about the type of pregnancy she was
going to have."
The possibility of selectively
reducing the number of embryos to
enhance the odds of survival for those
remaining was discussed. The
Wilsons elected not to do so, according
to Dr. Goldsmith.
Initially, Dr. Salesin and Dr.
Goldsmith could do little.
"Our treatment really began at
13 weeks," Dr. Goldsmith said. "She
was given the usual precautions, such
as not having intercourse and getting
as much bed rest as possible; the
things we do with • all multiple
She also was given a cerclage, a
procedure whereby the cervix is sewn
closed, and injections twice weekly of
Delalutin, an oil preparation of
"While not used widely recently,
we used to give it (Delalutin) to all our
patients who had multiple pregan-
cies," Dr. Goldsmith said. "We felt
that with five pregnancies, we need-
ed to use all of our methods to try and
get them to maturity."
During Mrs. Wilson's treatment
at Sinai, Drs. Salesin and Goldsmith
held their first consultations with Dr.
Schwartz and Dr. Gregory Goyert,
assistant director of maternal/fetal
medicine at Sinai.
"We discussed the realities of suc-
cessfully carrying quintuplets and
the potential risks," Dr. Schwartz
said. These included spontaneous
miscarriage, pre-term delivery and
logistical concerns. "We wanted to
make sure she knew of the availabili-
ty of selective termination and that
we would use all the means at our
disposal to avoid pre-term delivery."
Mrs. Wilson returned to her
Auburn Hills home for bed rest, with
Drs. Salesin and Goldsmith monitor-
ing her progress. By 18-20 weeks, she
already was at term size for a single
birth, Dr. Goldsmith said.
"At 20 weeks, she called me one
The medical teams wait for "their" babies inside and outside the "annex."
evening and said she was feeling a lot
of pressure," he said. "That was on
Oct. 20. I met her at the hospital and
confirmed it. The stitch (for the
cerclage) was intact and she was con-
tinuing on Terbutaline to decrease or
eliminate uterine contractions."
She was admitted, not to leave
Sinai again until this week.
hortly after Mrs. Wilson's ad-
mission, Dr. Schwartz met
with Dr. Rajendra Desai, direc-
tor of the Neonatal Intensive Care
Unit, Joan Schmidt, head nurse in
the Obstetrics and Gynecology
Department, Arlene Wofford, nurse
manager of labor and delivery, Dr.
Jim Kelly, former vice president for
clinical and medical affairs and Joe found from sources outside Sinai, he
Hooper, administrator in the turned inside to a plan developed in
Obstetrics and Gynecology Depart- 1985 for the care and delivery of the
ment, to determine when all of the Nader quintuplets. All were delivered
hospital's resources would be used to after 24 weeks' gestation with none
preserve the lives of the fetuses.
Dr. Schwartz said the plan ad-
"We had to decide at what point
many issues, but needed to be
they (the fetuses) were viable so we
could do all we could to sustain life; upgraded.
During Mrs. Wilson's 22nd week,
Dr. Schwartz said. "We all said 24
weeks, even though doing something Dr. Schwartz expanded the core plan-
ning group to include Drs. Goyert,
effectively at 24 weeks is remote."
But Dr. Schwartz didn't wait un- Salesin and Goldsmith, Margaret
til then to put a plan in place. Follow- Rand of the Risk Management
ing his initial consultations with Mrs. Department and Bobbie Lewis and
Wilson at 13 weeks, Dr. Schwartz Suzanne Timma of the Corporate
sought information about planning Communications Department.
At brainstroming sessions, Dr.
for multiple births, with emphasis on
four or more. When nothing could be Schwartz said many issues were
A Healthy Start
Mary Jo Wilson's ability to carry
quintuplets for 31 weeks was due, in
part, to a healthy body and mind.
Joanna Copes, a clinical nurse
specialist who assisted Mrs. Wilson
during her 11-week stay at Sinai,
said the patient's overall health,
coupled with emotional support
from her husband Bill and other
family members and friends allow-
ed her to endure the discomfort and
uncertainty associated with multi-
Ms. Copes worked closely with
Adrienne Nader who came to Sinai
in 1985 carrying quintuplets that
were delivered after 24 weeks' gesta-
tion, with none surviving.
"Meeting Mary Jo, I could feel a
bit more optimistic (about the
likelihood of a successful outcome)
than I did with the prior quin-
tuplets," she said. "Mary Jo was
much healthier coming into the
pregnancy. She needed, and had,
Ms. Copes said Mrs. Nader had
four children under age 7 at home
and had unplanned, spontaneous
quintuplets. She also was very thin
"They were a very needy family
for emotional support;' she said.
"One of her quintuplets was
named for me and I keep that as a
special memory," she added. "For
care givers involved with the prior
quintuplets, it was a traumatic
THE DETROIT JEWISH NEWS