Constable: Mom survives perilous birth with lives to celebrate

Too soon, and her baby could die or suffer life-altering complications. Too late, and mother Puja Pereira of Hoffman Estates might bleed to death. Even with perfect timing, Pereira needed a team of Northwestern Medicine doctors and four bodies' worth of blood transfusions to keep her alive during her daughter's birth.

“My husband and I were absolutely thrilled to find out we were expecting our third child. The pregnancy was absolutely normal, and actually a bit easier than my previous two pregnancies,” Pereira, now 36, says about the start of that third pregnancy. But during Pereira's routine 20-week exam at Northwestern Women's Health Associates, veteran ultrasound technician LeAnne Crocker noticed a problem and alerted Dr. Marc Feldstein, whose obstetrics and gynecology practice specializes in high-risk pregnancies.

Pereira was diagnosed with placenta accreta, a complication in which the placenta grows too deeply into the uterine wall and disrupts the typical detachment of the placenta after birth. Pereira had an even rarer and more dangerous form of the condition, called placenta percreta, in which the placenta “invades” her body, Feldstein says.

“Her placenta grew right through the uterine wall,” says Feldstein, noting that the placenta's growth threatened the mom's bladder and required her to have a hysterectomy to remove her uterus.

An increase in placenta accreta in the United States is linked to the rise in Caesarean deliveries.

“You are going to see more of this,” Feldstein says. “Each time you have a C-section, there's a scar on the uterus.”

That disruption in the uterine lining is where the placenta can start its unusual growth. The Caesarean-delivery rate in the U.S. has increased 60 percent since 1996. While the number has dropped slightly in recent years, C-sections still account for 32 percent of births, according to the Centers for Disease Control and Prevention. Feldstein says Northwestern Memorial Hospital's rate is about 20 percent.

Doctors needed to give Pereira's fetus the time to develop into a healthy baby, but they couldn't wait so long that the placenta's growth would attack the mom's organs.

“I just want to be alive for my two older children. But a mother's intuition is to say, 'I just want to make sure my child is healthy,'” Pereira remembers thinking. “They made the decision that I had to deliver at 34 weeks.”

Pereira, who has several doctors in her extended family, says she was told that she had more than a 10 percent chance of dying during the delivery.

“We were petrified - for myself, for her, for the kids,” remembers her husband, Isaac, who works as a legal project manager and is father to their 7-year-old daughter, Samaiya, and 4-year-old son, Armaan. “I was very scared. I just tried to stay optimistic.”

Because the placenta grew out of control in the manner of a cancer, Pereira met with oncology doctors, where she would be the only pregnant woman in a waiting room full of cancer patients.

A team of Northwestern surgeons delivered her baby during a six-hour surgery on Jan. 4, 2015, at Northwestern's Prentice Women's Hospital in Chicago. In the delivery room for the birth of their first two children, Isaac Pereira paced a waiting room for this birth.

“I was watching updates on the screen,” the dad says.

“It took five of us to control the bleeding,” Feldstein says of his team. The mom needed 34 units of blood, enough to replace four times her body's normal blood supply. Had she given birth at a hospital without the expertise or resources, the result would have been a “catastrophe,” Feldstein says.

“You aren't even awake when your baby is born,” says the mom, who was given general anesthesia. “I didn't even hold my baby for about 48 hours.”

Pereira spent three days in the intensive care unit and 10 days in the hospital. Her 5-pound baby needed to stay in neonatal intensive care for four weeks. The hospital found Pereira accommodations across the street so she could breast-feed and mother her newborn.

“We named her Jaaniya, which means 'my life' in Hindi,” says Pereira, who grew up in Hoffman Estates and graduated from Fremd High School in Palatine. Her parents emigrated from India.

Pereira and her 1-year-old daughter are healthy today, with no lingering effects of the traumatic delivery.

When she was well enough to visit her baby in the hospital, Pereira says staff members would greet her with, “You're that mom.” A mom with a similar condition died after refusing blood transfusions for religious reasons, Pereira says. Now, Pereira advocates for blood donation and says she wants women to know about the risks of placenta accreta and its potentially deadly complications.

“I was absolutely fortunate to be a part of Northwestern and have specialists who really helped make sure my baby and I made it through,” says a smiling Pereira. “This Mother's Day, I am so happy to share it with my three healthy children.”