Photo: Shanghai Dongfang Hospital multidisciplinary team for Qingqing surgery Interview subject courtesy of (the same below)
Yesterday was Mother's Day, and Qingqing, who had just become a new mother for one day, sent a holiday thank you to Liu Ming, director of the obstetrics department of Shanghai Oriental Hospital: "The 8 weeks of the epidemic have been spent with you, thank you for letting me have the most special Mother's Day gift." ”
It turned out that on March 11, at the 28th week of pregnancy, Qingqing was urgently admitted from the emergency department of the South Hospital of Dongfang Hospital due to "heavy bleeding" without warning, and spent 8 weeks of "central placenta previa" with medical staff during the epidemic. In the end, with the support of multidisciplinary collaboration, the delivery went smoothly on May 7.
The road to seeking a son has been bumpy And the epidemic has encountered heavy bleeding
The 36-year-old Qingqing's road to seeking a son has been full of twists and turns. The first pregnancy was shed 7 years ago, and in the following years, she failed to prepare for pregnancy many times. To make matters worse, she was diagnosed with "adenomyosis, ovarian chocolate cyst", and underwent 2 laparoscopic surgeries, dense adhesions in the pelvic abdominal cavity, and blocked fallopian tubes. Since 2018, there have been 7 egg retrievals and 3 transplants, all of which have failed. After more than 3 years, she finally conceived twins in September last year.
In March, with the gradually severe epidemic situation in Shanghai, the hospital of Jianka Maternity Examination was sealed, which made Qingqing, who had just turned 28 weeks, nervous, and could only pray that the baby in her belly would not have problems. Unfortunately, on March 11, 28+ 1 weeks pregnant, Qingqing had a heavy bleeding without any signs, and bright red blood flowed down her pants to her ankles, making her desperate for a while, was she going to lose her child? The question went back and forth in her mind countless times, and the more she did so, the more she needed to be calm. After making an emergency call in advance to confirm, she was sent by her family to the emergency department of the South Hospital of Oriental Hospital, and the receiving doctor found the seriousness of the problem: 28 weeks, twin pregnancy, pregnancy ultrasound prompted that the lower edge of the placenta was completely covered in the inner cervical opening, belonging to the central type of placenta previa, according to the description of bleeding at that time, it was estimated that there were 400 ml, the situation was not optimistic!
The emergency doctor immediately consulted the obstetrics department and immediately admitted her to the obstetric ward. After a detailed understanding of Qingqing's experience of conceiving along the way, Liu Ming, director of obstetrics, after careful evaluation, decided to temporarily carry out conservative treatment, give inhibition of contractions, promote fetal lung maturation, and actively prepare blood, consult with the neonatology department, and be ready for premature delivery treatment at any time. "Qingqing, the child is so precious, we work together to go back a little further, so that the child is older." Don't be afraid, during the epidemic prevention and control period, our medical staff are basically in the hospital 24 hours a day, and we will always guard you and do all the coping plans. Liu Ming's words were gentle but firm.
Under the careful treatment and care of the obstetric team of Dongfang Hospital, one week, two weeks, three weeks, four weeks... Qingqing experienced a special eight-week hospital stay, although the bed was long, But Liu Ming and the team constantly adjusted the treatment plan according to the situation, while paying attention to her psychological changes, guiding the adherence to proper bedtime activities...
Delivery on the agenda Nearly ten departments coordinate consultations
Fast forward to May, and qingqing, which has been more than 36 weeks old, still has a small amount of coffee-colored secretions from time to time, but a new situation has emerged: the ultrasound results found that the fetus is getting slower, and one of the babies has an umbilical cord around the neck twice.
"With a central placenta previa, by 36 weeks you need to plan your delivery." Liu Ming decisively judged that the delivery was put on the agenda, under her leadership, the obstetric team first conducted a difficult case discussion, the risk of serious postpartum bleeding in the central placenta previa is quite high, and a large number of blood products need to be prepared before surgery to prevent blood loss and emergency use.
However, at the moment of the epidemic, can we prepare so much blood at once? Qingqing's previous 2 ovarian chocolate cyst surgeries have confirmed that there is a fairly serious pelvic abdominal adhesion, which has caused great difficulty to this operation, not only has difficulties in hemostasis, but also increases the risk of injuring surrounding organs during surgery, common intestinal canal injuries, ureteral injuries, will affect the future quality of life of women. With a large area of placenta covered in the anterior wall of the lower segment of the uterus, can the premature twin babies of 36 weeks be able to withstand the pressure of anesthesia and maternal blood loss? Many high-risk factors, Liu Ming immediately decided, applied to the hospital for multidisciplinary consultation, and must make a complete system plan before surgery to ensure the safety of mothers and babies.
On May 6, another big discussion began. Under the leadership of the Medical Department of the Southern Hospital, obstetrics, gynecology, neonatology, anesthesiology, blood transfusion, ICU, imaging, gastrointestinal surgery, urology and other multidisciplinary online joint consultations were held to discuss the condition together to form an optimal plan. The section directors expressed their opinions and finally agreed that the operation time would start on time at 1 p.m. the next day.
The surgical plan has a framework and details: the blood transfusion department fully prepares blood, prepares the intestine before surgery, places a bilateral ureter catheter by the urology department first, the anesthesia department presides over general anesthesia, manages vital signs, the gynecology department goes on stage to assist in the operation, the gastrointestinal surgery preparation class is waiting for dispatch, the neonatology department arranges two groups of medical staff to welcome 2 premature babies, prepare for asphyxia resuscitation, the ICU is ready for admission, and the obstetric safety office is responsible for overall coordination.
After the end of the consultation, it was late, Director Liu Ming did not forget to visit Qingqing in the ward, informing qingqing of the risks at the same time, mainly to cheer Qingqing, telling the family members who sat on needle felt: We have made perfect preparations, please rest assured! The obstetric team once again held a meeting to divide the work, and the sand table deduced the surgical process.
Pictured: The day before Mother's Day, two cute baby girls were welcomed
Multidisciplinary collaboration Smooth childbirth welcomes new life
At 12:30 on the 7th, Qingqing was pushed into the operating room, and doctors from various departments joined her to officially start this long-awaited "birth battle".
Open venous access, deep venous catheterization, connect ECG monitoring, prepare autologous blood transfusion, start anesthesia. The operating room nurse prepares surgical instruments, ureteroscopes, double J tubes, suitable sutures, gauze, suction devices, necessary uterine shrinkants, etc. as required. After that, the urology department took the stage to first double ureter catheterization, and in just 5 minutes, I saw 2 double J tubes slowly inserted into the bilateral ureters in turn. The caesarean section is officially started! Liu Ming officially took the stage, after entering the abdomen, he only saw the lower part of the uterus purple-blue, the blood vessels were angry, avoiding the placenta attachment site for hysterical incision, 13:46 transverse delivery of the eldest daughter, birth weight 2590 grams, Apgar score 9 points-9 points-9 points, 13:47 points hip position to give birth to the little girl, birth weight 2160 grams, Apgar score 8-9-10 points!
The two little babies who were crying and crying were sent to the long-awaited team of director Hu Yong of the neonatal department under the stage, and the 2 groups of medical staff were treated by keeping the 2 little babies warm and cleaning the respiratory tract, and the babies looked rosy and in good condition. New life brings new hope, and everyone rejoices.
The second half of the surgical hemostasis is a difficult task, only to see that the placenta is completely attached to the lower segment of the uterus to cover the inner opening of the cervix, and after manual removal of the placenta, local bleeding is active. Local sutures are ineffective in hemostasis, as predicted before surgery, the posterior wall of the uterus is completely enclosed with the posterior peritoneum, and the bilateral adnexal areas are densely adhered. Wang Jianjun, director of gynecology, immediately came to the stage to assist in the operation, and the doctor skillfully performed bilateral ascending branch ligation of the uterine artery and uterine compression suturing, and the uterus miraculously stopped bleeding. Subsequently, the uterus is routinely sutured and the abdomen is closed. In order to continue to observe the bleeding in the abdominal cavity, a pelvic negative pressure drainage tube was also placed to ensure that nothing was lost. The operation ended smoothly in only 2 hours, and the total amount of bleeding was 700 ml, no blood transfusion, and the whole operation process was perfect!
After resuscitation of general anesthesia, Qingqing and the child returned to the ward safely, and the best results were achieved after 2 months of joint persistence. Perhaps the special experience in the epidemic is more precious, Liu Ming is also happy to almost cry: "Now more and more difficult to get pregnant, difficult to hold a baby, many of our pregnant women are like Qingqing, with many high-risk factors, such as IVF, advanced age, twins, polycystic ovary syndrome, pregnancy and immune diseases, etc., it seems that it often takes several years or even nearly a decade to get a child." ”
She lamented that this puts forward higher requirements for the multidisciplinary support of the obstetric team and even the hospital: "From keeping the child to giving birth safely, on this road, we have been working hard. For the special environment under the epidemic, I also hope that all pregnant women can give birth smoothly like Qingqing and see the sun. ”
Correspondent Sun Yu Xinmin Evening News reporter Gao Yang