The pregnant woman suddenly broke the water at night, and she had two uterus

On the night of April 4, the emergency department of the Huangpu Branch of Red House Hospital came to a pregnant woman Yunyun (pseudonym) who was 36 weeks pregnant, and her arrival made Zhu Menghan, the receiving doctor, immediately nervous.

Unlike ordinary pregnant women, Yunyun not only has a sudden premature rupture of membranes and preterm labor, but also accompanied by primary hypertension, overweight, advanced age, etc., in addition, she also has high risk factors for double uterus and double cervix.

Double uterus and double cervix is a congenital malformation of the reproductive tract, because the two sides of the Mullerian tube during the embryonic development period are completely unfused when they develop, and they develop separately, forming two uteruses, with their own fallopian tubes attached, each with its own function.

At this time, delivery is full of risks and challenges for Yunyun and doctors.

1

The situation is urgent, and I want to go to the Red House to give birth

Because she has been in the Red House Hospital for obstetric examinations, she trusts the doctors in the hospital very much, and even if her family lives in Minhang District, Yunyun still wants to give birth in the Red House. After the amniotic fluid broke that night, Yunyun was transferred to the Huangpu Campus by the 120 emergency department, but she did not have an effective time to report the nucleic acid when she came. The emergency doctor quickly guided Yunyun to do emergency nucleic acid sampling.

Dr. Zhu Menghan at work (right)

The baby is not full term, the fetal head is high, the cervical conditions are also very immature, and the double uterus and double cervix may have reproductive tract system dysplasia, if the vaginal trial may occur uncoordinated uterine contraction caused by vaginal trial failure, severe uterine rupture may occur to endanger the safety of the mother and the baby.

After the initial assessment, Dr. Zhu Menghan immediately reported to the head teacher, Xia Xian, deputy chief physician. The green channel started at the first time, the doctor prepared for antispasmodic and antihypertensive treatment, while handling the expedited admission procedures, the negative pressure operating room, the ward prepared at the same time, and the neonatology department and anesthesia department were also quickly in place. After full communication with Yunyun and her family, the doctor decided to start the emergency caesarean section procedure.

Considering that Yunyun had hypertension, oral anticoagulants until the night before, and that she had hysteroscopic surgery before becoming pregnant, there was a risk of intraoperative postoperative bleeding, and the operating room actively prepared blood.

Because of the requirements of epidemic prevention and control, family members cannot accompany pregnant women for the time being, doctors have been patiently communicating, and the accompaniment along the way has also made Yunyun relax and calm a lot. After the emergency negative nucleic acid report came out, the team in the negative pressure operating room had already been "fully armed" and waiting for the operation, and the operation was led by Deputy Chief Physician Xia Xian and Dr. Sun Yi.

2

Pregnant women with double uterus face two major dangers for emergency caesarean section

For Yunyun, the biggest risk of caesarean section is heavy bleeding and uterine lacerations, and the surgical team is racing against the clock to start "fighting".

In the operation, all the bleeding in the fat layer is obvious, and the doctor ligates the bleeding point while cutting, quickly separates the large omental adhesion after entering the abdomen, and then ligates the proliferative vascular plexus on the surface of the uterus.

After the sufficient hemostasis measures, the official delivery began, but the risks were still testing the doctors.

The surgery is intensely underway

Normally, the uterus is located in the middle of the pelvic cavity, which the doctor can accurately locate during surgery. Yunyun has two uterus, the pregnancy is on the left, you must first locate the head of the fetus, and then "straighten" the left uterus. Modern caesarean sections generally take a "transverse incision" in the lower uterus, and the length of the incision should reach the size of the baby's head circumference. However, the two uterus of Yunyun are crowded together, the surgical space is small, the lower part of the uterus at 36 weeks of pregnancy has not yet been formed, the uterine muscle layer is very thick and small, once the uterine incision is extended to the side during the fetal head removal process, the uterine artery ruptures, and it is very easy to cause serious bleeding, and the consequences are unimaginable. During the lateral incision, the doctor cleverly extends it from the edge of the incision slightly longitudinally to prevent the uterus from tearing laterally, and finally successfully delivers the baby.

3

Do everything possible to avoid danger

With a loud cry in the early hours of the morning operating room, a little princess weighing 2420g was born. The neonatologist immediately treats the airway to maintain normal breathing. Despite being born prematurely, the baby is growing well. The blood vessels around the uterine incision are extremely rich after surgery, the uterine body is soft and contract poorly, the placenta is stuck in the uterine cavity, and blood is constantly gushing out. Before it was too late to breathe a sigh of relief, the doctor quickly peeled off the placenta by hand, and the uterine shrinkage agent promoted uterine contraction and prevented postpartum hemorrhage.

Wearing heavy protective clothing and wearing three layers of sterile gloves for surgery, it was a severe test for delicate operations, but in this "unusual" caesarean section, the doctors were extra careful, carefully separating, ligating, stopping bleeding, cutting in the millimeter... Do everything possible to avoid the occurrence of heavy bleeding and uterine lacerations. 0:20 with the last stitch, the operation ended smoothly, the whole bleeding was only 300 ml, and everyone was deeply relieved.

At the moment of seeing her daughter, Yunyun, who had experienced transportation, emergency treatment and surgery, finally revealed the joy of becoming a new mother, and the family members who had been anxiously waiting finally calmed down after receiving the call.

"In fact, such emergency departments are not uncommon in ordinary times, but under the epidemic, pregnant women need a team with excellent skills and humanistic care." Deputy Director Xia Xian said. At present, the epidemic prevention and control is still in the stage of attacking the tough, in the face of unpredictable emergencies, in addition to fully ensuring the safety of mothers and babies, medical staff also have the warm waiting of "often comforting and accompanying".

Author: Li Miaoran, Sun Yi