"Often, critically ill pregnant women from other provinces and municipalities will suddenly rush in without any message in advance." It does not seem exaggerated that Jianhua Lin so describes the working conditions of maternal critical illness treatment team of Renji Hospital.

  Each rescue is a battle. Pregnancy with hypertension, prenatal bleeding, severe pre-eclampsia and etc, all of which sound a little strange to ordinary people, but are routine to Jianhua Lin and her team.

  The total delivery volume is 3046 cases from January to October of 2017 in Department of Obstetrics of Renji Hospital, accounting for only 1.8% of the city. But during the same period, 264 cases of critically ill pregnant women were rescued among the city's critical centers, of which Renji completed 127 cases, accounting for 48%.

"To find Jianhua Lin at Renji"

  A busy afternoon as usual, a pregnant woman appeared in the waiting area, her face was pale and her lips were slightly purple ... ... She came from Jiangxi, suffering from a complex congenital heart disease of "Aortic transposition". Her severe cyanosis and hypoxia indicated that continued pregnancy will seriously endanger the mother's life. All the doctors in many hospitals advised her to terminate the pregnancy, but she was not willing to accept the fate of the arrangements. She opened the door of Jianhua Lin’s consulting room, and begged for help to fulfill her wish as a mother. Dr. Lin is always familiar with such thirsty eyes. "Since you have come, undergo the hospitalization procedure for assessment." During the next few days, after total inspection, team discussions, and communication with her family members, detailed diagnosis and treatment plan was decided and the mother was gave 24-hour intensive care. After 35 weeks pregnancy, Jianhua Lin as the primary surgeon performed an operation to help the childbirth. Both the mother and her baby were safe. Another child who came to the world after hardships will be lifelong gratitude to "Mother Lin in Shanghai."

  Many women with severe heart diseases, which are theoretically not suitable for pregnancy, have all passed the difficult labor of pregnancy and childbirth. The diagnosis and treatment of pregnancy complicated with heart diseases by Department of Obstetrics has become a national famous specialty. When peers receive difficult pregnant women with heart diseases, their first reaction is often "Go to find Jianhua Lin at Renji Hospital in Shanghai." According to statistics, 70% of maternity obstetric women are high-risk pregnant women in Renji Hospital, and more than 1,000 high-risk pregnant women are transferred here for treatment each year. More than 100 critically ill pregnant women are rescued, accounting for about 50% of the city's total.

  In recent years, since the relaxation of the policy of second child in the country, the departments of obstetrics are also facing new problems. As the increased number of elderly pregnant women, the previous high cesarean section rate leads to a significant increase in the incidence of dangerous placenta previa, and massive hemorrhage is the leading cause of maternal death. Jianhua Lin’s team had fought 14 hours for successful rescue of a dangerous placenta previa patient bleeding for 15,000 ml. Jianhua Lin, with the help of other departments, continuously improve the technology. Department of Obstetrics in Renji Hospital took the lead in Shanghai to carry out the uterine artery embolization for postpartum hemorrhage. They also perform the first internal iliac artery balloon prepositioning before cesarean section to prevent postpartum hemorrhage, which significantly reduced the incidence of postpartum hemorrhage caused by dangerous placenta previa. They also endeavor to reduce hysterectomy, retain the patients’ reproductive function, while saving large amount of blood transfusion.

 Multidisciplinary work for safeguard of mothers

  According to the requirements of Municipal Health Planning Commission, each hospital should set up obstetric safety offices to improve the motherhood safety. And now the only maternity intensive care unit in Shanghai is located in Renji. Under the unified coordination of "Obetetric Safety Office", with the Obstetric Critical Rescue Center as a platform, the Departments of Critical Care Medicine, Anesthesiology, Cardiology, Cardiovascular Surgery, Hematology, Nephrology, Neurology and Neurosurgery of the hospital often "get together". In the words of Jianhua Lin, there will not be any remarkable achievements in the successful rate of maternal critical illness rescue in recent years without the support of a solid comprehensive strength of Renji Hospital.

  A parturient pregnant woman was transferred to Renji from other hospital because of serious unexplained chest tightness. No abnormalities could be observed on the surface, and vital signs were stable. On 16 o'clock that day, the results of color Doppler ultrasound came out, "A free-shaped stripes in right heart." Jianhua Lin’s heart slightly bang about this "Emboli off from right heart would cause pulmonary embolism." The consequences could be disastrous! She immediately informed the Obetetric Safety Office, requesting consultation of directors from all relevant departments. At 17:00, when all the directors were discussing the condition in the Intensive Care Unit's office, the nurse rushed in to say that the patient's blood pressure had dropped to zero. Fortunately, all the directors were on the scene, and they immediately gave oxygen supply by endotracheal intubation, cardiopulmonary resuscitation, booster and other rescue. They took a one-and-a-half hour of external chest compression, but the patient's blood pressure did not rise, and there was no heartbeat. Jianhua Lin begun to think how to inform the family members the rescue was invalid. However, on the halfway to account for the disease, Dr. Lin was surprised to find that the patient's blood pressure suddenly came up. "Probably a large pulmonary blood vessel is opened suddenly." They continued to rescue and maintain medication. On 23:00, the patient opened her eyes slowly, and was able to answer. Finally she was fully awake the next day.

  Critically ill pregnant women have to pass through "Three difficulties": last trimester, childbirth, puerperium. The intensive care unit (ICU) is an important guarantee for the smooth passing of the third difficulty. It provides continuous, dynamic and quantitative observation and evaluation of the critically ill pregnant women and provides standardized and high-quality life support. Sometimes, intensive care unit is front-line for the rescue.

  There had been a 38-year-old elderly critically ill pregnant women of 33 weeks pregnancy, was admitted to the ICU because of chest tightness accompanied by severe shortness of breath and hypoxia. Although no apparent cardiac abnormalities had been found for this patient in other hospitals’ examinations, Director of Department of Intensive Care Unit Yuan Gao felt anxious about the patient’s serious cyanosis and other signs. Not unexpectedly, ultrasound medical imaging showed that the patient is "Severe atrial septal defect with severe pulmonary hypertension." The obstetrician immediately performed cesarean termination of pregnancy for the patients, but the patient's condition was worsened in the following treatment, and her life was at stake. Yuan Gao et al dynamically monitored the 24-hour pulmonary arterial pressure of the patient by means of monitoring instruments such as pulmonary artery floating catheter on the one hand, and on the other hand used the latest therapeutic drugs to reduce pulmonary artery pressure while providing mechanical ventilation for respiratory support. After a full 72 hours of efforts from all medical staff throughout the department, the rescue was successful.

 Will miracles happen again?

  However, medicine is limited. Usually people think that having a baby is a happy event, but there is an old saying that having children is a "hell." Even if medicine is developed today, the risk to be mothers still exists.

  In particular, for those pregnant women who open the door of Jianhua Lin’s consulting room, many people are not suitable for pregnancy at all. Jianhua Lin says that as a doctor, the best treatment for these people is to terminate their pregnancy. However, being a woman, she also deeply understands their urgency in giving birth to their offspring. It is of course the best that both mother and child can be safe. However, if any one of the mother and the child can not be preserved, it is a major blow, not only for the patient, but also for the doctor.

  She talked about a story of a patient from other province, suffering from CHD for many years, and complicated with severe pulmonary hypertension. Jianhua Lin saw her purple lips and clubbing upon the first meeting, and knew without question that the patient had a serious heart disease. But when Jianhua Lin spoke that she was not suitable for pregnancy, the patient who had been pregnant for 13 weeks immediately knelt down, saying that there were two small sisters whose pulmonary hypertension were also 110 millimeters of mercury and had been subsequently successfully produced here by Jianhua Lin. "I know the risk. Please stay with me anyway. I'm willing to take a chance and give it a try." The patient shed tears.

  Jianhua Lin admitted her into the ward, and examinations were confirmed as expected that the patient were not suitable for pregnancy, otherwise the risk of death is extremely high. The patient could not be persuaded. When talking with her family members, their determination to have a child was also very firm, and signed the risk statement without saying anything else. Later, the patient came regularly for check-ups. Every time she came, Jianhua Lin persuaded her, but she didn’t listen. Up to 28 weeks pregnancy, the patient finally agreed to be hospitalized, when the pregnant woman’s cardiac function had begun to change ... ... In the end the child was born at 1090 grams, but the mother’s blood pressure and oxygen dropped straightly. She was sent to the ICU, but the physiological indicators couldn’t be raised up. The patient finally died despite of the multidisciplinary rescue.

  Obstetrics is usually considered as the happiest section in the hospital. However, as a Maternal Critical Illness Rescue Center, Department of Obstetrics feels full of responsibilities and sometimes even helpless: the wishes of the patients can only be respected and the limitation of medicine can not be ignored. "Like the children are the future, pregnant women themselves are also a vivid life, and sometimes they really can not gamble."

  There are still several critically ill patients in Dr. Lin's ward. Will miracles happen again? Dr. Lin and her colleagues promise that they would try their best.

(Chief reporter from Liberation Daily Gang Sun / Translator Weiwei Zhang)