In a pregnancy that defied the odds, a Phoenix woman gave birth Monday to a baby she had carried just outside her uterus, a feat so rare that doctors couldn't say for sure whether such a birth had ever occurred before.
Azelan Cruz Perfecto began the day in a precarious position, surrounded by a thin wall of membrane and muscle just outside the safety of his mother's womb. Doctors knew they needed to operate to get him out, fearing that if they waited too long, his protective bubble would burst.
His mother, Nicollete Soto, 27, of Phoenix, had been advised by doctors that carrying the baby brought risk to both his life and hers, but she wanted to see the pregnancy through, said her boyfriend, Victor Perfecto.
"We took a risk," he said at the hospital, hours after witnessing the successful birth. "We left it for the doctors to decide when to deliver the baby and God to decide everything else."
Everything else went fine. Azelan Cruz was born around 9:20 a.m. The premature baby, born at 32 weeks, weighed just 2 pounds, 14 ounces, but doctors say he's doing great.
Doctors originally thought that Soto was carrying the baby in her abdomen, completely outside her uterus. They feared that even if the baby were delivered successfully, there would be grave risk for the mother. The placenta might have attached itself to a vital organ, they feared, making its removal tricky, if they could detach it at all.
But after delivering the baby, doctors found that Soto didn't appear to have an abdominal pregnancy, as they thought. Instead, the embryo had attached itself to the area where the fallopian tube meets the uterus, or what is known as a cornual pregnancy.
That area of the uterus is not supposed to stretch enough to accommodate a pregnancy, said Dr. Rodney Edwards, one of the surgeons in the operating room Monday. Pregnancies of that type usually end at the 12- to 14-week mark, with the tube rupturing.
"For some reason, hers did not rupture," said Edwards, the director of the Maternal Fetal Medicine Center at Banner Good Samaritan Medical Center. "It continued to stretch."
Edwards did some cursory searches of medical literature Monday but had not yet determined how rare it is to have a cornual pregnancy result in a healthy baby.
"This is just a case that proves, in medicine, nothing happens 'always' or 'never,' " he said.
The placenta was not attached to a vital organ but instead was mostly attached to a uterine wall. Removing it was much simpler than the doctors expected. There had been a team of vascular, trauma, urology and radiology surgeons assembled for any possibility. But they were not needed. Perfecto, who watched his son being born and left the operating room with him, said he got word Soto was out of surgery about 10:30 a.m.
"All this weight just went away," he said. "I was so happy."
Perfecto and Soto have been dating for nine years after meeting at a birthday party in Buckeye. Perfecto said he will marry her as soon as he saves up enough money.
The couple already had one son, Aidan, 6, and had been trying for another child for a while.
Both are employed, he at a pediatrician's office and she at a day-care facility, but neither has insurance. A doctor Perfecto knew through his job agreed to see Soto early on in her pregnancy and all seemed normal, Perfecto said.
The unusual pregnancy was not discovered until the couple qualified for the state's insurance plan for indigents, AHCCCS, Perfecto said. By then, the baby was 18 weeks along.
Doctors said that if Soto's unusual pregnancy had been spotted earlier, they would have advised her to terminate it. The risk of rupture, and possible fatal blood loss, would have been too great, said Dr. William Clewell of the maternal-fetal center.
But with the fetus that far along, doctors knew they were already on dangerous ground. They advised Soto of the risks: Surgeons might have to remove her uterus or cut out a part of her bowel. If the placenta had attached to an organ for its blood supply, doctors would have to perform delicate surgery to sever it, or leave it attached and give Soto a drug used in chemotherapy to kill the remaining tissue.
But Perfecto said Soto was adamant. "She decided, 'I want to keep going,' " he said. "All I could do is support her and be there."
Soto was hospitalized in mid-March. Doctors did not want to risk a rupture with her away from a hospital. Up until then, Soto was working a nine-hour daily shift at day care, lifting toddlers and toys. In retrospect, Perfecto said, it was amazing that nothing happened during that time.
Soto's father, Benjamin Soto of Tucson, said that even as doctors debated the exact nature and complications of his daughter's pregnancy, she wanted to press forward. "She said, 'No matter what, I'm going to have this baby,' " he recalled.
Her faith wavered a bit on Monday morning, said Maria Garcia, the paternal grandmother. Soto was crying and worried that the surgery would go badly, Garcia said, in Spanish.
"I told her, 'Only God knows if he will live,' " Garcia said. "Have faith."
In the operating room, doctors handled her gingerly. Clewell said he advised one surgeon to not tap the abdominal area too hard.
"If you know you have a ticking bomb," he said, "one thing you don't want to do is play with it."
Perfecto stood by as doctors began the surgery and removed the wiggling, crying, baby boy. Soto was able to see her son for a few minutes, but Perfecto said the anesthetic was starting to kick in.
"She was in another world," he said.
Perfecto said he felt like his head was on a swivel, constantly looking at his newborn son and back at the surgeons operating on his wife. He finally followed his son out to the Phoenix Children's Hospital wing at Good Samaritan.
Surgeons had a relatively easy time with Soto. She needed no special medical intervention and didn't even lose much blood. Clewell said the only unusual aspect of her surgery will be a larger-than-normal abdominal scar.
Soto was groggy but in good condition Monday afternoon. She was fine enough mentally to decide among the three names that she and Perfecto had been bandying about. "She just told me," Soto said, after coming from his girlfriend's room.
The name Azelan is a variation of Aslan, the name of the Great Lion in the C.S. Lewis book "The Chronicles of Narnia," he said.
The baby is expected to be hospitalized for three to four weeks. Soto is expected to be released in three to four days.
Perfecto said the couple has to hit the stores.
"We haven't shopped for the baby," he said. They waited, he said, because had this day turned out differently, it would have been too painful to return it all.