Care team uses innovative intravascular balloon to slow down blood flow during baby’s delivery to prevent potentially fatal blood loss due to placenta accreta.
Samantha Whyte had already delivered three children, so she thought she knew what to expect with baby number four.
But welcoming her fourth daughter, Madelyn, turned out to be much different – it came with complications that threatened her life.
This time, more than two dozen specialists and staff were in the room during childbirth. Not only were care teams responsible for her baby's health and safety, but they were also taking critical steps to ensure that Whyte didn't bleed to death.
"The doctors did a really good job of explaining what was going to happen, and I knew we were in good hands. But they also didn't downplay the risks," Whyte says.
Whyte had been referred from her local provider in Saginaw to Michigan Medicine after being diagnosed with a serious pregnancy condition called placenta accreta at her 20-week ultrasound in June, 2019.
Typically, the placenta separates from the uterus after childbirth. But in her case, the placenta had grown too deeply into the uterine and bladder walls, meaning that some or all of it would remain connected after delivery.
This complication puts delivering women at a high risk of life-threatening blood loss, or postpartum hemorrhage, after childbirth.
Michigan Medicine is equipped with high level specialists through its placenta accreta program that brings together teams from maternal fetal medicine, gynecologic oncology, trauma surgery, anesthesia, nursing, social work, neonatalogy and the blood bank.
"Our hospital has the skills and experience to provide the specialized care that is necessary in high risk, complex deliveries like these," says Alissa Carver, M.D., high risk maternal fetal medicine physician at Von Voigtlander Women's Hospital at Michigan Medicine.
"If placenta accreta isn't detected and a woman gives birth somewhere that doesn't have the expertise or blood bank resources, it could be incredibly dangerous for both her and her baby. It's critical that women have access to highly specialized, coordinated care."
Placenta accreta is believed to be related to abnormalities in the lining of the uterus, which can happen from prior uterine surgeries like cesarean delivery. Doctors believe Whyte's previous three C-sections increased her risk.
Our teams worked cohesively every step of the way to take care of these two patients at the same time, resulting in the best possible outcome.Alissa Carver, M.D.
The first goal, Carver says, was to carefully monitor Whyte's pregnancy and make sure she didn't go into spontaneous labor, which would trigger bleeding before teams had an opportunity to take steps to control it.
The second was to plan a strategy to ensure she didn't lose blood too quickly after the delivery, which can quickly cause cardiovascular collapse then death without blood flowing to the heart muscle and brain. A hemorrhage can cause such rapid blood loss that a delivering mother can bleed to death in minutes without adequate care.
An innovative surgical technique helps prevent massive blood loss
At 34 weeks, in August, 2019, Whyte checked in at Von Voigtlander for a scheduled cesarean.
She was given a steroid medication to help support the baby's breathing after birth. Because Whyte had type 1 diabetes, she also needed to receive intravenous insulin.
"They had a huge staff of doctors and nurses taking care of so many details at once," Whyte says. "I knew they were as prepared as they could be to handle anything. But it was hard not to think about the worst case scenario."
In Whyte's case, teams opted to use the ER-REBOA intravascular balloon catheter developed for trauma and major bleeding. The technique helps slow down blood flow from large vessels in order to control postpartum bleeding.
Carver says without preparation, a person with Whyte's condition could have lost more than 10 liters of blood after childbirth.
Instead, Whyte lost nearly three liters and was treated with intravenous fluids, two units of donated blood, and cell salvage – a method that collects blood lost during a procedure and cleans it before giving it back to the patient.
"We don't use the ER-REBOA often, but after multiple communications and sharing images with various team members, we were convinced that it was the right technique for this case because of the risk of massive blood loss," Carver says. "We were amazed at the impact it had on our ability to decrease blood flow."
Because Whyte's case was extensive, she also needed a hysterectomy after childbirth to remove her uterus. This would help prevent potentially fatal blood loss that could result from any attempts to separate the placenta.
Once blood flow was controlled, surgical teams were able to repair the bladder and complete the hysterectomy.
Meanwhile, Whyte's newborn daughter, Madelyn, was taken to the Newborn Intensive Care Unit at Michigan Medicine C.S. Mott Children's Hospital.
"Our teams worked cohesively every step of the way to take care of these two patients at the same time, resulting in the best possible outcome," Carver says.
Whyte spent an additional three days in the hospital before being discharged.
"I went to see Madelyn as soon as I was able to," Whyte says. "It was overwhelming because of all of the stress leading up to that moment."
A healthy mom and thriving 1-year-old
Madelyn, who was born weighing just over five pounds, recently celebrated her first birthday and has been described as her mom's "mini-me."
"She started walking before she turned one and is just doing amazing. You would never be able to tell she was a preemie," Samantha says. 'She's full of personality, just really happy-go-lucky, curious and the most loving kid ever."
The strawberry blonde, blue-eyed toddler loves family time with her mom, dad, Jeff, and three older sisters, Scarlett, 3, Mariah, 12, and Shannon, 15. She's often seen stealing her older sisters' toys, dancing to music and running to give her parents hugs.
"If this hadn't been caught, we both could have easily died," Samantha says. "We are so thankful that we were at U-M, which was the best place to handle our situation and for the excellent care that we needed."
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