Coordinated Care For A Dangerous Condition Leads To A Healthy, Happy Outcome

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Improved, collaborative approach at Western Connecticut Health Network for diagnosis and treatment of placenta previa.

“I am here with my husband and children today, and I get to see my daughter and son grow up,” said Jill. “My doctors made that happen for me."

Having a baby is a joyous occasion for parents and families, filled with anticipation awaiting the birth of a happy, healthy baby girl or boy. For those suffering from the pregnancy complication, placenta previa, it can often become a worrisome time. With the growth of Western Connecticut Health Network’s Women’s services at Danbury Hospital, now offering a full continuum of care across physician specialties and communities, the introduction of more advanced maternal fetal medicine and neonatal care combined with contemporary technology and facilities, concern for this condition is becoming a thing of the past.

A patient with placenta previa
For Torrington resident, Jill Lynch, this diagnosis was distressing news. Pregnant with her second child, Lynch was under the care of her obstetrician, Dr. Orlito Trias of New Milford. Jill had a two-year old daughter born at just 34 weeks via cesarean section so Dr. Trias paid especially close attention through her second pregnancy.

Dr. Trias diagnosed Jill with the rare complete placenta previa at her 20 week check-up. When Jill had bleeding develop during her 29th week, Dr. Trias determined a visit with Dr. Matthew Kim, Director of Maternal Fetal Medicine at Danbury Hospital, for monitoring and follow up care was prudent to confirm suspicions that Jill's case was becoming more complicated. Dr. Kim concurred with Dr. Trias’s diagnosis using an ultrasound test, which confirmed Jill suffered from placenta previa accreta, a rare and more severe form of the condition. Together, the physicians then began to assemble the care team that was engaged to monitor Jill to ensure the best possible outcome was achieved for her and her baby.
First steps were bed rest for Jill at Danbury Hospital. She shared, “I trusted the physicians and nurses caring for me. They made me feel so safe throughout the entire process,” said Lynch. Dr. Trias noted, “Communications among the care team were regular and thorough so the entire team and the family were informed and on the same page throughout the process.”

After several days of continued bleeding, Dr. Trias, Dr. Kim and colleagues from Danbury Hospital’s continuum of care that includes community gynecologists, obstetricians, perinatologists, neonatologists and surgeons, determined that Jill should undergo a cesarean section. Due to the complicated nature of her condition, the full team was engaged to perform the procedure in the main surgical operating suite rather than the operating room in Labor and Delivery, to ensure the physician, surgical and anesthetic resources for her more complicated surgical condition were available for her care.

Landen Lynch was born at 30 weeks gestation weighing just 3 pounds, 5 ounces and spent the first fifty seven days of his life in the Spratt Family Neonatal Intensive Care Unit (NICU) receiving special neonatal care. Unfortunately, as a result of her placenta accreta Jill started to bleed severely requiring an emergency hysterectomy and more than 12 units of blood. While bleeding is not an uncommon occurrence for women with this condition, to require this much blood was unusual. The Mom spent a few days in the intensive care unit for monitoring where her condition prevented her from seeing her son for two days. Jill reflected, “I am here with my husband and children today, and I get to see my daughter and son grow up,” said Jill. “My doctors made that happen for me. I’m extremely grateful to all the physicians and staff who cared for Landen and me. Landen was cared for so well in the Spratt Family NICU. My daughter Leighton spent her time in the old NICU at Danbury Hospital and while she was well cared for, the difference of the newer facility is just amazing and made our time spent there so much more comfortable.”

Physician Commitment
“The success of this whole event was made possible through the concerted efforts of many individuals whose commitment, dedication and care have always defined the profession. In addition to believing in the strength of my patient Jill, I would be remiss if I did not acknowledge the efforts provided by our perinatologists, Dr. Matthew Kim and his colleague Dr. Guoyang Luo, in recognizing the problem based on the ultrasound,” said Dr. Trias. “Additionally surgeons, Dr. Robert Samuelson and Dr. Shoreh Shahabi, the anesthesiologists, resident interns and the very efficient NICU team provided seamless care for Jill and her family. Each and every one of these people had an emotional stake in the care process. Of course, we need to give the most credit to Jill and husband, Mark, for their strength and the unconditional confidence and trust shown in us.”

Dr. Kim shared, “This is a rare and difficult diagnosis for the patient. Even in 2012, this can be a major problem for pregnant woman. I’m delighted, but not surprised, by the way the entire care team pulled together across communities and areas of expertise for this happy outcome. The level of respect and collaboration shown, always keeping Jill and her family at the center of every decision, was impressive,” said Dr. Kim.

For neonatologist and NICU Medical Director, Dr. Edward James, it was heartwarming to see the Lynch’s second baby able to benefit from the newer NICU facilities. “We were very proud to provide care to Landen in the Spratt Family NICU after caring for his sister Leighton just two years ago in our old facility. We’re so pleased that both babies are thriving today,” said Dr. James.

What is placenta previa?
Placenta previa is a pregnancy complication which affects less than one percent of pregnant women. It is an obstetric condition in which the placenta attaches to the uterine wall close to, or covering, the cervix. The condition can occur as early as the later part of the first trimester, but is most commonly recognized later in the second or third trimester. It is a leading cause of ante-partum hemorrhage also known as vaginal bleeding, historically an extremely dangerous and even life-threatening condition before new diagnosis, treatment and skills that are applied today came into play. The level of the condition ranges from the low-level or marginal, to partial and complete cervical attachment as the more acute case. Placenta accreta is a risk whenever there is a placenta previa and a history of prior cesarean birth. In accreta, hysterectomy is often the only option.

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Andrea Rynn
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