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    Unprecedented Surgery In Hospital Of The Costa Rican Social Security Fund Saves Mother And Daughter

    Saint Vincent de Paul saves both lives

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    A team of specialists from the Saint Vincent de Paul Hospital (HSVP) saved the life of a mother and her baby by performing complex surgery during childbirth after being diagnosed with a rare placental disease.

    On September 14th, 2021, during her follow-up appointment, Wendy Chávez received the news from the perinatology specialist, Dr. Franklin Escobar, that she had a high-risk placenta accreta.

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    The mother of three children reported that the doctor found some anomalies in the ultrasound and with another doctor they determined the possibility of presenting placenta accreta. “They explained to me what it was about, the consequences for me and the baby, and that it was better to carry out a series of tests to corroborate or rule out the diagnosis,” said Mrs. Wendy.

    After a few days, it was confirmed that it was an infiltrative placental disease and the surgery was scheduled for October 14th, in order for the baby’s weight to increase.

    Complex surgery

    Perinatologist Escobar explained that, due to the complexity of the surgery, it was extremely important to have a multidisciplinary team present during the procedure, to guarantee the health of the mother and her baby.

    This type of surgery requires a series of resources that are not always available in every medical center, since it involves “a high level of multidisciplinary and comprehensive care, as well as advanced technology,” said the specialist, which includes: perinatologists for the management and prenatal diagnosis, neonatal ICU for the management of premature infants, adult ICU for the post-surgical management of the mother, Peripheral Vascular, Urology, Gynecology, General Surgery, Anesthesiology, Hemodynamics and Neonatology.

    After the patient underwent exhaustive examinations in which the best technology was used, including the Hemodynamics Unit, the team of specialists was formed, and the baby, Eimy, was born on October 14th.

    Process

    The normal cesarean section is a major surgery that involves an incision in a thin portion of the uterus. Of all deliveries, it is expected that 15% will be cesarean sections, however, in the country, the figure is around 30%.

    In the case of this cesarean section with a hysterectomy performed on Doña Wendy, the procedure required a wide incision in the abdomen, an exteriorization of the entire uterus with the baby inside, hysterectomy or surgery to remove the uterus with the baby inside, then, during surgery, the patient was transferred to hemodynamics where the arteries were clamped to decrease blood flow to the uterus. This consists of the placement of “balloons” by the Peripheral Vascular specialist before surgery. The baby was then delivered and the hysterectomy procedure was started, with successful results.

    It is “a complex process in which the aim is to save the mother and for her baby to be born,” said the specialist. Cesarean section with hysterectomy should be performed at 34 weeks; this approach tends to achieve the best balance between maternal and fetal outcomes.

    An inadequate approach during surgeries of this caliber can result in excessive bleeding in the mother and the risk of mortality is high, as well as neonatal complications, Escobar said.

    “In most cases with a diagnosis of placenta accreta, mortality turns out to be high, more so with a 34-week-old neonate, what happens is that an infiltration occurs in the previous cesarean wound, infiltrating in turn the uterus, bladder and intestines, behaving like a kind of tumor”explained the specialist.

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