[There are some not-so-good descriptions at the end of this chapter, so those who are not mentally tolerant can skip them]
If he encountered placenta previa and dystocia in the emergency department in the past, without the conditions for surgery, Kawei would choose to use the method taught to him by the obstetrics director at the time. He would first open a window for the placenta, and then use scalp forceps to clamp the fetal scalp [1 】, do the fixation.
After fixation, pulleys and weights are hung at the far end to simulate increased pressure on the placenta, accelerate delivery, and allow the child to leave the uterine cavity step by step. 【2】
Because the front end of the scalp forceps is slender, it can enter the slender cervix to traction the fetus. But this is a specialized tool used in obstetrics with placenta previa and difficult delivery. There is no roller weight now and it is impossible to find it.
What's more, the mother's condition is not good. Although her vital signs are good, there are still no strong uterine contractions after the rupture of membranes. The cervical opening is limited, and the traction of heavy objects alone may not be enough to pull out the baby.
Kawei glanced at the instruments at hand, and the only ones that could be used were forceps. In order for the forceps to be effective, the cervix, which was only about 4cm long, had to be dilated to 8cm.
It takes time to dilate the cervix. If the cervix is not dilated, the expansion of the yd will be very limited. If the hand is inserted for a long time, it will put pressure on the soft birth canal and cause tears. Kawei said that "the operation will be more brutal", but after actually doing it, he still hoped to be gentler: "Go to Guyon and ask him to bring the balloon used in urology."
"Okay." An assistant wrote down the name of the thing and ran out of the room quickly.
"Gauze pliers."
"Give."
"The gauze is too thick and cannot fit in at this width."
"Okay." Berget understood what he meant, untied the five layers of gauze and removed two layers, "Here."
The placenta is now in good condition and no bleeding is visible, but Kawei is still worried. Hemostatic forceps with gauze wrapped at the front can enter the birth canal and remove the remaining clots inside, so that the true amount of bleeding can be determined.
"One piece... it's about 50ml, two pieces... it's about 70ml, three pieces... roughly, let's count it to 40."
"Heart rate 88, blood pressure 124/76."
"It's okay, it's still stable." Kawei found no more clots, "Check the fetal heart rate again."
After saying that, Kallen brought Hujir a stethoscope, and Kawei looked at the mother. Her intention was very clear, she wanted to confirm whether there was any fetal movement. The mother also knew what he meant and shook her head helplessly: "No."
Soon, Hujir, who had explored the entire belly with an auscultation probe, began to shake his head, and the fetal heart rate and fetal movement continued to be double negative.
In modern times, when judging the life and death of an intrauterine fetus, B-ultrasound is used to see whether the fetal heart is beating. If there is no B-ultrasound, the only option is to rely on auscultation and maternal feeling. Hujir had been an obstetrician for so many years, so it was impossible for him to mishear the fetal heartbeat. Kawei was still worried, and he also took out insurance.
"It's been such a long time, so it's almost certain."
Kawei was helpless. The baby's back was leaning on the mother's belly and could be easily touched from the outside. In this case, the fetal heartbeat and movement were not heard, so no more miracles would happen: "Well , unfortunately, it is definitely stillborn.”
Confirmation and suspicion are two completely different states. Even though she has been mentally prepared, the mother still can't help but cry out in pain.
How she hoped the doctor would misdiagnose her.
After two more blood clots were cleared and the amount of bleeding increased by nearly 300ml, Kawei finally received the balloon Mosier said at the time. From the appearance, it is not much different from a modern urinary catheter, but because it is used to dilate the urethra, he still needs to determine the size of the balloon.
"Cheer up and show me where its limits are."
I have to say that the rubber chosen by Mosier has good expandability and can be expanded to about 10cm after inflating, which is a good help in dilating the cervix.
Quickly insert the catheter, use a syringe to pressurize the balloon, and then use a hemostat to clamp the mouth of the catheter to prevent spillage. However, perhaps due to the strength of the balloon itself, the expansion effect was not obvious. After half an hour, the cervical opening was still maintained at about 6-7cm.
It doesn't matter if you just dilate the cervix, it just takes a little more time.
But now the mother is still bleeding slowly. After clamping the blood clot twice just now, 400+ml of blood has come out one after another, and the blood loss has exceeded 700ml again. Simple transfusion could not satisfy the blood loss, so Kawei had to invite a second reporter to help with blood transfusion.
"Everyone is almost here, right?" Kawei asked, looking at the wall clock which was already close to 12 o'clock.
"They're all here."
"It seems that the blood is enough for the time being."
Although he said this, Kawei's face still looked ugly, because the cause of the bleeding could not be solved, and the mother's placenta was just a big sieve leaking blood.
If you want to get rid of the placenta, you must first release the baby, so as to stimulate stronger uterine contractions. In order to release this full-term fetus, it is necessary to ensure that the birth canal is sufficiently open, especially the cervix and the internal placental window.
"In the final analysis, the child is still too big, and the biparietal diameter is more than 9cm." Kawei said, "This kind of cervix cannot pass."
"Otherwise, let's do a cesarean section." Hugier suggested.
"I can still hold on, really!" The mother's physical strength is rapidly losing, and she is still thinking about the next child. "Please, please don't do surgery!"
! "
Kavi touched her belly again. Under the influence of oxytocin, the contractions were still weak.
The reasons have been analyzed so far. Placenta previa weakens the contractility of the myometrium; the uterine cavity is too large, and the placenta blocks the front. The child cannot stick to the uterus, and the pressure on the cervix is not enough, resulting in weak contraction; plus This is her third pregnancy, and multiparous women often have problems with uterine contractions.
Only one of them might be able to find a way to fight against it, but now it is very likely that all three will appear at the same time. This superimposed weakness of contractions makes Kawei feel very powerless.
"The reason is that the fetal head is too big and the cervical dilation is not obvious." Kawei once again clarified the position of the fetal back and confirmed that the fetal heart rate and fetal movements had completely disappeared. "The placenta is stuck there again and cannot be peeled off in advance. Once it is peeled off, it will be very difficult." It may be that the uterine contraction is too weak, causing heavy bleeding.”
Hujir could clearly hear the change in Kawei's tone, which was a precursor to making a decision: "Tell me, what should we do next?"
Kawei glanced at the mother, then at the crucified Jesus and the cross hanging on the wall, and said a solution that no one had thought about or dared to think about: "Since the diameter of the fetal head is the root of all problems, then reduce it. it."
"It makes sense, how to do it?"
Maybe it was because cesarean section was too science fiction, or maybe Kawei was at an age when he shouldn’t have mastered surgical skills. In short, Hujir didn’t understand the meaning and thought Kawei had some magical way to do it.
But Kawei knew from his reaction that he didn't understand, including everyone else who couldn't react because of the agreed-upon dogma. On the contrary, Shanwang, who had no experience in obstetrics, understood what Kawei meant and said it without hesitation:
"Doctor Kawei wants to destroy the fetuses. They are already dead anyway. It will consume the mother's physical strength and increase the risk. It is better to give birth to the babies in batches..."
What he said was the truth, but it was not the truth to be faced here. When the doctors in charge are more rigorous and have more faith, they will be less able to easily cross this hurdle: "What nonsense are you talking about? Destroying the fetus? Isn't this abortion? God will not tolerate us doing this!"
Shanwang couldn't be bothered by them: "But the child is already dead."
"No, we can't really tell whether the child is really dead. We can't do it casually. This is against the doctrine!"
"Didn't the professor agree with the diagnosis of stillbirth just now?"
"Maybe the fetal heartbeat was not obvious enough and we didn't hear it."
Hujir's resistance also inspired resistance from others: "There is no clear evidence that the child is dead. Directly destroying the fetus is tantamount to murder!"
Kawei put down the hemostat in his hand, sat on the steps aside, and looked at them tiredly: "How can we prove it?"
"After the child comes out, he can..."
"How to get out?"
"At once......"
As long as the doors and windows are blocked, the simplest problem can make people suffocate to death. Obstetrics without mature cesarean section is such a discipline that people love and hate. This is why Edward must bring Carvey to Paris. .
"The problem now is obvious. A multiparous woman has been in labor for nearly three hours. With the help of various assistance, the cervix is stuck at 7cm and is still. The placenta is fully covered and bleeding continues. The birth canal is not significantly expanded. The child's head is larger than This is a full two times bigger. How can we get the child out of this situation?"
Kawei once again reiterated the dilemma he encountered: "Surgeries are not allowed, stillbirths are not allowed to be touched, and the birth canal is torn by force, and it is not an ordinary tear. The cervix covered by the placenta is covered with blood vessels, and violence will definitely cause it. Causes massive bleeding. What do you want me to do? I'm not a magician!"
This was the first time that he got angry like this, and he was indeed annoyed by the strange Catholic regulations: "There are only three ways before you now, one is cesarean section, one is fetal destruction, and the other is waiting to die."
】
This is not only the dilemma Carvey faces now, but also the dilemma these obstetricians have always faced. The reasons may be different, but the results are the same. Without surgery or fetal destruction, the only option is the third dead end.
Seeing that everyone was silent, Kawei continued: "I don't have time to waste time. I need to do the first two, but not the last one. If I am sure to take the last way, I will go first."
"It's up to you......"
Hujier neither agreed nor refused, but chose to escape and became a hands-off shopkeeper.
Perhaps most people would do this when faced with this kind of choice, and there is nothing wrong with doing so, but the director of the first department who is responsible for all medical care and patients cannot.
"I'm not a doctor at the Main Palace Hospital. Does this mean that if something goes wrong, I will be responsible for it alone?" Kawei would not do this. He knew that a doctor was only a doctor after all, and no matter how tough he was, he could not resist the regulations of the upper level. "Since In this case, just wait until she is willing to have surgery and then call me."
After that, he took off his gloves and waited for the outcome of their final discussion.
Kawei is a doctor who performs surgeries at best, and Hugier has the final say in the maternity ward. In special circumstances, Kawei really cannot bear the responsibility alone, and there is no need for one person to bear the responsibility. Hujir must make a decision.
The conflict was kicked to Hugill like a ball.
Hujir was also very conflicted and could not bear the responsibility alone, so he could only choose to break the ball: "You should all know that under the premise that cesarean section is not possible, the method suggested by Dr. Kawei is much safer and more reliable. It was before We can’t do anything to live fetuses that are not full-term, but now the fetus is dead..."
A doctor next to him seemed to have seen through the outcome and quickly stopped him: "But..."
"Stop it!" Hujier raised his voice, "If you have the ability, persuade her to undergo surgery. This is not the first time you have seen such a pregnant woman. Is there a good ending? Almost not!"
"So hurry up and do the surgery!"
"Yes, with a saint like Dr. Kawei present, if we don't perform surgery now, how long will it take?"
After being busy for half a morning, the operation time is coming soon anyway. If the final outcome is still surgery, although the risk has increased a lot, Kawei is relaxed: "As I said, the operation must be fast. With the current uterine contraction, ability, it’s hard for me to imagine whether the already weak uterus can shrink back after surgical incision.”
The implication is that if you come to power now, you will most likely have to have your uterus removed.
On one side were his subordinates who were unable to judge the situation, on one side was the patient who refused to undergo surgery, and on the other side was Kavi who was unable to take responsibility. For the first time, Hujir faced such great pressure: "I have decided to destroy the fetus!"
"Director, think twice!"
"Professor, you can't do this. If the child is still alive, you will be punished by God!"
Hujier didn't waste any time and got to the point directly: "The two assistants went out to receive the audience. The remaining three and the nurse are all Dr. Kawei's people, so they are naturally on his side. I will definitely not say, Good Hope You won’t even say it, so as long as you two shut up, no one will know.”
After hearing this, the two of them were still muttering about doctrines and the like. Hujir was heartbroken: "One of you has raised three women outside, and the other has a debt of 20,000 francs from gambling. Don't think I don't know."
"Director, you..."
"this......"
"We didn't hear anything."
Kawei covered his ears and looked at his three assistants and Karen. Like their chief surgeon, they also covered their ears and shook their heads at the sight of the two men.
...
After struggling with many parties and clarifying the interests, Kawei was still in charge of the fetal destruction surgery: "I'm going to say something ugly beforehand, if the uterus still cannot contract after the baby comes out, I will definitely send you to the operating table."
"I see."
"No, you don't understand." Kawei took the oval forceps from Herman and explained, "As long as you go on the operating table, it's basically the rhythm of cutting out the uterus. You have no choice. Even before anesthesia, I I won’t say hello to you.”
"......I know."
"Okay." Kawei sat between her legs and inserted the oval forceps in his hand. "In view of the possible scenes that may appear later, I'd better explain."
Everyone:? ? ?
"I need to change the angle of the long diameter of the fetus so that it is parallel to the long diameter of the cervix, and then it can be pulled outward." Kawei touched his belly with one hand and changed the direction of the oval forceps with the other hand. "Fortunately, it is the head position. Let's deal with it. It’s much simpler. Let’s find the foramen magnum first. Do you know about the foramen magnum?”
Everyone nodded.
"Put the forceps through the fontanel, break up the brain tissue, and then pull it all out to reduce the size of the fetal head."
