The woman had difficulty conceiving and maintaining the fetus, and was told that she needed surgery when she was 5 months pregnant. Be sure to be careful about this disease!

Ms. Li, 40, has always wanted a child of her own. In the early years, she put off having children because she was devoted to her education career. When she wanted to have a child, she couldn't get pregnant. After hard work, Ms. Li finally got pregnant.

When she found out she was pregnant, Ms. Li was so excited that she couldn't sleep for several days. Every day, she touched her belly, fearing that something unexpected would happen.

However, fate seemed to play a big joke on her:

When she was 3 months pregnant, she had a little vaginal bleeding. After going to the hospital for examination, the doctor thought it was "threatened abortion", but did not rule out other possible diseases. But because she would rather believe it was just threatened abortion than believe anything else, she began the journey of preserving the fetus. After much effort, after various folk remedies, the bleeding finally stopped.

However, just over a month later, she not only started bleeding again, but also had severe abdominal pain. She couldn't stand it anymore and went to the hospital again.

If it was difficult to diagnose the baby at three months because it was not formed, the doctor found the problem right away this time: when he touched her abdomen, it was soft and there was no trace of the fetus. Combined with her severe abdominal pain and abnormally low hemoglobin, the doctor immediately thought of a disease - choriocarcinoma, which is a highly malignant tumor. If not treated in time, it is likely to be life-threatening.

As more and more tests were performed, the true nature of her illness gradually surfaced. At the same time, because the bleeding was almost impossible to control, Ms. Li gradually developed symptoms of shock.

Time is life. If the patient goes into shock, the anesthesia stage will be very risky. Therefore, the obstetrics and gynecology department immediately invited the anesthesia department for a preoperative consultation.

Seeing this case, the anesthesiology department also felt very difficult: this type of surgical anesthesia is different from ordinary gynecological surgery and full-term cesarean section. If it is a gynecological surgery, general anesthesia or spinal anesthesia can be used according to the characteristics of the surgery; if it is an obstetric surgery, spinal anesthesia is preferred. However, according to the diagnosis of the obstetrician and gynecologist, this patient is basically choriocarcinoma stage III. This means that lung metastasis may affect the implementation of general anesthesia. If spinal anesthesia is implemented, shock is also a major challenge.

Knowledge point: Choriocarcinoma is a trophoblastic tumor that has the characteristics of eroding tissues, blood vessels, and systemic blood flow metastasis. The most common metastatic sites are lung (80%), vagina (30%), brain (10%), and liver (10%). This patient had stage III choriocarcinoma. When she was admitted to the hospital, she had uterine lesion rupture, hemorrhagic shock, and lung metastasis, and had been coughing up blood for 7 days. In addition, massive blood loss, in addition to affecting hemodynamics, will inevitably cause coagulation-coagulation system disorders, thereby affecting intraoperative bleeding and even causing accidental bleeding during anesthesia.

On this side, the doctors were having a heated discussion on how to safely treat Ms. Li; on the other side, Ms. Li seemed unaware of the danger. Although she was still conscious, her cold limbs, barely normal blood pressure and accelerated pulse all indicated that she was in danger.

Since they could no longer wait, the doctor's attitude became tough. Although Ms. Li also requested to be transferred to another hospital or consulted with another hospital, the doctor rejected them one by one. At the same time, the operating room and the anesthesia department took action and made active preparations for the operation.

Perhaps, at that time, Ms. Li thought that the doctor was so unsympathetic and had such a bad attitude! Maybe she was also thinking: Can't you understand the urgency of an older woman wanting a child? However, the medical care at that time seemed like robots, without any humanity at all.

As it was impossible to communicate clearly with Ms. Li, the doctor called her husband and parents to sign the medical documents. Soon, Ms. Li was pushed into the operating room.

Between the decline in lung function and the possible further shock due to massive blood loss, the anesthesiologist chose general anesthesia. The anesthesiologist considered that even if there were lung metastases, such metastases were not sufficient to cause complete loss of lung function.

Some people also reminded us, what should we do if we cough up blood? The anesthesiologists answered that as long as the anesthesia is stable enough and the patient does not choke, the possibility of bleeding is still very low; in addition, even if bleeding occurs, the protection of the endotracheal tube and close monitoring can effectively save the lung function in time.

Under the strong support of the anesthesiologist, the operation was successfully completed.

After the operation, Ms. Li quickly woke up from anesthesia.

At this point, the doctor told Ms. Li why she could not continue to protect the fetus and could not wait: there was no fetus in her belly at all, but choriocarcinoma.

At this time, Ms. Li still doubted the doctor and said: "It's impossible! I did an ultrasound at 3 months and I was pregnant!"

The doctor told her: She was indeed pregnant at that time. However, it was an extremely rare clinical condition: a hydatidiform mole with a visible fetus. In most hydatidiform moles, the fetus is almost invisible. Even if the fetus is seen, it is difficult for it to survive. Her case belongs to the latter.

At this point, the doctor said with a hint of blame: If you had come to see a doctor earlier, perhaps it would not be choriocarcinoma.

Knowledge point: Choriocarcinoma is a highly malignant trophoblastic tumor that can occur secondary to molar pregnancy, which is a benign lesion. Most molar pregnancies can be cured after curettage. Ms. Li's condition could no longer be cured by simple curettage. In addition, given her condition, the doctor had to remove her uterus.

The tragic ending tells us that many diseases cannot be delayed, let alone wishful thinking and stubborn persistence. In this case, although the doctor misdiagnosed at 3 months, more importantly, the patient's decision also affected the doctor. If Ms. Li had noticed the statement "but other diseases cannot be ruled out", visited more hospitals or had more follow-up examinations, she might have discovered the problem earlier. At that time, it might have been just a benign disease. If she didn't get pregnant this time, she could get pregnant again later.