super anesthesiologist

Chapter 7 Premature Twins at 28 Weeks
What a thick fat!

Director Li Xiumei cut it down with a knife, and Li Mengxia's belly was like a super sponge, and the fascia layer could not be seen at all.After a little relaxation, the cut belly quickly closed, and a thread of blood squeezed out.

Li Xiumei frowned, and put her assistant Liu Lu's hands on Li Mengxia's belly, and pulled them out against the wound.

"That's it, use some force."

Liu Lu's face was swollen purple, as if she was exerting all her strength, but she was thin and small, and her strength was like a mantis holding a car in front of a giant like Li Mengxia, completely unconscious.

If she couldn't pull out the skin, Li Xiumei couldn't use the knife.

If the original incision cannot be found, re-cutting the skin is equivalent to cutting two wounds, which will not only affect the appearance after the operation, but also be very troublesome to heal.It is generally not done as a last resort, and peers will be mistaken for inferior technology if they see it.

The two were anxious on stage.

Because of premature rupture of membranes, the amniotic fluid will remain quickly, making twins in the abdomen extremely dangerous, not to mention premature babies.

Lin Xiaobei still clearly remembered the diagnosis in the case: precious son.

Most of these fetuses are test-tube babies, which are not easy to come by.In short, test-tube baby is the process of fertilizing the husband's sperm and the wife's eggs outside the body, and then transplanting the fertilized eggs into the wife's body (uterus), and supplying hormones to promote the process of fetal implantation and development.

In order to ensure the success of embryo transfer, multiple fertilized eggs are usually transferred, so IVF technology can easily allow pregnant women to conceive twins, sometimes triplets or even quadruplets or more.

Li Mengxia is pregnant with twins.

Don't waste it like this helplessly!
Lin Xiaobei asked the itinerant nurse Li Qiong, "Do you still have surgical gowns?"

"There is no disinfection, only disposable isolation gowns."

"That's okay, let's settle for now."

Li Qiong asked: "Why do you need an isolation gown?"

"I'll help Liu Lu and help Director Li."

Li Qiong was still hesitating, but Li Xiumei said happily: "Let Dr. Lin come."

Lin Xiaobei quickly put on the gown and gloves, and told Liu Xu, "Pay attention to your blood pressure."

Li Mengxia's blood pressure was as high as 190/110mmHg when she came in, but it stabilized at around 150/90mmHg after treatment.The fluctuation of blood pressure should not be too large. If it exceeds 30%, it will cause ischemia of various organs, especially for the fetus in the abdomen.

"Give way!" In order not to pollute Liu Lu, Lin Xiaobei kept a certain distance from her. At the same time, he covered his front with the middle laner, reached in from under the towel, and pressed Li Mengxia's belly and pulled it out hard.

"Is this okay?" He asked, the cut open was clearly presented in front of Li Xiumei like a ditch, and it seemed to have been widened a lot.

"Okay, okay." Li Xiumei quickly took the time to cut the knife, "Hey, that's it, very good, please hold on for a while."

The skin and flesh were turned outwards with the fat sandwiched between them. It was so thick that even the bleeding was not so obvious.

With Lin Xiaobei's help, Li Xiumei quickly entered the fascia layer, separated, and entered the pelvic cavity.It was only then that Lin Xiaobei withdrew.He wanted to give way to Liu Lu, after all, she was Li Xiumei's real assistant.

Liu Lu and Li Xiumei forcefully stretched the surgical incision from both sides.This action is very cruel, very bloody.

Standing by the side, Liu Xu tended to faint again.Lin Xiaobei patted her shoulder gently and asked her to sit down first.

"I'm going to cut the uterus soon." Li Xiumei reminded.

"Understood." Lin Xiaobei took out the two sets of neonatal tracheal intubation tubes, and checked again that the light source was on.Then he connected the oxygen suction tube to two sputum suction tubes (clean and unused) with a three-way connection, and divided them into two ends, so as to ensure that the baby can be given oxygen at the same time when the baby comes out.

Due to the premature rupture of the membranes, there is not much amniotic fluid left in the uterus, and the pressure is not strong, so there is no splashing around after the rupture of the uterus.

Li Xiumei fumbled in Li Mengxia's womb, and quickly pulled out a baby the size of a palm. The undeveloped genitals could barely be judged to be a boy.

It is difficult to describe Li Mengxia's Dabao in precise words.This 28-week-old premature baby has a translucent body, lots of fetal hair, and facial skin full of wrinkles like dry tree bark.Although the facial features are complete, the eyes are closed, there are no eyebrows, and the mouth is so small that at most a little finger can fit into it.

The Apgar score is a standard method of assessing a newborn's physical condition immediately after birth.Scores are based on five physical signs: skin color, heart rate, respiration, muscle tone, movement, and reflexes, with each score ranging from 0 to 2.A newborn with a score of 10 or above is considered a normal newborn, a score of 7 is considered mild asphyxia, and a score of 4 or less is considered severe asphyxia.

Most newborns' scores are between 7 and 10.

Dabao had no reaction at all, only 2 points at most - only the beating of his heart proved that the baby was still alive.

Li Xiumei cut off the umbilical vein, tied it, briefly cleaned the mouth and handed Dabao to the midwife who was ready at the baby table.

After receiving Dabao, the midwife quickly put the suction tube into his mouth, sucked out the dark green contaminated amniotic fluid, and then stepped aside to make way for Lin Xiaobei.

Dabao is so small that one big hand is enough to support him!
A silver carp weighing more than two catties is bigger than him!

Liu Xu's face was pale, seeing such a small baby for the first time, the fear in his heart could not be concealed.

"Pay attention to the adult's blood pressure and heart rate." Lin Xiaobei reminded, in fact, to help her distract.

He gently pried open Dabao's mouth with the newborn lens, and the specific anatomical structure in the premature baby's mouth was mostly not obvious.Dabao also only has a prototype, the tongue is very small and thin, and there is no tongue coating.The epiglottis resembles a dried corn kernel and is not easy to identify.

Under the light source of the laryngoscope, the entire mouth looks like an empty cave.

Inexperienced young doctors could not find the specific location of the glottis at all.

Lin Xiaobei gently picked up the "corn" with the front of the lens, and found two faint white lines behind, which were the undeveloped glottis.

Because Dabao's breathing is extremely fragile, the gap between the two white lines is still very narrow between opening and closing, and the 2.5mm (inner diameter) endotracheal tube is very thick.

Although Lin Xiaobei's intubation movements were very gentle, the stimulation of the endotracheal tube still caused Dabao to choke and cough. He actually struggled weakly, and his hands like chicken claws clenched into small fists like dates.

Lin Xiaobei gently wrapped the endotracheal tube around with special anti-allergic adhesive tape to fix it.

All movements were gentle. Dabao's skin was so fragile and tender. Just by gently lifting his chin with his hand, two shocking red marks were left on his face.

Starting to use a simple respirator to give oxygen, Lin Xiaobei called Liuxu over and instructed her how to squeeze the ball.It was a rare experience for her.

For such a small baby, the lung ventilation is too small, about 10ml.What is this concept?A small syringe pushes 5ml.

This kind of baby's lungs are not fully developed, lack of pulmonary surfactant, and their compliance is very small. A little force may burst the alveoli, and it is not easy to inflate the lungs if the force is too small.

The capacity of the neonatal simple respirator balloon is 50ml, and it is best to depress about 1/6 of the volume (8ml), and the balance depends entirely on the doctor's touch.

After the airway was maintained and established, neonatologist Zhang Wei gently placed the tip of the stethoscope on Dabao's front chest wall to listen to whether there were obvious lesions in his heart and lungs.

Although Zhang Wei uses a newborn breast piece with a diameter of 18mm (45-50mm for adults and 30mm for children), it still looks big and heavy when attached to Dabao.

The visual difference is like a huge bed placed in a small bedroom, leaving no other space for movement; it is also like a huge weight placed on a piece of tofu, which will collapse Dabao's chest wall at any time.

"It's okay, there are breathing sounds in both lungs, and the heart rate is estimated to be 100 (the normal heart rate of newborns is about 130)." Zhang Wei concluded after listening for more than a minute.

Only at this time did the midwife have the opportunity to intervene, cut off the umbilical cord for Dabao, disinfected it, and ligated it.

In this way, Dabao is considered finished.

Lin Xiaobei gently handed him over to Zhang Wei.After he took it, he put it on an electronic scale specially designed for babies. It was 1.25Kg, which was lighter than a silver carp.

Dabao had just been transferred (into the Neonatal Intensive Care Unit), and Xiaobao was just taken out of Li Mengxia's womb by Li Xiumei.

If "terrible" is used to describe Dabao's basic situation, then Xiaobao needs to add two words "totally".

According to gender, Xiaobao is a girl.

Li Mengxia's IVF luck was really good this time, and she had twins.

This is also the difference between in vitro fertilization and twin pregnancy through normal internal fertilization (of course it is not absolute).

Generally speaking, IVF twins are polyzygotic twins, and each embryonic tissue comes from a different fertilized egg.In addition to coming from the same mother at the same time, such twins have obvious differences in other aspects, such as gender, appearance, genetic material, and personality traits.

The vast majority of twins conceived by internal fertilization are monozygotic twins, which are two embryonic tissues produced by the fission of the fertilized egg during implantation.Such twins are the real "twins", with the same genetic material, gender, appearance, personality, and even living habits and personal hobbies are highly similar.

Because he is too young, Xiaobao cannot see any difference from Dabao (except for gender).Their common feature is the unique physical signs of premature babies: they are small, ugly, have many and deep skin folds, and have a lot of lanugo hair all over their bodies.

It's just that these two babies are smaller and uglier, especially Xiaobao.If Dabao is like a baby orangutan, then Xiaobao is like a little macaque.

With Dabao's "vaccination", Liuxu did not show the same panic as before. Perhaps she had developed immunity in her heart.

The midwife took Xiaobao from Li Xiumei, like holding an eggplant that had been beaten by Qiushuang, without any signs of life.

After hurriedly sucking her mouth clean, she quickly transferred Xiaobao to Lin Xiaobei's hands.

According to Apgar (Apgar) score 1 point, a weak heartbeat may suddenly stop at any time.

Lin Xiaobei immediately commanded: "Prepare for newborn resuscitation!"

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(End of this chapter)