High-risk pregnancy in China

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Roberta Speyer: Hello, I am Roberta Speyer reporting for OBGYN.net. I am in Beijing and I have the pleasure of talking to Dr. Bian and Dr. Xu. Dr. Bian studied under Dr. Xu and they are at the Peking University.

Dr Bian: Peking Union Medical College Hospital.

Roberta Speyer: I have to make other people say this because I mess it up every time. So Dr Bian, please would you say it?

Dr Bian: Peking Union Medical College Hospital.

Roberta Speyer: Thank you. Their interest is in high-risk pregnancies, that is what we are going to talk about today. You have another hospital here that handles most of the regular OB cases, is this true?

Dr Bian: Yes. We have a women’s hospital and we have between 900 and 1,000 deliveries per month, so most of the deliveries will go to that hospital. But our hospital is a specialist hospital so we see most of the complicated cases and have the pregnancies come to our hospital. We have about 150 to 200 deliveries per month. Most of them are highly complicated.

Roberta Speyer: How large is the community that you draw from, that come in? How far do people come to have their delivery here because you anticipate a problem? A hundred miles? Or just in the greater Beijing area?

Dr Xu: Some other provinces.

Roberta Speyer: So even other provinces far away?

Dr Xu: Far away.

Roberta Speyer: And I imagine you utilize a lot of the pack systems to look at the ultrasound scans and determine whether or not, how do you get the cases here? How do they decide? Do the local doctors refer them in?

Dr Xu: Some cases come from other provinces and stay in Beijing temporarily and give birth in our hospital. They have high risk.

Roberta Speyer: What is the most common cause for the high risk? Is there anything in particular or could there be a number of things?

Dr Xu: For example, maternal mother and fetal blood incompatibility.

Roberta Speyer: The RH factor?

Dr Xu: Yes.

Roberta Speyer: So that would cause a problem. What happens with the early pregnancy if they seem to be going into labour too soon? That is probably, do they try to bring them into the hospital then because they can get better care, I presume?

Dr Bian: I think for the pre-term, you know, we prefer the mother is referred when the baby is still in delivery, we forward the patient to a general hospital which has a good NICU, so people can choose. Sometimes they know the hospital’s name but PUMC is a good hospital and so they just drive to here.

Roberta Speyer: You have a large team, don’t you, to support you? Tell us about that.

Dr Bian: Yes, we have a strong ICU and NICU and we work very well, we have good cooperation with pediatricians and the staff.

Dr Xu: And assistance.

Roberta Speyer: So you probably . . .

Dr Xu: Other hospitals are general.

Roberta Speyer: General hospitals, so you have a broad base. You were one of the ones that started early on with this specialty, with this peri-natology and now maternal fetal medicine. How long have you been, now girls do not like to tell our ages, you know, but you have been doing this for a long time and trained many people?

Dr Bian: Yes. I started to work with Dr Xu in 1978.

Roberta Speyer: Really? Studied under her?

Dr Bian: Yes, as a resident, then as a chief attending and associate professor and professor, then under Dr. Xu as a director of our division and after that.

Roberta Speyer: Was she tough? She taught you a lot.

Dr Bian: Yes, absolutely, of course our duration becomes stronger and we have more and more doctors and we have more staff and also we have a lot of patients referred here with very special complications so it is not so common. On occasions like that, it can appear to probably not be necessary to come to our hospital, but there are some, and also we have a very strong genetic centre, so we have a lot of patients who have genetic problems where they have some babies with birth defects so that is their pre-natal care early in our hospital. So then we have another doctor who is a Professor, Su Nehu, he is the head of genetic consultant and the pre-natal diagnosis in our hospital since 1978.

Roberta Speyer: So it is a very strong team.

Dr Bian: Yes.

Roberta Speyer: And you are getting a lot more success with the survival rates.

Dr Bian: Yes.

Roberta Speyer: And from the sounds of her phone going off, I think there might be a case waiting for you.

Dr Bian: Sorry, I forgot it.

Roberta Speyer: Even as we speak, they are calling her. So you have seen over time that the application of maternal fetal medicine and different inter-disciplinary approach has increased the success rate, the survival rate. From what age? What do you say now in your career, how many weeks of gestation can you have a success outcome compared to, let’s say, 30 years ago?

Dr Bian: Thirty years ago?

Roberta Speyer: 20, 30 years ago. What was it like then?

Dr Xu: 30 years ago? It was probably like 34, 31 weeks.

Dr Bian: 28.

Dr Xu: 28, 26. It really depends.

Roberta Speyer: And better outcomes, also, for the babies?

Dr Bian: Yes.

Dr Xu: Yes.

Roberta Speyer: Well, it is wonderful to hear about what you are doing and we appreciate your taking the time. I think you had better go take that call because there could be a baby being born at this very moment. Thank you very much.

Dr Bian: Thank you.