Source: Affiliated to Obstetrics and Gynecology Hospital of Fudan University
On December 24th, the Christmas Eve in the Western Festival, but for our group, it is completely "battle of horror". Even if we are "young veterans", we are really "scared."
Xiaofan, a pregnant woman, is 32 years old. Although this is her first child, she is actually pregnant for her fourth time.In the 10 weeks of pregnancy, Xiao Fan went to the obstetrics of the obstetric card in Huangpu College District to pass the various production inspection items during early pregnancy and middle pregnancy.
But this is the obstetrics, and things will always happen so "suddenly".
At about 5 am on December 24th, Xiao Fan, who was nearly 33 weeks of pregnancy, began to feel a pain in the right lower abdomen, and then gradually aggravated and vomited.Xiao Fan observed at home for two hours and found that abdominal pain was not eased, and he immediately went to the emergency department.
On the evening of the 23rd, the night shift of our group. At 7:25 in the morning, before going to the class, I called the emergency department. I asked a doctor in the duty team to take a look.
Basic situation of pregnant women:
The heart rate is 92 times/min, the blood pressure is 94/70mmHg, the fetal heart is 150 times/minute.
Is gastritis?appendicitis?Or is the more fatal uterus rupture?
Considering that Xiao Fan had no nucleic acid report, the obstetric emergency department immediately opened the green channel and received the observation ward.
Originally, I had taken a shower, dressed in dresses, and prepared to go to the night shift. I heard that everyone in our group went to observe the room to collect patients. How can I get fat?
No, I always feel uneasy.But at this time, I didn’t expect that it would be so serious.Before leaving, I opened the hospital doctor workstation to browse the medical history.
I have not been in contact with Xiaofan before, and the words in the medical history made my adrenaline suddenly go up.
Right cord removal in the right side of 2019!
Look at the last ultrasound in this checkup: The placenta is located on the front and the right wall!
There are uterine corner resection and repair, and the uterus has "scars", which means that you are pregnant again. As the uterine pressure increases, there is a risk of rupture, and the placenta position is not good, and the uterine may be implanted in the uterus.But will it be broken?What is the specific week?This is hard to predict!
In the past, the doctor also noticed the relationship between placenta planting and uterine muscle layers in the process of birth checkup. It also explained that the risk of uterine rupture during pregnancy was also possible to terminate pregnancy in advance.
However, Xiao Fan never expected that he had been successfully survived, and he started abdominal pain when he slept.
If the uterus is really broken, even if it is one minute later, it will be two lives!
I quickly called to observe the ward: "Calling the big teacher ‘to pick it up! (Inpatient Wang Yan), this person is not like a rupture? How about the fetal heart?"
"She has vomiting. The pain is where the lower right lower abdomen is very low. It is not a palace corner. The fetal heart is good in front of the fetus. I do n’t know if it is broken?" Observing the ward is already in a hurry.
Even if it is not a palace horn, the uterine rupture may cause peritoneal stimulation!no!I have to fly to the bed of pregnant women to listen to the fetal heart.
"I can’t find the fetal heart …".What?IntersectionIntersectionLook again!
In the end, we heard the fetal heart in a relatively low position. The slowest was about 80, and it was slowly maintained at 100. The abdominal tension was still a bit high, and it supported the preliminary judgment of the uterine rupture!
The situation is extremely urgent, pregnant women and babies are in danger!Quickly notify the operating room, anesthesiology, neonatal department.
Report director!Open vein!Conduct!Calling blood!
"Teacher" already called the bed beside the bed on the way to us. I briefly looked at the fetal position and the right palace horn area. Sure enough, I saw the liquid area, and the uterine rupture was even more confirmed.
Director Hu Rong, who came, looked at the pregnant woman and said, "Why is it so pale and bloody? How much blood pressure?" To be honest, I did ignore this by the fetal heart problem. Xiao Fan was already in the early shock.
I believe that the midwifers and anesthesiologists in the delivery room operating room rushed over. Everyone also changed the surgical clothes and isolation clothes in the shortest time.Before I came to power, Director Hu Rong and I took off the white coat and put on a cleaning clothes in the "under the day of light." Anyway, the obstetrics are the "female man" like us.
Time is life, and in our hands, there are two lifestyles of the mother, and everyone who maintains the lifeline is everyone in the multi -disciplinary team.The once -aid drills have become so real at this moment. The multidisciplinary team established by obstetricians, anesthesia doctors, newborn doctors, and midwives is going to run with time.
The team completed the pre -surgery, transfer, and anesthesia intubation within 15 minutes.General anesthesia pushing medicine and skin peel into the abdomen, without a large amount of blood accumulation and blood blocks in the abdominal cavity, we quickly delivered the fetus and handed it to the neonatologist for rescue.
When the baby made the first cry, it indicated that the first lifelong rescue was successful.
The focus of the next step is to deal with the uterus of rupture and bleeding while resisting the shock, as much as possible to keep the mother’s uterus and life.
The anesthesia and nursing team quickly opened the three -way vein, and the blood products actively corrected the shock after the scene.
The uterine shock is not bleeding. After the blood is lost, the shock is corrected, and the uterus gradually rosy, but at this time, almost every "hole" is bleeding.
The number of beating in ECG monitoring is hope. During the period, the number of rapid declines during the period is really frightening, just like a colleague said: "When rescue, don’t look at ECG monitoring casually.Don’t command … "Putting the breathing cycle to the partners who fight side by side.
We carefully inspected the atmosphere on the stage and found that the placenta that should have been attached to the inner wall of the uterine cavity has been implanted from the original repair of the palace corner.The baby is in danger of life.Because the implanted part occupies about half of the palace horns, we re -repaired the uterus by artificially stripping the placenta and pruning some of the implanted muscle layers.
"The muscle layer is weak here …" Director Gu Weirong and director Xu Huan of the Ministry of Production Department all went to the isolation operating room.
Finally, under the cooperation of all people, various indicators began to recover, and Xiao Fan also turned in danger. The surgery at 10:30 was over, and the condition is currently stable.A total of 3400ml of bleeding during the operation is equivalent to changing half of the blood of the human body.
After getting off the operating table, my body was paralyzed and shaken!Those who can’t go down the night shift are behind their heads.
Thinking back that day, I "surgery" in the Heat, but I know that many people have helped the operating room, and many people do auxiliary work in the place where we cannot see.It even includes the transfer of specimens, blood receiving, and coordinating medicines. In front of life, all medical staff will go all out!