The fetus is growing and developing well, and the placenta blood supply is good......Hearing the words of Sun Luming, director of the fetal medicine department of Shanghai First Maternity and Infant Health Hospital, the haze on Yu Li's face was swept away, which was the first good news she had received since she was 20 weeks pregnant.
Fetal Medicine, this is a very special department, and the people who come here seem to be pregnant women, but they are actually fetuses. Moreover, there are no ordinary obstetric patients here, and all the babies in the womb of expectant mothers are suffering from fetal diseases.
As the first medical institution in China to standardize fetal medical diagnosis and treatment services, the fetal medicine department of a woman and infant has gone through more than 10 years.
At present, as the Spring Festival is approaching, some expectant parents are in mixed moods in the waiting area of the hospital. "Doctor, should this child be kept? In Sun Luming's clinic, difficult choices and thousands of joys and sorrows are repeated here. To solve the life and death problems related to the happiness of a small family, she knows that in addition to technology, there is only benevolence.
Sick fetuses have a place to seek medical attention.
As long as there are outpatient days, Sun Luming's work is basically "8 o'clock in the morning and 10 o'clock in the evening". Before the official opening of the clinic, she would habitually buy herself a cup of coffee to "recharge" for the day's work.
Yu Li was the first patient of the day, and this was her second pregnancy. In the first child, due to insufficient blood supply to the placenta and uterine malformation, the growth of the fetus in the womb was restricted, and labor had to be induced. Pregnant again, the couple was extremely nervous, and made a special trip from Shandong to Shanghai to ask Sun Luming to "escort".
Looking closely at the ultrasound results, Sun Luming smiled. "The precautions taken some time ago have worked, and the fetus is growing healthily. Hearing this, Yu Li and his wife were obviously relieved. Sun Luming carefully explained the key points and precautions for the follow-up, and carefully made an appointment for them for the next follow-up visit. "See you in the new year! "The two sides said goodbye to each other.
Childbearing is never easy. In recent years, the age of first marriage and childbearing of women in China has been continuously delayed, and the reproductive age is generally late, which has also caused a series of reproductive development health problems such as abnormal embryonic development caused by advanced maternal age.
Outside Sun Luming's clinic, some expectant parents from all over the country dragged suitcases in one hand and a thick stack of test reports packed in folders in the other, with mixed feelings.
NT screening, non-invasive screening and ultrasound macrostructure screening during prenatal check-up for pregnant women are like physical examination for the fetus. Sun Luming explained, this is like a physical examination, once the body "turns on the red light", you have to go to the specialist for further examination and **, fetal medicine is such an existence, of course, it is not limited to this. "The one-stop outpatient clinic of the Department of Fetal Medicine can ensure the whole process of service from screening, diagnosis, intervention, delivery to postnatal diagnosis and treatment of various fetal diseases. ”
Fetal medicine has been developed abroad for more than 40 years, but it has only been developed as an independent subspecialty in China for more than 10 years.
As soon as I graduated from medical school, I went to a maternity and infant school, and I learned skills from different teachers, from obstetric clinical, ultrasound examination to endoscopic operation, genetics knowledge, etc. At that time, Sun Luming didn't know that after "lighting up" these skills one by one, it was a "warm-up" for the development of fetal medicine. She was the first doctor in China to complete a three-year clinical training in maternal-fetal medicine in North America, and since then she has taken the lead in establishing a subspecialty in fetal medicine in China.
Since then, the needs of fetuses that were once scattered in obstetrics, reproductive medicine and other departments have been focused, and sick fetuses have a place to seek medical treatment.
To live or not to live, dilemmas are often staged.
If the prenatal examination reveals that the fetus is defective, it is a difficult choice to give birth or not. In Sun Luming's office, such difficult choices are often staged.
A 47-year-old pregnant woman who has conceived three children through IVF, should she reduce the pregnancy again to reduce the burden on her body when she has already lost one child?
A 38-year-old novice mother has just given birth to a healthy child, and she is unexpectedly pregnant again, but the prenatal examination shows that the fetus has superestrogenism syndrome.
You must know that a flash of thought by expectant parents is often related to the life and death of a small life, but how to help prospective parents make a choice without regrets?
As for "solving difficult problems", Sun Luming has his own ideas: spread out all the problems and explain them clearly and thoroughly. Therefore, she is always very "slow" in seeing patients, and each patient has at least half an hour of consultation time - this is a doctor's respect for patients, but also reverence for life.
28-year-old Cheng Munan was ready for surgery, but before she was officially admitted to the hospital, she hesitated and found Sun Luming again.
Cheng Munan showed a reverse arterial perfusion sequence of twins during pregnancy, which is a serious complication and has a very high perinatal mortality rate. Specifically, identical twins are formed by a fertilized egg**, and there is a vascular anastomosis at the placental level of the two fetuses, that is, "blood connection". * The later it is, the closer the bond between the fetuses becomes, and even conjoined twins may occur.
The twin fetuses in Cheng Munan's womb are more complicated, not only are they "connected by blood", but one of them is also "heartless", due to poor heart development, they absorb the nutrients of the other fetus through the connected bloodlines. Without intervention, the other fetus will be stillborn due to severe heart failure.
The reverse arterial perfusion sequence of twins can currently use intrauterine coagulation technology to coagulate the blood vessels in the 'flesh mass' through intrautero**, so as to save another fetus. "Over the past 10 years, Sun Luming's team has carried out more than 200 related cases**, and the survival rate of newborns after surgery is more than 80%, which is comparable to the level reported by international peers.
Sun Luming's hands have saved the lives of many critically ill fetuses, but even so, she still maintains a doctor's rationality and objectivity when communicating with her parents-to-be.
The main purpose of most intrauterine interventions is to create conditions for the treatment of the fetus after birth, and most intrauterine interventions are invasive, and there may be risks of miscarriage and preterm birth after surgery. At the same time, it is also necessary to consider the risk of long-term complications such as cerebral palsy related to fetal diseases, and if the pregnant woman and her family cannot afford it, they can also choose to give up. She is honest, the first in utero can not only pay attention to the survival rate of high-risk children after birth, but also pay attention to the long-term disability rate, after all, behind a choice is the happiness of three families.
For families who actively treat their babies, Sun Luming also gave strong support: "If you don't give up, I will do my best!" ”
In the consultation room, Cheng Munan and his wife glanced at each other, and finally made up their minds to seek a ray of life for the baby in their womb and continue to take risks.
Open the genetic "heavenly book" to reduce the occurrence of tragedies.
In the outpatient clinic of the fetal medicine department, there is also a large proportion of small families: some of them themselves are patients with rare diseases, some have rare disease patients in their families, and some have given birth to children with rare diseases. Asking Sun Luming for help, they have only one request, to give birth to a healthy baby.
Xiaozhuang is 30 years old, and three years ago, she gave birth to a 68 pounds boy. No, the child unfortunately died at the age of 2 months, and the reason is unknown. Now, she is pregnant again and wants to assess the possibility of a repeat tragedy from her previous pregnancy. When she set up a card in the outer courtyard, the doctor recommended her to see Sun Luming.
35-year-old Ah Zhen from Xiamen, due to the polr2a gene mutation, gave birth to her first child with neurodevelopmental disorders, "You can't repeat the mistakes of the past, please think of a way!" Holding Sun Luming's hand, Ah Zhen left tears.
The medical literature shows that everyone has 2 to 3 recessive pathogenic genes, and once a couple has the same defective gene, it is possible to have a baby with a rare disease. The only way to prevent and treat rare diseases is early screening, early detection and early intervention.
In Sun Luming's view, an important responsibility of fetal medicine doctors is to open the genetic "heavenly book" to reduce the occurrence of tragedies.
Many patients come to us for the last stop and ask us to help, which is why I can't bear to refuse every time I go to the clinic, and I always see it late. And what she hopes is that this can become the first stop for patients, "Couples who are willing to have children should do relevant screening before marriage or pregnancy, do a good job in primary prevention, and block the occurrence of genetic diseases from the source." ”
During the outpatient clinic, Sun Luming quietly told reporters that she used to be a literary young woman who loved singing, reciting, and playing the guitar, but after becoming a doctor, work became her only hobby.
When the reporter left the consultation room, there were still many small families waiting patiently. "It's expected to be busy until 10 p.m. again. She said that despite the hard work, she feels very happy, "Doing what I love the most, this light will always be on for patients." ”
The names of the patients in this article have been changed).
Author: Li Chenyan.
Text: Li Chenyan Photo: Yuan Jing, Photo provided by the interviewee Editor: Li Chenyan Responsible editor: Fan Liping.
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