Recently, the obstetrics team of Jiangsu Provincial People's Hospital (the First Affiliated Hospital of Nanjing Medical University and Jiangsu Provincial Maternal and Child Health Care Hospital) has continuously treated many critically ill women. Through various forms such as multidisciplinary consultation guarantee, medical staff helping grassroots hospitals, and opening green channels for treatment and treatment, the hospital has further smoothed the green channel for the treatment and referral of critically ill women, so as to "escort" the life safety of mothers and newborns in the province.
Multidisciplinary expert MDT consultation allowed pregnant women with hemophilia to become mothers smoothly
Ms. Li (pseudonym) was diagnosed with hemophilia B 6 years ago and has been living cautiously for fear of bumping into it. In order to fulfill her dream of becoming a mother, Ms. Li became pregnant with the help of three generations of test-tube technology under the premise of full prenatal genetic counseling by the provincial doctor. After becoming pregnant, Ms. Li and her family were very cautious and completed prenatal examinations under the joint supervision of the hematology department and obstetrics. During pregnancy, Ms. Li still occasionally experienced symptoms such as bleeding gums, and from 33 weeks of pregnancy, platelets began to decrease progressively, and the risk of bleeding increased.
In order to ensure the safety of the mother and fetus, the Provincial People's Medical and Obstetrics Department attached great importance to it, and when Ms. Li was 36 weeks pregnant, Zhang Guoying, director of obstetrics, organized the prenatal diagnosis center, hematology, pharmacy, laboratory, blood transfusion, anesthesiology, neonatology and other departments to carry out multidisciplinary consultation, and study and formulate a response plan for the possible bleeding risk of pregnant women during childbirth. "Pregnant women with hemophilia type B, lack of coagulation factor IX, poor clotting function, and high bleeding risk during cesarean section." Lu Ruinan, chief physician of the Department of Hematology of Provincial People's Medicine, said: "The first task is to supplement pregnant women with enough clotting factors in advance to prevent the occurrence of heavy bleeding during and after surgery. ”
A multidisciplinary team conducts MDT consultations to discuss treatment options for pregnant women with hemophilia
Ms. Li's perinatal IX factor use plan was personally formulated by Director Lu, and Chief Pharmacist Zou Ying of the Department of Pharmacy arranged a special person to ensure the supply of special drugs, and the laboratory department specially opened the "IX factor activity" examination project in Longjiang campus to meet the clinical monitoring of IX factor activity at any time. The Department of Blood Transfusion makes every effort to ensure the supply of perioperative blood sources, including red blood cells, plasma, cryoprecipit, platelets, etc. The anesthesiology department and neonatology department have arranged special personnel to prepare for the class, ready to participate in the rescue at any time.
Under the joint protection of several departments, the pregnant woman underwent a caesarean section at 37 weeks' gestation. Before the operation, Chief Physician Qu Lin infused factor IX, which increased its activity from 10% to 70%, and the operation process was smooth without excessive bleeding during the operation. After the birth of the baby, he was transferred to the neonatology department, where the neonatologist carefully examined him to rule out the occurrence of cerebral hemorrhage and gave a complete genetic test.
"The use of factor IX can neither be more nor less, and if you use less, you will bleed, and if you use more, you will have the risk of blood clots." After surgery, Director Qu's team monitored factor IX activity daily and accurately adjusted the daily factor IX usage based on real-time results. Six days after the operation, both the mother and the newborn were in normal condition and have been successfully discharged from the hospital.
The hemophilia mother was successfully discharged from the hospital and presented pennants to the medical staff
Speed of life and death, provincial and municipal hospital relays, to ensure the safety of mothers and babies of advanced pregnancy, high blood pressure, and mothers
On the morning of September 19, Taixing People's Hospital received a 43-year-old elderly pregnant woman with swelling all over her body. The blood pressure was as high as 254/184mmHg. The hospital immediately started the emergency process for high-risk pregnant women, and gave emergency treatment such as antispasmodic and blood pressure reduction, and promoting fetal lung maturation, but the blood pressure of pregnant women remained high. In the process of accompanying pregnant women for examination, medical staff constantly received a series of critical values: platelets 33*109/L; brainstem, thalamic infarction; Subcapsular hematoma of the kidney. “HELLP！ It's HELLP syndrome! Pregnant women are at high risk of red color. ”
As a technical cooperation unit of Taixing People's Hospital, Jiang Ziyan, deputy director of the Department of Obstetrics of Taixing People's Hospital, concurrently serves as the director of the Department of Obstetrics of Taixing People's Hospital. Under the limited technical conditions, the local receiving doctor immediately reported the case to Director Jiang Ziyan. The situation was critical, and Director Jiang, who was in the provincial people's hospital, made a referral decision as soon as possible, and urgently contacted 120 ambulances to escort the pregnant woman to the provincial people's hospital.
Time is life! "I have reported the situation with all the middle and preparatory class doctors, and everyone is in place and waiting for the patient to arrive." "We're already in contact with the blood bank for platelets." Jiang Ziyan reported and communicated with the hospital in advance, prepared in advance, and instructed Taixing People's Hospital to escort the medical staff with the car to pay attention to the blood pressure of pregnant women, prepare for first aid, and do their best to ensure the safety of pregnant women. Two hours later, the pregnant woman arrived safely at the provincial doctor.
Under the command of Lu Chao, vice president of Longjiang Campus and the medical office, the hospital opened a green channel throughout the whole process, and the team of Chief Physician Ge Zhiping, deputy director of obstetrics, received pregnant women as soon as possible, performed cesarean section at the first time, and infused platelets into pregnant women at the first time. After the baby was delivered, symptoms such as respiratory distress and hypoxia appeared, and the neonatal medical team of the Provincial People's Medical Neonatology immediately gave the newborn positive pressure ventilation for endotracheal intubation, and carried out cardiopulmonary resuscitation and chest compression, and the baby's condition finally stabilized. At 3 p.m., the operation ended successfully, and the woman was transferred to the ICU for a period of time to continue treatment and was successfully discharged from the hospital.
The obstetric team performs caesarean section for pregnant women with hypertension in advanced pregnancy
The obstetrics team poses with the woman who is about to be discharged from the hospital
Since July 2022, the Provincial People's Medical and Obstetrics Department has provided technical support to the obstetrics department of Taixing People's Hospital, and regularly dispatched obstetricians to grassroots hospitals for further in-depth cooperation. With the joint efforts of the two hospitals, five critically ill pregnant women were successfully diagnosed and treated, avoiding adverse maternal events and making positive contributions to the life and health of local pregnant women.
Correspondent Cao Yong Lian Lu Yangtze Evening News/Purple Cow News Reporter Yu Dandan
Proofreading Sheng Yuanyuan