By Katie Parsons
As a young girl growing up in Guyana, Koshal Manieram often dreamed about her future family. In her visions, she had a wonderful husband, and they were loving parents to four children.
Manieram watched her three sisters marry and start families, looking forward to the day when it would be her turn to hold her own baby in her arms.
She met the man of her dreams, Ajay Manieram of Orlando, in 2014 after the two connected through mutual friends and dated long distance through social media.
After their wedding in Guyana, her husband traveled back home and Manieram started the process of making her own permanent move to the U.S. Soon, she discovered she was pregnant.
But at 19 weeks along, Manieram delivered too early, and the baby girl couldn’t be saved.
“I pushed my little girl out but could not hold her or take her home with me,” Manieram says.
Still mourning her loss, Manieram was able to move to Orlando the next year to be with her husband.
“I thought, I will go to the U.S. and I will get better medical care, and will be able to give birth next time around,” Manieram says.
Within two years, she miscarried two more times.
“It was heartbreaking. My three sisters had no problems in their pregnancies. My eldest sister has five children. They would announce their pregnancies to the family and nine months later walk out of the hospital with their babies in their arms,” she says. “I really wanted to know what was wrong with me that I was having so much trouble keeping my babies during the pregnancies.”
Manieram was diagnosed with cervical insufficiency, also known as an incompetent cervix. Cervical insufficiency happens when a woman’s cervix opens, or dilates, too early during pregnancy and typically without any warning via pain or contractions. Once the cervix has dilated, miscarriage or preterm birth occurs.
A doctor performed a vaginal cerclage, or stitch in the cervix, a common first step once cervical insufficiency is diagnosed. It is usually placed at about 13 or 14 weeks of pregnancy and removed at week 37 so a full-term baby can be delivered vaginally.
Despite the intervention, Manieram lost two more babies at 19 and 23 weeks.
Having lost five babies, Manieram sought help from the experts at the Center for Maternal Fetal Medicine at Orlando Health Winnie Palmer Hospital for Women & Babies. When she became pregnant again at the end of 2018, Dr. Cole Greves, maternal-fetal Medicine doctor at the center, recommended the placement of an abdominal cerclage at the end of her first trimester.
An abdominal cerclage involves making one or more incisions in the abdomen to reach the cervix. The cervix is then stitched closed and babies must be delivered via Cesarean section for every pregnancy going forward. Dr. Greves explains that an abdominal cerclage is often placed when a woman has no cervix or when a properly placed vaginal cerclage has failed in previous pregnancies.
“In Koshal’s case, an abdominal cerclage just made sense,” Dr. Greves says.
Manieram decided the abdominal cerclage suggestion and this time, the intervention worked. Manieram carried her son, Rahul, to 39 weeks gestation and delivered him via C-section in May 2019. Her daughter, Khiara, was also delivered full term via C-section in February 2021.
While Manieram’s abdominal cerclage was the therapy that eventually led to her growing family, Dr. Greves says each patient has different needs.
“Our job is really to recognize the challenges for the individual mother and select the proper therapies that have the lowest risk and highest return for the mom,” Dr. Greves says. “And the highest return is a full-term baby in her arms.”
‘Forever Grateful for My Babies’
Today the Manieram family likes to enjoy fresh air at the parks in their Orlo Vista neighborhood. Manieram walks and runs with Khiara in a stroller while toddler Rahul climbs and jumps on a nearby playground with his dad.
It was heartbreaking. My three sisters had no problems in their pregnancies. They would announce their pregnancies to the family and nine months later walk out of the hospital with their babies in their arms. – Koshal Manieram, Maternal Fetal Medicine Patient
In the lowest moments of their journey to parenthood, the idea of two healthy children to take to a neighborhood park seemed far-fetched for the couple.
“Parenthood for me has so many moments of watching my kids’ happiness and thinking about how they came into this world and into our lives,” Manieram says. “I tell everyone I meet that Dr. Greves is the reason we are able to be parents. I am forever grateful for my babies.”
Dr. Greves says that outcomes like those for the Manieram family are what he and his colleagues strive to accomplish.
“Koshal is a great example of what we want for all of our patients,” Dr. Greves says. “We want a comfort level that develops out of the initial anxiousness of a high-risk pregnancy, and an end result of a healthy baby in a mother’s arms.”
As Manieram holds her healthy children in her arms, she prays for other mothers who are still waiting for their families.
“Cervical incompetence is real, but some women don’t want to talk about it. We fear the stigma of the problem,” Manieram says. “But I am a true testimony that no matter what the issue is, there must be a solution.”