Every operation in the medical field is a solemn commitment to life, an anxious contest against time.
A few days ago, the obstetric premature birth team of Shanghai First Maternity and Infant Health Hospital experienced a tense and difficult life rescue. A 36-week-old pregnant woman suddenly suffered massive vaginal bleeding and was transferred from 120 to the emergency department of the Eastern Hospital, which immediately initiated first-level rescue. In this time-critical battle, the hospital's multidisciplinary medical team ensured the safety of the mother and baby with superb medical skills and firm courage.
Outburst! The expectant mother was bleeding profusely and the baby was born safely on the operating table
Recently, the emergency department of a maternity and infant East Hospital welcomed a pregnant woman in critical condition. The pregnant woman was 36 weeks pregnant, and the pregnancy examination showed central placenta previa, at 9 o'clock on the same day, there was no obvious cause, and suddenly there was uncontrollable heavy vaginal bleeding, so she called 120 and transferred to a woman and baby. After receiving the treatment, the medical staff of the emergency department realized that the situation was urgent and immediately called Li Liping, director of the obstetrics preterm birth subspecialty.
After receiving the emergency phone report, Li Liping immediately set up a rescue team, decisively decided to carry out a first-level cesarean section, fully improved the preoperative preparations, established a "green channel" for maternal rescue, and sent the pregnant woman directly from the emergency to the operating room.
At 11:30, an emergency cesarean section was officially launched. Two minutes later, a healthy baby boy was born. The loud cry resounded in the operating room, the baby was safe, and the mother's hanging heart on the operating table was much more settled.
Critical! At the moment of life and death, quickly stop the bleeding and then "snatch" back a life
However, the real challenges of this surgery have only just begun.
In the process of stripping the placenta, Li Liping found that the placenta on the posterior wall of the uterus of the mother covered the inner cervical opening in a bowl-shaped shape and extended to the lower part of the anterior wall of the uterus. Based on the large amount of vaginal bleeding in a short period of time before childbirth, the difficulty of placental detachment during surgery, and the continuous outpouring of blood from the uterine cavity, Li Liping concluded that this was not a simple central placenta previa, but placenta implantation that was widely implanted in the myometrium.
The situation is critical, and it is urgent to stop the bleeding!
The team immediately performed lower uterine binding, local compression suturing of the lower uterine segment, and ligation of the ascending branch of the uterine artery with a tourniquet. As soon as this move came out, the bleeding was reduced compared with before, but there was still blood coming out, it turned out that the placenta implantation site was very low, and the contraction of the lower uterine segment was very poor, and the general local suturing could not achieve a satisfactory hemostatic effect. Li Liping decisively opened the peritoneal fold of the bladder, pushed down the bladder, and quickly carried out continuous narrowing and suturing of the lower uterine segment and cervix, reaching the external cervical opening. This series of skillful surgical operations quickly and effectively controlled the bleeding, and finally the Bakri balloon was placed in the uterine cavity, and the operation ended successfully at 12:50.
Peaceful! Multidisciplinary and efficient collaboration wins the battle to protect lives
The tense and orderly rescue came to an end, but the maternal intraoperative bleeding reached 1600 ml, which brought a lot of challenges to her postoperative recovery.
The medical team implemented personalized perioperative management for the newly escaped mother, including strengthening the monitoring of vital signs, uterine contractions and vaginal bleeding, blood transfusion and coagulation factor supplementation, active infection control, thrombosis prevention, gastrointestinal function restoration as soon as possible through gastrointestinal decompression, and psychological counseling. The mother recovered quickly after surgery and was discharged from the hospital soon after.
This rescue not only reflects the professional level of a woman and baby in the treatment of critically ill pregnant women, but also demonstrates the spirit of multidisciplinary teamwork. The efficient cooperation of obstetrics, surgical anesthesiology, neonatology and laboratory finally won the battle against time.
Written by: Huang Jiayue, Mao Xiaoyuan, Obstetrics Department, Eastern Hospital
Review: Li Liping, Chief Physician
Safety tips during pregnancy
1. High-risk factors for placenta accreta: history of cesarean section and placenta previa are the most important high-risk factors for placenta implantation, and other factors include previous uterine surgery history (such as myomectomy, abortion, curettage, manual placenta retrieval), postpartum endometritis, hysteroscopic surgery, endometrial ablation and uterine artery embolization, etc.; Uterine lesions or structural malformations, such as intrauterine adhesions, bicornuate uterus, endometriosis, etc.; as well as in vitro fertilization-embryo transfer, advanced age pregnancy, etc. 2. Diagnostic method of placenta accreta: ultrasound is the first choice, but there is no abnormal finding on ultrasound, and placenta accreta cannot be completely ruled out, and pelvic magnetic resonance imaging (MRI) is an important method to judge placenta implantation, which can be used as a means of further evaluation. Even if imaging studies do not reveal significant placenta accreta, patients with placenta previa should be alert if they have early vaginal bleeding or a large amount of vaginal bleeding. 3. Precautions for placenta implantation: reduce activities, avoid actions that increase abdominal pressure, prohibit sexual life, keep stool smooth, supplement fiber and iron-containing foods with a reasonable diet, and count fetal movements; If you have vaginal bleeding, go to the hospital immediately. Please pay attention to:
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