Beijing Union Medical College Hospital escorts the lives of mothers and infants with three complex and critical operations a day

When all over the country is immersed in the happy and peaceful festival atmosphere, more than 10 discipline teams of Peking Union Medical College Hospital are racing against the time to launch a life and death contest, and successively complete the rescue of three high-risk pregnant women. The people of Peking Union Medical College Hospital persevere diligently to protect the safety of pregnancy and childbirth and protect the health of mothers and infants. < / P > < p > Professor Qi Qingwei, Associate Professor Jiang Yulin, Associate Professor Zhou Xiya, attending physician LV Yi, deputy director of anesthesiology department Pei Lijian, executive chief nurse Wang Huizhen and head nurse Gao Haiyan in the operating room, Xiao mengsu and Gao pin in the ultrasound medicine department, attending physicians Zhang Yu, Tang Xiaoyan and Ma Jingran in pediatrics department, and Hao Na in the obstetrics genetics laboratory He specially came from home to perform the second intrauterine blood transfusion for Li Juan from Shanxi Province, together with the attending doctors of Obstetrics center Wang yongxue, pediatrics meimeiying and Gou Lijuan. < / P > < p > Li Juan is Rh negative blood group. At 29 weeks of pregnancy, ultrasound examination found that the fetus had severe edema and a large amount of ascites, which was caused by maternal fetal Rh blood group incompatibility. Li Juan and her family went to the clinic of Associate Professor Jiang Yulin of prenatal diagnosis and fetal medicine group of Peking Union Medical College Hospital on the afternoon of September 28. The professional group combined with the results of our hospital’s emergency ultrasound judgment, the fetus has serious anemia, fortunately, the umbilical vein has no abnormal pulsation. This shows that the fetal heart function is still in the compensatory period, but heart failure may occur at any time, and the fetus may die in utero. < / P > < p > in view of this situation, the most common treatment is to give emergency cesarean section to pregnant women and transfer the newborn to NICU. However, considering that her gestational age is only 31 weeks, she has not received any treatment to promote fetal lung maturation, and her fetus is suffering from severe anemia and heart failure. If cesarean section is performed at this time, the child’s survival probability is very small. There is also a way, is through the mother’s belly from the fetal umbilical vein for fetal intrauterine blood transfusion treatment, so that the fetus through the dangerous period in the uterus, and then cesarean section to pediatrics, so that the fetus can have a chance of life. < / P > < p > intrauterine blood transfusion is a high-risk operation. In the face of life hanging on the line, the people of Concorde have come up with the strength to fight and move forward. Gan Jia, director of the blood transfusion department, and Jiang Xin, assistant director of the blood transfusion department, said one after another that we should find the right donor red blood cells for the fetus regardless of all difficulties. On the morning of September 29, Li Juan accepted the most critical indirect antiglobulin test. At 4 p.m. on the same day, a multi-disciplinary consultation made an operation plan. From the pregnant women anesthesia plan, fetal anesthesia plan, calculation of fetal intrauterine muscle relaxant usage and dosage, fetal blood transfusion, development of ultrasound-guided plan, emergency caesarean section plan, neonatal rescue plan, to the specific use of what type of ultrasound machine, puncture needle, puncture frame, blood transfusion device, infusion pump, how to pack donor red blood cells and other details, all were discussed in detail. On the afternoon of September 30, in the operating room of the internal medicine building of Peking Union Medical College Hospital, Li Juan’s intrauterine blood transfusion treatment began. Under the ultrasound guidance of Xiaomeng Su, Associate Professor Jiang Yulin punctured the umbilical vein and got to the point. Professor Qi Qingwei took the umbilical vein blood and gave it to the laboratory for testing. It was confirmed that it was fetal blood, and then sent it to the blood transfusion department for further testing. Pei Lijian, deputy director of the Department of Anesthesiology, personally looked after the anesthesia and blood transfusion of pregnant women and intrauterine fetus. Zhou Xiya, associate professor of Obstetrics center, nervously carried out various calculations under the stage. Gan Jia, director of blood transfusion department, reported the test results of fetal umbilical cord blood and confirmed the diagnosis of RHD incompatible fetal hemolysis. In 35 minutes, 52 ml of o-rhd negative irradiated washed red blood cells were slowly infused into the fetus, and the operation was successfully completed. After blood transfusion, the condition of the fetus improved significantly. < / P > < p > in the following days, Peking Union Medical College Hospital continued to monitor Li Juan and she was in good condition. Until October 5, the hemoglobin of the fetus decreased to 3-4g, and the edema was slightly aggravated. Emergency cesarean section or retransfusion? < / P > < p > at 6:30 p.m. on October 5, the second multi-disciplinary consultation was held in the form of network conference, presided over by Zhang Zhanjie of medical department, and attended by Professor Gao Jinsong, deputy director of Obstetrics center, and Professor Meng Hua of ultrasound medicine. At this time, the fetus has been more than 32 weeks, and its weight is estimated to be no more than 1800g. Fully weighing the pros and cons, the multidisciplinary discussion decided to carry out the second intrauterine blood transfusion for Li Juan the next day, and make the emergency cesarean section operation plan and neonatal rescue plan. < / P > < p > on October 6, in order to reduce the amount of blood transfusion and reduce the burden of fetal heart, the blood transfusion department configured blood products with higher red blood cell concentration through centrifugation, separation of supernatant, removal of white membrane and other operations. Pediatrics quickly organized a rescue team to prepare all rescue equipment and drugs in accordance with the emergency plan, so as to prevent emergency cesarean section and make full preparations for rescuing premature infants. With our efforts, the second intrauterine blood transfusion was successfully completed. After 58 ml blood transfusion, fetal hemoglobin increased from 4 g to 9 g, which provided more safety and security for the newborn. On the morning of October 9, the Department of Obstetrics and Gynecology, pediatrics, blood transfusion department and medical department held a multi-disciplinary consultation for Li Juan for the third time. Considering that the current situation of the fetus is relatively stable and meets the rescue conditions of the newborn, the hospital decided to perform cesarean section at noon on that day, and make plans for intraoperative blood exchange treatment and intraoperative bedside cardiac ultrasound examination. The operation was smooth and Li Juan was in good condition. The child delivered 326 weeks prematurely, accompanied with systemic edema, massive ascites, pericardial effusion and anemia. He was immediately intubated in the operating room and then transferred to NICU. Pediatrics has taken over the baton of life, and is carrying out blood exchange treatment for the children, correcting hyperbilirubinemia caused by hemolysis due to incompatible RhD blood group, and further diagnosing and treating the complications of premature infants. At 0:00 on October 6, Zhang Jing and her family rushed from Hebei to Peking Union Medical College Hospital for emergency treatment. She had an abortion operation in the local hospital the day before the national day. She was going to take advantage of the National Day holiday to recuperate. Unexpectedly, she began to have upper abdominal pain, nausea, vomiting and fever on October 4. The local hospital found that her liver and kidney function was obviously damaged, and she had anuria and thrombocytopenia. < / P > < p > the critical and complex condition is the charge number. Zhu Huadong, director of the emergency department, immediately called the relevant departments to comprehensively sort out the patient’s condition and investigate the cause of the disease. The fever clinic ruled out the possibility of new crown infection at the first time. The comprehensive evaluation of emergency internal medicine indicated that acute liver insufficiency, acute kidney injury, acute myocardial injury and disseminated intravascular coagulation were the most likely causes of infection, and the source of infection became the primary breakthrough point of treatment. Emergency gynecological check patients, although abortion 5 days after the occurrence of the above disease, but ultrasound prompted a little residual uterine cavity can explain the patient’s current infection and multiple organ damage? Although the patient had symptoms of acute abdomen, there was no obvious intestinal perforation on emergency pelvic and abdominal CT, and there were too many questions about the patient’s condition. Emergency surgery considers that the patient has upper abdominal pain, abnormal liver function, and gallbladder ultrasound indicates sediment like stones or deposits. It is still necessary to closely monitor the possibility of acute abdomen related conditions. On that day, Professor Sun Zhijing, Associate Professor Dai Yi and attending physician Liu Qian, director of general gynecology center of gynecology duty team, rushed to the emergency department to check the patients and formulate the diagnosis and treatment plan. < / P > < p > on the morning of October 6, after the first round of multi-disciplinary consultation, the etiology of the patients was still unclear and difficult to determine. At this time, the patient’s abdominal pain was not relieved, and the indicators were still not improved. Professor Liu Xinyan, head of the family planning group of the obstetric center who came to the hospital from home, gave expert guidance. In order to exclude the multiple organ damage caused by intrauterine infection and actively correct the coagulation and metabolic disorders, the patient was pushed into the operating room at 10 p.m. on October 6. Dr. Ma Shuang and Liu Yuchao of anesthesiology department formulated and implemented a detailed anesthesia plan and closely monitored the patient’s vital signs. Professor Sun Zhijing operated carefully under ultrasound monitoring, performed intrauterine drainage, removed a small amount of residual decidua like tissue in the uterine cavity, and sent intrauterine swabs for culture and related tests. The patient returned to EICU after operation. < / P > < p > the evidence of intrauterine infection leading to such severe renal failure is not sufficient. In order to protect the kidney, the patient began to receive bedside hemofiltration on October 7. Under the guidance of Hematology, Nephrology and other specialist consultation, the possibility of hemolytic uremic syndrome is high, and the relevant examination needs to be further improved to make a clear diagnosis. At 3:00 p.m. on October 6, obstetrician Liang Shuo told his superior doctor Shan Ying that Wang Ting, a pregnant woman in labor, had flat fetal heart rate, poor variation and suspected intrauterine distress. Maybe I can’t stand it. ” < / P > < p > Shan Ying’s attending physician immediately rushed to the ward to check the patient: the fetal heart rate acceleration mutation is good, the uterine orifice has been opened 5 cm, the progress of labor is still good, the child is not too big, although the amniotic fluid is a little cloudy now, it is not clear that the grade III amniotic fluid. “Close monitoring of fetal heart rate changes, we can try vaginal delivery again.” Shan Ying explained her illness to the patient and her family. < / P > < p > one hour later, Wang Ting’s fetal heart rate monitoring was very unsatisfactory, and the obstetric center decided to have an emergency caesarean section. Contact the operating room, hand in the operation form, open the operation order, talk to the family members and sign The preparation work is closely linked and closely linked. When the signature form of cesarean section is given to the family members of the patients, the ward nurses have completed the preoperative preparation. When the front-line doctor came out of the ward with the signed informed consent, the operating room nurse Yang Qian had already pushed the operating car to the ward to pick up the patients. At the same time, the operating room has been in full swing to do the emergency cesarean section anesthesia preparation. < / P > < p > the cesarean section was successfully completed, and the amniotic fluid was stained with grade III feces during the operation. During the operation, when the child’s loud cry was heard before the umbilical cord was broken, everyone’s heart was finally put down. Mother and son’s peace is the best gift doctors receive during the festival= target=_ blank>08/16/2020