In February 2022, the Guangdong Provincial Health Commission issued the Implementation Plan for the Guangdong Provincial Action Improvement Plan for Maternal and Child Safety and Health (2021-2025) to provide policy support for the construction of a fertility-friendly society. How to make the population of childbearing age "well-conceived, born safely, and well-bred"? The Education and Health News Department of Nanfang Metropolis Daily will give full play to the advantages of Nandu Think Tank to conduct in-depth research on guangdong's fertility friendliness and help build a fertility-friendly society in Guangdong.
Not every woman has to be a mom. At the same time, we also respect the right of every woman to want to be a mother. When encountering great challenges in physical condition, a 52-year-old woman insisted on giving birth to a child, and the doctor always adhered to professional principles, from the initial strong persuasion to going all out to help her realize her dream, from the top three hospitals to the grass-roots community service centers, using technology, services, systems and love to build a fertility friendly guarantee for critically ill women.
"It was a miracle, when the child came out, everyone had red eyes", Wan Bo, director of the Obstetrics and Gynecology Department of the Third Hospital of Southern Medicine, recalled the baby he delivered on April 28, and couldn't help but get wet.
The baby's mother, Ms. Li, is 52 years old and still has high blood pressure and heart disease, which is not suitable for pregnancy, but she insists on giving birth to the child. After enduring all the discomfort of pregnancy and rejecting all the "too dangerous" warnings, she survived until 33 weeks of pregnancy and gave birth to a baby of more than 4 pounds by caesarean section.
Behind the smooth delivery of such a high-risk pregnant woman is the result of the joint efforts and institutional guarantees of doctors, hospitals, district maternal and child health workers, and community health workers.
Wan Bo, director of the Department of Obstetrics and Gynecology of the Third Hospital of Southern Medical College, performed a cesarean section for Ms. Li.
Cases
Her physical condition was not suitable to stop her determination to have more children
In March 2020, six months after the marriage of Ms. Li's only son, she died unexpectedly in Guangzhou, and Ms. Li was once unable to accept it, feeling that she "had no one to rely on".
Later, Ms. Li and her husband made a bold decision: to have another one. She conceived a child with the help of assisted reproductive technology, but since then, her physical condition has frequently lit up "red lights".
Wan Bo remembered that when he met Ms. Li, it was in early December 2021, when it was winter, Ms. Li was 12 weeks pregnant + about, her hypertension status made Wan Bo frightened, "At that time, the blood pressure measured was high pressure 180, low pressure 120, very high, she also had hypertensive heart disease, walking can only walk flat, climb three layers will not be able to breathe."
At that time, Wan Bo's suggestion to her was to terminate the pregnancy, but Ms. Li directly refused. In fact, Ms. Li had seen doctors in other hospitals several times before, and all the doctors thought that her physical condition was not suitable for pregnancy, but she resolutely refused the proposal to terminate the pregnancy, "each time she signed a refusal, asked to continue (pregnancy), and finally said 'he dies, he lives I live'."
After that, a group of medical nurses accompanied Ms. Li to start the risky pregnancy road.
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Medical care can't stop her from treating and looking forward to "miracles"
How risky is it? "Whether she is 52 years old or 32 years old, such a serious hypertension, heart disease, in medicine is not suitable for pregnancy", Wan Bo introduced, Ms. Li's biggest risk is that high blood pressure may lead to aortic dissection, blood vessel rupture, one is heart failure, "Later, we do not dare to persuade her, a persuasion she is excited, crying, blood pressure is higher, we have to worry about helping her control blood pressure, protect the heart."
To this end, Ms. Li's obstetric examination was arranged as a weekly examination, and each obstetric examination was simultaneously checked in the cardiovascular department to check the cardiac function, and Liang Yanqiong, deputy chief physician of the cardiology department of the hospital, consulted her and participated in her medical guidance throughout the pregnancy.
By 17 weeks of prenatal diagnosis, Ms. Li underwent an amniocentesis to rule out chromosomal abnormalities in the fetus, which gave Ms. Li and the medical care a little confidence.
Ms. Li also lived in the hospital twice, and under the supervision of the doctors in the community health center, she maintained a regular obstetric examination and standardized medication, and her blood pressure and heart function gradually improved, and she went to the third trimester safely.
"If we say that in the first four months we were mainly mobilizing (terminating pregnancy), after 24 weeks, the next two months, everyone's mood became 'expectation', looking forward to a 'miracle'," Wan Bo said.
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Until 33 weeks' gestation, caesarean section
The third trimester after 28 weeks of pregnancy is another dangerous hurdle for Ms. Li, because the whole body blood volume of pregnant women during pregnancy can increase by 40%-45%, especially 32-34 weeks of pregnancy, during childbirth and within 3 days after childbirth, which is the period with the heaviest cardiac load, and the risk of heart failure in pregnant women is greatly increased.
Wan Bo also remembers that once when she did the ultrasound for obstetric examination, Ms. Li was breathing heavily as soon as she lay down in the B ultrasound room, her face was pale and cold sweat, "we were all frightened, we could only help her up to do B ultrasound, she herself also said 'just a cold, it's okay', in fact, the heart failure symptoms of heart disease are easily confused with colds."
In this way, at 32 weeks, Ms. Li's heart function was on the verge of its limit, the treatment of preventing heart failure had reached a critical window, and the fetus had developed to a relatively safe level, and the doctors and nurses had a conversation with Ms. Li. After a comprehensive multidisciplinary consultation in the hospital, it was finally decided that Ms. Li would be given a caesarean section at 33 weeks' gestation.
On April 28, with the cooperation of medical staff from multiple departments, Director Wan Bo performed a caesarean section for Ms. Li. At 9:00 a.m., the fetus is delivered, the medical care immediately removes the foreign body on the mouth and nose of the newborn, while wiping the newborn's body and heat preservation, the umbilical cord can be seen around the neck for 1 week during the operation, and the umbilical cord is knotted, and after the umbilical cord beats away, the umbilical cord is broken, and the baby's crying sounds in the operating room.
"The mother cried, the medical staff followed the red eyes, the child came too easily," Wan Bo recalled.
Subsequently, Ms. Li was transferred to the ICU for a few days, spent a dangerous period of 3 days after childbirth, and was recently discharged from the hospital after a period of treatment in the general ward. Her baby is premature and will have to stay in the neonatal department for a while.
"I don't want to give up, if I want to give up, I won't be today," Ms. Li said looking back on this thrilling fertility process.
behind
Critically ill women are included in the three-level service management network
Community doctors continue to follow up at home and guide medication
Wan Bo proposed that Ms. Li was able to successfully give birth safely in the end, not only because of the efforts made by the mothers and the hospital itself, but also because of the meticulous guidance, communication and follow-up work done by the district-level maternal and child health care institutions and grass-roots community health centers.
Liu Xiaoyu, vice president of Tianhe District Maternal and Child Health Hospital, introduced that Ms. Li is one of the service targets of the "Critically Ill Maternal Upgrading Plan" implemented in Tianhe District in recent years, which has established a three-level service network of midwifery institutions, municipal maternal and child health care institutions, and community health service centers to help critically ill women in the jurisdiction.
Staff from the community health center in Tianhe District visit pregnant women.
In ms. Li's case, Director Wan Bo of the Third Hospital of Southern Medicine, as the first doctor of Ms. Li, promptly informed the Gynecology Department of Tianhe District Maternal and Child Health Hospital of the situation of Ms. Li as a critically ill mother, and after verifying Ms. Li's specific address, the Gynecology Department verified ms. Li's specific address, synchronized the situation to the local street community health service center, and assumed the responsibility of follow-up docking administrative resources, the three hospitals of Southern Medicine, and community doctors.
After the community health center evaluated Ms. Li's situation, it began to visit Ms. Li's home or online follow-up every week, and after learning that Ms. Li's fertility willingness was very firm and refused to terminate the pregnancy, she turned to the door to help her measure her blood pressure and guide medication in the later stage.
Dr. Peng Yanping of the Department of Gynecology and Child Health Of Tianhe Maternal and Child Health Hospital remembers that at the end of last year, there was a period of time at the end of last year, Ms. Li's blood pressure was not well controlled, and after the community doctor visited, she learned that she was afraid of having an impact on the baby, and she stopped one of the drugs on her own, and the medication was not regular, and the medication was done well, and the doctor's various guidance was done very well. She returned to her hometown for the New Year, and our doctor called her to chat with her and learn about her guidance."
Staff from the community health center in Tianhe District visit pregnant women.
"From our experience in recent years, this compliance of critically ill women is slowly established, based on good doctor-patient communication, the more confident everyone is in the back, the better the patient's compliance," Peng Yanping said, Ms. Li was recently discharged home, the news has been synchronized to the community health center, the community has arranged a door-to-door visit, planning to visit her once a week before 42 days after childbirth, and then, Ms. Li may be included in the follow-up service management network for chronic hypertension. Maintain the continuity of the Service.
According to reports, in the Tianhe District Maternal and Child Maternity Protection Department, critically ill women like Ms. Li are continuously included in the "CriticalLy Ill Maternal Improvement Plan", "on average, three or four new cases are reported every week, and we will implement it in each street."
"Our work for women and children is like a net, weaving a net with love to ensure the safety of mothers and babies," Peng Yanping said.
Liu Xiaoyu introduced that the "critically ill maternal improvement plan" for women and children in Tianhe District is also part of the critically ill maternal medical services promoted by Guangzhou in recent years, and this "closed-loop management" idea is gradually maturing and implementing into more grass-roots communities.
Thematic coordinator: Yin Lai, You Manni, Wang Daobin
Written by: Nandu reporter Li Wen correspondent You Hualing