Nineteenth Century Medical Guide

Chapter 373 369. Samuel: Is he a man? Is it a woman?

Shoulder presentation is very dangerous. In modern obstetrics, as long as there are conditions for surgery, the patient will basically be sent to the operating room immediately for cesarean section.

If the treatment is more theoretical, internal inversion surgery can be performed as long as it satisfies multiparous women, the cervix is ​​more than 5cm dilated, the membranes have recently ruptured, and the amniotic fluid does not flow out much. Change the originally unable transverse position to breech position, change shoulder presentation to foot presentation, and then perform breech traction to end the delivery.

Kawei is not an obstetrician, and has never seen shoulder presentation handled in the delivery room before. He only mentioned this internal inversion technique when communicating with the obstetrics department.

The technology must be good, and the difficulty is high enough. Anyone who can do it and dares to do it is a big shot.

With the development of science and technology, cesarean section technology has long been mature, and the soil for this technology is gradually disappearing. Moreover, the operation itself has certain risks, which can cause placental abruption, fetal respiratory distress and even uterine rupture. Compared with this, it is better to have a cesarean section once and for all.

Therefore, only health centers in remote mountainous areas that cannot perform cesarean sections have the opportunity to operate. It's just that doctors in health centers have less chance of encountering difficult labor. The less experienced they are, the higher the risk, and the less they dare to operate.

Obstetricians in the 19th century faced a completely different situation.

Regardless of how many people have learned internal inversion, the risk of cesarean section far exceeds that of internal inversion. Faced with all kinds of difficult labor, I would not do it if I could. If you encounter a stillbirth, there is no reason for cesarean section, and you can just accumulate experience in inversion surgery.

Of course, experience is experience, and the danger still exists, and it is greater than in modern times. Without first aid and surgical capabilities, if complications occur, it is very likely that one person will die and two people will die.

Senior obstetricians like Hugill and Samuel all have their own experiences with inversion, both good and bad. In the course of practicing medicine for decades, there will always be a few people who are unlucky. As the experience continues to accumulate, they will become inner demons, and no one can avoid them.

This is an empirical truth accumulated from bloody facts, and it is also the suffering that obstetricians must endure. It has been forcing obstetricians to find ways to break the situation. After hundreds of years of failure, safe cesarean section, which Carvey is now vigorously promoting, is probably the best way to break the situation.

Once it prolapses, the umbilical cord will be squeezed by uterine contractions and become stuck in the blood flow, causing fetal distress. Moreover, transverse delivery can easily lead to stagnant labor and cause uterine contraction weakness. In the end, even if a cesarean section is performed, there is a huge risk of postoperative hemorrhage.

At 11:44, Samuel sat down and began the internal inversion.

After a heated discussion, Samuel followed Carvey's advice, hoping that he could solve the problem on the spot.

It's better to have one alive than all dead.

No matter what is rotated, a certain force must be exerted at a certain position, and the fetus is no exception. The best place to apply force is the fetal foot.

Therefore, after weighing the pros and cons, and on the premise that Alex's physical condition was suitable for internal inversion surgery, Kawei believed that it would be more advantageous to perform internal inversion surgery first, and cesarean section was the last resort.

Now the fetal shoulders have prolapsed outside the uterus, and the shoulders do not match the ever-expanding cervix, leaving a gap easily causing umbilical cord prolapse.

What made him hesitate was definitely not his own skills, or the lack of suitable assistants to help, but the bloated road system, backward transportation and bad weather in Paris in the 19th century. It was the combination of these factors that greatly affected the judgment of the two people.

The subject is the Prince of Wales and the child is a son of Great Britain. This is one of the most famous private salons in Paris. Should I take the risk and perform endoversion surgery on the spot, or should I take the risk and send her to the hospital?

After determining the goal, the next step is to explore the goal.

"Pray? Maybe it's time to pray at this time. Ass, His Majesty Frederick and the Countess should all pray, including those in the main hall. But it's not me, and it's not our turn!" Kawei Shaking his head, his brain quickly replayed the possible surgery scenes, "God, this old man doesn't know how to perform internal inversion surgery, and he never uses a scalpel."

"You don't really want to leave the life of the young princess and the child, as well as the relationship between England and France, to God, do you?"

Road conditions, horses, drivers, and weather can all affect the princess's life or death. If anything happens in the meantime, there is really no room for maneuver if she is locked in the carriage. It is better to stay in the salon calmly.

From experience, Samuel was pessimistic about handling the princess' delivery.

Logically speaking, Kawei should not have hesitated. Shoulder presentation meant a cesarean section.

He did have the strength to be invited here by Melanie, and his nervousness did not affect his operating skills too much. After calming down a little, I applied vegetable oil to my clean right hand, closed my fingers, and stretched them in. 【1】

These are just purely internal factors. The real trouble is the hour after hitting the road.

"Maybe, maybe we could say a prayer."

It is too difficult to ensure the safety of both mother and baby when the baby is exposed in shoulder presentation. Instead of risking uterine rupture and performing internal inversion surgery, it is better to wait until the baby is no longer viable and then destroy the fetus and then induce labor. He knew that this approach was against Catholic teachings, and he struggled, but finally chose to reconcile.

Samuel felt bitter in his heart. He thought he was just going through the motions, but instead he accepted a hot thing. With the buffs stacked up, he really didn't dare to make any mistakes.

There are no eyes in the uterine cavity, so you can only rely on touch to determine whether you are touching the head, hands, feet or umbilical cord. The umbilical cord is easy to judge, as its length, thickness, and hands and feet are all different. The difference between the hands and feet depends on the length and thickness of the heels, fingers and toes. The most obvious one is that the thumb (big toe) is obviously different from the other four. 【2】

Because it had to pass through the cervix, pain was unavoidable. Samuel relied on lubrication to quickly enter the uterine cavity, stuffed the fetal hand back, and then found the fetal foot. 【3】

At the same time, the left hand determined the position of the fetal back against the mother's body, and then slowly searched for the other fetal foot. 【4】

After finding the two feet, Samuel grasped the fetal foot with the index and middle fingers of his right hand and slowly pulled it downwards. 【5】

At the same time, the left hand cannot be placed outside the abdominal wall and needs to be repeatedly moved back and forth between the fetal buttocks and head. At one moment, the fetal buttocks are pressed down to make it easier for the hands in the uterine cavity to hold the fetal feet. At the same time, the fetal head is pushed upwards, and the internal and external cooperation gradually turns the fetus into a breech presentation with foot presentation. 【6】

Samuel's method is not particularly perfect, but at least the purpose of the operation is achieved.

Fetal feet, he found them quickly. He immediately touched the fetal head. The position of the tire hip and tire back is very clear, and the direction of force is no problem. Alex is also quite brave and does everything she can.

But the key problem was that when he led the child's feet to the cervix, he thought that the internal inversion operation had been successfully completed. Unexpectedly, the cervix, which had been opened 7-8cm enough for his arms to enter, suddenly stopped moving, and his feet remained at the vaginal opening, unable to deliver the baby out of the body by the princess's own strength.

Samuel tried forceps and other available metal plates to help induce labor, but in the end he had to declare that the internal inversion operation had failed.

The reason for the failure is not that the cervix is ​​not fully dilated, because this cannot be controlled by human power alone. As long as there are no other problems, it is only a matter of time before the cervix is ​​fully dilated. As long as you wait quietly, you can perform breech traction when conditions permit.

The real reason for the failure was that the fetus did not move when the cervix was not fully dilated, and its legs just hung there, unresponsive.

This was very fatal in the 19th century when there was no modern fetal heart rate monitoring equipment. No one could be sure whether the child did not want to move or was unable to move.

"no solution anymore."

At 12:00, the internal inversion operation failed completely, and the surgery was performed immediately.

There are actually several obvious differences between cesarean section and other operations. There are fewer steps, the order of operations is fixed, and as long as there are no problems with uterine contractions, the amount of bleeding is very small. In addition, in order to improve postoperative recovery, the frequency of use of scissors during surgery is very low. This laid the hardware foundation for Kawei to perform ultra-fast cesarean section in a salon without any professional surgical equipment. But he still hesitated before taking action.

What is hesitant is not her own technical ability, but Princess Alex's determination: "Your Majesty, I will only give you 1 minute to think about it now. Please be sure to answer my question."

"what?"

The pain and violent contractions caused by the internal inversion surgery had consumed a lot of Alex's energy. After hearing this, she lay weakly on the coffee table and her voice dropped again and again: "What's the problem? Just ask."

After Kawei counted the so-called "instruments", he began to walk towards the water basin brought by the servant: "How much are you willing to pay to give birth to a child?"

"Pay?" Alex replied weakly, "Of course everything."

"Well, maybe I didn't explain it clearly. Let me ask the question in a different way." Kawei paused, immersed his hands in the water, then picked up the soap and rubbed it. "Are you willing to endure the pain of seppuku to give birth to a child?"

"Cut what?"

"Seppuku means cutting open the stomach." Kawei lowered his head and glanced at his stomach, "Because there is no ether here, and the only thing that can be used is yam tincture. Although I can guarantee that the child will be taken out within 5 minutes, the pain you need to endure is still No less than being hit by a cannonball on the battlefield.”

"I" Alex was a little confused, "Cannonball?"

"Yes, artillery shells, not those solid shells, but grenades. His Majesty Prince Frederick should have seen this when he joined the army. Such artillery shells will have a fuse ignited at the same time as they are fired, causing them to explode at a specific location. "

Kawei gestured with his hands and feet: "The fragments produced after the explosion flew everywhere, cutting limbs and even heads, like this, this and this."

"No! This was not 30 years ago, Dr. Carvey!"

Frederick couldn't sit still: "Where is there any operation without anesthesia now? Besides, aren't you a pioneer in promoting quantitative anesthesia technology?"

"It seems that His Majesty the Prince has never been to the battlefield."

Kawei was still discussing with the brothers and sisters, and his hands were not slow at all. After cleaning, he came to Alex: "There are not so many anesthetics on the battlefield, as is the case many times. Okay, one minute is up, princess Your Majesty, what’s your answer?”

Alex was clearly unprepared.

Two consecutive smooth births made her think that giving birth was just like that, and she would just endure it and it would be over. She never thought that she would have to face this kind of situation. Kawei didn't give her much time to think about it. How should she choose? ? ?

"If I refuse the surgery, what will you do next?"

Kawei and Samuel have similar opinions. They have to go to the hospital in the end no matter what. It is nothing more than the difference between going early and going late and how to go. The final treatment method is basically fixed, which is cesarean section, but the child born has basically no possibility of survival.

"What if we go to another hospital now?"

"Except for weather and road factors, even for other hospitals, it takes at least half an hour on the road." Kawei said, "Besides, they don't have oxytocin, they don't have proper cleaning procedures, and it's just as dangerous in the end."

After asking around, in the end there were two ways.

If one endures the pain, the child will most likely live; if the other gives up, the child will die.

Alex swore that if Albert was a considerate and warm man, if there were not so many rules in the palace and she could be given a certain amount of freedom, she would definitely say "come on, it's okay" without hesitation.

But now when she thought about having to endure such a thing for that man, she couldn't find any courage to come out.

Kawei looked at her, asked the two maids to tear open the dress, and then poured a whole bottle of cooking oil on her belly: "If you don't answer, I can only default to your motherhood. Don't worry, I am very confident about my skills. I’m confident it won’t take long.”

After saying that, he wiped his stomach with his hands and picked up the shining scissors.

Just as Kawei finished indicating the location of the incision, Alex seemed to have figured out one thing: "Wait!!!"

"Have you changed your mind?"

"last question!"

Kawei looked at the wall clock and darkened his face: "There is no time, Your Majesty Princess, please hurry up!"

The lying position caused the expanding uterus to press upwards on Alex's heart and lungs, causing her to speak intermittently: "Doctor Samuel, is my child a boy or a girl?"

"what?"

Samuel, who announced the failure of the internal inversion technique, just breathed a sigh of relief, thinking that he could relieve himself of responsibility, so he didn't listen to what they were saying and didn't react for a while.

After asking it again, he realized like everyone else that this was a very strange and difficult question to answer.

Now the child's feet are hanging outside the uterus, buttocks are stuck inside the uterus, and the amniotic fluid has basically drained away. The size of the cervix did not allow Samuel to reach in and judge the gender. It would be disrespectful to push the legs back and try to judge the gender, because it would become very dangerous.

And the most critical point is that Samuel doesn’t know whether the princess likes a boy or a girl. What if he makes a mistake?

"I know you want a boy!" shouted Frederick, "so it must be a daughter, right, Dr. Samuel!"

"How are you sure I want a boy?"

"You must have a boy!"

"Your Majesty, please don't add fuel to the fire!"

"Alex! You can't mess around."

Samuel's mind was in a mess, and even though Kavi kept comforting him and telling him to tell the truth, he couldn't calm down.

Because when he was doing the internal inversion surgery just now, he had been tense all the time. All he could think about was holding his legs and not letting go. He didn't even think of touching it, so he didn't know whether there was a boy or a girl in his belly.

ah! ! ! what to do? ? ?

(End of this chapter)