Special Delivery in California

By Anastasia Toufexis.

Soon after Patti Frustaci gave birth to a son, Joseph, she and her husband Sam decided they wanted another child. So Patti, 30, was put back on Pergonal, the fertility drug that had helped her conceive Joseph. The couple was aware that Pergonal increases the chance of multiple births,* but even so, says Sam Frustaci, 32, "we thought it might be fun to have twins." Last week the Frustacis got more than they bargained for. As a 40-member team of doctors, nurses and technicians crowded a special operating room at St. Joseph Hospital in Orange, Calif., Patti gave birth by caesarean section over three minutes to a staggering procession of babies: girl, boy, boy, girl, boy, boy. A seventh child, a girl, was stillborn. It was the largest multiple birth ever recorded in the U.S.

The infants, known only as Babies A through F, weighed in at just 1 lb. 1 oz. to 1 lb. 13 oz.; they were immediately whisked to the neonatal intensive care unit of nearby Childrens Hospital, where they were put on respirators. Said their father, an industrial-equipment salesman: "It's a unique experience to see them so small, so helpless, and to know that they're fighting for their lives." By week's end Baby F had lost the struggle.

Delivered nearly twelve weeks early, the infants suffered from a host of complications associated with premature birth. The major one: hyaline membrane disease, caused by the inability of only partially developed lungs to produce enough

surfactant, a fatty substance that helps keep the lungs flexible and prevents the air sacs from collapsing after each breath. To keep the airways clear, nurses trained to notice even the most subtle change in breathing patterns regularly suctioned the infants' mouths.

Each of the babies also had a circulatory problem known as patent ductus arteriosus. In a fetus, two of the heart's main blood vessels, the aorta and pulmonary artery, are connected by a short channel. In full-term infants, the passage normally seals off at birth or soon afterward, but in premature babies it often remains open. Result: too much blood is sent to the lungs, and the heart must work harder. To help correct the condition, the children were given the drug indomethacin, which decreases the body's production of a chemical that keeps the shunt open. The babies also suffered from jaundice, because their immature livers were unable to filter their blood properly, resulting in an excess of yellow bile pigments. To break down the pigments, doctors bathed the children in light from fluorescent lamps.

Even intensive treatment had its hazards, putting greater stress on the infants. They were so tiny that each day's blood tests siphoned off 10% of their blood, necessitating transfusions. Doctors guessed that their chances of surviving might be 50%. Baby F, the smallest, had been considered at greatest risk; at one point, his weight had dropped to a mere 1 lb. Affectionately dubbed "Peanut" by the staff, he could be held in the palm of one hand. Said Neonatologist Carrie Worcester: "They are all critically ill, but they are fighters." Their father was hopeful as well, and delighted by their liveliness. Said Frustaci after touching them during one visit: "They were kicking like little polliwogs."

Patti Frustaci, a high school English teacher, added 70 lbs. to her 115-lb. frame while carrying the septuplets. Surprised by her large size early in her pregnancy, doctors scheduled an ultrasound examination that detected three fetuses. A later sonogram revealed seven babies in her womb. The Frustacis were dazed. Recalled Sam: "I said to Patti, 'Dogs have litters.' "

To delay the birth as long as possible, Patti was confined to bed at St. Joseph on March 25 and given a drug to prevent labor. Meanwhile the staff held rehearsals for the coming event. Then last week, when Patti began having trouble breathing (the seven babies were pressing against her diaphragm) and her blood pressure shot up, doctors decided to deliver the infants. Later, the father for several minutes held his stillborn 15.5-oz. daughter, who doctors think died several days before the birth. Said Sam Frustaci, who like Patti is a devout Mormon: "The Heavenly Father had alternative plans for her. She gave up her life for the sake of others."

Fertility drugs, taken by women who have trouble conceiving, have been implicated in nearly all cases of mass multiple births. The all-time high, according to the Guinness Book of World Records, is held by a woman in Sydney, Australia, who in 1971 bore nine babies; none survived beyond six days. Pergonal, a mixture of hormones obtained from the urine of postmenopausal women, stimulates maturation of egg-bearing follicles within the ovaries; sometimes too many eggs are eventually released. "The problem is, it's a very, very delicate balance how much of the stuff to use," says Allan Weingold, an obstetrician and gynecologist at George Washington University Medical Center in Washington. Even with careful monitoring, he says, "you can still overshoot the mark considerably."

Each year an estimated 200,000 American women, roughly 15% to 20% of those having difficulty becoming pregnant, take fertility drugs, and some experts suggest that they are now being overused. "There are no magic fertility pills," says Reproductive Endocrinologist Martin Quigley of the Cleveland Clinic. "Some physicians may be using them indiscriminately in response to patient demands."

The Frustacis, though, had no regrets despite the emotionally draining vigil. Said Sam: "We knew it was going to be a touch-and-go situation." At week's end the prospects for the surviving infants were still uncertain.

FOOTNOTE: *About 15% of pregnancies in women taking Pergonal result in twins; another 5% in triplets or more.

With reporting by Melissa Ludtke/Los Angeles