Summer 2002
"Good, Safe Medicine"

Bridgeport Hospital's Bloodless Medicine and Surgery Program helped this Stratford mother deliver a healthy baby in spite of a high-risk pregnancy.

Early in their first pregnancy, Stacy and Matt Mezick learned that this was not going to be the blissful, blooming nine months they had expected. It was, in fact, going to be a high-risk pregnancy.

"Way back in the summer of 2001, the first ultrasound at my doctors' office, Women's Health Care of Trumbull, suggested that I had placenta previa," says Stacy.

She tosses that Latin medical term off pretty casually. And why not? In the next six months, she became very familiar with placenta previa, and what it was going to mean to her and her unborn child.

Her obstetricians referred Stacy to Bridgeport Hospital's Antenatal Testing Unit, where a more sophisticated ultrasound confirmed placenta previa. In this serious condition, the placenta is positioned low in the uterus so that it partly or completely covers the opening of the birth canal. The placenta, a large, flat organ attached to the inner wall of the uterus, helps nourish and provide oxygen to the unborn child.

Placenta previa can cause several problems:

  • Excess bleeding when the misplaced placenta tears away from the uterus
  • Premature labor—possibly when the baby is still too small to survive
  • If vaginal birth were to take place, the placenta could block the baby's passage through the birth canal. Or it could tear away and be delivered ahead of, or previous to, the infant. (This is where the term previa comes from.) Either event would cause serious blood loss.

Placenta previa can't be treated. There is no medicine or procedure that could have moved Stacy's placenta away from the birth canal. But the condition can be managed, to ward off trouble for as long as possible. And for the birth, Stacy could have a cesarean section—delivery of the baby by surgery rather than through the birth canal. That would prevent major blood loss during delivery. But first, Stacy and her doctors needed to make sure Stacy didn't go into labor before the baby was big enough to survive.

"To me, it's a matter of good health. I just didn't want a transfusion if it could possibly be avoided."

Bloodless Medicine & Surgery in The Birthplace at Bridgeport Hospital
Bridgeport Hospital's Bloodless Medicine & Surgery Program is the only service of its kind in Fairfield County with a dedicated coordinator to make all the arrangements for Bridgeport Hospital patients who want to avoid transfusions. The coordinator is the link between the patient and physicians, making sure that everyone on the team-including caregivers, patient, and family-understands the entire situation and has all the facts to make sound decisions.

In The Birthplace at Bridgeport Hospital, we respect your decision not to receive blood.

For more information call Ron Travaglino, 203-384-3848.

The first step for Stacy was to stop working. Starting in October, she began spending most of her time at home on the couch, avoiding any activity that might cause contractions.

But on November 12, at 32 weeks (normal delivery is at 40 weeks), the placenta began to separate from the uterus, and Stacy began bleeding. She went straight to Bridgeport Hospital and was taken directly up to The Birthplace. After consultation with Gary Kleinman, MD, a Bridgeport Hospital perinatologist (a doctor specializing in high-risk pregnancies), medications were started to stop contractions and control the bleeding.

Stacy needed constant observation from now on. So she went into Bridgeport Hospital's Special Care Maternity Program for high-risk pregnant women. And there she stayed for the next month, under the eyes of expert nurses.

Coordinated care was provided by a team of Bridgeport Hospital perinatologists, Obstetrics & Gynecology resident physicians (doctors who are dedicated to learning the specialty of OB/GYN), and her own obstetricians, all of whom saw Stacy daily. The goal was to make sure she stayed healthy—and pregnant. This was important, because twice more over the next month, as her placenta continued to separate from the uterine wall, Stacy had episodes of increased bleeding.

Loss of blood is, of course, a problem for the mother. It's also a problem for the baby, who relies on the oxygen it gets from its mother's blood until it is fully born and breathing on its own—so separation of the placenta can be harmful or fatal to the baby too.

Clearly, it's all about blood—the river of life that connects mother and baby. One way to ensure that the river keeps flowing is to provide blood transfusions—to replace what is lost with someone else's blood that matches the mother's in every important way.

"At this point, a hospital without a Bloodless Medicine program would probably be thinking about transfusion."

But Stacy was reluctant to receive transfusions. "To me, it's a matter of good health," she says. "I just didn't want a transfusion if it could possibly be avoided." Early in her stay at Bridgeport Hospital, she told her obstetricians how she felt. They immediately called Ron Travaglino, the coordinator of Bridgeport Hospital's Bloodless Medicine & Surgery Program, who explained to Stacy the steps that could be taken to prevent the need for transfusions.

Stacy's bleeding episodes caused her to become anemic. Anemia is a condition in which there is a lack of oxygen-carrying hemoglobin in the blood, so Stacy's doctors kept a close eye on her hemoglobin levels. A normal level is around 12-14. At one point, hers dipped below 10.

Stacy's doctors prescribed a weekly shot of Procrit®, a medication that makes the body produce more red blood cells. These are the cells that carry oxygen, so the more of them, the better.

"At this point, a hospital without a Bloodless Medicine program would probably be thinking about transfusion," says Ron Travaglino. "Instead, Stacy's doctors were patient. While monitoring Stacy's health, they watched and waited for the Procrit to do its job. Her hemoglobin crept back into the normal range.

Her doctors also prescribed iron, vitamin C, vitamin B12, and folic acid as supplements to nourish Stacy while her body worked hard to make new blood. These nutrients are good for any pregnant mother, but especially when anemia is part of the picture.

Meanwhile, perinatologists performed frequent ultrasounds to monitor the baby's growth and development.

The goal was to buy time. Stacy's care team wanted to take her as far as they could before her obstetricians had to deliver the baby.

In late November, at 34 weeks, her doctors began trying to plan for the cesarean section (c-section) they knew would be required. First they needed to know if the baby's lungs were mature enough to avoid severe respiratory problems after birth—so perinatologist Steven Laifer