A team of doctors led by Dr. Shaifali Patil, Consultant - Obstetrician & Gynaecologist at Motherhood Hospitals, Kharghar, assisted a 32-year-old woman with placenta previa and a significant fibroid measuring 10x10 cm (a fibroid that looks like a handball) in delivering a healthy baby weighing 2.7 kg. Both the mother and child are currently doing well.
Mrs Mehta's medical condition
Mrs. Anamika Mehta (name changed), a 32-year-old resident of Uran in Navi Mumbai and a banker by profession, was diagnosed with complete placenta previa, a condition where the placenta is located in the lower segment of the uterus, covering the cervix during her fifth month of pregnancy. Additionally, she was found to have a large fibroid. Further examinations through subsequent sonography confirmed that the placenta had not migrated to the upper segment of the uterus. Nonetheless, the patient was recommended to seek treatment at Motherhood Hospitals in Kharghar.
Dr. Shaifali Patil said, “Upon arrival during the 28th week of pregnancy, the patient’s condition was medically stable, and serial sonographies were performed to monitor the baby's weight and the placenta's condition, checking for any degenerative changes in the fibroid. After reviewing her reports, it was confirmed that she had complete placenta previa and a 10x10 cm myoma in her uterus.”
Complete placenta previa is a condition where the placenta partially or completely covers the opening of the uterus. The overall prevalence of placenta previa is 5.2 per 1000 pregnancies. The associated dangers can include severe vaginal bleeding during pregnancy or labor, excessive bleeding that can lead to anemia, shock, and the need for emergency surgery. In fact, the baby may experience oxygen and nutrient deprivation, increasing the risk of premature birth and complications related to prematurity. Additionally, there can be a higher risk of the placenta attaching deeply to the uterine wall, requiring a hysterectomy.
Factors that can lead to placenta previa
There are many factors that can lead to placenta previa, such as lower egg implantation, uterine lining abnormalities (fibroids, scarring), placental abnormalities, and multiple pregnancies (twins or previous deliveries). In her case, it was the low implantation of the gestational sac, which means the fertilized egg attached itself to a lower part of the uterus than it normally should.
This is considered a rare and dangerous condition during pregnancy.” Dr. Patil added, “Myomas, also known as uterine fibroids, are noncancerous growths that develop in the uterus. They are composed of muscle and fibrous tissue and can vary in size and location within the uterus, causing significant discomfort, placental complications, preterm labor, and abnormal bleeding. Our team closely monitored her pregnancy, conducting regular checkups and sonographies. It was observed that the placenta was located low in the uterus, completely covering the cervical os, which posed a risk of major hemorrhage or premature delivery.”
Myoma and potential hemorrhage
To mitigate these risks, Dr. Shaifali advised her to engage in complete bed rest, as any strenuous activity, such as walking fast or lifting heavy weights, could potentially trigger bleeding and increase the chances of premature labor and delivery. Mrs. Anamika expressed concern about the myoma and potential hemorrhage, which she didn’t have during her first pregnancy. Dr. Shaifali provided her with positive counseling, assuring her that if there was a risk of excessive blood loss during surgery, the myoma could be addressed at a later stage.
“During the 33rd week of her pregnancy, the patient experienced sharp abdominal pain and encountered difficulties with urination and bowel movements. After conducting an examination, it was determined that she was suffering from 'red degeneration,' a condition where degenerative changes are seen in the fibroid during pregnancy. To alleviate her pain, she was administered paracetamol and antacid injections, which proved effective. The patient was discharged after two days with proper care instructions and scheduled follow-ups.”
“During the 36th week, the patient experienced labor pain, and an antenatal checkup revealed the possibility of bleeding. We decided to perform a successful cesarean section (LSCS) to ensure the safety of both the mother and baby. Additionally, an open myomectomy was performed to remove the placenta and myoma. The cesarean was performed in a regular manner after the baby was delivered, and the team also checked for bleeding, as there was none during the c-section delivery.
The decision to proceed with myomectomy was made because the patient was hemodynamically stable (with stable blood pressure and heart rate). The patient delivered a healthy baby girl weighing 2.7 kg on September 4, 2023." said Dr. Patil.
Open myomectomy carries certain risks if not properly managed, including significant bleeding during the procedure, the potential risk of miscarriage due to damage to the uterus or placenta, a higher risk of infection affecting both mother and fetus, and an increased risk of uterine wall weakening and subsequent rupture during labor or future pregnancies.
However, the skilled team of doctors managed to carry out the procedure risk-free. “It is crucial to educate patients about the potential complications they are going through during their pregnancy, while also providing positive counseling to empower them mentally. Regular antenatal checkups, proper nutrition, and close monitoring are essential components of managing high-risk pregnancies like this one,” underscored Dr. Patil.