Miraculous birth of the triplet who grew outside the womb

DOCTORS PRAISED the fortitude of a mother who made medical history when she gave birth to triplets, one of whom had grown outside her womb.

The surgeons, from King's College Hospital in London, delivered the triplets last Friday after it was realised that one of the babies had created its own placenta outside the womb, putting the life of the mother, Jane Ingram, in danger.

The delivery is believed to be the first time such a pregnancy has been successful with the mother and all three babies surviving.

"I have never seen or heard of a case like this," said Davor Jurkovic, consultant obstetrician at the hospital, who led the procedure. "The chances of having such a pregnancy are one in 60 million." He added that Mrs Ingram's positive attitude and faith in the medical team were "crucial" to the birth of her son, Ronan, and said he was delighted that Ronan and his twin sisters, Olivia and Mary were making such good progress.

"Everything was made so much easier by an amazing positive attitude this mother displayed through the whole process," he said yesterday. "She understood that her situation was serious. She was fully aware of the risks, she had full confidence in us... Just before the babies were born she turned to me and said `I have faith in you'."

Doctors discovered that Mrs Ingram, 32, from Suffolk, was expecting triplets earlier in the pregnancy but it was not until the 28th week that they realised that Ronan had developed outside the uterus and was the result of an ectopic pregnancy. Mrs Ingram conceived naturally and was not taking any fertility drugs.

Ectopic pregnancy occurs when the fertilised egg implants itself outside the womb in the fallopian tubes. It is the leading cause of death in mothers-to-be in the first three months of pregnancy - accounting for 6 to 12 per cent of the 200-plus maternal deaths each year. It is life- threatening because the growing foetus ruptures the tube causing severe internal bleeding. Nearly 7,000 women a year have an ectopic pregnancy and the majority of cases result in termination.

Only 60 to 100 births from abdominal pregnancy have been reported world-wide and there has never been a recorded case of a successful combined pregnancy, said Professor Jedis Grudzinskas, of the Royal London Hospital.

Mrs Ingram and her son survived because when the fallopian tube ruptured the embryo attached itself to the exterior walls of the uterus and the bladder, allowing an effective womb to be created, doctors said. Mrs Ingram was at increased risk of haemorrhaging as the babies grew because the third baby was creating its own space in the abdomen and increasing pressure was being put on her uterus and bladder.

After the discovery of her condition, she was transferred to King's College Hospital where the birth arrangements were planned. A team of three surgeons, three anaesthetists, three paediatricians, three midwives and 11 theatre staff, were involved in the caesarean section delivery, which was performed 29 weeks and three days into the pregnancy.

The twin girls were born first, via a classical incision in the top of the uterus. The third baby had to be removed without damaging his placenta because of the risk of massive bleeding. His mother's bowel was moved in order to get him out. The operation took just over an hour. Olivia weighed 2lbs 10oz, Mary 2lbs 4oz, and Ronan 2lbs 1oz, all normal weights for 29-week babies. The mother and babies are making good progress, with all three babies breathing unaided and being fed milk through tubes.

"I was concerned that Ronan would have suffered stress from the position he was in and that he may have had problems breathing and with his limbs because he did not have the space and the nourishing atmosphere of the womb," said Dr Janet Rennie, consultant paediatrician. "But happily those concerns have not materialised. If anything he has been more robust than his sisters. He achieved natural respiration and came off the ventilator before the other two - perhaps because his lungs had to develop and were given the exercise they needed."

Mrs Ingram will leave hospital in the next couple of days. The babies are expected to be allowed home within six weeks.