A High-Risk Pregnancy,

It started, like many things in life, with a dream. Chase and Jenna Beideck had three boys – Cash, Colt and Crew – and considered having a fourth child. As time passed, though, they had started to close the door to that reality.

One night, Chase dreamt of a little kid cheering on their brother at a football game. The child was blond, curly-haired and wearing their brother’s jersey.

The Beidecks saw this as a sign to try for a fourth child. Their journey to get there, though, took some unexpected twists.

The Diagnosis

Jenna, a clinical assistant professor at UNMC College of Nursing, is at an advanced maternal age – any pregnancy at age 35 or older – so she was advised to get an advanced anatomy scan at the 20-week milestone. There, it was discovered that she had placenta accreta, a serious condition where the placenta attaches too deeply to the uterine wall. Patients who’ve had multiple C-sections, like Jenna, are at higher risk for this condition due to scar tissue buildup.

The risk of life-threatening blood loss is a major concern with placenta accreta. Her doctors told her that she would need a hysterectomy at the time of delivery to remove her uterus and reduce risk to both mom and baby.

After Jenna’s diagnosis, her care team formed a plan for delivery in a few months. Her maternal fetal specialist contacted Sarah Ongstad, MD, a vascular surgeon with Bryan Heart, about an idea to reduce risk of hemorrhage.

Her idea was to insert a balloon through the femoral artery to stop circulation to her uterus and pelvic area. This dramatically decreases the risk for severe blood loss.

Dr. Ongstad said inserting such a balloon is a natural extension of her usual practice. She reviewed the existing literature and data about this procedure and agreed to move forward with it. What she didn’t know until after agreeing to the procedure was that her patient would be an old friend and colleague.

Preparation

Jenna previously worked for Bryan in various roles, including as a nurse practitioner for Bryan Heart. She and Dr. Ongstad knew each other well. Dr. Ongstad reached out to Jenna to let her know she was on her case, which was a great relief for Jenna.

The technical aspects of Dr. Ongstad’s involvement were, in her words, unremarkable. What made it remarkable was the fact that she was doing it in conjunction with several other teams with whom she had rarely worked.

“It’s a skill set we use regularly,” Dr. Ongstad said. “It’s not hard for us to do. It’s normally a component of other procedures that we would just be applying in a completely different clinical context.”

During planning meetings with the necessary teams, she explained what she would need.

“With little prompting, they immediately put their heads together and just made it happen,” the doctor said. “There aren’t very many places of practice where that would be realistic, and that’s the single reason why it went as well as it did.”

Delivery Day

Jenna was scheduled for delivery and the procedure at around 35 weeks into her pregnancy; an early delivery is recommended for placenta accreta patients.

For Jenna’s other deliveries, there were a handful of people in the room, he said. For this baby, Chase walked into the delivery room and there were a few dozen people.

One of Jenna’s doctors, Dana Marsh, MD, noticed the anxiety on his face, Chase said. She came over and took his hand, telling him that every person in the room was there for a specific purpose – to provide the best care to his wife.

“She made me feel a little more at ease with everything,” he said.

If Dr. Marsh was Chase’s calming force, Neill Mollard, MD, was Jenna’s. Dr. Mollard was Jenna’s anesthesiologist, and she credits him for communicating with her and closely monitoring her pain levels throughout the entire procedure.

In the operating room, the team delivered her baby. Chase was there to cut the umbilical cord and then stayed with baby Crawford as he was transferred to the NICU.

After delivery, Dr. Ongstad accessed Jenna’s femoral artery through the skin with a small needle incision. She placed the balloon right above her uterus and placenta. Once the baby was removed, she inflated the balloon to restrict blood flow, and Jenna’s uterus and placenta were surgically extracted.

A Quick Recovery

Jenna wasn’t sure she would get to see her baby for hours, if not days, after the procedure. She was scheduled for an ICU room after the procedure but didn’t end up needing it. Dr. Ongstad said she went to visit Jenna the afternoon after the procedure, and Jenna was already with Crawford in the NICU.

Jenna recalls discussing with Dr. Ongstad at that moment how well the procedure went.

“It just blew our minds, because there were so many other problems we were foreseeing happening, but they didn’t,” Jenna said. “The whole team had prepared me for the worst, saying that this could be my most difficult recovery after childbirth, but I actually feel like it’s been the best.”

Crawford stayed in the NICU for 10 days after his birth and is now doing great at a few months old. Jenna said the NICU nurses were wonderful, taking excellent care of Crawford and working closely with her and Chase.

Reflecting back on the experience, Dr. Ongstad said it felt like fate that she would know the first patient to whom she provided this treatment.

“Jenna and I having a previous relationship, and me respecting her so much as a fellow provider and knowing how excited her family was for this baby, definitely made all of this extra special,” she said.

A Dream Come True

As cesarean surgeries become more common, the likelihood of placenta accreta has increased. Since Jenna’s case, Dr. Ongstad said there have been a few similar procedures done at Bryan Medical Center.

She feels lucky to be at a place where she is supported and can implement a new idea like this one quickly and successfully, paving the way for more families to benefit in the future.

“I work with the best people, and they took a little seed and completely watered it and made it grow.”

Through the collaboration of multiple teams at Bryan, Jenna and her fourth son came through an uncertain situation safe and sound. It remains to be seen whether Crawford gains blond and curly hair, but the rest of Chase’s dream has come true.

“You’re not really sure how things would go because this was the first time this procedure was done here,” Jenna said. “Having gone through it now, we are very thankful we were the first. Hopefully, this procedure helps a lot of people down the road."

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