[Many descriptions in this chapter may cause discomfort, so read with caution]
Since the birth of safe cesarean section, it has become the fundamental measure to terminate pregnancy with placenta previa, especially central placenta previa, and to rescue massive bleeding from placenta previa.
If you have a complete plan in advance, choose vaginal delivery in a prepared manner, and have fetal traction or fetal destruction to avoid continued heavy bleeding, this is undoubtedly a safety measure that can effectively reduce maternal tissue damage.
After all, cesarean section means physical damage, and central placenta previa often requires a fundal incision, which reduces the strength of uterine contraction and is not good for subsequent pregnancies.
Kawei has tried both options and knows that each has its own pros and cons. Cesarean section is about convenience in visual field and hemostasis, while yd delivery is about less damage and faster recovery. But if you are not fully prepared, there are considerable risks in both. What's more
Now that he has chosen to destroy the fetus, Kawei no longer has any worries.
As soon as the words came out, before these people could react, he replaced the obstetrician responsible for helping deliver the baby at the nearby Main Palace Hospital with one of his own: "Damirgang, press the fetal head... right here. , press down with the heel of your palm, and fix your head at the entrance of your pelvis."
Damirgaon had no worries about the two French doctors. He believed that if he wanted to learn skills, he would have to risk everything. He could do anything: "Is this enough?"
"Push harder."
"Try harder..."
"It's almost done." Kawei lay on his stomach and glanced at the fetal head that was forcibly squeezed downwards, then pulled Beget over, grabbed two broad-leaf hooks and stuffed them into his hands, "Separate the two sides, pull good."
"good."
"Herman..."
"Here we go, the hemostatic forceps." Herman found the most suitable instrument at hand just as Kawei finished talking about how to cut the skull. "Use these forceps to clamp the scalp to fix it."
"kindness."
Two hemostatic forceps clamped the child's scalp up and down, and the exposed middle fontanel was cut 2-3cm with the scalpel in Kawei's hand: "If you can't find the big and small fontanels or the child's head is not in a good position, you can choose cranial suturing. Straight through."
Because there was no cranial piercing device, Kawei could only use oval forceps instead. He used his palms to press the shaft lock between the central handles of the forceps, followed the incision that had been made, and closed it to enter.
There is no skull under the fontanel, and with just a little force, it is easy to penetrate the subcutaneous suture membrane and meninges: "The next step is simple. While fixing the fetal head, we open the forceps, then rotate left and right, stir Break the child's brain..."【1】
Kawei's emotionless commentary made everyone tremble. The two obstetricians from the Palace Hospital frantically crossed themselves on their chests and muttered words without daring to look directly.
"I repeat, this is a stillbirth. Haven't you ever seen a stillbirth?" Kawei showed no mercy, and the brain tissue flowed out after a while, or it could be said that it was forcibly taken out with the brute force of oval forceps. " What’s more, this result was a decision made by Professor Hugill after everyone discussed and agreed.”
"You don't have to bear the pressure, as long as you don't say anything out loud." Hujir knew that he had gone too far, "I just hope that tomorrow's major newspapers will praise this unexpected birth before the operation, instead of being the same weird and negative thing as before. "
Their eyes were still full of disgust and fear of abortion, but they had to agree under Hujier's intimidation.
In sharp contrast to them is good hope.
Without the shackles of religion, he could easily understand the reasons for destroying the fetus. In fact, there is no need to understand that abortion has been around for a long time.
What Shanwang really cares about is the abortion process, because compared to the complicated and high-end cesarean section, the fetal destruction technique requires much less learning. For them, it is not easy to come to Paris even once. If they don’t learn how to get something back, how can they see their ancestors?
"What if the fetal head position is not good and the fontanel cannot be found?"
"You can look for bone seams." Kawei always spared no effort in answering his questions. "The skull of the fetus has not yet closed, and the texture is soft, so it is easy to find."
Shanwang nodded, understanding what he meant, but immediately had a new question: "What if the child's head is like this..."
He made a strange posture, raised his head suddenly, and moved his chin forward: "What if the face is too low? There should be no bone seams here."
"That's easier." Kawei explained, "The face is all soft, and you don't even need a scalpel to make incisions."
Shanwang had no experience in surgery, but he had learned anatomy well from Huang Kuan, and he immediately understood what he meant: "Oh, it turns out it's the eyes and mouth. There are indeed many options to choose from after it is clear that the baby is stillborn." [2]
The two people spoke in English, and the content was somewhat shocking, but no one could understand it, so the scene seemed very calm.
Shanwang's writing never stopped, and the questions immediately extended from the head position: "It's not difficult to deal with the fetus with the head down, but what if it's breech? How to deal with the head with the butt down?"
"Break the legs first, and then they can come out in batches."
"So this is the idea..." Shanwang's eyes lit up, and he seemed to understand the central idea: "If it's horizontal, does it mean intercepting in the middle?"
"Indeed, if possible, use your hands to introduce a wire saw, which is an instrument used for craniotomy, and then perform transverse truncation." Kawei sighed, "The object can be the body, the neck, or other places, It depends on the handling habits and specific location.”
"understood."
It always sounds very weird for a Chinese-speaking Chinese and a German-speaking Austrian to discuss in English something forbidden by Catholicism in a French operating theater.
Kawei's miscarriage is still going on, and what she is encountering now is just a disagreement in ideas. The real trouble is actually the possible weakness of uterine contraction that will occur later.
As time passed by, some doctors began to gather at the entrance of the surgical theater.
They all came to appreciate the rare cesarean section, especially placenta previa, which may cause violent bleeding today. Everyone wanted to see how Kawei handled it. There is still nearly an hour before the operation. Such enthusiasm is enough to show the respect for Kawei.
But when they identified themselves with badges given by their medical association, they were told they could not enter.
"What does this mean? We agreed to enter the venue, why did we suddenly change our minds?"
"I don't know. I'm just a guard at the gate. I just received the order." Although there are gatekeepers here, they are not as overbearing as the surgical theater in Vienna. They are very casual. "Ask the obstetricians for the specific situation. .”
The two original surgical assistants now appeared at the entrance of the theater, serving as explanations: "The operation may be cancelled."
"Cancelled? How could it be canceled?"
"Did something happen to Dr. Kawei?"
"Don't be ridiculous. Paris is so safe. How can something go wrong?"
"I mean other situations, such as being unable to get away for a while, or other reasons..."
Their initial reaction was like that of ordinary people. It was the kind of expectation that had been built up for most of half a year, but finally collapsed in an instant. But when their medical brains began to work crazily, someone noticed another possibility: "Is there something wrong with the mother?"
"Placenta previa, 37 weeks belly again..."
"Isn't it a sudden labor?"
"It's possible, but that would be troublesome."
The two assistants had no idea what was being done in the preparation room, and they were not around when the decision to destroy the tire was made.
And the so-called telling the truth is the same as what they said, telling the whole process of the mother from labor hemorrhage to before. The bleeding may not seem serious, but only obstetricians who have been exposed to placenta previa know how dangerous it is if the cervix does not open, the placenta does not descend, and the child gets stuck in the uterine cavity.
"Doesn't Dr. Kawei have medicine? Isn't it okay to use medicine?"
"I tried it but it didn't work. The bleeding has been more than 700 ml so far. It took a blood transfusion to barely maintain the normal level!"
"Placenta previa, the month is enough, and there is still bleeding, so what are you waiting for? This should be the perfect opportunity for surgery. Just cut open the uterus and take out the baby!"
"Yeah, if you can't go down there, then you can go down the belly. Isn't it just a coincidence?"
Most of the people who came were experienced surgeons, and even obstetricians from many other hospitals. The more they heard about it, the more they felt that there was something fishy about this matter. The assistant didn't think too much, and explained the situation of the mother who didn't want surgery and just wanted to give birth.
"So the time of the operation cannot be determined, and the final decision of whether to operate or not is entirely up to Dr. Kawei himself."
"This is so messy. Delivering placenta previa depends entirely on luck. If you are not careful, the mother's life will be lost."
"More than that... I saw the operation two days ago. Dr. Kawei's cesarean section was as clean as picking up an oyster. It is definitely an advantage over the slow yd delivery! It is an absolute advantage. !
! "
The louder the praise, the more excited those who want to see the operation become, and the more they question the decision not to have surgery temporarily: "Since it is the doctor who has the final say when it comes to treatment, why should we listen to the mother? If it is the mother who makes the decision from the beginning. , then what else do you need a doctor for?”
As soon as these words came out, comments abounded. Apparently, they had met some patients who thought they knew a lot: "Only doctors who have gone through rigorous training know how to judge the condition. What do patients know?"
"Even if someone is really fooled, it's just a coincidence. Can you fool one person, but can you fool a hundred or a thousand?"
"Some doctors are indeed so benevolent that they ignore the objective realities of medicine."
"I don't think Dr. Carvey would have made this misjudgment."
"But he is too young after all, and it is normal for him to be inexperienced. Coupled with his temper and personality problems, he is likely to be led by some patients."
"Don't forget, Professor Hugill is also inside. That stubborn old man must be self-centered and would not agree to such a random treatment plan."
Such a makeshift discussion was launched based on a piece of incomplete information.
As more and more people gathered outside the operating theater, the information discussed spread wider and wider, enough to be dispersed into small groups. The content became more and more outrageous. From choosing yd delivery, several development routes gradually emerged.
Some said they were unwilling to undergo surgery for the time being, some said they were deliberately putting on a show to increase their net worth, some said Edward had not given enough money and were considering whether to increase the money, and some said Kawei had lost interest in cesarean section... .There are all kinds of things.
Kavi did not know this, and the two assistants did not go back to inform them in order to maintain order at the theater entrance.
"The brain tissue is almost out..." Kawei did not remove the oval forceps, but flushed the yd with physiological saline to remove the tissue adhering to the wall. "After the cranium is penetrated, the skull will be crushed."
Just like Kawei said before, skull crushing is not really cutting into pieces, but squeezing the skull hard to reduce the size of the fetal head. Only in this way can the biparietal diameter be reduced and the head should match the cervix that has stopped expanding.
Skull crushing requires more brutal skull crushing forceps [3], which have a large contact area and strong force, and can end the process in a short time.
】
But now Kawei only has oval forceps, which are incomparable in power and very awkward to operate: "I now insert one blade of the forceps into the fetal head, and the other blade between the outer fetal head and the uterine wall, and slowly lock it. Then try to see if it can be pulled out." [4]
It is not difficult to destroy the fetus. The only thing that needs to be paid attention to is whether the mother's own birth canal is damaged, including instrument damage and puncture wounds caused by broken bones.
For Kawei, these are all avoidable, especially the former. Almost every operation into the uterine cavity is guided by fingers. Avoiding the latter requires some luck, and there are some requirements for skull crushing or other tire-destroying operations.
"Fortunately, it is in the head position, so there is no need to cut off the limbs or the body or the fetal head."
Kawei seems to have quite a lot of experience in abortion: "After the cranial fracture, we will directly perform traction, which will cause very little damage to the cervix. Next, we have to see whether the traction can really be as smooth as a normal delivery. If there is some difficulty in delivering the shoulder, ..."
As he was speaking, he began to exert outward force with his hands, successfully pulling the deflated fetal head out of the cervix and into the outer opening of the vagina.
I don’t know if everything went wrong today, or if God was angered by destroying the fetus, but after most of the fetal head was exposed, the dead baby got stuck there and could no longer be pulled out.
"It's not really a shoulder difficulty, it's really what you said..." Kawei reached into the vagina again, and after exploring around, he felt the position of the shoulder and clavicle, and he came to deal with it without hesitation. Tools, "Here, give me scissors, the sharpest ones."
