Media Release
Mangaluru, Sep 11: In a remarkable display of medical expertise, a multidisciplinary team at KMC Hospital Dr B R Ambedkar Circle, Mangaluru, successfully managed a highly complex case involving a 38-year-old woman from Payyanur. The patient, who had previously undergone three caesarean sections, faced a life-threatening complication during her fourth pregnancy due to placenta percreta, a condition where the placenta invades the muscle layers of the uterus and can invade into surrounding organs like urinary bladder.
The patient was referred to KMC Hospital from a private hospital in Payyanur as she developed pain and bleeding during her 8th month of pregnancy, in view of the severity of her condition which was identified during the second trimester. The multidisciplinary team, headed by Dr Vidyashri Kamath, consultant OBG, Dr Sanman Gowda, consultant urology, Dr Mario Bukelo, consultant neonatology, and Dr Madhusudan Upadya, consultant anaesthesiology and team, worked together to ensure a safe delivery and recovery for both mother and child.
Dr Vidyashri Kamath, who led the obstetric team, stated, "In this challenging case, patient was suffering from Placenta percreta which is a serious pregnancy complication where the placenta invades deeply into the uterine wall and sometimes even attaches to nearby organs, like the bladder which is inseparable following delivery. The incidence of pl accreta has increased 10-fold in the last decade due to the increase in the number of caesarean deliveries. It is one of the important causes of maternal morbidity and mortality and leading cause of hysterectomy post-delivery.
"This typically provokes heavy bleeding which can be life threatening and usually necessitates massive blood transfusion, admission to ICU, prolong hospitalisation and leads to loss of fertility due to hysterectomy and damage to other structures like bladder and ureter. Early diagnosis of the problem, meticulous planning regarding the procedure timing and place of delivery, presence of a multidisciplinary team with blood bank facilities becomes pertinent to reduce maternal morbidity and mortality," she said.
“This patient was an unbooked case in her 4th pregnancy with 3 previous caesarean sections at 32 wks of pregnancy came to us as she was diagnosed to have placenta percreta with partial invasion of urinary bladder. She had pain abdomen and bleeding which required immediate delivery to save her and her baby’s life from potential risks arising from this condition. She had to undergo caesarean hysterectomy after taking measures to reduce the blood loss with bladder repair where in after baby delivery the entire uterus was removed and urinary bladder repair was done. She received plenty of blood and blood products during and post-surgery as haemorrhage is a major hurdle in such cases. She was monitored in ICU for tackling minor post op issues and discharged after 1 week of admission,” Dr Vidyashri added.
Dr Sanman Gowda, who handled the urological aspect of the surgery, added, “The preoperative imaging suggested that the urinary bladder was involved by the invading placenta. After the successful delivery of the baby, with sharp dissection of the bladder from the uterus, bladder repair was performed. Challenging, tough and critical part is separating Urinary bladder from uterus and Placenta, with high risk of bleeding, which needs to be minimised, which was well managed. Meticulous preoperative evaluation and planning with a multidisciplinary approach are key in such complicated cases. After the bladder repair, a cystoscopy was conducted to evaluate the bladder endoscopic ally, which revealed normal, uninvolved ureteric openings into the bladder. This outcome reflects the importance of a collaborative approach in managing high-risk pregnancies."
Following the caesarean section, the baby, born prematurely at 31 weeks with a low birth weight of 1.76 kg, was immediately shifted to the Neonatal Intensive Care Unit (NICU) under the care of Dr Mario Bukelo. "The infant made a full recovery and was released on day 15 of the NICU stay at KMC Hospital Mangaluru. Thanks to the combined efforts of our skilled nurses, advanced facilities, and the dedicated NICU team” said Dr Bukelo.
The patient's successful outcome underscores the critical role of multispecialty care in handling complex medical conditions. Dr Madhusudan Upadya, consultant anaesthesiologist, played a pivotal role in managing the patient's condition throughout the procedure.
Saghir Siddiqui, regional chief operating officer, KMC Hospital, Mangaluru, commented on the achievement, stating, "This case exemplifies the high standard of care we strive to provide at KMC Hospital. Our multidisciplinary medical team and experienced support staff ensured that patients with even the most complex conditions receive the best possible treatment and outcomes. We are proud of our team's dedication and expertise, which continue to make a significant difference in the lives of our patients."
The successful management of this case by the team at KMC Hospital Mangaluru highlights the institution's commitment to providing advanced medical care, ensuring the safety and well-being of both mother and child in even the most challenging situations.
About Manipal Hospitals
As a pioneer in healthcare, Manipal Hospitals is among the top healthcare providers in India serving over 7 million patients annually. Its focus is to develop an affordable, high-quality healthcare framework through its multispecialty and tertiary care delivery spectrum and further extend it to out-of-hospital care. With the completion of the acquisition of Medica Synergie hospitals and AMRI Hospitals Limited (acquired in Sept 2023), the integrated network today has a Pan-India footprint of 37 hospitals across 19 cities with 10,500+ beds, and a talented pool of 5,600+ doctors and an employee strength of over 18,600.
Manipal Hospitals provides comprehensive curative and preventive care for many patients from around the globe. Manipal Hospitals is NABH, and AAHRPP accredited and most of the hospitals in its network are NABL, ER, and Blood Bank accredited and recognized for Nursing Excellence. Manipal Hospitals has also been recognized as the most respected and patient-recommended hospital in India through various consumer surveys.