A woman in Shanghai who had just had a spontaneous abortion, as a close contact with her positive husband, was also sent to the hotel for isolation. She found herself bleeding continuously, nervous and scared, and called the doctor on the online consultation platform.
The phone was answered by Min Yujia, a male doctor in the obstetrics and gynecology department of a hospital, who asked about the condition in detail, comforted the other party and said that this is normal, "just like if you fall, the wound will take two days to heal", and told her what to deal with in case the situation is serious.
Zhou Yuanyuan, an obstetrician-gynecologist and a pregnant woman who is 36 weeks pregnant, understands the sensitivities, anxieties and worries of these expectant mothers best. When asking online, in addition to giving pregnant women a reasonable diagnosis, she will also try to comfort them as much as possible, "not only doctors, but also companions."
Pregnant women have always been a group of people who have attracted much attention during the epidemic in Shanghai. Sealing and control disrupts the original rhythm of pregnancy testing for some pregnant women, and when there is an unexpected situation, some people will first choose online consultation.
In early March, the Shanghai Municipal Leading Group for Epidemic Prevention and Control issued the Work Plan for Guaranteeing Maternal Medical Services During the COVID-19 Cluster in Shanghai, which clearly stipulates the process of maternal visits. All midwifery medical institutions are required to strive to provide health education, clinical consultation, psychological support and medical guidance for pregnant women through various forms such as Internet hospitals.
In order to solve the needs of patients, many top three hospitals in Shanghai have opened up all-day Internet medical treatment, and many doctors such as Min Yujia, Zhou Yuanyuan, including Shanghai doctor Xiao Chengwen, who is assisting Xinjiang, have joined the ranks of online consultation.
In most cases, doctors cannot rely on online consultation to completely solve the patient's problem, but through meticulous communication, it can help judge the condition and give professional treatment suggestions. Help patients make a choice between "going" or "not going" to the hospital under the pandemic.
Here's what they say:
On the evening of April 1, a pregnant woman was carried out of an ambulance outside the emergency room of the Shanghai International Peace Maternal and Child Health Hospital. Photo by Xinhua News Agency reporter Yuan Quan
Min Yujia: Show patients the way
After the shanghai sealing and control management, we began to implement the rotation of duty, the doctors of the department were divided into two groups, one round for 7 days, 7 days on the go, and 7 days off. While on duty, the doctor was in the hospital. The duty room has two bunk beds, which can accommodate 4 people, and there are also doctors who set up camp beds in the office. This avoids the doctor from going back and forth every day, increasing the chance of infection.
At the beginning of April, the number of ordinary outpatient clinics in our hospital was about 60 a day, and there were always many people with fever clinics. The hospital stipulates that the doctors in the outpatient clinic and the ward do not cross each other to prevent infection, and I am on duty in the ward, and I will receive some online consultations between work.
During this period, online consultations have increased a lot more than before, and at twelve o'clock in the evening, there are still people who come to consult.
At present, online consultation is mainly three types of situations: bleeding in early pregnancy, obstetric examination and abortion.
Early pregnancy bleeding is very common, but in normal times, there is a problem, you can directly register to find a doctor, give yourself the next diagnosis, should take medicine to take medicine, the treatment treatment. Now, because of the sealing at home, this situation occurs, and the patient's panic and fear are magnified. Maybe online consultation is also a way for them to do it.
Usually in this case, I will first determine whether she is threatened with blood or cervical bleeding. Ask her if she's had a gynecological exam recently, if she has any cervical problems. If it is convenient, I would recommend that she go to the hospital for a check-up, and if it is not convenient, let her observe the amount of blood. If the amount of bleeding is small, take a break at home, eat more things that are easy to digest, avoid constipation, and most people can get better by resting. If there is more bleeding, she will still be recommended to go to the hospital to do ultrasound and medication to protect the fetus. Because there are certain restrictions on online consultation, no one can be seen, no examination can be done, and she can only be guided to deal with it according to her medical history.
Because of the epidemic, many pregnant women cannot do routine obstetric examinations and are very anxious. I will let her relax, if there is no abdominal pain, no heavy bleeding, about 7 weeks to do a B ultrasound, by 12 weeks, go to the health check can be. In the second trimester, go to the hospital once every 3 to 4 weeks; After the third trimester (34 weeks), go once every two weeks. Because of going to the hospital during special periods, there is also a certain risk of infection.
There are also more people consulting. A lady who is more than nine weeks pregnant asks if she can do abortion. I told her that it is generally possible within ten weeks, and if it is in the control area or the prevention area, you can come to our hospital to register, do examinations, and make an appointment for surgery. Medical resources are now limited, and surgery should be arranged according to the size of the patient's gestational age.
One afternoon, I received an online consultation, and a woman was bleeding about a week after the spontaneous miscarriage. Her husband tested positive and went to the square cabin. Knowing the situation, I told her that after the miscarriage, bleeding within two weeks is normal, as long as the amount is not large, this is the repair process of the endometrium, just like if you fall and the wound takes two days to heal.
The lady was alone in the hotel at the time, and had just had a miscarriage, no one to accompany her, her voice sounded nervous, and after I told her about the situation, I felt that she was a little more relaxed.
Now online consultation, I feel that more often, I play a comforting role. For example, some time ago, a pregnant woman tested positive for nucleic acid and cried a lot, especially worried about affecting the child. I sent her some foreign research data and told her that according to foreign reports, there are people who have no problem. Unless you have a prolonged fever or have other problems during pregnancy and obstetric examination, the impact of this disease on the fetus, as far as the current research results are concerned, is not particularly large.
There is never a 100% thing in medicine, I can't say, you are certainly fine, but I will tell you some data, some facts, so that the other party is more convinced and more relaxed.
During the pandemic, the rules for seeking medical care have changed, and they have changed. Because of the relative asymmetry of information, many people can only understand through online consultation, and what doctors need more is his professionalism and his calm and accurate judgment of the problem. In this way, after the patient receives this information, he will be more stable in his heart and know where to go.
You say I haven't encountered anything particularly touching lately, and it seems that there is none. Everyone has their own joys and sorrows, and we usually see a lot. If everyone is so emotional, there is no way to work. During the epidemic, since everyone has this need, I will try to help answer it. Although it is said that it is not possible to completely solve the problem, there is a way to give people a finger, and it can solve a little problem.
During the epidemic period, the hospital opened a maternal love nutrition station to distribute free breakfast to pregnant women who came to the obstetric examination to take home. Image source: Fudan University Affiliated Obstetrics and Gynecology Hospital official WeChat public account.
Zhou Yuanyuan: Pregnant mothers help pregnant mothers
Since the epidemic, many patients have no way to seek medical treatment, we can only try to expand the number of online outpatients, our hospital's Internet clinic is open all day on weekdays, and the previous week was only open for half a day.
I am also a pregnant woman in the third trimester, plus someone in the community where I live has been tested positive, during this time I stay at home and participate in some online consultations on other platforms.
For example, some patients will ask, doctors, I can't go to the hospital now, I can't dispense medicine, and the drug stopping has a big impact on my disease? Also said that I originally had an appointment for surgery, but now I can't go, will my illness change? Or if there are positive cases in our community, can we go to your hospital? I will explain to them in response to these confusions and make up for the information gap. In general, when the question is answered, they are not particularly anxious.
I met a more anxious consultation, one day at twelve o'clock in the middle of the night, a man left a message on the Internet saying that her wife is pregnant, the nucleic acid test is positive, and now there are fever symptoms. I sent several in a row, and I felt very anxious. He wondered how this situation should be dealt with. And does positive nucleic acid in pregnant women have an effect on the baby?
I saw it the next morning and got back to him right away. First tell him that from the current research, the possibility of this virus affecting the baby through the placenta is very low, don't worry too much. Then address her current symptoms, such as some physical cooling methods. Finally I reminded him to remember to report it.
In early April, a pregnant woman called for consultation, she was very anxious, said that she had thrombophilia, to use heparin for a long time, during the epidemic, she could not go to the hospital to dispense medicine, she wanted to find a doctor online. Long-term patients like her are very experienced, and when they consult, they will send you detailed medical records. After confirming all the records, I gave her medicine. Fortunately, several drugs she wanted, all on the e-commerce platform, and at that time, she could also express delivery, which helped her solve this problem.
Because some hospitals cannot be treated, many pregnant women who are in labor have been transferred to our hospital, and the amount of delivery in our hospital is larger than before the epidemic, but the doctors are decreasing, because some doctors are isolated at home, so our workload is getting bigger. Some time ago, I was left in our department and another doctor to see an outpatient clinic.
Pregnant women who come to the obstetric clinic now also ask some special questions: Doctor, during this time, I am not eating well, is my baby not well nourished, not growing well or not developing well?
Online consultation and face-to-face consultation are not the same, you go to the doctor, maybe the doctor three or two minutes to see you. But platform consultation sometimes has to ask for a long time, like I like to ask the patient's situation clearly, but also with her to ask for the report of the previous examination, some patients do not understand, will be anxious.
In special times, we can only say mutual understanding. Not long ago, working in the hospital, a patient said, you are such a big pregnant woman, still at work, my tears flowed down the N95 mask, fortunately still wearing a protective mask, no one was found. I'm 36 weeks pregnant, but there's no way, there are few doctors and patients need it.
Therefore, I can understand the pregnant women who seek medical treatment during this special period. During pregnancy, people are more sensitive. When online consultation, their anxiety is deeply experienced, and I will try to give them a reasonable diagnosis and comfort them appropriately.
Obstetricians and gynecologists attend remote consultations. Image source: Fudan University Affiliated Obstetrics and Gynecology Hospital official WeChat public account
Xiao Chengwen: Online consultation with pregnant women in Shanghai in Xinjiang
I am the chief physician of the Obstetrics and Gynecology Hospital affiliated to Fudan University, and since August last year, I have been going to Xinjiang with the medical team of the unit to support.
My online reception time here is fragmented, if it is a phone call, you can make an appointment, a call is about 15 minutes. If I'm busy, I'll dial back later. If it is graphic, then I will reply in time when I see it.
In most cases, in the case of not being able to meet with patients and not being able to examine their bodies, it is difficult for me to completely solve their problems through online consultation, but I can help patients analyze the condition, judge the timing of treatment, and give suggestions during the closure period through patient inquiries.
I remember more clearly that one night at 10 o'clock, a patient in Shanghai told me that she felt some pain in her left lower abdomen, which had been in pain for more than 1 hour, and she was worried about whether it was an ectopic pregnancy, and she was now isolated at home, and it was difficult to go to the hospital. I carefully asked her about the symptoms, the extent of the pain, and I judged that she was most likely ectopic, so I strongly recommended that she immediately report to the community and go to the nearest hospital for examination. Later, she contacted me and said that it was indeed an ectopic pregnancy, and went to the hospital with the help of the community, and our colleagues in front of her also helped her to operate in time to eliminate the risk. This case can be said to be a relatively urgent situation.
There is also a pregnant woman, who previously had about 17 weeks of amniocentesis surgery in a tertiary hospital in Shanghai, so at 17 weeks, she is sealing and controlling, what if she can't do surgery? I analyzed her, her chromosomal abnormalities are relatively small, don't worry. My advice is that it doesn't matter if it's a little later, and when the epidemic eases a little, you can make a new appointment. Because if she takes the green channel to do amniocentesis, when she returns home, she may have to go to a separate isolation environment, and life is very inconvenient.
This conclusion is to combine the patient's condition and then give advice, not blindly, must be scientific to evaluate the timing of her visit.
There is also a patient, she is sealed in the office, eating takeout every day. And she has a history of fetal arrest, so she is very nervous, and can not eat folic acid tablets, I mainly help her relieve anxiety, such as to help her judge whether there is an early pregnancy reaction, because sometimes pregnant women's anxiety itself will also lead to miscarriage and adverse consequences. In fact, what I can do is to give her some nutritional guidance, such as the variety of diets as diverse as possible, must be a small amount of diversity, disguised as a multivitamin supplement.
In fact, pregnancy is a physiological state, generally not life-threatening, so in terms of medical priority, the maternal population is not as good as acute patients. But in the process, they still need professional advice and psychological support. I also feel relieved if my advice can really help patients.
When the epidemic in Wuhan was in 2020, I returned to the online consultation platform and began to do some science popularization and live broadcasting on the Internet. At that time, I felt that for people in isolation, online can still solve some problems.
During the epidemic in Shanghai, the obstetrics department of our hospital was in normal operating condition. When pregnant women come to our hospital, we will open a green referral channel for pregnant women, and there are also patients in other hospitals who have been examined for maternity, and temporarily transfer to our side.
In fact, our hospital is for pregnant women to build a group, to help them answer some questions, answer some of their anxieties about obstetric examination, the hospital is doing their best to do some things.
Like me, it's almost impossible to save people through remote consultations, my abilities are limited, and what I do is very insignificant compared to those on the front lines.
On the evening of April 1, nurses from the International Peace Maternal and Child Health Hospital prepared for treatment at the emergency pre-screening desk. Photo by Xinhua News Agency reporter Yuan Quan
(Min Yujia, Zhou Yuanyuan, Xiao Chengwen as pseudonyms)
Beijing News reporter Wang Shuangshuang Zhu Qinghua intern Wang Yifan
Edited by Hu Jie, Proofreader Zhang Yanjun