Miracle baby, developed outside the womb, is delivered safely at Sinai

July 20, 1991|By Jonathan Bor

Everyone knows the womb as the safe harbor that nurtures the developing fetus and shields it from danger. It's a rare baby who grows outside the womb, a miracle baby who survives nine months and emerges unharmed.

Ten days ago, a 33-year-old woman in the waning days of an apparently normal pregnancy found out to her horror that her baby had developed outside the womb, nestled within a cluster of organs that have nothing to do with the reproductive system.

And in a delicate operation that most obstetric teams don't perform in a career, a crowd of doctors and nurses at Sinai Hospital delivered a miracle -- a 6-pound, 4-ounce baby boy -- and patched up a mother who survived an ordeal that easily could have killed her.

"This is a major-league surgical procedure," Dr. Phillip J. Goldstein, an obstetrician who assisted in the operation, said yesterday. "The fact that the mother and child survived makes us feel very good about it. But the surgery itself is fraught with danger."

Mother and child left the hospital Wednesday but weren't present at a press briefing yesterday.

Hospital officials said the woman wanted to keep their identities private.

An estimated 1 in 10,000 fetuses grow outside the womb, but the vast majority of them die when the placenta begins to separate and bleed sometime during the pregnancy, according to Dr. Charles T. Canady Jr., an obstetrician who directed the surgery and cared for the woman during her pregnancy.

Medical literature mentions about 100 babies who have survived a full-term "abdominal pregnancy." Many of those, however, survived with the mental and physical problems that can occur when the baby, without benefit of a protective womb, presses up against the organs that surround it.

This one was different. Dr. Goldstein said the baby "looks great" and should develop normally despite a slightly elongated head that has already started to round out.

Remarkably, Sinai has delivered two babies who survived abdominal pregnancies.

The first was delivered five years ago, but Dr. Goldstein said he didn't know how the child was doing because the mother didn't return for follow-up care.

An abdominal pregnancy occurs when a fertilized egg gets stuck in the fallopian tube and, rather than dropping into the uterus, either migrates through the tubal wall or reverses course and slips through a space between the tube's entrance and the ovary.

This year's miracle mom, said Dr. Canady, had all the earmarks of a perfectly normal pregnancy.

An ultrasound test early in her pregnancy did not detect the baby's odd nesting place, and she suffered only the "normal" degree of discomfort that can be expected with pregnancy until she was about three weeks shy of her due date.

But then, a searing pain overcame her -- a pain so intense she demanded that her family drive her immediately to the hospital.

Dr. Canady said he was "tipped off" to the abdominal pregnancy when he tried to perform a pelvic examination and couldn't feel her cervix.

It's a classic symptom, he said: abdominal pregnancies tend to stretch the empty uterus so high into the abdomen that it is often impossible to feel the cervix at the uterus' base.

He couldn't find her membranes and figured that her uncommon pain began when the baby's amniotic sac burst and the baby pressed up against the mother's organs.

Doctors told her about her unusual problem and the impending surgery.

"She understood the gravity of the situation," he said yesterday. "It required surgery; the surgery had risks. I expect she was, like most patients, scared to death."

Dr. Goldstein remembered it this way: "She looked at me right in the eyes, eye to eye, and said 'Am I going to live?' "

The woman was rushed into the operating room. Surgeons cut into her abdomen, pushed aside the uterus and found the baby cradled beneath the intestines -- which had been squeezed high into her abdomen -- and lying against the rear abdominal wall.

They grabbed an arm, reached for its head and lifted the baby into the world. It all happened in a matter of minutes.

But the bulk of the 4 1/2 -hour operation was devoted to separating the placenta, the organ that nourishes the fetus, from its many attachments.

It had folded over the baby and attached itself to every blood source it could find: the intestines, the abdominal wall and the omentum, a fold of fatty tissue that protects organs from infection.

To remove the placenta, surgeons had to cut one blood vessel after another, tying each one off to stem the resulting blood loss.

During a treacherous stage of the cutting, Dr. Goldstein said, the patient lost 3 1/2 quarts of blood in eight minutes -- more than 60 percent of her blood supply.

She could have died from blood loss, Dr. Canady said, but the anesthesiologist anticipated the problem and connected her to special lines that replaced her blood almost as fast as she lost it. New techniques of blood replacement have helped make the operation safer for the mother, Dr. Goldstein said.

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