WEEKLY NEWSLETTER MAY 14, 2021

I knew that a triplet pregnancy almost always delivered prematurely, but not this early! Mary was only sixteen weeks along and was in active labor, with her cervix 5 cm dilated. She had previously undergone an evaluation for infertility and was placed on cloiphene induction of ovulation. This can result in a double ovulation in about ten percent of cases. In Mary’s case, she ended up with trizygotic triplets! She was seeing me, as a maternal-fetal medicine specialist, for prenatal care.

In spite of my best efforts to stop the contractions, she progressed in labor to complete dilation and delivered an immature stillborn fetus. What a tragedy! I knew it was just a matter of time before the other two fetuses would also deliver!

Imagine my astonishment, however, when after the first baby had delivered, the contractions began spacing out and eventually disappeared. I trimmed off the umbilical cord as close to the cervix as possible and waited. Over the next few days, at bed rest, Mary’s cervix gradually closed and reversed its effacement. It was as if labor had never occurred.

I had never seen a case like this before; I could hardly believe it! Mary eventually inquired, “Since I’m not doing anything here in the hospital, why can’t I do the same thing at home?” Dumbfounded, I replied, “I guess so.” Over the next weeks and months, at repeated outpatient prenatal visits, I was able to document that the remaining two fetuses were thriving and growing in the safety of Mary’s uterus. Perhaps she would go to term! But it was not to be.

Seventy-four days later, at twenty-seven weeks gestation, with urgency in her voice, Mary called me again. “Doctor, I think I am in labor again!” “Come to the hospital immediately and I’ll meet you there,” I responded. She was again 5 cm dilated, but for the second time; and it was clear to me this pregnancy was coming to its final end.

I took Mary to the operating room and prepared her for cesarean delivery. This event happened twenty years ago, so, at this early gestational age, survival was not guaranteed. As I made the incision, I prayed: “Lord, if it be Your will, please allow these two remaining babies to survive!” Mary’s twin daughters weighed 900 grams (2 pounds 0 ounces) and 980 grams (2 pounds 2 ounces), both with one-and-five-minute Apgar scores of 4 and 7. After sixty-days, Mary took her remaining twin daughters home from the neonatal intensive care nursery at LLUMC.

A few years ago, at a wedding, I met Mary, her husband, and her twin daughters. What a privilege to unexpectedly meet these two beautiful young women, completely normal and doing well, a miraculous testimony to the great God we serve!

–Elmar P. Sakala, LLUSM class of 1973-B, is a professor in LLUSM department of gynecology and obstetrics. He also has an MPH degree. He was LLUSM Teacher of the Year in 1996.