Nineteenth Century Medical Guide

Chapter 326 322. Or Satan's Hand
[There are some not-so-good descriptions at the end of this chapter, you can skip them if you don’t have enough psychological endurance]

If he encountered placenta previa dystocia in the emergency department before, and in the absence of surgical conditions, Carvey would choose to use the method taught by the director of obstetrics at that time, first open the window of the placenta, and then clamp the fetal scalp with scalp forceps [1 ], to fix.

After fixing, pulleys and heavy objects are hung on the far end to simulate the pressure on the placenta, accelerate delivery, and let the baby leave the uterine cavity step by step. 【2】

Because the front end of the scalp forceps is slender, it can enter the slender cervix for traction of the fetus.But this is a specialized tool for obstetric placenta previa dystocia, and now there is no, and it is impossible to find roller weights.

What's more, the mother's condition is not good. Although the vital signs are not bad, there are still no strong contractions after the rupture of the membranes, and the dilation of the cervix is ​​limited. The traction of heavy objects alone may not be enough to pull out the child.

Carvey glanced at the instruments at hand, and only forceps could be used. To play the role of forceps, at least the cervix, which is only about 4cm, must be dilated to 8cm.

It takes time to dilate the cervix, and the expansion of the yd will become very limited if the cervix is ​​not dilated. How much the hand is inserted for a long time will put pressure on the soft birth canal and cause tears.Carvey said that "the operation will be more brutal", but in fact he still hoped to be softer: "Go to Guyon and ask him to bring the urology balloon."

"Okay." An assistant wrote down the name of the thing and ran out of the room quickly.

"Gauze pliers."

"Give."

"The gauze is too thick to fit in this width."

"Okay." Berget understood what he meant, and untied the five-layered gauze strip, removing two layers, "Here."

Now the placenta is in good condition and no bleeding can be seen, but Carvey is still worried.The hemostatic forceps wrapped with gauze at the front can enter the birth canal and remove the residual blood clot inside, so that the most realistic amount of bleeding can be judged.

"One piece. It's about 50ml. Two pieces. It's about 70ml. Three pieces. About, let's count it as 40."

"Heart rate 88, blood pressure 124/76."

"It's okay, it's still stable." Carvey didn't find any more blood clots, "Check the fetal heart rate again."

After speaking, Karen brought Hujill a stethoscope, while Kawei looked at the mother, with a very clear meaning, just to confirm whether there was fetal movement.The parturient also understood what he meant, and shook her head helplessly: "No."

Soon, Hu Jier, who had explored the entire abdomen with the auscultation probe, also began to shake his head, and the fetal heart rate and fetal movement continued to be double negative.

Modern judgment of fetal life and death in the uterus is based on B-ultrasound to see if the fetal heart beats. If there is no B-ultrasound, it can only rely on auscultation and maternal feelings.Hu Jier has been an obstetrician for so many years, and it is impossible to mishear the fetal heart rate. Carvey is still worried, and he has also taken out an insurance policy.

"It's been so long, so it's almost certain."

Kawei was very helpless, the baby's back was leaning against the mother's belly, and could be easily touched from the outside. In this case, the fetal heartbeat could not be heard and there was no fetal movement, so there would be no more miracles: "Well , Unfortunately, it is determined to be a stillbirth."

Diagnosis and suspicion are two completely different states. Even if she has already been mentally prepared, the mother can't help but let out her pain.

How she wished the doctor had misdiagnosed her.

After two more blood clots cleared up, and the amount of bleeding increased by nearly 300ml, Carvey finally ushered in the balloon that Mosier said at the time.From the outside, it looks like a modern catheter, but because it is used for urethral dilation, he still needs to determine the size of the balloon.

"Come on, show me where the limit is."

It has to be said that the rubber used by Mossier has good expandability, and it can expand to about 10cm after pumping, which is a good help for dilating the cervix.

Quickly insert the catheter, pressurize the balloon with the syringe, and clamp the mouth of the catheter with a hemostat to prevent spillage.However, it may be due to the strength of the balloon itself. The effect of stretching is not obvious. After half an hour, the cervical opening is still maintained at about 6-7cm.

It doesn't matter if you just dilate the cervix simply, it just takes more time.

But now the parturient is still bleeding slowly. After clamping the blood clot twice just now, 400+ml of blood has been shed one after another, and the blood loss has exceeded 700 again.Simple infusion could not satisfy blood loss, so Carvey had to invite a second reporter to help with blood transfusion.

"It's almost time for everyone to come." Carvey asked, looking at the wall clock that was close to 12 o'clock.

"It's all here."

"The blood seems to be enough for the time being."

Having said that, Kawei's face is still ugly, because the cause of the bleeding cannot be solved, and the placenta of the parturient is a big sieve for bleeding.

If you want to get rid of the placenta, you have to let the baby out first, so as to stimulate stronger contractions.To release this full-term fetus, it is necessary to ensure that the birth canal is sufficiently unobstructed, especially the opening of the cervix and the placenta inside.

"In the final analysis, the child is still too big, with a biparietal diameter of more than 9cm." Carvey said, "This kind of cervix is ​​difficult to pass."

"Otherwise, it's better to have a cesarean section." Hu Jier suggested.

"I can still hold on, really!" The mother's physical strength was rapidly losing, and she was still thinking about the next child, "I beg you, please don't have surgery!!!"

Carvey touched her belly again, and the contractions were still weak under the action of oxytocin.

There are several reasons for the analysis so far. The placenta previa weakens the contractility of the myometrium; the uterine cavity is too large, and the placenta is in front of it, so the child cannot cling to the uterus, and the pressure on the cervix is ​​not enough, resulting in weak contraction; plus She is the third child, and the uterine contractions of multipartum women often have problems.

Only one of them may be able to find a way to fight, and now it is very likely that three of them will appear at the same time. This superimposed contraction weakness makes Kawei feel very weak.

"The reason is that the fetal head is too large, and the cervical dilation is not obvious." Carvey once again clarified the position of the fetal back, and made it clear that the fetal heart and fetal movement have completely disappeared. It may be because the uterine contractility is too weak to cause heavy bleeding."

Hu Jier could clearly hear the change in Kavey's tone, which was a sign of a decision: "Tell me, what should I do next?"

Carvey glanced at the parturient, then looked at the crucified Jesus and the cross hanging on the wall, and said something that no one had thought of or dared to think about: "Since the diameter of the fetal head is the root of all problems, then shrink it it."

"That makes sense, how should I do it?"

Maybe it was because the cesarean section was too sci-fi, or maybe it was because Carvey shouldn’t have mastered surgical skills at an age. In short, Hu Jier didn’t understand the meaning, and thought that Carvey could have some magical method to do this.

But Carvey knew that he didn't understand when he saw his reaction, and others, including others, couldn't react because of the established dogma.On the contrary, Shan Wang, who had no experience in obstetrics, understood what Carvey meant, and said the words without hesitation:
"Dr. Carvey is going to destroy the fetus. Anyway, he is dead. Consuming the mother's physical strength increases the risk. It is better to take the children in batches."

What he said was the truth, but not the truth to be faced here.The more rigorous and confident the responsible doctor is, the less he can easily cross this hurdle: "What nonsense are you talking about? Destroying a fetus? Isn't this just abortion? God won't tolerate us doing this!"

They couldn't control Shanwang: "But the child is already dead."

"No, we can't really judge whether the child is really dead, we can't just do it casually, it's against the doctrine!"

"Didn't the professor agree to the diagnosis of stillbirth just now?"

"It may be that the fetal heart rate is not obvious enough, we didn't hear it."

Hu Jier's resistance also aroused the resistance of others: "There is no clear evidence to prove that the child is dead, and directly destroying the fetus is tantamount to killing!"

Carvey put down the hemostat in his hand, sat on the steps beside him, and looked at them tiredly: "Then how do we prove it?"

"You can do it after the baby comes out."

"How do you get out?"

"At once"

As long as the doors and windows are blocked, the simplest problem can suffocate people. Obstetrics without a mature cesarean section is such a subject that people love and hate. This is why Edward must bring Carvey to Paris. .

"The current problem is obvious. A multipartum woman has been in labor for nearly three hours, and the cervix is ​​stuck at 7cm with the help of various aids. The placenta is completely covered and is still bleeding. The dilation of the birth canal is not obvious. This is a full two laps, how can we get the child out of this situation?"

Carvey once again reiterated his predicament: "Surgeries are not allowed, stillbirths are not allowed to be touched, and the birth canal is forced to tear, which is not an ordinary tear. The cervix covered by the placenta is full of blood vessels. Violence will definitely It caused massive bleeding. What do you want me to do? I'm not a magician!"

This was the first time he got angry like this, and he was indeed annoyed by this strange rule of the Catholic Church: "There are only three roads in front of you now, one is a cesarean section, the other is a broken fetus, and the other is waiting to die."

This is not only the dilemma that Carvey is facing now, but also the dilemma that these obstetricians have always faced.Maybe the reasons are different, but the result is the same, there is no option of surgery and abortion, and finally can only take the third dead end.

Seeing that everyone was silent, Carvey continued: "I don't have time to waste time. I need to do the first two, but I don't need the last one. If I'm sure I'll take the last one, I'll go first."

"it depends on you"

Hu Jier didn't agree or disapprove, but chose to escape and became the hands-off shopkeeper.

Perhaps the vast majority of people will do this when they encounter this kind of choice, and there is nothing wrong with doing so, but the chief of the first department who is responsible for all medical staff and patients cannot.

"I'm not a doctor at the main palace hospital. Does this mean that if something goes wrong, I'll be responsible for it alone?" Carvey will quit doing this. He knows that a doctor is just a doctor after all, and no matter how strong he is, he can't resist the upper-level regulations. "Since In this way, then call me when she is willing to operate."

After that, he dragged off his gloves and waited for the result of their final discussion.

Carvey was at best a performing surgeon, and Hujill had the final say on the maternity ward.When encountering special circumstances, it is really impossible for Carvey to take responsibility alone, and there is no need for one person to take responsibility. Hu Jier must make a decision.

The contradiction was kicked to Hu Jier by him like a rubber ball.

Hu Jier is also very contradictory, and has no way to bear it alone, so he can only choose to break the ball: "Everyone should know that on the premise that caesarean section is not possible, the method suggested by Dr. Carvey is much safer and more reliable. It was before We can't do anything with live fetuses that haven't matured at full term, but now the fetus is dead."

A doctor beside him seemed to have seen through the ending, and hurriedly stopped him, "But."

"Stop it!" Hu Jier turned up the volume, "If you have the ability, you can persuade her to go for an operation. This is not the first time you have seen this kind of pregnant woman. Is there a good ending? Almost none!"

"So hurry up and do the surgery!"

"Yeah, a master like Dr. Carvey is here. If you don't perform the operation now, when will you wait?"

I have been busy for half a morning, anyway, the time for surgery is coming soon. If the final outcome is still surgery, although the risk has increased a lot, Kavey is at ease: "It's still the same sentence, the surgery should be fast, because the uterus is contracting now. It is difficult for me to imagine whether the already weak uterus can shrink back after the uterus is surgically incised.”

The implication is a sentence, now on stage, there is a high probability that the uterus will be cut off.

On one side are subordinates who cannot judge the situation, on one side are patients who insist on refusing to undergo surgery, and on the other side is Kavey who cannot take responsibility. This is the first time that Hu Jier faced such great pressure: "I have decided, destroy the fetus!"

"Director, think twice!"

"Professor, you can't do this, if the child is still alive, you will be punished by God!"

Hu Jier didn't talk nonsense, and went straight to the point: "The two assistants have gone out to receive the audience, and the remaining three and the nurse are all Dr. Kawei's people, so they are naturally on his side. I definitely won't say it, Good Hope Not to mention, so as long as the two of you shut up, no one will know."

After hearing this, the two were still muttering about teachings and other things. Hujier was heartbroken: "One of you raised three women outside, and the other owed 20000 francs for gambling. Don't think I don't know."

"Director, you."

"This"

"We didn't hear anything."

Carvey covered his ears and looked at his three assistants and Karen.They also covered their ears like their own masters, and shook their heads as they looked at the two men.

After many entanglements and clearing up the interests, it was still Kawei who presided over the abortion operation: "I'm ugly, if the uterus still can't contract after the baby comes out, I will definitely send you to the operating table."

"I see."

"No, you don't understand." Carvey took the oval forceps from Herman's hand and explained, "As long as you go to the operating table, it is basically the rhythm of cutting off the uterus. You have no choice, even before anesthesia. I won't say hello to you."

".I know."

"Okay." Carvey sat between her legs and stretched the oval forceps in his hand, "In view of the possible scenes that will appear later, let me explain."

Crowd: ? ? ?
"I need to change the angle of the long diameter of the fetus so that it is parallel to the long diameter of the cervix before it can be pulled outward." Carvey touched his stomach with one hand and changed the direction of the oval forceps with the other. It's much simpler. Let's find the foramen magnum first, you know the foramen magnum?"

The crowd nodded.

"Putting forceps through the fontanel breaks up the brain tissue and then pulls it all out, reducing the volume of the fetal head."

(End of this chapter)