Ms. Wu, who was pregnant for 28 weeks, suddenly suffered a type A aortic dissection tear, and his life was hanging on the line. A multi-disciplinary expert team of obstetrics and gynecology, cardiothoracic surgery, anesthesia and , intensive care medicine, , neonatal, and other major disciplines, and completed cesarean section and aortic arch replacement within 12 hours. Not only did Ms. Wu save her, she also gave her a cute baby.
The sudden acute aortic dissection tear of pregnant women is in danger
On September 27, the obstetrics and gynecology department and emergency department of Xinhua Hospital received an emergency referral request from the other hospital. A pregnant woman with sudden severe abdominal pain and fainting will be transferred through the green channel for consultation and rescue of critically ill pregnant women in Shanghai. The emergency department and obstetrician immediately arranged CT angiography and ultrasound examination. The results showed that the patient at 28 weeks of pregnancy had an acute A aortic dissection, which was severe, and tears occurred from the root of the aorta to the abdominal aorta.
The aortic wall is divided into three layers: the inner membrane, the middle layer and the outer membrane. aortic dissection is the endometrial rupture of the aortic artery, and a tear parallel to the aortic wall occurs, which makes only a thin outer membrane remaining in the aortic wall, prone to rupture and rapid large-scale blood loss and death. Mei Ju, director of the Department of Cardiac Thoracic Surgery, introduced that the incidence rate of pregnancy combined with aortic dissection is 0.4 to 100,000 yuan, and the mortality rate of mother and child is extremely high.
"This is a catastrophic disease, and the increase in mortality rate is calculated by hour." said Ding Fangbao, chief physician of cardiothoracic surgery, , "In the 48 hours before the onset, every hour after the mortality rate will increase by 1%, which means that if it is not properly disposed of within 48 hours, half of such patients will die."
Maintain large and small? Can you save them all?
"It's so dangerous!" When experts from various disciplines were urgently called by the Medical Department of Xinhua Hospital/Professional Safety Office, everyone's first reaction was like this. "There is a fetus in the abdomen, and the mother and fetus are in danger of life at any time!"
At 4 pm, Ms. Wu was quickly transferred to the intensive care unit of cardiothoracic surgery, and the experts quickly conducted consultations and discussions and plan formulation. "The most important question is whether to terminate the pregnancy first or do cardiothoracic surgery first?" said Wang Xipeng, director of obstetrics and gynecology.
In layman's terms, this is a medical choice and effort that can protect the big and the small, or can be saved together.
If the aortic surgery is performed first, extracorporeal circulation is required, and the patient's body temperature will drop significantly, which may endanger the fetus; if the fetus undergoes cesarean section first, the fetus cannot use oxytocin normally after delivery, which will lead to poor uterine contraction, etc., and may cause severe postpartum bleeding of . In domestic medical discussions, 28 weeks of pregnancy is a key choice for pregnancy and aortic dissection: 28 weeks ago, if the patient strongly requests, aortic surgery to retain pregnancy can be performed; if the patient has a strong request, he/she can undergo cesarean section and cardiothoracic surgery at the same time. Ms. Wu has just entered 28 weeks of pregnancy.
"Considering that Xinhua Hospital is not only a critically ill-affected maternal rescue center, but also a dangerous newborn rescue center, we still decide to have both small and small insurance, and have a cesarean section first and aortic replacement at the same time." Wang Xipeng and Mei Ju repeatedly discussed and reached an agreement: "We hope to complete two treatment surgeries under an anesthesia and a large incision to give the child and mother a chance to have a child."
surgery was orderly, and the mother and son were successfully recovered
0 After the surgical plan was determined, Sheng Xujun, director of the medical department, coordinated and confirmed various details again, including surgery and blood preparation, and a relay race began. At around 6 pm, Du Jianer, deputy director of the Department of Anesthesia and Critical Care Medicine, Shen Sae, chief physician of anesthesia, and Xu Yanyifang were responsible for anesthesia. Under their escort, Jin Minfei, deputy director of the Department of Obstetrics and Gynecology, took the stage to start a cesarean section.
"The key point of our operation is to control bleeding. The smaller the wound, the better." At less than 7 o'clock, a baby boy came to the human world from his mother's abdomen. Then, Jin Minfei performed a series of hemostasis operations such as placenta stripping surface and uterine incision, as well as a series of hemostasis operations such as filling the water capsule in the uterine cavity. After observation, Ms. Wu's uterus contracted well after giving birth, and Mei Ju's team took over the baton from the operating table.
With the support of life in vitro circulation, Mei Ju team began to carefully replace and suture. Ms. Wu’s aortic dissection is very serious, and the range of aortic arch replacement is large, and at least more than 100 needles must be sutured. This requires the cardiothoracic surgery team to have superb and solid surgical capabilities in order to control time and ensure the safety of the surgery. At 2 a.m. on September 28, the relay operation was successfully completed, and it was 12 hours since I received the news of the dangerous situation. From preparation, discussion, to treatment, Xinhua Hospital has helped the mother and son win hope of life with its strong comprehensive strength.
On the morning of September 29, Ms. Wu woke up. Although some assisted breathing training is still needed, she can write; on October 19, Ms. Wu was able to recover on foot in the cardiothoracic surgery ward; on October 22, Xia Hongping, deputy director of the neonatal department, said that the weight of a boy who was born only 1.2 kilograms has increased to 1.7 kilograms, and his vital signs are basically stable. Ding Fangbao introduced that Ms. Wu's condition is now stable and further treatment may be needed in the future.
"Although the incidence of aortic dissection in pregnancy is not high, if pregnant women have a family history of disease, such as Marfan syndrome, or if there has been sudden death among their families, they should strengthen examinations during pregnancy." Wang Xipeng reminds, "If pregnant women have hypertension , dizziness, palpitations during pregnancy, examinations of cardiopulmonary function and large blood vessels should be strengthened. If there is a crisis, try to wait for delivery in critically ill pregnant women rescue centers." Editor-in-chief of
column: Gu Yong
Source: Author: Huang Yangzi Shi Jiaqi
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