A Miraculous Birth

In 2008, after seven years of fertility treatments, Liane Santilli became pregnant with twins. Naturally, Liane — a nurse anesthetist at Allegheny General Hospital — and her husband were thrilled.

 But there were concerns about one of the embryos. “When I had my first ultrasound at three weeks, it wasn’t even visible — it looked like a bruise on my uterus,” says Liane. Doctors initially thought the embryo would be reabsorbed by the body and not progress to the fetus stage. Yet this baby would defy almost everyone’s expectations. Dr. Ronald Thomas, director of maternal-fetal medicine for West Penn Allegheny Health System, specializes in high-risk pregnancies, and Liane’s certainly fit that bill: She carried twins (a boy and a girl), was of “advanced” maternal age (at 32) and had undergone fertility treatments. “It was clear that the [female] twin was not growing well,” Dr. Thomas says. “Liane even heard from one specialist that there was ‘no hope.’” Dr. Thomas felt otherwise.

 Five months into the pregnancy, Liane experienced significant bleeding and suddenly became a patient at her workplace. At first, it looked as though neither twin would survive, and Liane was advised to consider terminating the pregnancy for medical reasons. “My family was there in my hospital room [with] all my friends — we talked about the choice I had to make and prepared ourselves for the end,” she recalls. “Then Dr. Thomas walked in with a list of medications [I could take]. He said, ‘You can sit in this room as long as you want. It’s up to you.’” He wasn’t guaranteeing, but he was giving me an option. So I looked at my friend and said, ‘I’m not [terminating]. I’m gonna sit here as long as I want.’ Dr. Thomas never gave up on us.” Liane stayed put for two months, as Dr. Thomas and the rest of the crew in Allegheny General Hospital’s Program for High-Risk Obstetrics worked to monitor the health and development of the twins.

There were two crucial markers they needed to reach for a viable live birth: a minimum gestation of 27 weeks and a baby weight of at least 600 grams (one-and-a-half pounds). As the girl continued to lag behind in growth, it became, Dr. Thomas says, “an ongoing tightrope walk to reach those goals — and even if we did, there were concerns about survival.” Other problems developed, including the boy’s unusually low-lying placenta and the girl’s partially separated placenta (which could have led to dangerous bleeding at delivery). Then, at just over 29 weeks — less than seven months — Liane began bleeding again and went into labor. Dr. Thomas determined that the boy had developed an infection; the twins had to be delivered immediately via C-section. The boy came out first, weighing more than 3 pounds, followed by the girl, who weighed just about the minimum — one-and-a-half pounds.
 Both babies were rushed to the neonatal unit, placed on ventilators and treated for infection, as well as the respiratory distress common to preterm infants. From that point on, though, Isabella and her brother John would continue to make forward progress. She stayed longer in the unit than he did, but in time, she was growing and thriving. More than three years later, there have been only minor complications from Liane’s difficult pregnancy. Now, she says, “they’re normal, healthy kids. John is into cars, trains and trouble. Isabella had some feeding issues [which are common with premature babies] that we worked through. She’s a bit small for her age, but no one ever believes she started out at a pound-and-a-half.”