The Department of Obstetrics and Gynecology

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Maplewood Mom and Baby Beat Odds

Although babies are born everyday, the arrival of some babies is practically a miracle. Hikaru Wakeel, born June 15, weighing 4 lbs., 10 oz. is shown here with his proud and grateful parents Bibi and Hirohisa Hayakawa of Maplewood, N.J. The Hayakawa’s had been trying to have a baby for three years. When Hikaru’s twin brother miscarried during the 17th week of Mrs. Hayakawa’s pregnancy, physicians in Saint Barnabas Medical Center’s Division of Maternal-Fetal Medicine used every treatment available to prevent Hikaru from following the same fate as his brother. Though facing a 95 percent mortality rate, Hikaru survived and was born at just over 36 weeks gestation, with the assistance of Kalavathi Ayyagari, M.D., who has a practice in Maplewood. Hikaru is named after the main character in The Tale of Genji, the oldest novel in the world.

LIVINGSTON, N.J. – Bibi and Hirohisa Hayakawa of Maplewood, N.J., had been trying to have a baby for three years. Eventually, with the assistance of in vitro fertilization, Mrs. Hayakawa became pregnant. When the Hayakawa’s learned they would be having twins, due in early summer 2001, the couple was ecstatic. But on January 30, an unanticipated turn of events turned their dream of having a family into a nightmare.

In late January, Mrs. Hayakawa, then at 17 weeks gestation, experienced unexpected bleeding and had to be rushed to Saint Barnabas Medical Center. In the throws of a miscarriage, Mrs. Hayakawa lost the first fetus en route to obstetric surgery before she could be stabilized and attempts were made to prevent the second fetus from miscarriage.

According to Dom Terrone, M.D., perinatologist at the Division of Maternal-Fetal Medicine, Mrs. Hayakawa’s miscarriage was caused by cervical incompetence, a condition in which the cervix dilates prematurely, leading to miscarriage or premature delivery. “Even aggressive intervention would provide less than a 5 percent chance of survival for the remaining twin,” he said.

For Dr. Terrone, there were serious risks to consider with any efforts to save the remaining fetus. Attempts to delay the birth of a second twin are called a “delayed interval delivery,” and represent a relatively new area of medical research. Health risks for mother and baby alike are increased dramatically due to the chance of infection caused by the rupture of the membrane from the loss of the first fetus. Likewise, according to the medical literature, treatment tends to hold off the birth of the second fetus for only a matter of days, sometimes four weeks at most. Since a full - term baby is 37-40 weeks gestation, and the youngest surviving infants have been born at 23 ½ weeks gestation, Baby Hayakawa would need at the very least a minimum of another six and a half weeks in his mother’s uterus to survive. Another five weeks above and beyond that benchmark would increase his health and survivability significantly. But the odds were not in his favor.

For the Hayakawa’s, the decision was more personal. Despite the devastation of losing her first twin, a boy, whom she and her husband, a software engineer, named Nosomu, which is Japanese for “hope,” she steadfastly followed strict guidelines and spent time both at home and in Saint Barnabas’ high-risk maternal-fetal medicine department, waiting and hoping.

Treatment included tocolysis (medicine to prevent labor); antibiotics to prevent infection; a cerclage, or stitches to prevent premature delivery; as well as bed rest. “Dr. Terrone and his colleagues, particularly Dr. Richard C. Miller, as well as Dr. Kalavathi Ayyagari, my OB/GYN, were very cautious in managing the remainder of my pregnancy,” said Mrs. Hayakawa. “I knew Dr. Terrone had done all that he could do and that our chances were very slim. But after all we had been through, we were more than willing to take those chances.”

“We are delighted the Hayakawa Baby reached this gestational age with no ill effects for Mrs. Hayakawa,” said Dr. Terrone. “We have used this technique before, as have our colleagues around the world, but it is rare for a delayed interval delivery to achieve an additional 19 gestational weeks. There is no question that the first twin could not have been saved given the quick manner in which Mrs. Hayakawa miscarried; the vast majority of women, unfortunately, lose both babies. It is gratifying for our team (including the perinatologists, residents, our high-risk maternal nursing staff, and other support personnel) that our efforts were so successful. I have nothing but praise for the Hayakawa’s, particularly Mrs. Hayakawa, for demonstrating such a commitment to this pregnancy despite the many obstacles.”

On June 15, Mrs. Hayakawa gave birth to 4 lb., 10 oz. Hikaru Wakeel with the assistance of her obstetrician/gynecologist Dr. Ayyagari of Maplewood; Albert Franco, M.D.; Jennifer Malabre, R.N.; and Galina Gendelman, R.N. The labor and delivery took place naturally at just over 36 weeks gestation.

“Hikaru No Genji or ‘the shining Genji’ is the main character from The Tale of Genji, a Japanese novel written by Murasaki Shikibu in approximately 1000 A.D. Shikibu is a woman writer and her book is the first novel ever written,” explains Mrs. Hayakawa, who has an M.A. in Spanish literature and is learning Japanese. “So it is a significant piece of literature for several reasons.” Hikaru along with Wakeel, which means guardian in Urdu and Arabic, can loosely be translated as the Hayakawa’s “Shining Guardian.” “For us, it is such a miracle and a blessing to have him. Throughout the last four and a half months, Hikaru has been a glimmer of hope for my husband and I and now that we can actually hold him in our arms, we are overwhelmed by the happiness and light he has brought to our lives.”

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