Nineteenth Century Medical Guide

Chapter 325 321. The Hand of God
[I have already introduced many concepts when I wrote about cesarean section before, so I won’t go into details here]

For other multiparous women, the cervix has already opened 1 hour after labor, and then the membrane ruptures, and delivery enters the fast lane.Sometimes there is no dividing line between the first stage of labor and the second stage of labor at all, and the battle is over in up to ten hours.

But the one in front of him was stuck in the first step.

The cause was not her own body, but the central placenta previa covering the cervix, which thins the cervical muscles and reduces the force of the contractions during labor.Such patients are the most troublesome, not only stuck in the birth canal, but also stuck in their own lives.

The obstetrics department of the main palace hospital is not strong, perhaps it can be said that the obstetrics department in the whole world is not strong.

Many obstetricians have encountered and handled only a handful of cases of placenta previa throughout their lives.

Moreover, there is no internal connection in experience between these cases. Even if the life of the previous case was saved, it is a fluke. Maybe the next case will die directly in front of me with the same method.

Although Carvey is a surgeon, in the early years, the domestic division was not detailed. The emergency department must take over the laboring women. In addition, when going to the countryside to assist, he will also encounter many obstetrical problems. He has done a lot of work as a midwife.

At that time, the level of domestic surgery was limited, and cesarean section was far less popular than it is in modern times. Although foreign guidelines listed cesarean section as the optimal treatment for placenta previa, there were still quite a few pregnant women who could not accept safe cesarean section.

However, the basic surgical concepts were already in place at that time, and the situation was very similar to that faced by Carvey now.

If you want to deal with yd delivery with placenta previa, the key issues are hemostasis, placental separation and final uterine curettage.These operations are all related to life. If you want to do it well and achieve your goal, you need to use some violence, and there is no elegance at all.

"I can only do my best. If it really gets to the point where it can't be solved by manipulation, I reserve the right to do the final surgery."

Carvey asked his assistant to get the necessary equipment, and drew a deadline for himself: "I am a doctor, and keeping the patient alive is the first priority. If you just want me to kill you, I refuse to provide any medical services
Seeing what she wanted to say, Kawei didn't give her a chance, and reiterated his position: ".This is my premise. I am only responsible for saving people. As for whether you can live or not, that is your private matter. I respect your choice. Please also respect my profession."

His words finally had some effect, and the mother acquiesced to his approach.

"Are you sure you want to do this?" Hu Jier didn't quite agree with this plan. "I just checked that the cervix is ​​not dilated. This is a full-term child. Let alone 2500 grams. Do you want to dilate the cervix by hand?"

The size of the baby is indeed a problem, but that will be considered later. What is more important now is how to open the birth canal: "We still have to solve the problem of the placenta first."

"If yd gives birth, it can only be stripped slowly." Hu Jier has experience in treating more than a dozen cases of placenta previa, "I just hope that the amount of bleeding will not be too large during the stripping."

"400ml of blood has already flowed out before the placenta is delivered. It is definitely not possible to peel it off directly." Carvey directly rejected his suggestion, "Blood transfusion first, completely stabilize blood pressure and heart rate before doing it slowly. Now that the baby is gone , there is no need to rush this matter."

As an unremarkable little reporter in the Paris Review, Safit always thought that he could catch a piece of shocking news by his own ability and ignite the lifeless Parisian press.But the truth is not that simple, everything has to pay attention to some luck, even interviews are no exception.

In fact, after staying in this industry for a long time, Safit still believes in some metaphysics. Sometimes the hard-earned relationship network ends up being very frustrating.

Furthermore, being on the list of 13 candidates like today is pure luck.

Of course, this matter cannot be attributed to luck, after all, being able to accept blood matching has something to do with it.It's a pity that the person who helped him match the bridge was not selected, it can only be said that God's will tricks people.

Safit doesn't understand what blood type means, he only knows that he only needs to agree to drain some useless blood in order to gain the opportunity to enter the theater of surgery.

Relevant personnel will gather in the preparation ward of the surgery theater from 11:200 noon, and the opening time of the surgery should not be exceeded at the latest.Each person is temporarily limited to [-]ml once, and if necessary, the amount of bloodletting can be gradually increased.

This is a boon for almost all French journalists.

On weekdays, it costs at least 20-30 francs to drain the blood, and you have to make an appointment at a pharmacy or hospital in advance.If you are in a hurry, the price is likely to double.But now these are all free, the hospital also provides lunch, plus witnessing the whole process of the operation, it is really profitable.

After winning the lottery, Safit even doubted the authenticity of the news, but considering the history and reputation of the main palace hospital, he rushed to the hospital early in the morning.

As the saying goes: the early bird catches the worm. Safit and several other reporters who entered the surgery theater before 11 o’clock were taken to the preparation ward by a nurse before explaining their purpose: “Have had breakfast Is it gone?"

"Ah."

"Have you not been sick recently?"

"No."

Karen touched his forehead: "Is it normal to urinate and defecate?"

"Um"

Safit was a little strange when she asked: "Excuse me, what is this for?"

"The blood transfusion is ahead of schedule." Karen didn't explain any more, but just said, "Wait here, and follow me when I call you later."

"Oh wait!" Safit asked quickly, "Isn't the surgery in the afternoon? Why is there a blood transfusion now?"

"Surgical conditions are changeable, and accidents may occur at any time." Karen explained a little, and left the ward without further words, "This is a surgical theater, not your newspaper office. Stay here obediently and don't run around, or you will be arrested." Disqualified."

The sudden change made the reporters who arrived early feel uneasy.

Originally, they discussed the order of admission, and then each contributed the operation situation they saw at that time, and finally pieced together a relatively complete picture.Although there is a tendency of homogenization, they all have their own experience, and the words used in the final report will definitely be different.

"What should we do now? We are the only ones present, maybe it will be over when those people arrive."

"Isn't that good?"

"Well, it's good, but there's always something wrong with it."

"What's wrong?"

"Is this an early operation?" Safit's subconscious feeling was fairly accurate, and he immediately noticed it. "If it's not an operation, then what's the point of us being here? It's nothing more than contributing a little blood."

Confusion and unknowns quickly filled the preparation ward, and what they were worried about was not their own blood but whether the operation would proceed.

Until 10:44, Karen called Safit with the latest news: "Mr. Safit, please take off your shirt, put on a mask, and follow me."

"okay."

Safit did as she wanted, tied her long hair tightly with a headband, and followed Kallen into the tunnel.This is the only aisle in the operating theater, three people wide, with light-transmitting windows on both sides, but the creaking floor makes people feel flustered.

The room they went to was actually not far from the place where they gathered, and they arrived within a few steps, but the smell of blood after opening the door made the atmosphere more tense and depressing.

"Someone is here." Karen led him into the room, "Everything is ready, let's go now?"

"Come on, your heart rate is a little faster."

Safit knew the young man who spoke up, an Austrian surgeon who had recently appeared frequently in French newspapers.Now his mind is full of question marks. Due to the occupational disease of a reporter, he couldn't help but open his mouth soon: "Isn't the surgery in the afternoon? Why?"

Just a few words popped out, and everyone's eyes were on him.

"Karen, didn't you remind them before the selection?" Kawei's face became ugly.

"I told you." Caroline was a little anxious, "Mr. Safit, I reminded you yesterday that you are not allowed to ask questions here, especially questions related to patients."

"This is not the gate of the hospital, my friend from the reporter."

This was the first time Safit encountered such a situation, and he finally sensed that the atmosphere was not right, so he quickly apologized and lay down on another bed not far from the mother as required, without daring to say anything more.

The bed was much higher than before, almost level with his chest, and he had to step on three steps to get up.There are bed curtains on both sides, as long as you sleep on this bed, you will basically be isolated from the outside world.

"Stretch out your hand." Karen put an instrument table beside the bed. "We can't control the specific amount of blood transfusion. Everything depends on the fluctuation of your heart rate and blood pressure."

Safit didn't understand what it meant, but just nodded: "It's okay, come on."

Sterilized with alcohol, the cold needle was inserted into an artery in the arm.There is a little pain, but it is completely tolerable. After all, this kind of novel experience is not available to everyone.In the period of rapid development of science and technology, it is really lucky to have the honor to participate in such a medical pioneering work.

Originally, Carvey still hoped to treat the blood with sodium citrate, and then use glass bottles and rubber straps for infusion.

However, considering the stock of medicines, Carvey still chose direct blood transfusion.

Safit's blood pressure is already higher than that of the parturient, coupled with the pressure difference on the arteriovenous, the blood can be quickly pumped into the parturient's blood vessels.Soon his blood pressure dropped from 128/79 to 120/70, and his heart rate increased slightly.

"Pull it out." Carvey said, "The blood pressure and heart rate here have also stabilized."

"it is good."

Karen pulled out the needle, pressed a large sandbag on his arm, and pressed it with a cloth strap: "Okay, Mr. Safit, then you need to return to the room just now and rest for about an hour."

"ended?"

"ended."

The whole process greatly exceeded Safit's imagination, and he was invited out of the room before he even thought about what to say when he went back later.There were still people standing around the pregnant woman, who knew nothing about it except that something bad had happened.

Karen just asked him to go back to rest, and immediately put himself into work on the other side.

Now that the blood transfusion is done, the troublesome placenta has to be dealt with next.

Considering the possibility of placental adhesion or even implantation, Carvey did not choose the bare-handed peeling that Hujill said at the beginning, but used a more meticulous method: "Use a dilator to expose the field of vision, and then give me the largest vascular forceps , Get the gauze ready."

"This is."

Naturally, Hu Jier has never seen such an operation. For many doctors, this is a treatment method that only existed in the old primary hospitals in China: "I want to avoid the placental leaflets and make a hole in the placenta in their gaps."

There is no need to remove all the mountains at once if a big mountain blocks the way. You can make a hole according to the size of the car and let the car pass through.

"Fenestration of the placenta is a compromise between delivery and surgery." Carvey pinched the tip of the hemostat and put his whole hand in. "While puncturing the placenta, we can also put the The fetal membranes pierced the cervix and only opened 5cm, so give more oxytocin."

Such a bold approach has completely opened Hu Jier's horizons, and also refreshed his views on placenta previa for many years.

The hemostat passes through the cervical canal, and then passes through the inner opening, the blood clot covering the surface, and comes to the placenta.What Carvey wants to puncture is not the placental leaflet, but the gap, and the bleeding is almost negligible. At the same time, the outward force of the hemostat can also expand the placental window and cervix.

In the process of expanding from the inside out, the surrounding placental leaflets will be physically squeezed, and the local blood sinus will be closed to a certain extent.

"It's a risk to remove the placenta now, and it's easy to bleed heavily, so you must be careful when you do it." As soon as Kawei finished speaking, his fingers felt a warm current, and the amniotic fluid blocked in the fetal membranes in the uterine cavity flowed out, " The turbidity is really high, and there is meconium, which is really hypoxic."

After the amniotic fluid leaks, the uterine cavity shrinks, and the volume drop will further promote uterine contraction.

However, the condition of the mother's uterus is not good, the contraction is only slightly enhanced, and there is no way to reach the level of childbirth.

At this time, another fork appeared in the process.

If there is no problem with the fetal heart rate, as long as the oxytocin does not stop, the baby can be delivered smoothly after 2-5 hours.But the fetal heart rate has not been detected since just now, and there is no fetal movement, so it can almost be determined that the baby is dead.

Theoretically, you can directly choose to destroy the fetus, and the space required to leave in batches is smaller, but Carvey still wants to try again: "Now it is the head position, I slowly dilate the cervix with my fingers, and then use forceps to get the baby out. "

"Why don't I expand it."

Carvey glanced at Hu Jill: "Can the teacher guarantee that her cervix will not be torn?"

"."

It is useless to say more after a brief hesitation, because that is the performance that has never considered this point, and it also shows that Hu Jier is not confident enough: "After all, this is my patient, let me do it, and the placenta is inside , it will be troublesome if it touches the placenta."

(End of this chapter)