Source: Maternity Frontline in the Health Industry
Editor’s note: With the development of the economy and society, the age of women’s first marriage and first childbearing in my country has been gradually delayed. In addition, with the introduction of my country’s “three-child” policy and the decline of women’s willingness to bear children, the age of women giving birth at an advanced age has been gradually delayed. The queue is gradually “growing”.
The protagonist of the story is an elderly pregnant woman.
Recently, at the Guizhou Provincial People’s Hospital, doctors helped a 42-year-old pregnant woman with a rare “uterine torsion” give birth to twins.
In order to fulfill the eldest daughter’s wish to add another brother or sister, Yingzi (pseudonym), 42, and her husband successfully conceived twins through IVF technology. However, advanced twin pregnancy is extremely demanding for Yingzi’s physical test.
But in the second and third trimesters, Yingzi discovered that she had gestational diabetes mellitus, intrahepatic cholestasis of pregnancy, elevated blood lipids, abnormal coagulation function, and deep venous blood stasis in both lower extremities. and many other complications.
And as the gestational weeks increase, Yingzi’s body is already overwhelmed. In order to make the child born safely, Yingzi was admitted to the maternity ward for the third time.
After admission, Song Hongbi, chief physician of the Obstetrics Department of Guizhou Provincial People’s Hospital, led the treatment team to formulate a diagnosis and treatment plan for Yingzi, and decided to give her a cesarean section at 35 weeks and 3 days of pregnancy.
On the day of the operation, Song Hongbi found that the position of Yingzi’s uterus was very likely to have changed abnormally. After careful exploration of the abdominal cavity, the surgical team determined that this was an extremely rare “uterine torsion”.
After much consideration, the obstetric team decided to perform a lower uterine cesarean section (modified cesarean section) by manually repositioning the twisted uterus into an anteverted and flexed position. “Because the traditional cesarean section (cesarean section of the uterus) takes out the fetus, the muscle tissue of the uterine incision is thick, the suture is often unsatisfactory, there is a lot of bleeding, the rate of uterine rupture during re-pregnancy is high, and the incidence of postoperative adhesions is high.”
When the twisted uterus was gradually lifted and slowly moved backward to the upper left of the abdominal cavity of Yingzi, until the uterus returned to an anteverted and flexed position, and the mother’s vital signs were stable throughout the reduction process, two premature births The newborns were delivered smoothly. Today, Yingzi and the two newborns are recovering well without complications and discharged from the hospital.
Because Yingzi is an advanced pregnant and lying-in woman, the elasticity of pelvic tissue decreases, and the uterus in twin pregnancy is significantly enlarged, which makes the uterine ligaments endure more than 8 months of pregnancy with reduced elasticity , a critical situation of twisting 90 degrees to the lower right occurred. Song Hongbi said that Yingzi did not have any symptoms during pregnancy, and the uterine blood flow was normal during the operation, no purple-blue changes were seen, both fetuses survived, and the birth scores were both good, which is rare.
The case reflects the various “hardships” of the elderly pregnant population in the current society.
With the development of economy and society, the age of women’s first marriage and first childbearing in my country has been gradually delayed. In addition, with the introduction of my country’s “three-child” policy and the decline of women’s willingness to bear children, the cohort of elderly mothers has gradually increased. “grow”.
“It is medically believed that pregnancy at the age of 35 or more is called advanced pregnancy. The optimal age for women to give birth is 23 to 28 years old, and women over 35 years old belong to advanced maternal age.” Prof. Fan Ling from the Beijing Obstetrics and Gynecology Hospital affiliated to the Medical University told the health community that more and more women are giving birth to a second child at the age of 40. These factors have led to a substantial increase in the number of pregnant women at advanced age in the current society.
Pay attention to screening and diagnosis before and during pregnancy
Because the fertility and physical function of elderly mothers are in a state of gradual decline, and are affected by a variety of risk factors in the environment and society for a long time, the risk of adverse pregnancy outcomes is compared with that of pregnant women of the right age. It is 2 to 4 times higher, which seriously threatens the life and health of mothers and babies. “With age, the incidence of pregnancy complications and comorbidities increases, such as gestational diabetes and hypertension, miscarriage, preterm birth, stillbirth, overweight and obesity, etc.” How to avoid these risks? Professor Fan Ling reminded that the inspection must be carried out regularly in accordance with the requirements. In addition, elderly women are prone to chromosomal abnormalities, so it is recommended that elderly women pay more attention to prenatal screening and diagnosis during pregnancy.
In addition to screening and diagnosis, the “Expert Consensus” also emphasizes that pre-pregnancy health assessment should be carried out for elderly women, including past history, reproductive history, family history, gynecological disease examination and other general conditions As well as pre-pregnancy health education, assessment of whether elderly women are suitable for pregnancy, etc.
The timing of pregnancy termination is also different between advanced-age pregnancy and right-age pregnancy. Normal-age pregnant women are recommended to induce labor after 41 weeks, those with diabetes but not using insulin after 40 weeks, and those who use insulin before 40 weeks. For older women, pregnancy should be terminated at around 39 weeks. The Guidelines for Preconception and Pregnancy Care (2018) recommend that pregnant women aged ≥40 years should terminate their pregnancy in a timely manner before 40 weeks of gestation.
Professor Fan Ling and the mother
Enhancing maternal management during pregnancy
The childbirth period is a high-risk period for women of both appropriate and advanced age. “Older mothers will also have poor uterine muscle contractility, poor pelvic floor muscle elasticity, ligament tension, insufficient labor force, and poor psychological quality during childbirth, which may affect childbirth, especially vaginal childbirth. Dystocia is easy to cause.” Fan Ling The professor pointed out that strengthening the management of elderly mothers during childbirth can reduce the risk of complications during childbirth.to ensure the safety of mothers and babies.
The “Expert Consensus” also gives some feasible suggestions for the management of elderly women during labor, mainly as follows:
1. Pay attention to the mental state of elderly mothers and establish their confidence in vaginal delivery;
2. Pay attention to maternal vital signs, especially blood pressure changes;
3. Pay attention to the general condition of the puerpera, and timely replenish energy during labor, and suggest a small amount of semi-liquid food for several times;
4. Beware of uterine atony;
5. Labor analgesia is recommended;
6. During childbirth, if the elderly mother strongly desires to change the mode of delivery, the indications for cesarean section should be relaxed.
It is worth reminding that some mothers are not aware of their physical symptoms during childbirth and cannot describe the problems in their bodies in time. Professor Fan Ling suggested that doctors and midwives should closely monitor maternal blood sugar, blood pressure and other vital signs. “Some women don’t say it when they are not particularly uncomfortable, which makes medical staff ignore some important information. Therefore, during the production process, doctors and midwives should guide women to understand whether they are unwell, whether they need to urinate, etc. very important.”
Professor Fan Ling
Beware of postpartum hemorrhage
Whether it is primiparous or multiparous, the concern for elderly mothers does not end after giving birth, and elderly mothers are more likely to have problems such as postpartum hemorrhage, postpartum urination, and postpartum eclampsia after delivery . “Older age itself is an independent risk factor for postpartum hemorrhage, and advanced preventive medication must be taken for elderly mothers to prevent the occurrence of postpartum hemorrhage.” Professor Fan Ling emphasized that postpartum mothers’ psychological concerns should not be relaxed. Expectant mothers should be reasonably guided in breastfeeding and postpartum rehabilitation, establish a good attitude, reduce the occurrence of postpartum depression, and conduct psychological counseling when necessary.
At the same time, postpartum physical recovery is also a very important point. Elderly mothers should pay attention to strengthening the rehabilitation exercise of pelvic floor function to improve the quality of life.
Despite advances in medical technology, pregnancy at an advanced age is less scary. But “not afraid of 10,000, just in case”, the probability of dystocia, postpartum hemorrhage, and high blood pressure in advanced pregnancy is still very high. Professor Fan Ling suggested to give birth at the best gestational age as much as possible, to ensure that the physical condition during childbirth is the best, the energy is abundant, stay away from advanced pregnancy, and reduce the probability of physical abnormalities.
“Older pregnancy is a type of high-risk pregnancy, and it is also a high-risk pregnancy with a high proportion. But other high-risk pregnancies cannot be ignored, such as diabetes, hypertension, and autoimmune diseases. Pregnant women with other diseases, too much or too little amniotic fluid, abnormal fetal position, macrosomia and other fetal abnormalities belong to the category of high-risk pregnancy.” Professor Fan Ling reminded that many high-risk pregnancies can only be found through multiple prenatal examinations, and only early Screening early detection, in order to achieve early treatment and early treatment. Therefore, prenatal screening and diagnosis must not be ignored, whether it is an elderly woman or a pregnant woman with other high-risk pregnancies!
Expert Profile: Fan Ling
Fan Ling, Chief Physician and Professor of Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University.
Graduated from Capital Medical University in 1983, has been engaged in clinical work in obstetrics and gynecology for 37 years, and has rich experience in the diagnosis and treatment of high-risk pregnancy and obstetric complications, and the treatment of critical obstetrics. Published more than 70 papers in academic journals. Presided over a number of scientific research projects such as national key research and development projects, national science and technology support projects – sub-projects, municipal science and technology commission, and the first fund.
Main social part-time job:
Member of the Obstetrics Group of the Chinese Medical Association Obstetrics and Gynecology Committee;
Member of the Standing Committee of the Early Life Development and Disease Prevention and Control Professional Committee of the Chinese Preventive Medicine Association;
Vice-chairman of the Natural Birth Promotion Branch of China Maternal and Child Health Association;
Vice chairman of the High Risk Pregnancy Management Professional Committee of China Maternal and Child Health Association;
Vice Chairman of the Professional Committee of Perinatal Nutrition and Metabolism of China Maternal and Child Health Association;
Member of the Standing Committee of the Expert Committee on Maternal and Child Health Education of China Maternal and Child Health Association;
Vice-chairman of the Obstetrics and Gynecology Professional Committee of the Beijing Association of Integrative Medicine;
Member of the Standing Committee of the Perinatal Medicine Branch of the Beijing Medical Association and head of the Collaborative Group of Critical Care Medicine;
Member of the Standing Committee of Maternal Fetal Medicine Professional Committee of the Maternal and Child Health Research Association;
“Chinese Journal of Obstetrics and Gynecology”, “Chinese Journal of Perinatal Medicine”, “Chinese Journal of Obstetrics First Aid”, “Chinese Journal of Obstetrics and Gynecology Clinical”, “Chinese Journal of Maternal and Child Health”, etc. Journal editorial board.
Source: Clinical Frontline, Official WeChat of Guizhou Provincial People’s Hospital