Hybrid OR: An oasis for high-risk deliveries

Kristin Kuhn.

When Huntington resident Kirsten Kuhn learned that a condition called placenta accreta had complicated her pregnancy, she and her doctor decided that the only place to give birth was at North Shore University Hospital. That’s because the hospital is the area’s only facility equipped with a special operating room (OR) for high-risk deliveries.

During delivery in a normal pregnancy, the placenta separates easily from the uterine wall. In cases like Ms. Kuhn’s, that separation is very difficult and often causes massive hemorrhage. To minimize that risk, doctors place thin catheters (immediately before delivery) into the uterine blood vessels. After delivery, these catheters significantly decrease the blood supply, and the mother’s risk for hemorrhage.

Placement of these catheters requires specialized imaging equipment. Most hospitals require that high-risk maternity patients go to the radiology department for catheter insertion, and then to the OR for a cesarean section. Depending on the type of procedure, the mother may need to return to the radiology department for additional imaging studies.

Moving high-risk maternity patients around increases the chance of displacement of the catheters and a delay in controlling the mother’s bleeding, which is potentially dangerous. But a hybrid OR prevents the need to move the patient by offering surgical and radiological tools in one place — heading off the potential threat of hemorrhage.

Using a hybrid OR for such high-risk deliveries is the wave of the future, especially considering the dramatic increase in patients with placenta accreta, said Adiel Fleischer, MD, chair of obstetrics/gynecology for North Shore University Hospital and LIJ Medical Center and the physician who brought Ms. Kuhn’s son, Kellen, into the world.

“This enables us to perform the radiological intervention on short notice and change catheters if necessary, and that allows the surgery to continue while minimizing the risk of hemorrhaging and creating the best outcome for our patients. This approach has resulted in a significant improvement in our management of this life-threatening obstetrical complication.”

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