After 5 miscarriages, couple find their answers at Orlando Health
Growing up in Guyana, Koshal Manieram often dreamed about her future husband and children.
As a young woman, Manieram watched her three sisters marry and start families, and looked 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 when 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 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, she moved to Orlando the following year, hoping to try again to start a family.
Looking for answers
Within two years, she miscarried two more times.
“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,” she says. “I really wanted to know what was wrong with me.”
Manieram was diagnosed with cervical insufficiency, which happens when a woman’s cervix opens too early during pregnancy. Once it dilates, miscarriage or preterm birth occurs.
A doctor performed a vaginal cerclage, or stitch in the cervix, which is 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, she sought help from the experts at the Center for Maternal-Fetal Medicine at Orlando Health Winnie Palmer Hospital for Women and 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.
“In Koshal’s case, an abdominal cerclage just made sense,” Dr. Greves says.
Manieram carried her son, Rahul, to 39 weeks gestation and delivered him via C-section in May 2019. Her daughter, Khiara, also was delivered full term via C-section in February 2021.
‘Forever grateful for my babies’
Today, the Manieram family likes to enjoy fresh air at the parks near their Orlando neighborhood, something Manieram never envisioned in the lowest moments of her journey to becoming a mother.
“I tell everyone I meet that Dr. Greves is the reason we are able to be parents,” Manieram says. “I am forever grateful for my babies.”
Dr. Greves says 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.”