Rare Monochorionic Triplets born at Holtz Children’s to First Time Parents

By: Miranda Torres

After trying to start a family for a few years, Dominican Republic natives Fernanda Pou Lama and her husband Manuel Trancoso were thrilled when they found out they were expecting. Fast-forward 13 weeks, the couple was shocked to discover they were expecting not just one child, but three. While the excitement did not wear off, the overwhelming reality of a more high-risk pregnancy and delivery set in, which is what led them to The Women’s Hospital at Jackson Memorial.

The couple had previously decided to deliver at a hospital in Miami. However, during a weeklong visit, they were turned away by nearly every hospital and maternal-fetal medicine (MFM) specialist they reached out too due to their case being too high-risk. It wasn’t until their OB-GYN contacted a former colleague that Pou Lama and Trancoso found Rodrigo Ruano, MD, PhD, director of the UHealth Jackson Fetal Care Center and division chief of UHealth Jackson Maternal-Fetal Medicine.

“Dr. Ruano was very clear with his plan from the beginning, so it was a no-brainer to move forward with him as our MFM specialist,” Pou Lama said.

Three week later, the couple was informed that Pou Lama was carrying monochorionic triplets, also known as “mono mono” triplets, a rare condition that only occurs in one in 100,000 births. Two of the babies share the same placenta and amniotic sack, while the third baby has its own placenta and amniotic sack.

Working together with the soon-to-be parents, Dr. Ruano came up with a care plan that allowed Pou Lama and Trancoso to remain in the Dominican Republic until the triplets reached 28 weeks gestation, with monthly visits to The Women’s Hospital. They would deliver the babies via Cesarean section at 32 weeks to allow the triplets enough time to develop, but not pose higher risk to their and Pou Lama’s safety.

Pou Lama’s OB-GYN stayed in constant communication with Dr. Ruano, allowing both care teams to be up to speed on mom and the babies’ conditions at all times.

“We knew Fernanda had to be admitted at least four weeks before her scheduled delivery because there were many risks facing the babies since they are mono mono triplets,” Dr. Ruano said.

Among the risks were umbilical cord entanglement, cardiac issues, cerebral palsy, HELLP syndrome, placenta insufficiency, and growth restrictions. Pou Lama was also facing a higher risk of severe preeclampsia and gestational diabetes. In order to prevent these complications, increased prenatal management was key. Dr. Ruano evaluated the growth of the babies, their hearts, the blood flow within the umbilical cord, and the blood flow to the brain weekly.

“Those four weeks we spent inpatient before the birth were very long, especially with Thanksgiving in the middle of it all, so it took a toll on us,” Trancoso said.

On November 28, just two days shy of 32 weeks, Pou Lama began experiencing contractions.

“I kept thinking, this is not happening to me, it’s not possible, I’m only 31 weeks along. We never even spoke about contractions with Dr. Ruano since we planned for a C-section at 32 weeks,” she said.

With Dr. Ruano’s approval, Pou Lama was started on steroids, magnesium, and iron to prepare for the delivery. A multidisciplinary team of 30 clinicians was present to ensure all potential complications could be treated immediately.

“We needed to work as a team to ensure there were no risks for the mom or any of the three babies, something that is only possible at a place like Jackson,” Dr. Ruano said.

Once all three babies were safely delivered, they were immediately taken to Holtz Children’s Hospital’s NICU. Thanks to the extensive prenatal care, the triplets were healthy. They received oxygen for the first two days as a precaution because the part of the brain that alerts the lungs to breathe automatically does not fully develop until 32 weeks gestation, but they were breathing completely on their own soon after.

Due to her recovery, Pou Lama was unable to see the babies until the following day, but was able to hold them by that weekend. The triplets, Leonor, Rosalia, and Martina, are growing and maturing daily. The couple is looking forward to their first holiday as a family of five, and hope to be back home in the Dominican Republic in the new year.

“If we could say one thing to the staff at The Women’s Hospital and Holtz Children’s, it would be thank you,” Trancoso said. “The ability to go home and sleep well at night knowing that our girls are being well taken care of is priceless.”

“Everyone has been above and beyond what I would have believed,” Pou Lama added. “We could not imagine delivering anywhere else.”

Rodrigo Ruano, MD

Maternal-Fetal Medicine, Obstetrics & Gynecology