Chapter 2050: Bao Da is still a child, an ancient proposition

The Imperial Women's and Children's Hospital is one of the few gynecological and pediatric hospitals in the Imperial Capital and even the country.

The number of newborns delivered each year is about 15,000.

It’s bustling all the year round, and it’s a city. Even in the New Year, other large top three hospitals have been deserted, and it is still lively.

Unlike other large-scale integrated top-three hospitals, the majority of people here are beaming, not downcast.

After all, the import of Ding Ding is a good thing, it is a good thing.

There are more than a dozen obstetric wards in the Women and Children's Hospital. In the doctor's office of each ward, the banners are full and the hangs are not hanged.

Everyone has a good spirit, and the mother and son are safe. It is also reasonable to send good money and send a banner.

It’s just that the atmosphere in the obstetrics area is somewhat wrong today.

The door of the doctor's office was closed, and those who did not go to the surgery were sitting in the office. The professors in the outer court and the leaders of the hospital were sitting in the office.

The air stagnate, as if it was a major medical accident, no one spoke.

It happened more than two months ago.

A 39-year-old maternal woman found a congenital aortic stenosis in the abdomen during the examination.

At that time, the fetus was only 24 weeks, and the congenital aortic stenosis can be seen. It can be said that the level of women and children's hospitals is quite high.

Seeing the results of this test, the doctor explained the condition with the patient and the patient's family.

Due to congenital abnormalities of the aortic valve, the left ventricular outflow obstructive heart disease accounts for 3%-6% of congenital heart disease.

If the fetus has aortic stenosis in the early and middle pregnancy, as the pregnancy increases, the left ventricular filling volume will be affected and continue to decline.

Eventually, it may lead to progressive dysplasia and heart failure, forming a left ventricular dysplasia syndrome.

From birth to treatment, even in the mother's womb, children face new dangers every day.

Step by step is a hurdle, the wrong step is the ghost gate.

There is a great possibility of death in the womb, and even if it is born alive, it will face countless troubles.

The doctor recommends induction of labor, which is an option that best suits the current situation.

However, the pregnant woman herself is almost forty. In order to have a child, she has become a mother's dream. She has paid a lot. In the case of already having pregnancy-induced hypertension, it continues to persist.

For her, giving up this option does not exist.

After listening to the doctor's rumor, the pregnant woman firmly refused to induce labor, while crying, while expecting a miracle.

Perhaps with the process of pregnancy, the child's condition is not aggravated, but is relieved. This situation is not impossible, but the possibility is extremely low, so low that it is not considered at all.

After choosing abortion, pregnant women traveled throughout the emperor, as long as the hospital with a high level, the final conclusions are consistent.

This time, it was because the fetal condition was worsening in yesterday's prenatal examination.

The aortic valve pressure differential was gradually increased from 22 mmHg to 85 mmHg. The ratio of left and right ventricles gradually became imbalanced. During the observation process, fetal pericardial effusion and mitral regurgitation occurred one after another.

All indications indicate that the congenital aortic stenosis of the child is progressing extremely severely and that heart failure occurs.

Just 32 weeks pregnant...

The pregnant woman still disagreed with the induction of labor, and she disagreed at 24 weeks. After 8 weeks, her attitude was firmer.

Although she knows that after a Caesarean section, the child may have to undergo major surgery and even die, but she still does not give up.

After discussion in the in-hospital and out-of-hospital expert groups, three treatment methods were summarized.

First, close observation and conservative treatment.

In fact, this is no way, the current state of the child can not support the natural delivery of 38-40 weeks.

Second, preparation for caesarean section, after the child's output, directly on another operating table, open thoracotomy, surgery for his congenital aortic stenosis.

This kind of treatment is very risky.

The child's own growth in pregnant women is not very good, only 32 weeks, there are symptoms of pericardial effusion and heart failure.

Surgery is a good thing to do... It is very difficult, but it becomes a very simple and easy operation compared with the postoperative recovery of the child.

This step is also chosen by almost all doctors.

The doctor of the operation, the hospital also invited the nationally renowned doctor Liu Cixi as the chief surgeon.

In this type of surgery, Dr. Liu Cixi is the one who has done the most in China and the highest number of successful cases. But even so, the success rate of surgery is less than 30%.

To be honest, if you choose to keep the children, it is likely that you will have to face the end of the world.

Ultra-difficult surgery, ultra-low success rate, and huge daily cost are all problems.

In addition, there is a third type of surgery - neonatal cardiac surgery and catheter intervention technology development, can do intrauterine interventional therapy.

It sounds like an impossible treatment.

The principle is simple, interventional surgery for congenital aortic stenosis. Open the stenosis area as early as possible to improve aortic blood flow as soon as possible.

The benefits are enormous, can promote fetal left ventricular development, creating opportunities for biventricular circulation after birth.

And if the surgery is perfect, the fetus can continue to grow in the mother's body, and it has been naturally delivered for 38-40 weeks.

The next one and a half months to two months is vital to the fetus!

but,

just,

It sounds beautifulThe intrauterine interventional treatment has not been around for a long time.

In 1991, the world's first related treatment case was first reported by Maxwell D et al. The literature was published in the case report of New England magazine, which caught the attention of many interventionists at the time.

To date, more than 200 clinical cases have been reported internationally, concentrated in Western countries. Aortic valve balloon dilatation is the majority, with a technical success rate of more than 50%.

Well, more than 50%, in other words, the mortality rate is over 40%, nearly 50%.

This is also marginally acceptable for cardiothoracic surgery after laparotomy.

but!

Interuterine interventional surgery is extremely dangerous.

In addition to the fetus, there are risks to pregnant women.

The second option, pregnant women is ok no problem. However, to choose intrauterine interventional surgery, pregnant women share half of the life of the fetus.

At this time, there was a disagreement between the patient and the patient's family.

The pregnant woman insisted on a third type of intrauterine intervention, while the family asked for a second operation.

It is an ancient proposition that Bao Da is still a child.

When the medical level is underdeveloped, it is terrible to produce dystocia. There was no caesarean section at that time, so there would be such a proposition.

Nowadays, the level of medical technology is advancing by leaps and bounds, and it is a false proposition to protect the children.

But when this ancient choice was placed on the table, all the doctors had no choice but to find out that it actually existed.

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