About to give birth to her first baby, a 33-year-old Baltimore County woman thought she was going to die.
Dr. Charles T. Canady, struggling to deliver her full-term baby under rare and adverse conditions at Sinai Hospital, had answered honestly when she insisted on knowing what she was up against.
He had told her there was at least a 20 percent chance she would not make it. Actually, he was sweating out a potential catastrophe -- the loss of both the mother and the baby.
That was nine days ago.
But, today, the mother -- who does not want to be identified -- and her 6-pound, 4-ounce baby boy are alive and well after having made a little bit of medical history.
The Towson obstetrician-gynecologist, only eight years out of medical school, has successfully confronted an abdominal pregnancy, an experience that most ob-gyn specialists never have in a lifetime.
An abdominal pregnancy occurs in 1 out of 10,000 pregnancies.
It is an ectopic pregnancy, which means that it is located outside the uterus. There are four kinds of ectopic pregnancies, but the one in which the egg is fertilized in a Fallopian tube and then perforates into the abdomen is the most unusual.
According to medical literature, only about 100 abdominal pregnancies have ever gone full term, Canady said today.
Most abdominal pregnancies are terminated early because usually the mother has pain in the second or third month.
On July 10, the newborn infant was surgically removed from the woman's abdomen, where as a fetus it had developed while the placenta had attached itself "to anything and everything it could get its blood supply from," Canady said.
Actually, the placenta had affixed itself to the woman's small and large bowel, the omentum -- an organ that is connected to the stomach and has a very rich blood supply "that placentas love" -- and the back of her abdominal wall, he explained.
"We found the baby behind the uterus and its placenta was stuck up in the abdomen and it had a cord that went all the way down into the pelvis," he said. "We had to cut away all the attachments of the placenta."
It took four and a half hours to free the baby and surgically repair
the anesthetized mother, who was bleeding heavily and needed a transfusion of 10 pints of blood.
When the baby did arrive, he came into the world "screaming and kicking" just like any other healthy new arrival, the attending physician said.
The baby was born with a cone-shaped head and a slightly flattened nose because his tiny face had been compressed between the back of the uterus and the mother's sacrum, or tailbone. But, with time, those imperfections are expected to disappear, Canady said.
"Pediatricians have performed several neurological tests on the baby and they tell me that he is 100 percent normal in his development," he said. "But, of course, the baby will be followed closely because you really can't tell a lot until babies are 1, 2 and 3 years old."
With the harrowing delivery behind him, Canady said, "I am just thankful that we were able to get two good outcomes.
"We had tremendous odds against us to lose one or the other or even both. We never want to lose a baby. But losing a mother is an obstetrician's nightmare. To get two good outcomes and a healthy mom under such circumstances is more rewarding than anything I've done up to this point."
Canady said he also was thankful that he was in a hospital that was able to handle the delivery's complications. An oncologist and a chief of ob-gyn could be called on a moment's notice, and there was 24-hour anesthesia and a blood bank available to meet the woman's needs.
The mother, who was not available for comment, came into the hospital early that morning, complaining about severe pain in her abdomen, which seemed to get worse when the baby moved. She had not had any episodes of pain or other difficulties during the pregnancy.
She was hooked up to electronic fetal monitoring to see if she was having contractions normally associated with labor. That was not the case. She then underwent ultrasound testing. The results were inconclusive.
"This looks like an abdominal pregnancy to me," Canady said to a few doctors who had gathered to hear the diagnosis.
Canady ordered an MRI, or magnetic resonance imaging, sophisticated diagnostic test that makes the body transparent. It confirmed the doctor's suspicions: The baby was attached to the abdomen without the protective amniotic sac that normally surrounds it in the womb.
After making at least a 10-inch incision from above the navel down, opening up the woman's abdomen and taking a good look, Canady said, "I knew then I would need all the help I could get."
He called in Dr. Philip Goldstein, the hospital's chief of ob-gyn who had been through the same experience about seven years ago, Dr. Ira Horowitz, a gynecologic oncologist and Dr. Carol Levi, Sinai's chief ob-gyn resident.
"I got the baby out, but then everybody scrubbed in and we worked, and worked and worked," he said.
"The literature says you should take the baby out, close the mother up and leave the placenta in. But the problem we had is that she was bleeding from where the placenta was attached. We had no choice. We had to remove the placenta so we could take care of the bleeding or else she might have bled to death."
Canady earned his medical degree from the University of Medicine and Dentistry of New Jersey at Newark and was an intern and resident at Sinai Hospital before joining a private group practice in Towson. His wife, Dr. Marilyn Martin, is a Baltimore County Health Department psychiatrist.