Staying Three Steps Ahead

Marissa Chrismer was at her first ultrasound with her fiancé, Dylan, when the couple got some surprising news—there were three babies on the screen. 

“I said, ‘I’m sorry, can you scan again? I don’t think that’s possible,’” Marissa recalls. “And then she turned the monitor toward me and showed me three separate embryos.”

It was quite the twist for the first-time parents, one that raised a lot of questions. 

“Am I going to be OK?” Marissa, 28, remembers wondering. “Are the babies going to be OK? All these questions run through your mind.”

Because multiple births can come with higher risk, Marissa’s OB-GYN referred her to a maternal-fetal medicine specialist, a sub-specialty of obstetrics that oversees mothers’ and babies’ health during high-risk pregnancies. That care team, comprised of WashU Medicine specialists at Missouri Baptist Medical Center, kept Marissa comfortable, answered her questions, and stayed ahead of potential complications so she could have the best chance for a healthy pregnancy and delivery.

Expect the expected

Following that ultrasound, Marissa enlisted the help of Jeannie Kelly, MD, MS, a WashU Medicine OB-GYN and maternal-fetal medicine specialist. Minutes into their first appointment at Missouri Baptist Medical Center, Dr. Kelly had Marissa feeling at ease.

“I felt very comfortable with her from the get-go,” Marissa says. “This is a vulnerable situation and you’re sharing a lot of things, but she gave me a lot of information to help me process it all.”

“Pregnancy brings a mix of emotions for many patients, but when you suddenly see three babies on the screen, it can be overwhelming,” Dr. Kelly says. “With Marissa, I could see the excitement and the anxiety all at once, but despite that shock, she came in ready by asking thoughtful questions, advocating for herself and the babies, and trusting us to guide her safely.”

The triplets were a trichorionic-triamniotic (tri-tri) pregnancy, which accounts for approximately 75% of triplet pregnancies, meaning each baby developed in its own sac and had its own placenta. Multiple pregnancies get designated as high-risk because of the increased likelihood for early delivery, gestational diabetes, and preeclampsia.

Preeclampsia is a condition that causes high blood pressure and can cut off the flow of blood, oxygen, and nutrients to the fetus. If left untreated, it can cause organ damage or seizures for the mother. Because preeclampsia happens in 50–60% of triplet pregnancies, Dr. Kelly kept a close eye on Marissa’s blood pressure and other vitals to monitor the increased risk.

“Our goal was to anticipate issues before they appeared and build a plan that kept Marissa and the babies safe every step of the way,” Dr. Kelly says. “Partnership is at the heart of maternal-fetal medicine, and we wanted to make sure Marissa never felt alone in those decisions.”

Still, Marissa’s pregnancy was smooth and roadblock-free ahead of the scheduled cesarean section in the 36th week. She was working and, despite gaining nearly 100 pounds during the pregnancy, Dr. Kelly encouraged Marissa to stay on her feet as long as she was comfortable. Two weeks before the delivery, Marissa’s blood pressure was high enough that Dr. Kelly sent her home from an appointment with a blood pressure cuff and instructions for monitoring her numbers and keeping them from rising. 

When Marissa’s numbers didn’t improve, Dr. Kelly and Marissa decided to deliver two weeks early at Barnes-Jewish Hospital.

“What makes our care unique is the strength of the entire system,” Dr. Kelly says. “For Marissa, she could be seen close to home at Missouri Baptist, but she also had seamless access to the sub-specialty resources at [Barnes-Jewish Hospital] and the Level IV neonatal intensive care unit at St. Louis Children’s Hospital. When her status started to change late in the pregnancy, that integration meant we could adapt quickly while keeping her and the babies exactly where they needed to be.”

Unicorn triplets

On April 6, Marissa and Dylan welcomed Charlotte Elizabeth, Harper Rose, and Amelia Ann to the world. All three girls weighed in at around 4 pounds and were moved to St. Louis Children’s Hospital’s Level IV neonatal intensive care unit (NICU), the highest level of medical care available, while Marissa received medication to lower her blood pressure. 

Marissa spent the next two weeks recovering and visiting the girls daily. Barnes-Jewish and St. Louis Children’s are connected by a short skybridge, which was the primary reason why, when given the choice, Marissa chose to deliver at Barnes-Jewish. 

The bridge allows parents to stay close to their newborns, which helps manage stress and promotes bonding during those important first moments of life. After 16 days in the NICU, all three girls were released on the same day.

Today, the triplets are happy and healthy, and Marissa’s had no lingering effects from the pregnancy. The continuity of care from WashU Medicine specialists—from convenient, close-to-home check-ins at Missouri Baptist to delivery at Barnes-Jewish and the highest level of pediatric care at St. Louis Children’s—created a positive and compassionate experience that still stays with her.

“The team at St. Louis Children’s was unbelievable,” Marissa says. “I loved that when the doctors made their rounds, they allowed us to sit in on them and learn more about how the girls were doing. Everyone at BJC, St. Louis Children’s NICU, and the WashU Medicine maternal-fetal medicine teams were great.”

Maternal-fetal medicine specialists are obstetrician-gynecologists who have specialized training in diagnosing and treating pregnancy complications and fetal conditions. At BJC HealthCare and WashU Medicine, our team of experts care for more than 1,000 women with high-risk pregnancies each year. Learn more about our services here.