Nineteenth Century Medical Guide

[Many descriptions in this chapter will cause discomfort, watch carefully]

From the beginning of the birth of safe cesarean section, it has become the fundamental measure of placenta previa, especially central placenta previa, to terminate pregnancy, and to rescue massive hemorrhage of placenta previa.

If a complete plan is set up in advance, and a preparatory delivery by yd is prepared, and at the same time there is a contingency plan for fetal traction or fetal destruction to avoid continued massive bleeding, it is undoubtedly a safety measure that can effectively reduce maternal tissue damage.

After all, cesarean section means physical damage, and central placenta previa often requires a fundal incision to reduce the strength of uterine contraction, which is not good for subsequent pregnancy.

Carvey has tried both methods, and knows that each has its own advantages and disadvantages. Cesarean section occupies the convenience of vision and hemostasis, while yd delivery occupies less damage and faster recovery.But if the preparations are not complete, there is no small risk in both.not to mention

Now that he has chosen to destroy the tire, Kavey no longer has any worries.

As soon as the words were out of his mouth, before these people could react, he replaced the obstetricians in the surrounding main palace hospital who were in charge of delivering babies with his own: "Damirgang, press the fetal head at this position, use the heel of your palm to press down , fix the head at the pelvic entrance."

Damirgang didn't have any worries about those two French doctors at all. Based on the idea that if he wants to learn technology, he has to go all out. He can do anything: "Is this enough?"

"Try harder."

"Try harder"

"It's almost there." Kavi looked at the fetal head that was forcibly squeezed downwards, then pulled Bergett again, grabbed two wide-leaved yd hooks and stuffed them into his hands, "Separate the two sides, pull good."

"it is good."

"Herman."

"Here we come, hemostatic forceps." Herman searched for the most suitable instrument from his hand just as Kavi finished talking about breaking the skull, "Use these forceps to clamp the scalp to fix it."

"kindness."

Two hemostatic forceps clamped the child's scalp up and down, and the exposed middle fontanel was incised 2-3cm with a scalpel in Carvey's hand: "If you can't find a big or small fontanel or the child's head is not in a good position, you can choose craniosynthesis. Go right in."

Because there is no cranial piercer, Carvey can only use oval forceps as a substitute. Use the palm of your hand against the shaft lock between the central handles of the forceps, and close the incision along the already made incision.

There is no cranium under the fontanel, and only a little force can make it easy to penetrate the subcutaneous suture and meninges: "The next step is simple, while the fetal head is fixed, we open the forceps, then rotate left and right, stir Broken children's brains"【1】

Kavey's emotionless commentary made everyone present tremble. The two obstetricians from the Main Palace Hospital frantically crossed their chests, chanting words, and dared not look directly at them.

"I repeat, this is a stillbirth. Haven't you seen a stillbirth?" Carvey didn't show any mercy, and the brain tissue flowed out in a short while, or it could be said that it was forcibly taken out with the brute force of the oval forceps." What's more, this result is a decision made by Professor Hu Jier after everyone discusses, communicates and agrees."

"You don't have to bear the pressure, as long as you don't say anything." Hu Jier knew that he had gone too far just now, "I just hope that tomorrow's major newspapers will praise the accidental delivery before the operation, instead of the same yin and yang as before. "

The eyes of the two were still full of disgust and fear of abortion, but they had to agree to it under Hu Jier's intimidation.

In stark contrast to them is Good Hope.

Without the shackles of religion, he can easily understand the reasons for the ruined fetus.In fact, there is no need to understand it at all. Abortion has a long history.

What Shanwang really cares about is the abortion process, because compared with the complicated and high-end cesarean section, the content of the abortion technique needs to be learned is much smaller.For them, it is not easy to come to Paris once, and how to meet their ancestors if they don’t learn something to go back.

"What if the fetal head position is not good and the fontanel cannot be found?"

"You can find the bone seam." Carvey always spared no effort in answering his questions, "The skull of the fetal head is not closed yet, and its texture is soft, so it's easy to find."

Shanwang nodded, understood what he meant, but immediately had a new question: "What if the child's head is like this?"

He made a strange pose, raised his head sharply, and put his chin forward: "What if the face is too low, there should be no bone seams here."

"That's easier." Carvey explained, "The face is full of soft spots, and there is no need for a scalpel to make an incision."

Shanwang has no experience in surgery, but he learned anatomy well from that Huang Kuan, and immediately understood what he meant: "Oh, it turns out that it is the eyes and the mouth. There are indeed many ways to choose after it is clearly stillborn."【2】

The two were using English, and the content was a bit shocking but no one could understand it, so the scene seemed calm.

Shanwang's pen never stopped, and the question immediately extended from the head position: "It's not difficult to deal with the fetal head down, but what about the breech position? How to deal with the head when the buttocks are down?"

"Twist the legs first, and then they can come out in batches."

"It turned out to be this way of thinking." Shanwang's eyes lit up, and he seemed to understand the central idea: "Wouldn't it be cut off in the middle if you put it horizontally?"

"Indeed, if possible, introduce a jigsaw by hand, which is an instrument for craniotomy, and then do a horizontal cut." Carvey sighed, "The object can be the body, the neck, or other places, It depends on the habit of handling and the specific location."

"understood."

It always sounds very weird for a Chinese-speaking Chinese and an Austrian who speaks German to discuss in English what is forbidden by the Catholic Church in a French surgical theater.

Kavey's ruined fetus is still going on, and what he encounters now is only the inconsistency of ideas. The real trouble is actually the weak contraction of the uterus that may appear later.

As time passed, some doctors began to gather at the entrance of the surgery theater.

They all came to appreciate the rare cesarean section, especially today's placenta previa that may cause violent bleeding, and everyone wanted to see how Carvey handled it.There is still nearly an hour before the operation time, such enthusiasm is enough to show respect for Kavey.

But when they showed their identities with badges from their physician associations, they were told they couldn't enter.

"What does this mean? Why did you suddenly change your mind when you agreed to enter the venue?"

"I don't know either. I'm just a gatekeeper. I just received an order." Although there are guards here, they are not as overbearing as the operation theater in Vienna, and they are very casual. "Ask the obstetricians for details." .”

The two original surgical assistants now appeared at the entrance of the theater, playing the role of explanation: "The operation may have to be cancelled."

"Cancel? How could it be cancelled?"

"Is something wrong with Dr. Carvey?"

"Don't be joking, how could something happen when Paris is so safe."

"I mean other situations, such as being unable to get away for a while, or other reasons"

Their reaction at the beginning was like that of ordinary people. It was the kind of anticipation that had been built for half a year, but finally collapsed in an instant.But when their medical brains started to run wildly, someone noticed another possibility: "Is there something wrong with the mother?"

"Placenta previa is a 37-week belly again."

"It's not a sudden labor, is it?"

"It's possible, but that would be troublesome."

The two assistants didn't know what was going on in the preparation room, and they weren't there when the decision to ruin the tire was made.

And the so-called telling the truth is the same as what they said, telling the whole process of the parturient from the bleeding to before the labor.Bleeding does not seem to be serious, but only obstetricians who have been in contact with placenta previa know how dangerous it is for a child to get stuck in the uterine cavity if the cervix is ​​not dilated and the placenta is not going down.

"Doesn't Dr. Carvey have medicine, and medicine doesn't work?"

"I tried it, but it didn't work. The bleeding has been more than 700ml so far. After a blood transfusion, it can barely maintain the normal level!"

"Placenta previa, the month is enough, and there is still bleeding, so what are you waiting for? This should be the perfect opportunity for surgery, just cut the uterus and fish out the baby!"

"Yeah, it's not good to go down, so go to the stomach, isn't it a coincidence."

Most of the surgeons who came here were experienced surgeons, and there were even many obstetricians from other hospitals. The more they heard, the more they felt that this matter was strange.The assistant didn't think too much about it, and said again that the mother didn't want the operation, but only wanted to give birth in YD.

"So the time of the operation cannot be determined, and it is up to Dr. Carvey to decide whether to perform the operation in the end."

"This is too messy. The delivery of placenta previa depends entirely on luck. If you don't pay attention, you will lose the life of the mother."

"More than that. I watched the operation two days ago. Dr. Carvey's cesarean section was clean and neat. Fishing for a baby is like fishing for oysters. It is definitely an advantage over slow childbirth! It is an absolute advantage!!!"

The higher the praise, the more excited the people who want to see the operation, and the more they question the decision not to have the operation temporarily: "Since it is treatment, it is up to the doctor to have the final say, why should we listen to the mother? If the mother made the decision from the beginning , then what do you need a doctor for?"

As soon as this remark came out, there were a lot of comments. It was obvious that they had encountered some patients who thought they knew a lot: "Only doctors who have undergone strict training know how to judge the disease. What do patients know?"

"Even if someone is right, it's just a coincidence. Can you get one right, a hundred or a thousand?"

"Some doctors are indeed too benevolent, so benevolent that they ignore the objective reality of medicine."

"I don't think Dr. Carvey will make such a miscalculation."

"But he is too young after all, it's normal for him to be inexperienced, coupled with his temper and personality problems, he is likely to be led by the nose by some patients."

"Don't forget, Professor Hu Jier is also inside. That stubborn old man must be self-centered, so he wouldn't agree to such a messy treatment plan."

Such an impromptu discussion was launched on the basis of a piece of information and imperfect information.

As more and more people gathered outside the operation theater, the information discussed became wider and wider enough to be dispersed into small groups.

Some say they don’t want to have surgery for the time being, some say they’re putting on a show to increase their status, some say Edward hasn’t paid enough and are considering whether to pay more, and some say Kavey has lost interest in cesarean section. There are all kinds of things. .

But Carvey didn't know this, and the two assistants couldn't go back to inform them in order to maintain the order at the theater entrance.

"The brain tissue is almost coming out." Carvey did not remove the oval forceps, but first rinsed the vagina with normal saline to remove the tissue that adhered to the wall. "After the craniotomy, it is craniotomy."

Just like what Carvey said before, craniotomy is not really shredding, but squeezing the skull hard to reduce the volume of the fetus's head.Only in this way can the biparietal diameter be reduced, allowing the head to match the cervix that has stopped expanding.

Skull crushing requires more rough cranial crushing forceps【3】, which has a large contact area and strong force, and can end this process in a short time.

But now Carvey only has oval forceps, which are incomparably powerful and awkward to operate: "I will now insert one leaf of the forceps into the fetal head, and place the other leaf between the outer fetal head and the uterine wall, and wait until it is slowly locked. Then try to see if it can be pulled out.”【4】

It is not difficult to destroy the fetus. The only thing that needs to be paid attention to is whether there is any damage to the mother's own birth canal, including instrument damage and puncture injuries caused by broken bones.

For Carvey, these are all avoidable, especially the former, almost every operation of entering the uterine cavity is guided by fingers.The latter requires some luck to avoid, and there are some requirements for skull crushing or other tire destruction operations.

"Fortunately, it is the head position, so there is no need to strangle the limbs, and there is no need to transect the body or the fetal head."

Carvey seems to have quite a lot of experience with abortion: "After the craniotomy, we directly perform traction, and the damage to the cervix is ​​very small. The next step is to see whether the traction can really be as smooth as the natural delivery. If there is some difficulty in giving birth .”

As he was speaking, he began to exert force outward with his hands, and smoothly pulled the deflated fetal head out of the cervix and into the external opening of the vagina.

I don't know if everything went wrong today, or the damaged fetus offended God. In short, after more than half of the fetal head was exposed, the dead baby was stuck there straight and could not be pulled out again.

"It's not really shoulder dystocia, it's really what you say." Kawei reached into the yd again, explored left and right, touched the position of the shoulder and collarbone, and asked for treatment tools without hesitation, "Come on, Give me scissors, the sharpest kind."