Nineteenth Century Medical Guide

Chapter 315. 311. Twins
[The previous chapter swallowed this chapter, and it didn’t work after several times, wait a minute, sometimes it’s like this]

"Gentlemen, after a safe and normal delivery, Mrs. Mislon found that the head of the fetus was not in the pelvis in the ninth month of pregnancy."

Carvey stood in the center of the operation area, looked around the fully-filled auditorium, and explained the situation of the pregnant woman in detail: "All obstetricians including Professor Hu Jier hoped that she could give birth again, but the delivery date is approaching, and seeing that there is no hope of getting pregnant, No one can guarantee the safety of mother and child during forced vaginal delivery.

Circumstances forced us to resort to extreme measures, a cesarean section which I had studied and practiced fluently in Vienna, and which was the main reason for my trip to Paris.

As for the safety of the operation, it is completely within the controllable range. In the past eight months, I have performed the operation 28 times, all of which have achieved good results.

Seven newborn fetuses died within 24 hours, accounting for 7%, and the remaining fetuses died within three days in five cases, accounting for 25%.Neonatal mortality is higher compared to vaginal births, but for obvious reasons, because the fetus that requires cesarean delivery is itself very dangerous.”

Before any new technology is applied, it will be blocked by old conservatives, not only because of differences in ideas, but also because of conflicts of interests.

In the 19th century, the mortality rate of full-term newborns within one year was as high as 15-20% [1], and those premature babies rarely survived.Cesarean section is an artificial termination of labor, especially for women with placental abruption. Surgery is often considered at 36 weeks, and the later the more dangerous.

Cesarean section has undoubtedly become the hardest hit area for premature babies.

In Paris, where the birth rate continues to decline, the neonatal mortality rate is a very sensitive topic. Carvey's remarks quickly responded: "Doctor Carvey, is the neonatal mortality rate too high?"

"Yeah, the three-day mortality rate has exceeded 40%, and I'm afraid no more than half of them can survive within a month, which is unacceptable."

Hu Jier snorted, and retorted before Kawei spoke: "Let's not mention how unreasonable your rushing words are, even if it is about the matter itself, how many newborns with dystocia in your hands can survive? Half? I'm afraid you can't even guarantee 20%!"

The obstetrician, who is also half a pediatrician, revealed the cruel truth. In the face of dystocia, it is difficult for the mother to live, and it is even more difficult for the fetus to live.

Risks of low body weight, syphilis transmitted from mother to child, umbilical cord infection, air pollution, nutritional deficiencies, hygiene problems of breast milk substitutes. In Paris, the attitude of many parents towards their newborns is increasingly oriented towards the "eugenics" of animals develop.

That is to say, let them fend for themselves, and those who survive will naturally be eugenics, and they will naturally receive eugenics.

Carvey has no way to solve this problem. Pediatrics, especially neonatal theoretical knowledge, cannot be formed overnight, and even he is not professional.Now that there are no qualified antibiotics, enough endotracheal intubation to deal with the respiratory tract of newborns, and systematic medical supporting measures, he can only watch those babies die as soon as they are born.

".I can't do anything about neonatal mortality, but at least I ensure the safety of the mother. In all 28 caesarean sections, the postoperative mortality rate of the mother was 0."

This is the highlight of today, the number 0 has become a heavy attack on those who make things difficult.

The stage was soon filled with voices of doubt, more uneasy than before.In their eyes, it is impossible to have a 0% mortality rate in surgery. Even for lithotripsy, which has the least trauma, the mortality rate has dropped again and again, and it has remained at about 5%.

This is still the level suppressed by those strong men in the urology department. If it is placed in the countryside, the death rate will only be higher.

What is to be done now is a cesarean section, and the mortality rate exceeds [-]%.

After all, it was a tour surgery demonstration, and the condition of the mother and the fetus was also stable. In the face of their doubts, Carvey still needed to elaborate.In addition to surgical techniques and anti-infection before and during surgery, one of the important factors is hemostasis and blood transfusion.

The depletion of oxytocin and sodium citrate indicated that he could not effectively stop the bleeding, and there was also great uncertainty in autologous blood transfusion.

Although many people have been found to be able to transfuse blood during the operation, excessive blood transfusion is inherently risky.Therefore, before the operation, Carvey had already obtained the mother's consent. If there was unstoppable bleeding during the operation, he would cut off the uterus without hesitation.

"Removing the uterus is not the same as the cesarean section mentioned earlier."

"It's not because Paris lacks the medicines I use." Carvey asked everyone to wash their hands and put on masks and gloves, and at the same time instructed them to make disinfectant towels. "The one I brought myself was used up yesterday morning."

"That doesn't prove it either."

Seeing that there are still people who want to make a sound, Kawei immediately turned around and stopped: "I have already stated it before entering the surgery theater, and now I repeat it again. If you want to see my operation, you must wear the same mask as me, or Don't talk. This operation will inevitably cause a lot of discussion among you, but it is not good for the mother. If anyone violates the regulations, please leave now!"

In an instant, there was no sound in the theater.

The surgeon has the final say in the surgery theater, they are not fools, and they will never waste this precious viewing opportunity because of some unnecessary trivial matters, after all, there are still many people who want to watch but can't get in.

"I will continue with what I just said."

Carvey measured the parturient's belly with his hands, asked the nurse to prepare the ether, and began to look for the place where the knife should be inserted: "The parturient's full-term second child has a heart rate of 94 beats per minute, and the blood pressure cannot be measured because of the lack of a sphygmomanometer, but the cardiopulmonary auscultation is very good. It's normal. The abdomen is distended, the fundus of the uterus is two fingers below the xiphoid process, and the fetal heart rate is normal. Let's go to anesthesia for cesarean section now."

The black mask was gently covered over the mother's mouth and nose, and her eyes were fixed on Kawei, full of hope.

Carvey glanced at the parturient, smiled back, and confirmed the depth of anesthesia after she closed her eyes, and immediately said: "Okay, give me a vascular clamp and a scalpel. Unlike the previous cesarean section, the surgical incision is in the lower abdomen. About 3cm below the bilateral anterior superior iliac spine. Then.”【1】

This time, Carvey did not choose to cut the skin directly, but used vascular forceps to clamp the skin at both ends and in the middle of the scheduled incision, revealing three signs to ensure the correct position of the incision.

Why do you want to do this?
Why make a logo before cutting?
Why bother making sure the incision is in the right place before cutting the skin?

The doctors in the auditorium were very puzzled, but silence was strictly ordered in the theater, so they could only stare at the operating table with doubts and dare not say anything.

Before the operation, Hujier had communicated with Kavey about the operation method and steps. The index fingers and thumbs of both hands pressed the two ends of the incision, and exerted force on both sides to tighten the skin to facilitate the skin incision. 【2】

"Gently cut the skin, the incision is about 15cm, and then only cut 2-3cm to the lower fat layer and fascia layer." Kawei's hand was very light, and he immediately made a small incision with the blade, and then returned the scalpel to the doctor. Called the nurse, "Give me the scissors."【3】

This step makes people wonder. The scalpel has always been the patent for cutting the skin into the abdominal cavity. Why did you switch to scissors halfway?
What can scissors do?
Still want to cut fat?

Carvey did not do what they thought, but bypassed the fat layer, directly inserted the blade of the scissors under the fat, and cut the fascia delicately with a fast and small range: "The movement should be gentle, and the scissors should not be opened too much. Otherwise, it will damage the muscle tissue under the fascia and cause unnecessary bleeding. 【4】"Vascular forceps. "

After cutting the fascia, replace the scissors with the forceps, and further separate the adhesion between the rectus abdominis on both sides by about 3-4cm.Then Carvey made a move that made everyone feel strange.

He forgoes all tools and opts to widen the incision laterally with his fingers. 【5】

Seeing this on the stage, they couldn't help but exclaimed. Even in the barbaric medieval or even more barbaric and disorderly crime zone, no one has ever seen anyone who is so vicious as to tear the enemy's wounds.

But as soon as they spoke, they forcibly suppressed their voices, because this pulling was just the beginning.After expanding a certain distance, Carvey and Hujill put their index fingers and middle fingers on both sides of the separated rectus abdominis respectively, overlapped their hands, and slowly increased the outward traction from light to heavy, pulling the rectus abdominis, subcutaneous The fat is torn outwards and upwards at the same time. 【6】

"Pay attention to keeping the two fingers perpendicular to the muscles, and don't tear them up and down, as this will easily damage the blood vessels."

Carvey and Hujill exerted more and more force until finally, like in a tug-of-war, they leaned back all over, just to enlarge the incision in the fat layer.

This exaggerated posture makes it hard to believe that it happened in an elegant surgical theater. The silence agreement is not a mandatory agreement after all, and soon attracted criticism from more than one person: "Dr. Carvey, what are you doing?"

Seeing the first person eating crabs, the second immediately followed: "Even if it is murder, you have to use tools. This is the most basic difference between humans and animals!"

"Placing a good tool without using it and using it directly???"

"Savage Austrians!"

What Kavi did was a new type of cesarean section, a new type of lower uterine segment cesarean section improved by Israeli doctor Stark.Its characteristic is to take the method of tearing and pulling the subcutaneous fat layer, completely retain the blood vessels and nerves running in it, and rely on the maternal own tissue elasticity to achieve better hemostasis.

With less bleeding, there will be less vascular ligation by external force in the operation, and at the same time, tissue ischemia will be reduced, and the operation time will be shortened.

This method of surgery is very popular in China, and it also shortens the original operation time from nearly one hour to less than 20 minutes, which is very suitable for the number and intensity of cesarean section operations in domestic obstetrics. 【7】

"If you have any doubts, you can bring them up after the operation. Don't affect the operation." Carvey made the last warning, "Your mouths are releasing bacteria!"

Some people will be overwhelmed by this aura, while others will not succumb to this oppression.Seeing Kavey's brutal and ignorant behavior, someone immediately stood up, said "I can't accept this kind of surgery!", and left the theater.

This time he got up and quickly brought three or four people with him, and the atmosphere in the surgery theater was extremely gloomy.

But in Carvey's eyes, these audiences are completely redundant, and only his patients and assistants are really important: "Mr. Hujill, the fat layer is almost done, and the peritoneum is separated below."

"it is good."

Carvey still chose to use his hands to tear a small hole in the peritoneum, put his index finger into the abdominal cavity, and tear the peritoneal incision in the up and down direction: "Because the incision is left and right, the incision is also torn horizontally when you use force up and down, so you can Avoid injury to the lower bladder.” [8]

Hu Jier waved to Shan Wang, and immediately took an abdominal expander and protective hook from the other party.

The preparation work is completed by one or two assistants, and Carvey can concentrate on the cutting and separation: "Protect the incision, let's check the direction of the uterus, and at the same time see the position of the bladder. Use a scalpel to cut the peritoneal reflection horizontally, and then use a scalpel. The fingers tear along the incision and eventually detach and push down on the bladder."

"Leaving aside the fat layer, this is a very standard and sophisticated procedure of lower abdominal incision."

Suddenly another person's voice sounded on the stage. Everyone looked at him and thought that Kawei was going to chase someone away again. Unexpectedly, the other party pointed to the mask in front of his mouth and nose: "What's the matter? You can talk with the mask on."

"Of course." Carvey said, "If the few people just now are like Professor Cedieu, I will not drive them away."

"Your operation method is too novel."

"But it's very easy to use." Carvey said, "Isn't the teacher also the kind of person who sticks to trifles?"

"I've seen your craniotomy yesterday, and I'm immune to it now." Cedieu looked at the operation area, his face was actually cold all the time, "Everyone, I can guarantee with my personal reputation that those who missed this The person who underwent the operation will definitely regret it!"

Carvey didn't feel that his operation was anything special, it was nothing more than the result of stealing his teacher again and again, and there was still a big gap compared with the obstetric masters who delivered their babies in a few minutes.

But he also agrees with Cedieu's words, because the mother's belly is not simple.

"The position of the uterus in the operative field is very high, but its volume is not twins. It's not a 'twin' of twins." After separating the lower uterine segment, Kavey put his hand into the abdominal cavity and made a simple exploration, ".Uterus Something in the rear seemed to be pushing it forward."

This was an unexpected situation that he had guessed before the operation. Before Hu Jier and the others could react, he had a plan for the operation: "Heart rate?"

"It's almost the same as before, it has been floating between 85-105."

"Get the baby out first." Carvey took the scalpel, cut open the lower uterine fascia and muscles, and then made an incision along the myometrium, still choosing to tear apart about 10cm by hand, "suction device."

"Here we come." Shanwang handed the suction tube to Hu Jier, and squatted aside to shake the handle.

Hujier put the suction tube on the edge of the incision, while Carvey held a vascular forceps in one hand and a scalpel in the other, and said, "After I cut the amniotic sac."

"...I'll just insert the suction device in."

"Then I give the handle a quick shake and the amniotic fluid is sucked out."

"let's start!"

(End of this chapter)