In a normal pregnancy, the umbilical cord of the fetus inserts into the middle of the placenta as it develops. With a velamentous cord insertion, the umbilical cord inserts into the fetal membranes then travels within the membranes to the placenta. The exposed blood vessels are not protected as they would be in a normal pregnancy and are vulnerable to rupture. Rupture is especially likely if the vessels are near the mother’s cervix, in which case they may rupture in early labor putting the unborn baby at risk. This is a serious condition called vasa previa.
Growing a Family
When Elsa Battaglia and her husband Scott decided to start a family, they knew there might be some age-related risks. Elsa’s obstetrician/gynecologist of 10 years, John Bertrand, M.D., F.A.C.O.G., of Walnut Hill OB/GYN Associates, was also well aware of the increased risk factors for the 41-year-old mother-to-be.
For this reason, Bertrand called upon the additional expertise of Brian Rinehart, M.D., a maternal fetal medicine specialist at North Texas Perinatal Associates and medical director of the Maternal High Risk Program at Texas Health Presbyterian Hospital Dallas.
Together, the physicians would support Elsa and her husband through a difficult diagnosis. During a routine ultrasound at 20 gestational weeks, Rinehart discovered that Elsa had a velamentous cord insertion with vasa previa. The diagnosis meant that the Battaglia baby was at a high risk of bleeding to death at the time of labor.
“In high-risk pregnancies, a combination of standard and color Doppler ultrasound techniques are used to identify and evaluate the baby,” Rinehart said. “When the condition was noted in Elsa’s case, Dr. Bertrand and I discussed the situation at length and spoke often throughout the pregnancy. During the remainder of the pregnancy, she underwent frequent ultrasound exams to evaluate the baby’s vessels and to ensure that Elsa’s cervical length did not shorten ― basically to make sure that it was safe to continue with the pregnancy.”
Staying Boring and Safe
The pregnancy progressed without any complications and the two physicians made the decision to deliver the Battaglia baby at 34 weeks, hopefully in advance of any early labor. At 30 weeks, Elsa made several outpatient trips to the Labor and Delivery desk in the Margot Perot Center for Women and Infants at Texas Health Dallas, where a nurse administered two steroid injections 24 hours apart to accelerate the development of the baby’s lungs.
“Albeit a serious situation, we were comforted by the fact that the complication had been discovered, we talked through what it meant with the doctors and a plan was developed as to how to best proceed,” Elsa said. “All along, Dr. Rinehart would remind us to ‘stay boring’ and we listened to his advice.”
A Collaboration of Caring
A few days prior to the planned delivery, Bertrand and Rinehart met to map out where the blood vessels were in Elsa’s lower uterine to ensure they would be avoided during the C-section. In the Margot Perot Center, Dr. Bertrand worked slowly and methodically during surgery in an effort to keep Elsa’s water in tact while he delivered the baby based on the strategy mapped out with Rinehart.
Samuel Charles Battaglia was born at 7:46 a.m. on Dec. 20, 2013, weighing in at a healthy 6 pounds and 4 ounces. After being checked out by the neonatal intensive care physician who was on hand in the delivery room, the family was pleased to find out that baby Samuel could accompany Elsa to the center’s Postpartum Unit ― no NICU required.
“The health of the Battaglia baby speaks to the outstanding level of care and maternal fetal medicine capabilities available in the High Risk and Labor and Delivery units at Texas Health Dallas,” Bertrand said.
“The hospital’s outstanding facilities and staff make the management of potentially complicated cases safer and easier than they would likely be elsewhere,” Rinehart added. “We are fortunate to have such resources available in the Dallas-Fort Worth area.”
The Battaglias went home as a family on Dec. 24 for what Elsa described as “the best Christmas ever!”
Physicians on the medical staff practice independently and are not employees or agents of the hospital or Texas Health Resources.