As cesarean delivery rates have climbed in recent decades, obstetricians are seeing a rise in placenta accreta, a rare but potentially life-threatening condition in which the placenta attaches too deeply into the uterine wall.
The complication can lead to severe hemorrhage during childbirth and often requires complex, multidisciplinary care. In many cases, treatment includes a hysterectomy to prevent catastrophic blood loss.
At Community Regional Medical Center (Community Regional) in Fresno, patients across the Central Valley have access to that level of coordinated care. The hospital, a primary teaching site for UCSF Fresno, brings together specialists from obstetrics and gynecology, emergency medicine, family and community medicine, and surgical disciplines to manage these high-risk cases.
“We have everybody that’s needed here,” said Pamela Emeney, MD, UCSF professor of obstetrics and gynecology. “We have interventional radiology, a blood bank, and colon, bladder and trauma surgeons.”
Community Regional serves as the only high-risk pregnancy and delivery center for a five-county region with the expertise and technology required for a dedicated placenta accreta surgical team. As a result, physicians there treat a high volume of these cases, providing critical experience for medical trainees.
Emeney, who joined UCSF Fresno in 2008, leads surgical training for OB-GYN residents and has overseen numerous complex cases. Without timely, specialized care, she said, placenta accreta can quickly become fatal.
“Placenta accreta is something we all learn about in medical school and have a healthy amount of fear for,” said Raksha Dutt, MD, a fourth-year OB-GYN resident. “It’s something you don’t expect to see very often, but we see a significant number of cases here—which has been invaluable for learning.”
Residents at UCSF Fresno are involved in patient care at every stage. They assist in high-risk clinics, participate in hospital care, and gradually take on more responsibility as they advance. Junior residents support patient management, while senior residents lead care under the supervision of attending physicians.
“They see each case to ensure such expertise continues to grow,” Emeney said. “During their fourth year of training, chief residents are prepared to perform surgeries on patients, putting into play everything they learned through lectures and observation.”
By the time they reach their final year, residents have performed multiple hysterectomies and emergency cesarean sections—skills that are both essential in treating placenta accreta.
For Dutt, the experience has been both demanding and rewarding. Over the course of her training, she has cared for patients through multiple pregnancies and gynecologic procedures.
She said the high volume of complex pathologies provides a great learning environment, which prepares trainees to handle critical situations.
“These are situations you want to be prepared for, and so much obstetrics involves emergent situations that you may never have seen and that you'll have to deal with at a random time,” said Dutt. “The number of cases that we get to see here and the amount of hands-on exposure that we get, allows us to be prepared as we move out of residency.”
Dutt says one of her biggest takeaways from the residency program with UCSF Fresno is learning to manage multiple high-pressure responsibilities at once.
“Learning how to triage and handle a very busy labor and delivery floor while also concurrently managing a busy gynecologic and oncology service is a huge takeaway from this residency program,” she said.
For Emeney, the impact of that training becomes clear long after residents graduate. She still receives calls from former trainees who encounter placenta accreta cases in their own practices.
“They’ll call and say, ‘Dr. Emeney, I had a case last night, and it went really well—I knew what to do,’” she said. “It’s incredibly gratifying to know that what we teach here makes a difference. That’s what makes this work so meaningful.”
