On September 1, Dr. ZHOU Fenhe of Shanghai First Maternity and Infant Hospital (FMIH) (a Tongji University affiliate) and member of the sixth batch of “Group-type” medical teams assisting Xizang (Tibet) in Shanghai, performed the first ultrasound-guided amniotic fluid reduction operation in Shigatse People’s Hospital, Xizang Autonomous Region. At this time, it was less than a month since he left Shanghai for Xizang.
On August 5, Dr. ZHOU Fenhe bode farewell to his family and colleagues and left Shanghai for Xizang. He overcame altitude sickness and made full use of the intrauterine intervention techniques of fetal medicine to relieve the pain of Xizang patients. This allowed the advanced medical treatment techniques of Shanghai to land in the Xizang areas, and promoted the active knowledge and technology of local medical personnel. In less than a month, he performed two operations of intrauterine fetal intervention at the Shigatse People’s Hospital, of which both were unprecedented in the Xizang areas.
The Department of Obstetrics and Gynecology at Shigatse People’s Hospital admitted a special case referred by the county hospital on September 1. The 35-year-old woman “Dolma” (an alias) was pregnant for 26 weeks and arrived to the hospital with abdominal distension which had lasted for one week and was aggravated for three days. As lead physician of the Department of Fetal Medicine, FMIH, Dr. ZHOU diagnosed quickly the pregnant woman presented special complications of monochorionic twin pregnancy based on his years of clinical experience. He then organized a multidisciplinary consultation with Directors PU Chi of the Department of Obstetrics and Gynecology and HOU Yongzhi of the Ultrasound Department at Shigatse People’s Hospital. The results of the ultrasound confirmed Dr. ZHOU’s diagnosis.
After a thorough evaluation, Dr. ZHOU diagnosed the pregnancy with a specific complication of the monochorionic twin pregnancy more specifically as twin-to-twin transfusion syndrome (TTTs). Without intervention, the mortality rate for both fetuses is upwards of 90%, and pregnant women may also experience premature rupture of membranes at any time which can be life-threatening if an excessive amount of amniotic fluid is released instantaneously. After holding a discussion with Director PU Chi and Director BA Sang, he decided to conduct the first ultrasound-guided amniotic fluid reduction operation at the Shigatse People’s Hospital.
In the same afternoon, Dr. ZHOU led the relevant medical personnel of the Department of Obstetrics and Gynecology to carry out an amniotic fluid reduction operation with a negative pressure aspirator, which aspirated a total of 2,500 ml of amniotic fluid successfully. The operation went very smoothly and relieved the pregnant woman’s discomfort substantially, achieving the initial diagnosis and treatment of TTTs and sparing sufficient time for further treatment.
The FMIH Department of Fetal Medicine and Prenatal Diagnostic Center is the first batch of Shanghai-level prenatal diagnosis centers in China and the first one approved by the Shanghai government. It has taken the lead in standardizing and developing several new intrauterine treatment techniques in China. The procedure is one of the intrauterine interventions in fetal medicine and its main role is to treat the acute polyhydramnios to pregnant women’s severe discomfort, according to SUN Luming, Director of the Department of Fetal Medicine. Currently, there are no facilities in the Xizang areas for carrying out fetal mirror laser surgery or fetal reduction operations for patients with TTTs. The rapid amniotic fluid reduction procedure can win time for the subsequent treatment planning, and reduce the risk of serious maternal obstetric complications.
On the day of the successful treatment of the twin-pregnant woman, Dr. ZHOU also used the concept and means of fetal medicine to successfully treat a 25-week pregnant woman presenting early-onset severe preeclampsia. During the two operations, he showed the staff members of the Department of Fetal Medicine how to correctly scan the fetus and placenta using ultrasound, and how monitoring can be used during the precise punctures. The participating medical staff observed both operations, and they were enthusiastic about learning the application of fetal medicine and intrauterine intervention techniques in obstetric clinical practice.
“As a center for critical maternal resuscitation in the western region, the Department of Obstetrics and Gynecology at the Shigatse People’s Hospital has introduced knowledge and techniques of maternal-fetal medicine here and I hope that my experience will provide more useful ‘tools’ for the medical staff in Shigatse,” Dr. ZHOU said.
Secretary of the FIMH Party Committee YANG Xinchao said: “SFMIH has helped the Department Obstetrics and Gynecology of Shigatse People’s Hospital by taking charge of one specific department of local hospitals. At present, five doctors have continued to help enhance the comprehensive strength of the local departments of Obstetrics and Gynecology.”