Imperial Women's and Children's Hospital is one of the few gynecological and pediatric hospitals in Imperial City and even in the country.
About 35,000 newborns are delivered every year.
This place is bustling with people all year round. Even during the Chinese New Year, when other large tertiary-A hospitals are deserted, this place is still lively.
Unlike other large comprehensive tertiary-A hospitals, most people here are happy instead of downcast.
After all, adding more imports is a good thing, a great thing.
There are more than a dozen obstetric wards in the Women's and Children's Hospital. The doctors' offices in each ward are so full of banners that they can't even hang them anymore.
People feel refreshed when happy events occur, and mother and child are safe, so it is natural to send wedding money and banners.
It's just that there's something wrong with the atmosphere in the first obstetrics ward today.
The door of the doctor's office was closed tightly. People who were not undergoing surgery were sitting in the office. Experts and professors from other hospitals and leaders of this hospital were sitting in the office.
The air was stagnant, as if a major medical accident had occurred, and no one spoke.
It happened more than two months ago.
A 39-year-old maternal woman found that her child in her abdomen was suspected of having congenital aortic stenosis during an examination.
At that time, the fetus was only 24 weeks old, and congenital aortic stenosis could be seen. It can be said that the level of the Women's and Children's Hospital was quite high.
After seeing the examination results, the doctor explained the condition clearly to the patient and his family.
Left ventricular outflow tract obstructive heart disease due to congenital abnormal development of the aortic valve accounts for approximately 3% to 6% of congenital heart disease.
If the fetus develops aortic stenosis in the first or second trimester of pregnancy, the filling blood volume of the left ventricle will be affected and continue to decrease as the pregnancy prolongs.
Eventually, progressive dysplasia 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 can lead to death.
The possibility of stillbirth is very high, and even if it is born alive, it will face countless troubles.
The doctor recommended induction of labor, which was the best option for the current situation.
But the pregnant woman herself is almost forty. In order to give birth to a child and fulfill her dream of becoming a mother, she has sacrificed a lot. Even though I already had pregnancy-induced hypertension, I continued to persevere.
For her, giving up was not an option.
After listening to the doctor's tactful story, the pregnant woman resolutely refused to induce labor and cried bitterly while looking forward to a miracle.
Perhaps as the pregnancy progresses, the child's condition will not worsen but will be 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 abortion, pregnant women traveled all over the imperial capital, and as long as the hospitals were of high quality, the final conclusions they gave were the same.
This time, it was because yesterday’s prenatal check-up revealed that the fetus’s condition was deteriorating.
The aortic valve pressure gradient gradually increased from 22mmHg to 85mmHg. The ratio of the left and right ventricles gradually became imbalanced. During the observation process, fetal pericardial effusion, mitral regurgitation and other conditions appeared one after another.
All signs indicate that the child's congenital aortic stenosis is developing to a very severe degree and will develop symptoms such as heart failure.
Just 32 weeks pregnant...
The pregnant woman still did not agree to induction of labor, not at 24 weeks. After 8 weeks, her attitude became more firm.
Although she knows that after a caesarean section, the child may have to undergo constant major surgeries or even die, she still does not give up.
After discussions between in-hospital and out-hospital expert groups, three treatment methods were summarized.
First, close observation and conservative treatment.
In fact, there is no other way. The child's current condition cannot survive natural delivery at 38-40 weeks.
Second, prepare for a caesarean section. After the child is delivered, he will go directly to another operating table for thoracotomy and surgical treatment of his congenital aortic stenosis.
This treatment method carries huge risks.
The child itself did not grow very well in the pregnant woman's body. At just 32 weeks old, the child already had symptoms of pericardial effusion and heart failure.
The surgery was easy to do...it was extremely difficult, but compared with the patient's postoperative recovery, it became a very simple and easy surgery.
This step is also voted for by almost all doctors.
The hospital also invited the nationally renowned Dr. Liu Cixi to perform the surgery.
Dr. Liu Cixi has performed the most surgeries of this type in China and has the highest number of successful cases. But even so, the success rate of surgery is less than 30%.
To be honest, if you choose to keep the sick child, your family will most likely face the end of losing both human and financial resources.
Ultra-difficult surgeries, ultra-low success rates, and huge daily expenses are all problems.
In addition, there is a third surgical method - neonatal cardiac surgery and the development of catheter interventional technology, which can perform intrauterine interventional treatment.
This sounds like an impossible treatment.
The principle is simple, interventional surgery is used to treat congenital aortic stenosis. Open up the stenotic area as soon as possible and improve the aortic blood flow as soon as possible.
The benefits are huge, as it can promote fetal left ventricular development 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 natural delivery at 38-40 weeks.
The next one and a half to two months are crucial 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 document was published in a case report in the magazine "New England" and attracted the attention of many interventionalists at the time.
To date, more than 200 clinical cases have been reported internationally, mostly in Western countries. Aortic valve balloon dilatation accounts for the majority, with a technical success rate of over 50%.
Well, over 50%, in other words, the mortality rate is over 40%, almost 50%.
Compared with cardiothoracic surgery after laparotomy, this mortality rate is barely acceptable.
but!
Intrauterine interventional surgery is extremely risky.
In addition to the fetus, there are risks to pregnant women.
The second option is definitely fine for pregnant women. However, if you choose intrauterine interventional surgery, pregnant women share half of the fetal life risk.
At this time, differences arose between the patient and his family.
The pregnant woman herself insisted on the third type of intrauterine interventional treatment, while her family members requested the second type of surgery.
To protect adults or children, this is an ancient proposition.
When the medical level was underdeveloped, dystocia was fatal. There were no caesarean sections at that time, so there was such a proposition.
However, with the current rapid advancement of medical technology, whether to protect adults or children has become a false proposition.
But when this ancient choice was put on the table, all the doctors were helpless to find that it actually existed.