Chapter 326 322. Or maybe it’s the hand of Satan

Author: Hao Xifeng

Chapter 326 322. Or maybe it’s the hand of Satan

[There are some not-so-good descriptions at the end of this chapter, so those who don’t have enough psychological endurance can skip them]

If he encountered placenta previa and dystocia in the emergency department before, without the conditions for surgery, Kawei would choose to use the method taught to him by the obstetrics director at the time, which was to first open a window for the placenta, and then use scalp forceps to clamp the fetal scalp [1

】, do the fixing.

After fixation, hang pulleys and weights 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. However, this is a specialized tool used in obstetrics when placenta previa is difficult to deliver. 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 membranes rupture. The cervical opening is limited, and the traction force of heavy objects alone may not be enough to pull out the baby.

Kawei glanced at the instruments at hand. 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 vagina will be very limited. If the hand is inserted for a long time, it will put pressure on the soft birth canal and cause tearing. Kawei said that "the operation will be more barbaric," but in reality

After actually getting started, I still hope to be gentler: "Go to Juyong 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-layered gauze strip, removed two layers, "Here."

The placenta is now in good condition and no bleeding can be seen, 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. There are about 50ml, two pieces. This is about 70ml, three pieces. About, let's count it as 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 she shook her head helplessly: "No."

Soon, Hujier, 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 heartbeat is beating. If there is no B-ultrasound, the only way is to rely on auscultation and the maternal feeling. Hujier has been an obstetrician for so many years, so it is impossible to mishear the fetal heartbeat. Kawei still

Don’t worry, I’m also covered by 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 bleeding volume increased by nearly 300ml, Kawei finally received the balloon Mosier mentioned at the time. From the appearance, it is not much different from a modern urinary catheter, but because of the use of

For urethra dilation, 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 used by Mosier has good expansion properties and can be expanded to about 10cm after inflating, which is a good help in dilating the cervix.

Quickly put in the urinary catheter, use a syringe to pressurize the balloon, and then use a hemostatic forceps to clamp the mouth of the catheter to prevent overflow. But maybe it is a problem with the strength of the balloon itself, and the effect of expansion is not obvious, and it lasts for half an hour.

The cervical opening is 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. Since the blood clot was clamped twice, 400+ml of blood has been released one after another, and the blood loss has once again exceeded 700. Simple infusion cannot satisfy the blood loss, so Kawei had to call in a second person to help.

Blood transfusion reporter.

"Everyone has almost arrived, 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."

Even though he said this, Kawei 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. To release the full-term fetus, you must ensure that the birth canal is sufficiently open, especially the cervix and the internal placenta 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 be passed."

"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!!!"

Kawe touched her belly again. Under the influence of oxytocin, the contractions were still weak.

The causes 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 contractions; plus

This is her third pregnancy, and multiparous women often have problems with uterine contractions.

Only one of them may still 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 uterine contractions makes Kawei feel very powerless.

"The reason is that the fetal head is too big and the cervix is ​​not dilated significantly." Kawei once again clarified the position of the fetal back and confirmed that the fetal heartbeat and movement 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 something 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, what should we do?"

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 as soon as Kawei saw his reaction, he knew that he didn't understand. Others, including others, failed to react because of the conventional dogma. On the contrary, Shanwang, who had no obstetrical experience, understood what Kawei meant and had no scruples.

Say it out loud:

"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 is the truth, but it is not the reality we are facing here. The more rigorous and believing the doctor in charge is, the less easily he can cross this hurdle: "What nonsense are you talking about? Destroying the fetus? Isn't that what it means?"

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 hemostatic forceps in his hand, sat on the steps nearby, and looked at them tiredly: "How can we prove it?"

"You can do it after the baby comes out."

"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 subject that people love and hate. This is why Edward must bring Carvey to Paris.

.

"The current problem is obvious. A multiparous woman has been in labor for nearly three hours. With the help of various assistants, her cervix is ​​stuck at 7cm. 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 is the first time that he has become angry like this, and he is indeed annoyed by the strange Catholic regulations: "There are only three options before you now, one is cesarean section, one is fetal destruction, and the other is waiting to die."

This is not only the dilemma that Kawei faces now, but also the dilemma that these obstetricians have always faced. The reasons may be different, but the results are the same. There is no option of surgery and fetal destruction, and in the end, there is only 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 bear the responsibility 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.

At best, Kawei is a doctor who performs surgeries. 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 only one person to take responsibility. Hugier must make the final decision.
To be continued...