Surgical Obstetrics and Placental Abnormalities

Since 2008, the Brigham and Women’s Hospital (BWH) Program for Surgical Obstetrics and Placental Abnormalities has offered specialized, compassionate care for women who face a complicated delivery due to a cesarean section identified as being complex, risk for heavy bleeding, or need for an additional surgery or hysterectomy. Our goal is to provide a healthy, safe delivery for each mother and child through careful preparation, medical expertise, and multidisciplinary teamwork. Patients may come to us at the beginning of their pregnancy, at the time they are diagnosed with a condition, or prior to becoming pregnant.

Surgical Conditions that Complicate Pregnancy

Patients we care for include women with the following conditions or histories that may complicate deliveries:

• Prior abdominal or pelvic surgeries
• History of multiple cesareans or one or more complicated cesareans
• Abnormally shaped uterus
• Uterus with extensive scar tissue
• Large or numerous fibroid tumors of the uterus
• Prior surgery to remove fibroids
• History of hemorrhaging at time of delivery
• Placenta previa or placenta accreta – Learn more about placenta accreta care.

Planning for Labor and Delivery in High-Risk Pregnancy

Our maternal-fetal medicine specialists begin by identifying at-risk patients – by history or ultrasound – before or early in pregnancy, and carefully planning the timing and steps of the delivery. By combining this individualized preparation with our rich resource of multidisciplinary specialists, our goal is to make otherwise complicated and difficult deliveries run in a smooth, controlled manner. Afterward, our team offers both immediate and long-term follow-up care.

Multidisciplinary Care for Pregnancy Complications

Our surgical obstetrics patients are cared for by a multidisciplinary team who are prepared to promptly respond to our patients’ needs.

Our team members include:

• High-risk obstetricians (maternal-fetal medicine specialists)
• 24-hour, on-site availability of specialized obstetric anesthesiologists
• Neonatal specialists from Boston Children’s Hospital
• Expert pelvic surgeons, urologists, general surgeons, and oncologists
• Specialized obstetric radiologists
• Interventional radiologists with extensive OB-GYN experience
• Intensive care specialists
• 24-hour availability of blood bank and transfusion specialists
• Psychological support, particularly for patients with placenta accreta or those who have experienced traumatic childbirth

While all specialists are available whenever needed, our experienced high-risk obstetricians perform the majority of procedures – including cesareans, hysterectomies, and hemorrhage management – in a routine manner. Most deliveries are completed in our Labor and Delivery Unit, under spinal or epidural anesthesia, with dedicated obstetric nurses and staff.

Although a cesarean delivery is often recommended for women with high-risk pregnancies, our goal is for women to have vaginal deliveries when possible. With our high delivery volume, our staff has extensive experience managing vaginal birth after cesarean (VBAC) and its potential complications. Learn more about VBAC delivery.

Specialized Surgical Services

Our patients benefit from advanced, specialized obstetrics services at BWH including:

• A hybrid operating room – This innovative operating room enables our interventional radiologists and obstetric surgeons to work side-by-side, which shortens a patient’s time in the operating room and their recovery time.
• Round-the-clock availability of cell salvage and perfusionists – Many women who are at risk for hemorrhaging are interested in cell salvage, which involves recovering and re-infusing a patient’s own blood. This process gives the patient the comfort of knowing that the blood being used is perfectly compatible.
• Family-centered cesarean delivery – With many of our patients requiring cesarean deliveries, we try to make their experience as personal and positive as possible, without compromising care. Some of our high-risk surgical patients may be offered this novel cesarean option, which allows patients to see their baby being delivered and emphasizes contact between baby and parents.
• Integrated pre- and post-pregnancy care with our infertility and minimally invasive surgical specialists – Many of our patients require uterine surgery or fertility treatment before or after their high-risk pregnancy. We work closely with physicians from our Center for Infertility and Reproductive Surgery who specialize in uterine fibroids in order to coordinate our patients’ pre-, post-, and between-pregnancy care. Our Program also provides long term gynecology care for those with ongoing needs.
• Multidisciplinary management – A multidisciplinary team meets regularly to discuss each patient throughout their course of care. The team includes high-risk obstetricians, ultrasound specialists, and obstetric anesthesiologists. Interventional radiologists, urologists, oncologists and surgeons join our team whenever needed for a particular patient.

Appointments and Locations

• To schedule an appointment with a physician who specializes in surgical obstetrics and placental abnormalities, please contact us at (617) 732-4208.
• Physicians may contact us at (617) 732-9894.
• For patients or physicians who have questions about our program or are seeking another opinion, you also may visit Mass General Brigham Online Specialty Consultations.

Surgical and Placental Abnormalities Leader

Daniela A. Carusi, MD, MSc
Division of Maternal-Fetal Medicine