Many women, after Googling placenta accreta, will come into their first obstetrics consultation with fears of what will happen to them and their baby. Daniela Carusi, MD, MSc, director of Surgical Obstetrics at the Brigham, aims to combat these fears and treat this condition with sound management plans and the assistance of staff who are well-trained in helping accreta patients. In few other hospitals will patients find a team of health professionals, from obstetricians to mental health experts, for whom the treatment of this uncommon condition is managed through such a well-practiced and coordinated effort.
“It’s still a critical situation, but we now have services all over the hospital that have expertise in taking care of these patients,” said Carusi. “We’ve pulled together obstetricians, anesthesiologists and nurses. We have radiologists that we work with, as well as surgeons, urologists and perfusionists, all well-trained in managing this condition.”
A Special Focus on a Serious Condition
Carusi first developed an interest in high-risk pregnancies after completing her residency at the Brigham. Many women with rare conditions or high-risk pregnancies would come to the hospital, and she noticed that patients with placenta accreta would often require the attention of the whole floor they were staying on due to the difficulty of delivery.
Placenta accreta occurs when the placenta attaches abnormally to the uterus, and this causes the blood-flow around the placenta to increase. This makes it difficult for the placenta to come out and puts women at risk for hemorrhaging. It is one of the highest risk factors for maternal morbidity, and though uncommon it has increased in occurrence over the years.
Carusi decided that she wanted to feel competent dealing with this condition and help those around her feel the same. For over 10 years, she has built a practice around placenta accreta, providing the best treatment options she can for it and expanding the medical community’s understanding of this condition.
Her efforts to improve quality of care do not end at her unit of the Brigham. Carusi actively engages smaller health care institutions all around New England. “We reach out to hospitals that are less equipped to deal with this, and we help to identify patients early in pregnancy,” said Carusi. “We’ll help to transfer many of these patients to the Brigham, but I also have patients in Maine and in New Hampshire with whom I’ll coordinate so they can receive their prenatal care at home and transfer in time for their delivery.”
Seeing this condition as often as she does, Carusi noticed there was a subset of placenta accreta patients who had received in vitro fertilization (IVF). This is a risk factor that providers were not previously aware of, and she now works to increase awareness and educate other health professionals to understand this connection so that they can provide better care.
One of the many research projects she is currently working on seeks to understand what exactly about IVF causes the risk of placenta accreta to increase. Carusi and her colleagues have pinpointed receiving a frozen embryo rather than a fresh one as a factor. She notes that many of her accreta patients are eager to participate in research and clinical trials so they can help themselves and women like them.
Carusi has also recently brought in mental health experts to her team because many accreta patients suffer from post-traumatic stress disorder (PTSD) after delivery. She has teamed up with perinatal psychiatrists and social workers for a study to help understand the mental health needs of accreta patients. Over the past year, Carusi and her team have brought back past accreta patients and performed a series of focus groups with them, talking about what the patients perceived their mental health needs to be before and after delivery and where their care team could improve their birth experience. Carusi hopes to reduce the risk of PTSD for her patients and make their experience the best it can be in all aspects, both physical and mental.
Carusi leans into the challenge of her work, which many shy away from due to the morbidity and difficulty of the condition.
“When I first started focusing on accreta, I would give talks and people would come up to me and ask me why I would ever want to do this,” said Carusi. “I thought that if it was that difficult, I wanted to be comfortable with it. And I can speak for my whole team, that as a unit we feel very capable of helping patients with this condition. I think that means a great deal to the patients, when they come in and we can tell them, I know that you’re anxious, but we’ve got a plan in place, and we’ll get you through this.’”