Spring 2004
Special Circumstances


Halfway through her fourth pregnancy, Kim Bassett woke up at 2 a.m. and discovered she was spotting. Not much, but enough to startle her. A quick call to obstetrician Mary Beth Harman, MD, was reassuring, but Dr. Harman wanted to see her at 7:00 the next morning.

Dr. Harman did an ultrasound and was concerned at what she saw. Fully aware of Kim´s special circumstances, she immediately sent her and her husband, Brian, to Bridgeport Hospital´s Antenatal Testing Unit (ATU).

  
Kim and Brian Bassett with (left to right) Benjamin, William, and Jonathan, and the newest Bassett. Boy? Girl? Read the story and find out!
The special circumstances: Kim´s three sons had all been delivered surgically, by cesarean section. (See "Caesar´s Mom,") "The more cesareans a mother has, the greater the likelihood of complications-in particular, prob-lems with the placenta," explains Dr. Harman. (The placenta, or afterbirth, is a pancake-shaped structure, rich with blood vessels, that is attached to the inner wall of the uterus. This is where the mother´s circulatory system and the infant´s meet, so nutrients and oxygen from the mother´s bloodstream can be transferred to the baby´s bloodstream.)

In the ATU that morning, perinatologist Gary Kleinman, MD, a specialist in high-risk pregnancies, did a targeted, or Level 2, ultrasound. With special expertise in analyzing detailed ultrasound images, Dr. Kleinman was able to clearly see the placenta. He confirmed Dr. Harman´s suspicion: Kim´s placenta was placed low and at the front of her uterus, covering her cervix. (The cervix is the opening of the uterus into the birth canal.) This condition, called placenta previa, can cause vaginal bleeding during the pregnancy, and severe bleeding during delivery.

Worse yet, there was a strong suspicion that as Kim´s placenta grew, it would cover the scars from her previous c-sections, causing a condition called placenta accreta. This means that the placenta does not come cleanly away when the uterus contracts after the baby is born, as is normal. Instead, it sticks to the scar tissue, and as the uterus contracts, the placenta and its blood vessels tear, causing very serious-possibly life-threatening-bleeding.

So now Kim and her physicians knew this would be a complicated delivery, requiring special monitoring and expertise. Her team of high-risk specialists would need to watch for and prevent premature labor, in order to give the baby as much growing time as possible. Then they would need to deliver the baby in a difficult cesarean section procedure, avoiding excess blood loss under circumstances where this would be harder than usual.

There was never any doubt where Kim would deliver: Bridgeport Hospital, home of the area´s most experienced perinatologists, with access to the highest quality medical and surgical specialists for the delivery itself.

But for the moment, Kim was stable, so Dr. Kleinman sent her home with instructions to rest as much as possible.

For the next three months, regular visits to her obstetricians, Dr. Harman and Leslie Goldstone-Orly, MD, and frequent ultrasounds in the Antenatal Testing Unit helped Kim´s team of physicians to monitor her baby and keep a close eye on the placenta as it grew. Meanwhile, Kim continued spotting, just a little, "…until it got kind of routine," she says.

But what was happening inside Kim was not routine. Eventually, an ultrasound performed by perinatologist Steven Laifer, MD, chief of Obstetrics at Bridgeport Hospital, confirmed her physicians´ suspicions. Her growing placenta had become attached to the cesarean scar-and it continued to invade the scar tissue until it became placenta increta-it grew through the scar tissue and into the wall of the uterus. This delivery was going to be very high-risk. In addition to the delivery, it was likely that Kim would have to have a hysterectomy-removal of the uterus.

Kim and Brian were beginning to realize just how special this delivery was going to be. At one point, Kim asked Brian, "Are you afraid that I´m not com-ing back to you?" When he admitted his concern, she said firmly, "I´m not going anywhere. I have a job to do, raising our children, and I´m going to finish it!"

Around Thanksgiving, Kim´s doctors decided it would be safest to deliver the baby early, before labor began or any serious bleeding developed. Because de-liveries like Kim´s can become very complicated, her doctors wanted to have a team of highly experienced specialists available to handle anything that could pos-sibly happen. A scheduled cesarean made it possible to ensure that all of the team members would be on hand. So December the end of the 36th week, was chosen as Delivery-Day.

At this point, an army of behind-the-scenes sup-port people sprang into action to make the complex arrangements that were necessary. No fewer than nine expert physicians needed to be coordinated, and their schedules cleared for the morning of the 17th so that they could be in the Operating Room to assist in the delivery. Space was booked in one of Bridgeport Hospital´s main Operating Rooms, rather than the Labor & Delivery Unit Cesarean Room, because of the number of people on the team and the complexity of the procedure. The Labor & Delivery Unit scheduled extra nurses for Dec. 17th so that one of them could go to the OR for Kim´s delivery, while the Labor & Delivery rooms remained fully staffed.

Anticipating that Kim would lose blood during the delivery, arrangements were made for her to go regularly to Bridgeport Hospital´s MedEase outpatient medicine unit in the weeks before delivery. There she was given injections of Procrit® to increase her body´s production of red blood cells.

Then there was the question of blood donations. There was every possibility that Kim would need transfusions during and after her delivery. She was of course not able to donate any of her own blood in advance, because she and the baby needed every drop in her body. So seven people donated blood for Kim, including Brian; her aunt; her father-in-law, mother-in-law, and brother-in-law; a friend of the family; and Nancy DeGennaro, RN, the nurse-midwife at Drs. Harman and Goldstone-Orly´s office. The blood donated especially for Kim was couriered from the blood banks to the hospital.

The week before Delivery-Day, Kim caught a cold. "Every time I coughed, I bled," she recalls. She phoned Nancy DeGennaro for advice, and Nancy told her to go to the hospital immediately.

Fortunately, once Kim reached the hospital the bleeding stopped. However, she did not go home again. Her high-risk team wanted her in Bridgeport Hospital where they could keep a close eye on her.

On December Kim was taken to the Antenatal Testing Unit for amniocentesis to determine if the baby could survive early birth. (In amniocentesis, a needle is placed through the abdominal wall into the uterus to withdraw some of the fluid from the amniotic sac surrounding the fetus.)

The news was good! Analysis of the fluid showed that the baby´s lungs had matured to the p