Two pregnant women from Hubei are about to give birth, but they suffer from extremely dangerous heart failure and pulmonary embolism with hemoptysis. After being urgently transferred to Wuhan for medical treatment, the obstetrics team of Wuhan University People’s Hospital (Hubei Provincial People’s Hospital), together with multidisciplinary experts, promptly rescued the two through emergency cesarean section surgery, and ultimately safely discharged the mother and baby.

Luotian, an elderly pregnant woman, is at risk of sudden heart failure

Ms. Xu, a 35 year old woman from Luotian, Hubei, is 36 weeks pregnant and has recently experienced symptoms of breathing difficulties and coughing. A few days later, her breathing difficulties have worsened, and she has started to sit upright breathing, unable to lie flat, and accompanied by chest tightness and discomfort. After a preliminary examination at the local hospital, the doctor suggested that Ms. Xu go to Wuhan University People’s Hospital for further examination and treatment as soon as possible.

That evening, the family brought Ms. Xu to Wuhan University People’s Hospital overnight for treatment. After admission, relevant examinations were completed, and the cardiac examination results showed that the patient’s various atrioventricular cavities were enlarged, with an ejection fraction of only 20% (normal range of 50-80%) and a heart function of level IV. This means that the mother has already developed heart failure, and her life is at risk at any time.

Professor Fan Cuifang, Director of Obstetrics and Gynecology, immediately applied to initiate multidisciplinary discussions on MDT throughout the hospital. After on-site examination and comprehensive evaluation by experts from the departments of cardiovascular medicine, critical care medicine, cardiovascular surgery, anesthesia, and neonatology, it is believed that the mother’s heart function is extremely poor and she cannot tolerate cesarean section surgery. It is recommended to transfer to the critical care department first, and then undergo cesarean section to terminate the pregnancy after the heart function improves. The next morning, after a night of intensive care and treatment, the expert team comprehensively evaluated the condition of the parturient at this time, and it was relatively safe to undergo a cesarean section. If we continue to wait, we may miss the best time for a cesarean section.

After explaining the condition to Ms. Xu and her family and obtaining their consent, Professor Fan Cuifang led the team to perform an emergency cesarean section surgery. During the surgery, Professor Wang Long from the Anesthesiology Department quickly established an anesthesia channel, and a team of obstetricians Fan Cuifang, Chen Jianhua, and Bao Yan performed a cesarean section. Professor Zhan Liying from the Department of Critical Care Medicine, Professor Xia Hao from the Department of Cardiovascular Medicine, Associate Professor Ruan Yongle from the Department of Cardiovascular Surgery, and Zhang Ting from the Department of Neonatology are on standby at any time to handle emergency situations. In the end, the surgical team successfully delivered a baby weighing nearly 6 pounds.

After 3 days of treatment in the intensive care department, Ms. Xu was successfully transferred to the obstetric ward for further treatment. After examination and evaluation by cardiovascular physicians, it was determined that Ms. Xu’s physical condition had recovered well. At the same time, the baby tends to stabilize in the neonatal department and can be discharged with the mother at that time.

Director Fan Cuifang introduced that with the increasing number of elderly pregnant women in China, the number of pregnancies complicated with heart disease is also constantly increasing. Pregnancy combined with heart disease is extremely dangerous, often requiring doctors to race against the "Grim Reaper", urgently evaluate and undergo cesarean section to terminate the pregnancy. The successful treatment of Ms. Xu this time is also a reflection of the multidisciplinary team of Wuhan University People’s Hospital’s successful treatment of critically ill pregnant women.

Xiantao parturient’s sudden pulmonary embolism is on the brink of death

Coincidentally. Ms. Han, who is 28 years old, lives in Xiantao, Hubei. At 36 weeks of pregnancy, she was treated at a local hospital for chest tightness, discomfort, and repeated hemoptysis without significant improvement. After being advised by a doctor, she was transferred to the obstetrics and gynecology department of Wuhan University People’s Hospital for treatment.

After the pregnant woman was admitted to the hospital, Professor Bao Yan and Professor Liu Chunwang in obstetrics immediately completed relevant examinations for her, and urgently invited relevant departments such as Respiratory and Critical Care Medicine, Intensive Care Medicine, Radiointervention, Thoracic Surgery, Anesthesiology, and Neonatology to comprehensively evaluate her condition and discuss treatment plans.

Three hours after admission, Ms. Han experienced hemoptysis again, with the lowest monitored oxygen saturation being only 80%. After emergency treatment by the doctor, combined with the examination results, it was determined that she was highly likely to have pulmonary embolism and needed to undergo an immediate cesarean section to terminate the pregnancy. Further postoperative examination was conducted to determine the cause of hemoptysis.

Director Fan Cuifang introduced that pregnancy with pulmonary embolism and hemoptysis is extremely dangerous. Pulmonary embolism leads to obstruction of pulmonary artery blood flow, local necrosis of lung tissue, rupture of blood vessels, and hemoptysis. 34% of sudden deaths caused by pulmonary embolism in pregnant women occur within 1 hour, 39% within 24 hours, and 27% within 3-5 days. Therefore, time is life, and emergency cesarean section surgery is urgent.

During the operation, under the escort of Professor Lei Shaoqing from the anesthesia department and the protection of multidisciplinary experts, Professor Bao Yan and Professor Liu Chunwang successfully completed a cesarean section for the patient, delivering a baby weighing over 5 pounds. After the cesarean section was completed, the doctor immediately performed an emergency chest pain triad CT scan on Ms. Han who was still on the operating table, and the result showed pulmonary embolism.

Ms. Han was immediately transferred to the intensive care unit and received symptomatic treatment from the team of Associate Professor Cao Xia from the Department of Respiratory and Critical Care Medicine I. Under the joint protection of a multidisciplinary team, three days later, Ms. Han, who had escaped danger to her life, was successfully transferred from the intensive care department and returned to the obstetrics ward to continue treatment. A few days later, she was discharged and returned home with her baby for recovery.

MDT model successfully treated over a hundred high-risk pregnant women

Director Fan Cuifang of Obstetrics and Gynecology stated that most critically ill pregnant women have sudden and critical conditions, which seriously endanger the safety of mother and baby. Wuhan University People’s Hospital organized experts from relevant departments such as internal medicine, surgery, anesthesiology, critical care medicine, neonatology, transfusion, and laboratory departments to establish a MDT (multidisciplinary diagnosis and treatment model) team for critically ill pregnant women in 2019, in order to treat various types of critically ill pregnant women in a timely manner and provide quick and effective treatment for critically ill pregnant women A personalized, standardized, and refined full process management system to jointly ensure the safety of mother and baby.

Since its establishment, Wuhan University People’s Hospital (Hubei Provincial People’s Hospital) has successfully treated over a hundred high-risk pregnant women with MDT, including those with pregnancy complicated with pulmonary hypertension, septic shock, intracranial malignant tumors, acute severe pancreatitis, and pregnancy induced acute fatty liver, which require "life and death speed" treatment.

This article is reprinted from "Dingxiangyuan"

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