A pregnant woman with lupus erythematosus has a fetus with congenital heart disease
Pregnant woman TL, 33 years old, living in Hanoi, has had lupus erythematosus for 6 years. During pregnancy, you will still be examined at a private clinic. However, in the 22nd week of pregnancy, the doctor discovered that the baby had a heart rhythm disorder. Normally, the fetal heart rate fluctuates between 120 and 160 times per minute, but the baby in the pregnant woman's womb has a very slow heart rate, fluctuating only from 50 to 60 times per minute.
Ms. TL quickly went to Hanoi Obstetrics and Gynecology Hospital for consultation and monitoring at the Prenatal & Newborn Screening and Diagnosis Center. After the consultation meeting on August 14, Dr. Doctor. Dinh Thuy Linh, Director of the Center for Prenatal and Neonatal Screening and Diagnosis - Hanoi Obstetrics and Gynecology Hospital, commented that the fetus has a severe prognosis, with intrauterine growth retardation, enlarged heart, and pericardial effusion. large number, with level III atrioventricular block. With such a particularly serious fetal health situation, Ms. TL continued to be treated for lupus erythematosus and was transferred to Obstetrics Department A8 to closely monitor the fetus's situation.
Through inter-hospital consultation, the Council considered transferring the baby to the hospital after birth. Although the distance between Hanoi Obstetrics Hospital and National Children's Hospital is short, the decision to transfer hospital immediately after the baby is born poses some serious risks. The fetus in this case is at risk of heart failure or circulatory collapse due to low heart rate and poor health due to slow growth in the uterus during pregnancy.
Based on the fetus's very severe third-degree atrioventricular block, placing a pacemaker immediately after the baby is born becomes extremely urgent, which can bring the baby's ventricular rhythm back to normal, thereby improve the medical condition.
The Council agreed to seek guidance from the Director of Hanoi Obstetrics Hospital - Prof. Dr. Nguyen Duy Anh and the Director of the National Children's Hospital - Associate Prof. Dr. Tran Minh Dien, to appoint a team of cardiologist. vascular and emergency resuscitation of the National Children's Hospital, headed by the team is Dr. Nguyen Ly Thinh Truong - Director of the Cardiovascular Center, National Children's Hospital in coordination with doctors for prenatal and obstetric diagnosis. diseases, anesthesia, resuscitation, neonatology, hematology of Hanoi Obstetrics and Gynecology Hospital to coordinate in performing the surgery to place a pacemaker for the baby immediately after birth at Hanoi Obstetrics and Gynecology Hospital.
Two consecutive surgeries to save the new baby.
Initially, the plan was to maintain the fetus in the mother's uterus until the 37th week to ensure the baby's maturity before performing the surgery. However, at week 35, the fetal heart situation changes very quickly. Through ultrasound, the doctor discovered that the fetus had decreased heart function, a large amount of pericardial effusion, and signs of cardiac tamponade in the right heart chamber. In particular, Doppler ultrasound results showed that the fetus's condition was getting worse. The slow development of the fetus in the uterus has become more serious.
Installing a pacemaker right in the Obstetrics Department saves the life of a newborn baby with congenital heart disease
After the consultation meeting, Professor Nguyen Duy Anh decided to perform an early cesarean section to ensure the safety of the fetus's life. At 15:9 p.m. on October 10, preparations in the operating room were extremely urgent, all elements of surgical conditions and strict regulations on sterility had to be ensured to perform a surgery. pediatric cardiology right at Hanoi Obstetrics and Gynecology Hospital.
Dr. Tran The Quang and Master Nong Thi Thuy Hoa, along with medical staff from the Department of Voluntary Anesthesia and Intensive Care, Center for Prenatal and Neonatal Screening and Diagnosis - Hanoi Obstetrics and Gynecology Hospital have cooperated. Collaborate with the team of doctors at the National Children's Hospital to create detailed plans and prepare necessary equipment and machinery.
The preparation team worked non-stop. At 7:10 a.m. on October 10, two important surgeries took place in succession. Under the direction of Professor, Dr. Nguyen Duy Anh - Director of Hanoi Obstetrics Hospital, Master, specialist II Pham Thi Thu Phuong and doctors from the Department of Neonatology have prepared all equipment. Medical equipment, medication, and pre-order in the operating room to prepare for neonatal resuscitation.
Master, Specialist II Doctor Nguyen Thi Thuy along with a group of medical staff from the Department of Hematology and Blood Transfusion prepared blood and blood products to ensure readiness for the baby's surgery.
At 8:20 a.m. on October 10, Dr. Do Tuan Dat - Head of Obstetrics Department A10, along with the surgical team, performed a cesarean section. The baby weighing 4g was born crying.
Right when she was born, her heart rate was very weak, only about 50 beats/minute, sometimes even down to 35 beats/minute. This situation poses a big challenge. If transferred to the hospital, the baby may be in danger during the transfer process.
The medical team quickly brought the baby into the operating room, set up an endotracheal tube, performed tests and echocardiograms, assessing the heart rate and medical condition. The condition is completely controlled by doctors.
The surgical team of the National Children's Hospital, with the participation of Dr. Nguyen Ly Thinh Truong - Director of the Cardiovascular Center, Dr. and Dr. Nguyen Thanh Hai - Head of the Arrhythmia Unit, Master Doctor and Doctor Nguyen Dinh Chien - Deputy Department of Anesthesiology and Resuscitation, Master and Doctor Tran Quang Vinh - Surgeon of the Department of Cardiovascular Surgery and Master Vu Thanh Ha - Head Nurse of the Department of Anesthesiology and Resuscitation, performed direct surgery on the baby.
After the pacemaker was successfully placed and the ventricular rate increased to 120 times/minute, the baby was transferred to the National Children's Hospital for continued monitoring and treatment.
After 14 days, the baby's heart rate was stabilized with the help of a pacemaker. She has been reconnected with her mother and is in stable health to continue the treatment process.
Doctors operate on babies.
Professor, Dr. Nguyen Duy Anh, Director of Hanoi Obstetrics Hospital, shared that thanks to developments in the field of medicine and close pregnancy monitoring, abnormal pregnancies can be detected. timely detection and intervention to create a good and healthy life for newborns. For cases where the fetus has severe congenital heart disease, intervention immediately after the baby is born can be a golden opportunity to save the child's life.
PV
