Happiness Times Five

The woman called the hospital and said she had traveled from her home in war-torn Sudan to the United States. She was seeking her mother-in-law's blessing of her pregnancy, but now that she was here, she feared there was something wrong -- and any trouble would be multiplied by five.

So the staff at Anne Arundel Medical Center told her to come in right away. When physician William Sweeney gave her an ultrasound, it showed all he needed to know: quintuplets at 19 weeks of development.

If mother and children were to survive, the doctor concluded, they would need all the help they could get. That began 11 weeks of intensive treatment involving more than 30 physicians, nurses and other specialists at the hospital in Annapolis.

Yesterday, doctors and the woman's family announced the good news. Mother and the five babies, born Dec. 2, were just fine. They were the first quintuplets in the hospital's 106-year history, the first in Maryland in more than three years. And although they will spend the next three weeks in the medical center's neonatal unit, the prognosis is good.

"With quintuplets, you take all the difficulties that can happen to a normal pregnant woman and multiply by five," Sweeney said. "We were prepared for the worst and got the best."

Adwai Malual, 28, had come to the United States to obtain the blessing of her mother-in-law, a family figure who traditionally plays an important role in a woman's pregnancy, family members said. Her husband stayed behind in Sudan, where he serves in the military.

She traveled to her mother-in-law's home in Minnesota, but while she was there, she suffered complications and had to be taken to an emergency room, doctors said. When it became clear she would need more sophisticated treatment, she traveled to Prince George's County to stay with close family members -- and that eventually led her to Anne Arundel Medical Center, a few miles away.

"When Adwai learned she was pregnant, she had mixed feelings of great joy and, at the same time, great worry and confusion of how this would be," said her mother, Anne Abyei, at yesterday's media briefing at the hospital. Medical conditions are poor in Sudan, but now -- "thanks to God," Abyei said -- Malual was in a modern facility, with trained doctors and staff.

Within the first few days, Sweeney formed a team of specialists. Their goal was to extend the pregnancy as long as possible without risking the health of Malual or her babies. She came to them at 19 weeks, with a womb already stretched almost to the equivalent of a full-term 40-week pregnancy. Every week they could wrest from nature gave the babies a better chance at life.

"Twins average 36 or 37 weeks, triplets 32 or 33. With quintuplets, beyond 28 is great," said obstetrician Joseph E. Morris.

Doctors had her eating constantly. But with her swollen belly, she couldn't eat more than a few bites without feeling full.

When Malual reached 30 weeks, she exceeded doctors' greatest hopes. Already her body was showing the signs of wearing down -- shortness of breath, an overworked heart and a tiring kidney. So they scheduled surgery for Dec. 2, a slow morning in the delivery room.