On October 10, 2024, Edna Zamora, who was pregnant, woke up to use the bathroom, leaving behind a trail of blood. Her husband called 911 to transport her to UC Davis Medical Center’s Emergency Department.

The care team was ready for her. Zamora’s provider had already referred her to UC Davis Health’s Fetal Care and Treatment Center after discovering a placenta lodged too firmly in her uterine wall due to scar tissue from previous cesarean sections. Her placenta had begun to outgrow the uterus and attach itself to other organs.

After delivering the baby via C-section, what remained of Zamora’s placenta wouldn’t stop bleeding. She went into a rare and life-threatening condition that causes abnormal blood clotting in the body’s blood vessels.

She would need a series of surgeries performed by 24 total surgeons. That meant the obstetric surgical team needed blood, and a lot of it. Luckily, the patient was in the right place.

A series of lifesaving surgeries

During Zamora’s first surgery post C-section, the operating room laboratory team contacted Medical Director of Transfusion Services Sarah Barnhard. She called for reinforcements: Blood couriers, on-call laboratory staff, and even remote workers helped process blood orders.

Despite heavy blood loss, obstetric surgeons needed to let Zamora’s body rest for a couple of hours after the procedure. 

This is the reason why we need blood donors in our community: to support each other.—Sarah Barnhard, medical director of Transfusion Services

Then four trauma surgeons returned her to the operating table for an additional surgery to control the bleeding from the remaining placental tissue. During that third surgery, they removed one of her kidneys because the placenta had grown into the organ.

The care team continued their extraordinary resuscitation efforts the following day. Surgeons inserted a balloon catheter, called a Resuscitative Endovascular Balloon Occlusion of the Aorta, into Zamora's aorta. It helped block blood flow downstream, allowing them to prevent further blood loss for a couple of hours.

In recovery, the ICU care team continued to measure her carbon dioxide and arterial blood gas. A typical person measures around 40 millimeters of mercury (mmHg). Zamora’s was 107 mmHg, but it was improving. Over the course of a day, it dropped to 55. Then climbed back to 60. Something else was wrong.

Trauma surgeon David Shatz and his team, along with gynecologic oncology surgeons, returned Zamora to the operating room for her fifth surgery in 36 hours. They reopened her abdomen and removed seven liters of blood clot from her belly.

That's when they discovered a final bleeding vessel in her lower pelvis and tied it off.

Well-timed recovery

Finally, Zamora started to improve. Despite sedation and intubation, she was opening her eyes. She was young, strong and had just delivered her seventh baby.

She had certainly earned a couple of days rest, before the final two surgeries that closed her abdomen. 

During her time in the hospital, Zamora's body had required a uniquely large amount of blood. A significant trauma procedure can require as much as 50 units; her procedures needed 474 units in all. As a Level 1 trauma center, UC Davis Medical Center is equipped to provide for such needs.

“It's very atypical for patients to need as much blood as she did,” Barnhard said. Only once every couple of years does the hospital experience such critically high demand for a single patient.

She noted the team was careful to ensure they always had enough blood on hand to supply the rest of the hospital, despite the extraordinary amount needed to save Zamora’s life.

“This is the reason why we need blood donors in our community: to support each other.”

Full-service trauma

Though she remained intubated and sedated in the Surgical Intensive Care Unit, Zamora was stabilizing.

Then Shatz received a phone call. Could the Neonatal Intensive Care Unit (NICU) nurses bring Zamora’s newborn daughter for a visit?

“I’ve never had a baby in the adult ICU before,” Shatz said with a smile.

Neonatal nurse Alisse Bath brought the infant, named Bella Genesis, into Zamora’s room. She was fussy. But as soon as she laid near her mother, she quieted. Mom’s eyes filled with tears.

“It was so special to assist with making this interaction happen for both of them,” Bath said.

Incidents of placental accreta have risen dramatically as C-section deliveries increased. In the 1960s, 1 in 30,000 pregnancies had an accreta complication; in the early 2000s, the number jumped to 1 in 533 pregnancies.

Like many hospitals, UC Davis Health offers birthing services. But as the only Level 1 Trauma Center in the region, serving adult and pediatric patients across Northern California, the medical center features extensive resources for complex pregnancy and childbirth.

“We have all of the different specialty providers available and ready to collaborate and coordinate care,” said Perinatal Unit Director Angelique Silva. “We serve 33 counties and provide care other facilities do not have available to them.”

Her team plans weeks in advance to admit patients like Zamora. For a single placental accreta, they coordinate with OBGYN, Gynecologic Oncology, Trauma and across ICU units, not to mention referring hospitals and providers.

Another benefit of a Level 1 trauma center: lots of blood. Had she gone to a lower-acuity hospital, Zamora may not have survived.

“We see patients all the time — bad car accidents or gunshot wounds — that if they didn’t come to a place like this, they wouldn’t make it,” Shatz said. “They go home never knowing how close they were to never being on this earth again.”

Zamora doesn’t remember much of her time in the hospital, though she experiences flashbacks. She recently reviewed her medical notes. “I technically almost died for six minutes,” she said. “They keep saying it’s going to hit me, but it hasn’t hit me yet.”

For now, family and physical therapy are her focus. Baby steps.