An Anne Arundel County woman, pregnant with triplets, has delivered one of them 13 weeks prematurely at Union Memorial Hospital. The other two still are being carried.
Although Baby A has been born, neither the young mother nor hospital obstetricians know when Baby B or Baby C will arrive. They could remain inside the mother for a few weeks or two months. There is even a chance they could die, doctors say.
Dr. Norman H. Daikoku, the mother's obstetrician-gynecologist, and other baby specialists agreed yesterday that this is a rare situation, but not without precedent.
Since Baby A -- a 2-pound, 2-ounce girl -- was born Monday, the hospital has been abuzz with news that one of the triplets is in the intensive care nursery while the other two are yet unborn.
It's rare, experts say, to be able to deliver one baby without delivering the others.
In the vast majority of cases, obstetricians would have followed standard procedure and brought all three of the babies into the world within 15 minutes of each other. About five years ago, Daikoku had asimilar case. The woman went into labor, then miscarried and lost all three of her babies.
"This time, I wanted to save as many of these babies as I could," Daikoku said. "I chose not to say, 'One is coming, so they must all be delivered now.' I chose to deliver one and see if the others would stay there and be OK." The others are higher in the womb.
Babies who are born prematurely often suffer from possibly fatal respiratory distress syndrome due to underdeveloped lungs that cannot stay inflated. The longer these babies can be kept in the womb, the stronger their lungs will be and the better their chances of survival.
Baby A does have respiratory distress syndrome and is on a ventilator, but appears to be holding her own, said Daikoku. The parents declined to be identified and interviewed at this time.
"I'm very impressed that Daikoku was able to stop this woman's labor after the birth," said Dr. Steven A--ek, another OB-GYN physician in practice at Union Memorial and a clinical associate professor at the University of Maryland Medical Center.
"It was a wonderful thing that he did. He did it to give the other babies their best shot at survival. It's a lot easier to just deliver them. It takes guts not to."
The Gambrills woman came into the Baltimore hospital Saturday with preterm labor, which is common in multiple pregnancy cases. She had been on fertility drugs and had conceived through the GIFT program,which is similar to in vitro fertilization, another program that helps childless couples.
When she arrived at the hospital, her cervix was dilated 3 or 4 centimeters and the baby's head was low. Daikoku and others tried to stop the labor with anti-contraction drugs, but Baby A was not to be deterred.
However, the drugs, given in hope the babies could remain inside the protective womb longer, soon did what they were intended to do and the birth process of Baby B and Baby C was halted.
"There have been reported cases where, with twins and with triplets, they have delivered one, and one or two others have remained inside the mother and been born weeks apart, but that is very unusual," Adashek said.
"It's very lucky to be able to stop these and the big thing you worry about is, since the first one is delivered, is there any sign of infection in the second or third."
Since Baby A's arrival, Daikoku has been monitoring the mother's condition and that of Baby B and Baby C twice daily. He is looking for changes in her temperature and her white blood cell count and checking the fetuses for signs of infection or changes inheart rate or blood, using ultrasound and other sophisticated tests.
Asked if a long stay in the uterus poses dangers for Baby B and Baby C, A--ek said, "It's a fine balancing act, especially after the first one delivers. Besides risks of infection, there are the risks of just a normal pregnancy -- a cord accident, for example, which means the baby could die inside.
"You're taking those risks vs. the risks of prematurity that include lung, intestinal and eye problems. But, as long as no infection occurs, the longer the babies stay inside, the better."