In hospitals across the country, OBHG clinicians deliver lifesaving care every single day. Their around-the-clock presence ensures that all obstetrical patients receive immediate, unbiased care.
Today’s story focuses on OB/GYN hospitalist Dr. Luis Castellanos and how he delivered lifesaving care to a patient.
Summary:
The journey of patient care is often unpredictable, but when a well-coordinated team comes together, extraordinary outcomes can be achieved. This story from Dr. Luis Castellanos, an OB hospitalist in Texas, showcases the critical role of collaboration and the immense impact of hospital-based OB care.
“At one of Texas’s largest referral hospitals, we care for high-risk pregnancies every day. Our accreta team—a multidisciplinary group of OB hospitalists, maternal-fetal medicine specialists, gynecologic oncologists, and anesthesiologists—exists to manage complex cases of placenta accreta. This rare but dangerous condition occurs when the placenta grows too deeply into the uterine wall and can result in severe hemorrhaging.
One of our patients was admitted early in her pregnancy, at just 15–16 weeks, with a diagnosed placenta accreta following significant hemorrhage. She remained hospitalized as we prepared for a planned cesarean hysterectomy at 23 weeks and 1 day. Unfortunately, complications arose sooner than expected.
At 9 p.m., I was called to the antepartum unit, where the patient was hemorrhaging and in significant abdominal pain. Upon arriving at her bedside, I realized the urgency of the situation and called for an immediate cesarean delivery.
In the operating room, we discovered that the placenta had perforated through the lower uterine segment and adhered to the bladder. I quickly delivered the baby, who was handed off to the NICU team for resuscitation. While controlling the bleeding, I initiated the hysterectomy. Shortly after, the gynecologic oncologist arrived and joined me in carefully separating the bladder from the uterus.
Despite the challenges, our teamwork made the difference. The patient required 10 units of packed red blood cells and additional blood products, yet we stayed ahead of her blood loss. Midway through the procedure, a bladder defect was identified, and a urologist was called to repair it.
Thanks to our rapid response and the collective expertise of our team, the patient stabilized and recovered more quickly than expected, bypassing an extended stay in the ICU. She was discharged just a few days later.
The following week, the patient returned for a staple removal and follow-up care, expressing heartfelt gratitude for her care team. However, her post-op journey was not without challenges.
During a scheduled cystogram and voiding trial to remove her Foley catheter, administrative missteps resulted in a series of delays and misplaced appointments. Determined to ensure her care wasn’t compromised, I spent the morning navigating these roadblocks—ultimately taking her to the correct department myself.
Despite the setbacks, we made the most of the day. While waiting for the next appointment, I accompanied the patient to visit her baby in the NICU. Later, we stepped outside to witness a solar eclipse together—an unexpected but touching moment in her recovery journey.
This case demonstrates the profound difference a dedicated hospital-based OB team can make. With expertise, readiness, and compassion, we not only saved the mother’s life but gave her baby a chance to thrive.
Today, her baby continues to make progress in the NICU, a testament to the power of multidisciplinary care and the resilience of this family.
For me, this experience reaffirms why I chose to be an OB hospitalist: to provide life-saving care when it matters most and to walk alongside patients through their most vulnerable moments.”
Watch the video to hear Dr. Castellanos’ story of lifesaving care.