Chapter 2049 Protect the Adults or Protect the Children, an Old Proposition

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

Around 35,000 newborns are delivered each year.

It is bustling and bustling all year round. Even during the Chinese New Year, other large tertiary hospitals are deserted, but this place is still lively.

Unlike other large comprehensive tertiary hospitals, most of the people here are beaming, not downcast.

After all, it is a good thing to add a child to import, and it is a great thing.

There are more than a dozen obstetric wards in the Women and Children's Hospital, and the doctor's office in each ward is so full of pennants that they can't even hang them.

People are in good spirits on happy occasions, and mother and child are safe, so it is only natural to send wedding money and silk banners.

It's just that the atmosphere in the obstetrics 1st ward today is a bit wrong.

The door of the doctor's office was closed tightly, and those who hadn't undergone surgery were all sitting in the office, while the experts and professors from the outer hospital and the leaders of the hospital were sitting in the office.

The air was stagnant, as if there was a major medical accident, and no one spoke.

It happened more than two months ago.

A 39-year-old pregnant woman found that the child in her abdomen was suspected to have congenital aortic valve stenosis during the examination.

At that time, the fetus was only 24 weeks old, and congenital aortic valve stenosis could be seen. It can be said that the level of Women and Children's Hospital is quite high.

Seeing the test results, the doctor explained the condition clearly to the patient and the patient's family members.

Left ventricular outflow tract obstructive heart disease is caused by congenital abnormality of aortic valve, accounting for about 3%-6% of congenital heart disease.

If the fetus develops aortic valve stenosis in the first and second trimesters, the filling blood volume of the left ventricle will be affected and continue to decrease as the pregnancy period prolongs.

Eventually, progressive hypoplasia and heart failure may result, forming hypoplastic left heart syndrome.

Children face new dangers every day, from birth to treatment, and even in the mother's womb.

Every step is a hurdle, and a wrong step is the gate of hell.

There is a high possibility of stillbirth, and even if it is born alive, it will face countless troubles.

The doctor suggested induction of labor, which is the most suitable option for the current situation.

But the pregnant woman is almost forty, and she has paid a lot in order to have a child and realize her dream of becoming a mother. In the case of already having pregnancy-induced hypertension, I am still persisting.

For her, the option of giving up is non-existent.

After listening to the doctor's tactful narration, the pregnant woman resolutely refused to induce labor, crying bitterly while expecting a miracle to happen.

Perhaps as the pregnancy progresses, the child's condition does not get worse, but gets relieved. This situation is not impossible, but the possibility is extremely low, so low that there is no need to consider it at all.

After choosing to preserve the pregnancy, the pregnant woman traveled all over the imperial capital, and as long as the hospitals with high standards gave the same conclusions.

But this time, it was because the condition of the fetus was found to be deteriorating during yesterday's prenatal examination.

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

All signs indicated that the child's congenital aortic valve stenosis was developing to a very severe level, and heart failure and other manifestations appeared.

Just 32 weeks pregnant...

The pregnant woman still did not agree to induce labor. She did not agree at 24 weeks. After 8 weeks, her attitude became more determined.

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

After the discussion of the expert group inside and outside the hospital, three treatment methods were summed up.

First, close observation and conservative treatment.

In fact, this is an unavoidable solution. The current state of the child simply cannot last 38-40 weeks for natural delivery.

The second is to prepare for a caesarean section. After the baby is delivered, he will go directly to another operating table and perform a thoracotomy to treat his congenital aortic valve stenosis.

This type of treatment carries enormous risks.

The child's growth in the pregnant woman's body was not very good. At only 32 weeks, he already had symptoms of pericardial effusion and heart failure.

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

This step is also voted by almost all doctors.

The hospital also hired the nationally renowned doctor Liu Cixi as the surgeon for the operation.

Dr. Liu Cixi is the one who has performed the most such operations in China and has the highest number of successful cases. But even then, the success rate of the operation is less than 30%.

To be honest, if you choose to keep the child, the family is likely to face the ending of no money and no money.

Ultra-difficult operations, ultra-low success rates, and huge daily expenses are all problems.

In addition, there is a third surgical method - the development of neonatal cardiac surgery and catheter intervention technology, which can be used for intrauterine interventional therapy.

It sounds like an impossible form of treatment.

The principle is simple, interventional surgery for the treatment of congenital aortic stenosis. Get through the stenosis as soon as possible and improve the blood flow of the aorta as soon as possible.

The benefits are huge, as it can promote the development of the fetal left ventricle and create opportunities for biventricular circulation after birth.

And if the operation is perfect, the fetus can continue to grow in the mother's body until 38-40 weeks of natural delivery.

The next month and a half to two months are critical for the fetus!

but,

only,

It sounds beautiful.

Intrauterine interventional therapy 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 a case report in the "New England" magazine, which attracted the attention of many interventional physicians at that time.

So far, more than 200 clinical cases have been reported in the world, mainly in western countries. Balloon dilatation of the aortic valve accounts for the majority, with a technical success rate of over 50%.

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

Compared with cardiothoracic surgery after laparotomy, this mortality rate is also barely acceptable.

but!

Intrauterine interventional surgery has a very high risk.

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

In the second option, pregnant women are sure to be fine. But to choose intrauterine interventional surgery, the pregnant woman shares half of the life risk of the fetus.

At this time, differences emerged between the patient and the patient's family.

The pregnant woman insisted on the third type of intrauterine interventional treatment, while the family members requested the second type of surgery.

To protect the adults or to protect the children is an old proposition.

When the medical level is underdeveloped, dystocia is fatal. There was no caesarean section at that time, so there was such a proposition.

But now the level of medical technology is advancing by leaps and bounds, it has become a false proposition to protect adults or children.

But when this ancient choice was put on the table here, all the doctors found helplessly that it really existed.