Surviving a complex pregnancy and coming to terms with loss

Much can go wrong during a pregnancy. Having a team of specialists at the ready can mean the difference between life and death.

At age 38, Kristin Tribble and her husband were ready to have children together. With her two daughters from a previous marriage, the family was preparing for a growing household.

Kristin worked with her obstetrician, and while she was of “advanced maternal age,” she had planned everything out. 

Getting pregnant wasn’t easy, but after a miscarriage, she was pregnant, and everything seemed to be going well.

Over the next few weeks, Kristin would learn she was carrying twin boys. She and her husband named them Sebastian and Donovan. Plans were set, and the family started bonding. Her daughters started making plans for having twin boys in the house.

But over the next few weeks, hope started to turn to fear that Kristin’s life might be in danger. 

A little bleeding at 10 weeks

Kristin’s pregnancy began getting scary shortly after some bleeding at 10 weeks. An ultrasound showed everything looked fine, but the bleeding continued.

At 18 weeks, Kristin started bleeding more and began to pass large clots. The placenta for Sebastian had implanted low — over the cervix. Donovan had a placenta that did not attach correctly to the uterine wall, and he was not expected to survive.

“I knew that if I started to bleed heavily before 24 weeks, the priority would be saving my life,” said Kristin, who is a nurse. “If I could get to 24 weeks, there was a chance that at least Sebastian would live.”

“Kristin’s bleeding was caused by placenta previa, which meant that Sebastian’s placenta was covering the cervix,” said Reed Nett, M.D., OB/GYN with Advocates for Women’s Health, a Part of Norton Women’s Care. “Many times this condition will correct itself as the pregnancy progresses and the placenta rises with the growing uterus so that it is no longer on the cervix.

Sebastian low placenta and Kristin’s previous C-sections also raised the fear of placenta accreta, in which the placenta implants deeply into the uterine wall.

“Nearly 1 in 2,500 pregnancies have placenta accreta, increta or percreta,” Dr. Nett said, referring to other types of the condition. “It can be caused by previous cesarean sections and often results in a hemorrhage and hysterectomy at birth.” 

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Striving for 24 weeks, but preparing for the worst

“I knew that if there was some form of accreta I could die, but I tried to be positive,” Kristin said. “The team at Norton Women’s & Children’s Hospital started preparing for what they would need to help save me — and hopefully my babies.”

Kristin and her family were able to celebrate Thanksgiving at home, and they began to feel optimistic. In early December, she began to have cramps and pass some blood clots. The worry level rose, since she was still less than 24 weeks.

At 22 weeks, a checkup revealed she was fully dilated and would deliver right away. Sebastian’s placenta was also still over the cervix. 

The twins still were 10 days away from having a strong chance. But Donovan had already passed, which had forced Kristin into labor. Sebastian was still kicking, but there were risks he would have major medical problems. 

Kristin signed the necessary forms in case she needed a hysterectomy during the delivery. She was taken to the operating room. The boys were delivered, and Kristin was surprised to learn she had not needed a hysterectomy.

“I woke up and found that Sebastian was still alive, and the placenta had separated from my uterus easily, which indicates no accreta,” Kristin said. “The doctors were able to save my uterus, but I was in a lot of pain. Then I started to hemorrhage.”

The interventional radiology team is always standing by

While the team from the neonatal intensive care unit watched over Sebastian, the labor and delivery team focused on Kristin. They implemented hemorrhage protocols, but the bleeding continued: Donovan’s placenta had actually grown into the uterine muscle. The condition is called placenta increta. 

“Placenta increta is extremely serious,” Dr. Nett said. “Her placenta was growing into the uterine muscle, but it was not easily detectable.” 

The condition required a hysterectomy, but even afterward, Kristin continued to bleed.

Kristin had developed a clotting issue, and it was not safe for her to undergo surgery. The only chance was the team from interventional radiology that is on call at all times to address hemorrhage issues.

Kristin had feared her life could be in danger. Now it was. 

Saying goodbye to Donovan and Sebastian

 “I knew the situation wasn’t good,” Kristin said. “They actually ran with my bed to the interventional radiology suite to get me ready.”

Bryan M. Denham, M.D., an interventional radiologist who practices at Norton Women’s & Children’s Hospital, was prepared. His job is to use radiologic images to precisely thread tiny catheters through blood vessels to the site of the problem and fix it. The minimally invasive procedure carries fewer risks than traditional surgery.

“Dr. Denham came in and was so relaxed — he had it under control, and I felt like I had some hope. I was awake through the procedure and heard him exclaim, “I got it!’ – I knew I was going to be OK.”

“Much like in a cardiac catheterization, we go into the arterial system through the groin,” Dr. Denham said. “We can then inject contrast to image the blood vessels and find where the bleeding is coming from.  Once we find it, we can then maneuver the catheters, or even smaller microcatheters, into the bleeding vessel and stop the hemorrhage. We have different ways in which we can stop the hemorrhage, such as coils that actually plug the bleeding vessel.”

The bleeding stopped within 5 minutes of inserting a coil into the artery. Kristin, who had been extremely pale, rapidly regained her color as the anesthesia team continued monitoring her.

“If I had been anywhere but Norton Women’s & Children’s Hospital, I believe I would have died,” Kristin said.

While the fight for Kristin’s life had been going on, Sebastian lost his battle.

“I should have died several times, but I didn’t”

“After having the (interventional radiology) procedure, I was able to finally hold my boys and say goodbye,” Kristin said. “The child life team came in, and we made molds of their feet and footprint plaques they made into butterfly wings. My daughters were able to meet them, and it was the most horrific experience made beautiful.

“My husband and I lost a lot in 48 hours, but I still had my life and my daughters. I am living proof that the right team was in place. I should have died several times, but I didn’t.”

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