Having just given birth to a baby girl who has not yet reached full term, this newly mothered patient was transferred from the Women's and Children's Hospital to our hospital due to "pulmonary hypertension" and was admitted to the Cardiology Department. The daughter is still in the neonatal intensive care unit of the women's and children's hospital, and the mother is living in the intensive care unit of the cardiology department of another hospital, the mother and daughter are separated, and the heavens are separated, so poor mother! What a poor little baby!
Forget which sage said that a woman who has not become a mother is an incomplete woman! Nowadays, some couples pursue pleasure, admire Dink, and evade their responsibilities to society, in contrast, this woman risks her life to conceive and have a child, and her risky behavior, although undesirable, is really respectable. Fortunately, the patient stayed in my department for a week, and now the symptoms have lessened and the situation has improved significantly. However, for patients with "pulmonary hypertension", we still cannot clearly explain the cause.
The patient was in the pregnancy of 6 months of chest tightness, asthma, shortness of breath symptoms, to 7 months, that is, at the end of last month, the patient's symptoms were significantly aggravated, both lower limbs also appeared depressed edema, so did cardiac ultrasound, found that the left heart system is normal, EF 70%; but the patient's right heart enlargement, tricuspid valve ~ a large amount of reflux, the main pulmonary artery is also significantly widened, estimated pulmonary artery pressure as high as 84mmHg! The patient's situation is obviously not suitable for continuing the pregnancy, so the patient chooses to terminate the pregnancy early in the women's and children's hospital, and the newborn who is only seven months old has left the mother's comfort nest (uterus) early and came to this world early! The mother, who had just become a mother and had not yet had time to look at the baby, was also hurriedly transferred to the intensive care unit of a general hospital. Throughout the Spring Festival holiday, the patient spent in the intensive care room, I wonder how the mother was in the moment of transfer? Was she worried about her baby lying in another hospital?!
Women can't tell their physical condition before pregnancy, anyway, there was no discomfort at that time. During pregnancy and obstetric examination, just pay attention to check the condition of the fetus, as for adults, there is no electrocardiogram, no cardiac ultrasound, no contact with radiation during pregnancy, let alone chest X-ray examination, CT chest x-ray. In short, how the previous situation, there is no relevant examination data, no one can say clearly, until the symptoms are obvious, the doctor, the patient both sides only attracted attention, this check, did not expect to be such a serious pulmonary hypertension! So, how exactly did her "pulmonary hypertension" cause it?
With the increase of the month of pregnancy, the uterus gradually becomes larger, compressing the pelvic cavity and even the inferior vena cava, resulting in venous return disorders of both lower limbs, venous thrombosis of the lower limbs is very likely, once the thrombus falls off, of course, it is not a large thrombus, the large thrombus falls off the embolic pulmonary artery, it is going to die, here is the broken venous thrombosis shedding, blocking the distal branch of the fine pulmonary artery, this situation is neither fatal nor causes obvious symptoms, but the pulmonary fine arteries due to ischemia and hypoxia, reflex spasm, over time, It is not impossible to cause increased pressure in the pulmonary arteries. Women's and children's hospital after finding that the patient's D-dimer was significantly elevated (19.06mg/L) and quickly transferred to the hospital, the emergency department of our hospital also reviewed the D-dimer (7.32mg/L, still elevated), emergency blood gas analysis (reduced partial pressure of oxygen, 68.2mmHg), and successively improved the heart ultrasound, pulmonary artery CTA, double lower limb vein B ultrasound examination, although the double lower limbs did not find signs of thrombosis, but the pulmonary artery CTA did suggest "pulmonary embolism", So the emergency into the cardiology intensive care unit, respiratory department, I.CU consultation, to the patient with low molecular weight heparin anticoagulation, special purchase of bosentan drugs combined with Hebei Shuang to reduce pulmonary artery pressure treatment, diuretics to eliminate edema, soon, within a week of the patient's symptoms reduced, both lower limb edema disappeared, heart rate decreased, review blood gas oxygen partial pressure increased, D-dimer is also close to normal. However, after several re-examinations of cardiac ultrasound, pulmonary artery pressure remained high, and the last examination of pulmonary artery pressure was estimated at 88 mmHg.
Is the patient originally present with pulmonary hypertension, which gradually worsens during pregnancy, and the pulmonary embolism plays a role in fueling the waves? Or is it a long-term recurrence of chronic pulmonary artery embolism that eventually causes pulmonary hypertension? If it is concluded that the latter is committed, it seems that the patient's pulmonary artery embolism is not frequent and particularly serious, and it is indeed impossible to perfectly explain such a high pulmonary artery pressure from the perspective of the pathogenesis process! So, is there anything else possible?
Yesterday, the patient was discharged from the hospital. We hope that patients can go to more professional hospitals to solve these puzzles. At present, the patient has just given birth, whether to sit in confinement first, or go to the higher hospital as soon as possible, the family does not seem to have made a decision, we do not know!
May mother and child be safe, and only send blessings!
