Several weeks into her second pregnancy, Bianca Chavarria sensed something was wrong. The baby felt unusually heavy, and she experienced significant pressure in her abdomen.

“It didn’t feel like my first pregnancy at all,” said Chavarria, then 20, of Floresville, Texas, just outside San Antonio.

When her doctors downplayed her symptoms, Chavarria took matters into her own hands and conducted her research. She discovered a potentially fatal condition called placenta accreta, where the placenta fails to detach from the uterus, causing massive bleeding.

The condition, which is fatal for 7 in 100 women who develop it, tends to affect expectant mothers like Chavarria who previously delivered children by cesarean section.

She soon faced another challenge: her doctor informed her that her hospital didn’t have enough blood on hand to treat the condition. Consequently, at eight months pregnant, she was referred to San Antonio’s University Hospital, where she was promptly diagnosed with placenta accreta.

Ideally, doctors prefer to have months to plan for such births, but Chavarria’s baby couldn’t wait. Two days later, in October 2021, she delivered a healthy baby boy despite experiencing massive blood loss.

“The amount of blood that we used just for Bianca’s case—a lot of hospitals don’t carry that much blood in the entire hospital,” said Dr. Caitlin Martin, co-director of the placenta accreta program at University Health.

San Antonio’s University Hospital has established itself as a leader in treating placenta accreta spectrum due to its innovative blood program. About six years ago, San Antonio launched a citywide program to make whole blood available on rescue vehicles and in trauma centers. Numerous studies show that whole blood, which isn’t broken down into platelets and other components after collection, is the most effective treatment for people bleeding to death.

University Hospital has its own blood bank and transfusion center, which is crucial in treating conditions that result in massive blood loss. “These cases, unfortunately, it’s almost always a question of life or death,” Martin said.

The city’s whole blood program was pioneered by a retired Air Force trauma surgeon named Donald Jenkins, part of a coalition of former military doctors and nurses advocating for the availability of whole blood to civilians after witnessing its benefits in treating soldiers on the battlefield.

“The thing that really gets me is how you can do this in a tent in the desert, and we claim we can’t do it in the cities of the United States,” Jenkins said. “That doesn’t wash.”

The system relies on careful coordination among the local blood bank, rescue workers, and the main hospital. But the approach to treating placenta accreta patients at University Hospital extends beyond maintaining a ready supply of whole blood.

A special unit of OB-GYNs, gynecological oncologists, trauma surgeons, and other specialists approach each case from every angle. They meet weekly to discuss upcoming placenta accreta cases and devise individualized plans for each patient.

“Our team looks at the images,” Dr. Patrick Ramsey, chief of the hospital’s Maternal-Fetal Medicine division, said. “Our surgical teams are all present. Our high-risk obstetric teams are all present. Our baby doctor teams are all there. We’re all going to talk about how we’re going to coordinate that delivery to make it happen in the safest way possible.”

The focus on placenta accreta began about 10 years ago when doctors at the hospital noticed an increase in life-threatening blood loss associated with the condition. Approximately 20 years ago, the incidence rate was 1 in several thousand, but it has now risen to 1 in 300 to 1 in 500 women.

To address this, Ramsey and other doctors established the special unit to manage high-risk cases. Coincidentally, San Antonio began implementing its whole blood program around the same time.

“The comprehensive teams are critically important,” Ramsey said. “Having that whole blood available adds that icing on the cake to make things much, much stronger, much, much better, to improve outcomes for moms and babies.”

Key to the system is the blood bank, where 20 new donors sign on every day. “On a day-to-day basis, we carry about 100 units between the ambulance service providers, the local trauma center, and what we have in inventory here,” said Adrienne Mendoza, CEO of South Texas Blood and Tissue.

The center relies on a rotation program in which blood is first provided to rescue helicopters and ambulances. If unused, it undergoes testing to ensure safety before being supplied to a partner hospital for use in trauma cases. “So very little blood gets wasted,” Mendoza said, estimating the waste at less than 1%. “And that’s really important to us because the donors’ gift is so precious.”

Chavarria recently returned to the hospital to see Martin and give her children the chance to meet the woman who saved their mother’s life. Two-year-old Draven, who was born under Martin’s care, ran up to her and waved hello. Violet, 4, also greeted the doctor enthusiastically.

Seated next to Martin, Chavarria expressed her gratitude. “I feel like I’m sitting next to a superhero right now,” she said. “It’s truly a blessing because I never thought I would ever meet you again, and I wanted to thank you for everything.”

Then she embraced the doctor who saved her life, solidifying the bond created through this life-saving experience.