting pretty intense, but I was determined not to deliver in the car. As manager of Security Services at the Pavilion, I’ve seen moms deliver right as they pull up to the concourse. Fingers crossed, I didn’t want that to happen to me. I instructed my husband, “I am not having this baby in the car, and I don’t want to have this baby without medication. Hurry!”

82014BWfamily640 - 2Sure enough, we arrived at the hospital 35 miles later. The security guard placed me in a wheelchair as we headed up to my labor and delivery room. By that time, I was nine centimeters dilated. The nurses were wonderful and made sure I got my epidural like I requested. After a couple of pushes, Sydney made her grand debut! Our daughter was born June 8, 2013, at 7:55 p.m. weighing 8 pounds, 4 ounces and 21 inches long.

For my husband, Sam, and me, Sydney is our miracle baby.

At a very early age, I knew getting pregnant would be impossible. While in my mother’s womb, an ultrasound revealed that my right ovary was severely cystic and doctors removed it when I was a mere 10 days old. As a teenager, I remember my mom telling me, “Maybe we should look into freezing your eggs if you decide to have children one day.” But, I vetoed that idea because it was a non-issue back then, since I wasn’t thinking about children.

Fast forward to 2008 when I faced another health scare that jeopardized my chances of having a baby. Out of nowhere, I started having debilitating headaches, eye pressure pain, teary eyes and uncontrollable nose bleeds which spewed out of me like a fire hydrant. The emergency room doctor diagnosed me with severe allergies and suggested I take over-the-counter medication for relief. He also discovered a tiny polyp inside my nose, but didn’t treat it at the time. So, I just packed my nose with ice to stop the bleeding.

It wasn’t until later, when my symptoms got worse, that I realized this polyp in my nose was growing out of control. When I arrived at the University of Michigan Hospital, doctors performed an MRI and noticed the tumor in my nose had grown behind my eyes, punctured my dura and grew across my face into my sinus cavity. The tumor had ruptured which caused the profuse bleeding in my nose.

I underwent two surgeries to remove the tumor and a frozen biopsy revealed it was cancer. I had a subcranial resection where I was cut from ear to ear. Surgeons cut a big chunk of my forehead and part of my nose. I ended up losing my sense of smell and taste in the process, but I was so happy to be alive.

The lengthy surgery, which lasted for 15 hours, was nothing compared to the burning pain from the radiation treatments.

I underwent radiation for my head and neck to ensure there were no miniscule cancer cells lurking, since this type of cancer – estheseioneuroblastoma – can easily spread to the thyroid gland.

Although I successfully beat cancer – which I am grateful for – the radiation treatments damaged my pituitary gland, which impacted my left ovary’s ability to function normally.

My husband and I tried for five years to have a baby, but we realized we needed help. When we moved to Houston in 2009, my OB-GYN recommended that we meet one of Texas Children’s fertility specialists, Dr. William Gibbons. She said, “I really want you to meet him. He’s not only the best in his field, but he’s just fantastic to work with.”

When we met Dr. Gibbons for our consultation appointment at Baylor Clinic – before the Family Fertility Center opened in the Pavilion – he reassured us, “It may be tough, but we’re going to make it happen. I have no doubts that we will be successful.” That’s the encouragement my husband and I so desperately needed.

Before we started fertility treatments, I underwent surgery to remove scar tissue that built up in my right fallopian tube as a result of the ovarian removal surgery I had as an infant. Dr. Gibbons wanted to make sure my fallopian tubes were flowing freely before we started intrauterine insemination (IUI).

After three rounds of IUI, which took us a year to complete, I got the miraculous news that we were waiting to hear, “You are PREGNANT!” Sam and I were so excited and shocked at the same time. After taking a whole bunch of home pregnancy tests, we called Dr. Gibbon’s office, and sure enough, an ultrasound confirmed we were expecting!

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Since the first day we laid eyes on her, Sydney has brought our family so much joy. At 14 months, she’s learning to walk, so we’re locking down the house at this point.

Sam always makes fun of me and says that I’m a paparazzo because I take so many pictures and videos of our miracle baby. But, you have to, because she is growing up too fast!

Every day, I am grateful for Dr. Gibbons and his team for helping me, and other families, conceive their dream of motherhood.

Sometimes life throws obstacles in our path, but we are bigger than any obstacle. We can triumph over any circumstance by staying positive and focused on achieving our goals.

June 10, 2014

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Many hospitals have Neonatal Intensive Care Units (NICUs), but not all NICUs are the same.

Texas Children’s Newborn Center is one of the only level IV NICUs in the Houston region that is able to provide babies with the highest level of care. In fact, many area hospitals with less advanced NICUs transfer infants to us when more experience and specialized care is required.

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The American Academy of Pediatrics differentiates between units by defining levels of care based on the complexity of medical conditions the facility is equipped to treat. We hope this will help you better understand the different levels of care in the NICU:

Level I: Regular nursery care available at most hospitals that deliver babies

Level II: Intensive care for sick and premature infants

Level III: Comprehensive care for more seriously ill newborns

Level IV: Major surgery, surgical repair of serious congenital heart and anomalies that require cardiopulmonary bypass and/or extracorporeal membrane oxygenation (ECMO) for medical conditions. Level IV units include the capabilities of level III with additional capabilities and considerable experience in the care of the most complex and critically ill newborn infants and should have pediatric medical and pediatric surgical specialty consultants continuously available 24 hours a day.

Many area hospitals have level II or III NICUs, but are not equipped to provide the most advanced level of care some newborns need. Our combined level II and III NICUs offer specialty care for newborns. An additional level IV NICU located across the connecting bridge gives babies more extensive support and access to dozens of pediatric subspecialists.

Texas Children’s Newborn Center was recently ranked no. 2 in this year’s U.S. News & World Report survey, a gain from last year’s no. 17 ranking. As you know, U.S. News ranks the top 50 pediatric centers in 10 specialty areas, so being recognized within the top two is no small feat.

Our commitment to improving neonatal outcomes is really something to be proud of, and I am grateful that our diligent efforts are making a positive impact in the lives of so many babies.

For more information about Texas Children’s Pavilion for Women and our Neonatal Intensive Care Unit, visit here and to take a video tour of our NICU, visit here.

May 27, 2014

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By Dr. Tiffany McKee-Garrett

When a baby is born, parents want nothing more than to love and protect their child. Part of that protection starts right after birth with the administration of a vitamin K injection. Babies are not born with sufficient vitamin K levels and cannot get adequate amounts of vitamin K from breast milk, so this injection, given within the first hour after birth, is crucial because it helps a baby’s blood to clot normally, which prevents vitamin K deficiency bleeding (VKDB) in newborns.\

A dangerous trend
A recent CDC report confirmed that there has been a nationwide increase in parents refusing the vitamin K shot for their newborns – and this dangerous trend, often based on inaccurate information found online and faulty science, is causing more babies to experience hemorrhaging that is preventable and may cause brain damage or even death in some cases.

In the United States, administration of intramuscular vitamin K at birth to prevent all forms of VKDB has been standard practice since first recommended by the American Academy of Pediatrics in 1961. Without the shot, the incidence of early and classical VKDB ranges from 0.25 percent to 1.7 percent of births and the incidence of late VKDB ranges from 4.4 to 7.2 per 100,000 infants. The relative risk for developing late VKDB has been estimated at 81 times greater among infants who do not receive intramuscular vitamin K than in infants who do receive it.

Early VKBD usually presents in previously healthy appearing infants as unexpected bleeding during the first two weeks of age, usually between the second and fifth day after birth. The bleeding can present as oozing from the umbilical cord area, bleeding from the circumcision site, persistent oozing from puncture sites, gastrointestinal hemorrhage, and/or bleeding into the brain, which can result in significant neurological complications that have a lifelong impact on a child.

Late VKDB is an indication of severe vitamin K deficiency and presents as unexpected bleeding, including brain bleeds in infants 2-12 weeks of age. Complications of late VKDB may be severe, including death. It classically presents in exclusively breastfed infants who received either no or inadequate neonatal vitamin K. It can also present in infants with intestinal malabosorption defects.

The myths
One myth about vitamin-k injections is that they are linked to leukemia, but studies show absolutely no relationship between getting vitamin K as a baby and an increased risk of leukemia. Another myth is that the vitamin K injection increases the risk of jaundice – which is inaccurate. Jaundice associated with vitamin K has been observed only in high risk babies (such as premature babies) in doses 30-60 times higher than the dose we give.

Some parents also argue that injections cause babies pain, but this pain is very brief and the benefits of the injection are very much worth a short period of discomfort. Parents are encouraged to mitigate this brief uncomfortable experience by holding baby skin to skin before and after the injection or allowing the baby to breastfeed before, during and/or after getting the injection.

In the not so distant past, infants and children had high rates of dying early in life. During the 20th century alone, the infant mortality rate declined greater than 90 percent and the maternal mortality rate declined 99 percent! Much of this is due to advancements in modern medicine. While it might seem nice to do things completely naturally, modern medicine has saved the lives of countless mothers and babies.