For Ariadna Gavan and her husband, Sean, pregnancy was defined for years by uncertainty rather than expectation. “I thought my body just wouldn’t allow me to carry a child full term,” she said. Over three years, the couple lost three babies — all born prematurely, all alive at birth, and all unable to survive because of how early they arrived.
The first loss occurred in June 2023 at 21 weeks. Gavan was traveling in her home country of Brazil when she went into labor without realizing it.
“I was used to pain at that time,” she said, explaining that earlier hospital visits had not revealed any urgent concerns. The baby was delivered unexpectedly in a hotel bathroom. “Very traumatic,” she said. “And because there were no medical records of what happened to me, they didn’t really know why.”
At that point, Gavan had already been under the care of Yitzhack Asulin, M.D., MSc, FACFS, FACOG, a Urogynecologist with Pascack Valley Medical Group. Dr. Asulin had previously identified uterine fibroids while she was trying to conceive. After the first loss, he decided to remove the fibroids, believing they could be irritating the uterus.
Twins in the NICU
In early 2024, Ariadna became pregnant again — this time with twins. “There are no twins on my side, no twins on my husband’s side,” she said. “It was a surprise, but a sweet surprise.” Because of her history, Dr. Asulin also referred her to Keith Lescale, M.D., a maternal-fetal medicine specialist, for additional monitoring.
Throughout the pregnancy, Gavan’s cervix appeared stable. “It was always long and closed,” she said. “I wasn’t dilating in any way.” Then one day, when she was 24 weeks along, she woke up with cramping and went straight to the hospital. “I wasn’t going to take chances,” she said. Despite emergency measures, she went into labor and underwent an emergency C-section.
Both twins were born alive and transferred to a higher-level NICU. One died two days later. The other survived eight days before complications overtook him. “They both had bleeding in their brain and lungs,” Gavan said.
Silent complication
The repeated losses eventually led to a diagnosis: cervical insufficiency. “It’s very silent,” she said. “It doesn’t give you signs until it’s too late.” With a confirmed cause identified, Dr. Asulin proposed a transabdominal cerclage, a surgical procedure intended to prevent the cervix from dilating prematurely.
Getting approval for the cerclage was not straightforward. Gavan’s husband Sean, said state guidelines typically require documented losses that meet specific criteria. “They didn’t count the baby we lost in Brazil,” he said. “They wanted us to have another loss, but Dr. Asulin said no. He championed our case to get approval — there was no way he was letting that happen.”
The cerclage was placed in January 2025. Gavan became pregnant again in July. This time, monitoring was constant. “He said, ‘We’re going to monitor you like a hawk,’” she said. Multiple ultrasounds were alternated every week between physicians. Steroid injections were given to support lung development. “Everything was very planned,” she said.
Abundance of caution
Even so, anxiety followed every symptom. “We went to the hospital probably eight times out of fear,” she said. By late February, doctors decided Gavan should remain hospitalized. On March 1, after contractions increased, Dr. Asulin performed a C-section at just over 35 weeks.
Their son, David, was born healthy. “He came out beautifully,” she said. He required no NICU stay and remained with his parents throughout their hospitalization. “We were ready for him to need extra care,” she said. “But he didn’t.”
Now home, David is doing well. “No complications,” Gavan said about his first pediatric visit. For the two parents, the outcome still feels unfamiliar. “We had thought about adoption,” she said. “We thought about everything. We didn’t know if this would ever happen.”
When she looks at David, Gavan does not separate the moment from the people who helped her reach it. “Every time I look at my child, I think of Dr. Asulin,” she said. “If it wasn’t for him, my child wouldn’t be here. I know that.”
For more information about maternity and other women’s services at Pascack Valley Medical Center, visit our website.