Patient Stories:Caroline Kevany

My third and last pregnancy was unlike the previous two, which were both standard pregnancies without a blip, which ended in C-section deliveries.

I found out I was expecting in early January 2017 and was thrilled, this was hopefully going to be our third baby with a distant lingering for a fourth if we were lucky enough. Towards the end of that same month I had an early scan privately around the 7week mark, as I had done in my other pregnancies. At the scan the sonographer said there was no heartbeat, a collapsed yolk sac; and it was most likely a missed miscarriage, she referred me to the National Maternity Hospital (NMH). Their sonographer said the same thing, however I had to have two further scans there before they would confirm this fully. At around the 9 week mark I was going in to have a final scan followed by a D & C, when the sonographer told me there was a baby and a heartbeat, measuring in line with the dates, I could not believe it; but I was so happy and rushed to call my husband who was about to travel back from the UK to collect me after the procedure. The sonographer said there were subchorionic hematomas (small bleeds) and I think the reason they could not detect a baby until this late stage was because of the early stages of Placenta Accreta Spectrum (PAS), that I was blissfully ignorant of at this time.

Life was good and Cleo (6), Oscar (3) and my husband Robert and I were all excited with the thoughts of a new addition to our family. It was only at the 20week anomaly scan that things became stressful and worrying once again, we were given an antenatal diagnosis of either unilateral or bilateral talipes (clubfoot) by the sonographer who also mentioned that my placenta was low lying and she said they would continue to monitor this. We were then referred to the high-risk unit in the hospital for regular check-ups, and to be honest I had no idea about the connection between previous C-sections and a low-lying placenta (Placenta Praevia) and the risk of PAS. Robert and I were totally distracted by there being potentially something wrong with our baby, that our entire focus was on her. At this stage I had the Harmony test done for Trisomy 13, 18 and 21 because of the clubfoot diagnosis, we were relieved when this came back negative. Later in the pregnancy towards the end of June I began to develop Polyhydramnios (too much amniotic fluid), at this stage my mind was in overdrive and melt down mode, reading about the connections with clubfoot, Polyhydramnios and the potential for genetic issues with our baby, the anxiety levels were sky high. I had convinced myself that there was something very wrong, so much so that when I was told I needed to have an MRI in Vincent’s Hospital to confirm whether I had PAS or not, it was at the very bottom of my list of things to worry about. The MRI confirmed that I had PAS and I was then referred to one of the NMH’s specialist consultants Dr. Ruaidhrí McVey who was going to look after me, my baby and manage the delivery, which was scheduled for 35w 5d, our September baby was no longer going to be a Virgo, she was going to be a Leo 🙂

Thankfully I had no bleeds through the entire pregnancy and therefore I did not have any long stays in hospital like so many of the amazing PAS mum heroes. I was admitted two days before delivery and given steroid injections to mature baby’s lungs. On the morning of my surgery I had a strong sense of calm about me, I was so happy that this was nearly over, I needed my daughter here to see her and all my hopes were that she would be healthy. I don’t think I fully understood at this stage what the implications of the surgery were. I was put under general anaesthetic on 17.08.17, with a central line inserted in my neck for blood transfusions and Margot was delivered safely that morning and brought straight to NICU and put on a CPAP to assist her breathing. The surgery lasted about 6hours and was longer than originally anticipated as I had a lot of blood loss, totalling just under 9 litres. During the operation I had a total hysterectomy and my bladder was sectioned, and ureters cut as they had stuck to my womb, I had several units of blood products transfused. When I woke up in the theatre and saw the clock it was almost 4pm. I was then transferred to HDU for about 30hours where I received more transfusions, Robert and my parents were at my bedside and I was able to look at photos of Margot on Robert’s phone. I managed a trip to NICU to meet my daughter two days later in a wheelchair, she was perfect, and I think one of the toughest bits is that she was never in my room with me, I always feel guilty about that missed time with her. The physical recovery was difficult and the pain hard to deal with at times, I had ileus arising from my bowels being handled during the surgery which made eating and drinking impossible for about 5days after the operation. Another really difficult thing to deal with was the fact that Margot had to stay on in Holles Street as she had issues with feeding, and we had to return to collect her two weeks after her birthday. The care that I was given in the NMH before, during and after the surgery was outstanding, Dr. McVey and Dr. Robson had a multi-disciplinary team in place to deal with all of the complications that can arise from PAS and the complex lifesaving surgery required.

It’s almost three years now since Margie was born and I think the emotional, long term effects from a traumatic experience like this should not be underestimated; and this is where the Placenta Accreta Ireland Support Group at the hospital has really helped, being able to connect with other women who have been through a similar experience and can give advice and support one another is just so important. Everyone’s PAS journey is different, but they are all as important as one another and I think so many of us just want to share our story and feel understood. Being able to meet in the NMH also gives me a legitimate excuse to visit the maternity hospital that I have such happy memories of January 2011 (Cleo), May 2013 (Oscar) and August 2017 (Margot).