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Zhang Lu
Obstetrics
About me
Graduated from the 7-year program in Clinical Medicine at Shandong University School of Medicine.
Proficient in diseases
Common obstetric diseases and various difficult miscellaneous diseases. For example, pre-eclampsia, gestational diabetes, fetal abnormalities, placental implantation, complications of twin pregnancies, gynecologic malignant tumors. Working at Qilu Hospital of Shandong University, a national key discipline.
Voices
Does premature rupture of membranes require a cesarean section?
Premature rupture of membranes refers to the rupture of the membranes before labor begins, causing amniotic fluid to leak periodically from the uterine cavity. Pregnant women with premature rupture of membranes can choose either vaginal delivery or cesarean section. Simply having a premature rupture of membranes is not an indication for cesarean section, but in some special cases of premature rupture of membranes, a cesarean section may be necessary. First, if the mother has previously had a cesarean delivery and experiences premature rupture of membranes in a subsequent pregnancy, a cesarean may be chosen; second, if the fetal position is abnormal, such as breech or transverse lies, after the rupture of membranes, a cesarean may be necessary; third, cesarean can be considered if fetal hypoxia occurs. For typical cases of premature rupture of membranes, a vaginal delivery can be attempted, but during the process, it is important to enhance fetal heart monitoring. If severe complications such as fetal hypoxia or placental abruption occur, it may be necessary to switch from vaginal delivery to cesarean section.
How to check for uterine prolapse after childbirth
During routine postnatal checks after natural childbirth, it is important to evaluate the recovery of pelvic floor function, including checking for the presence and severity of uterine prolapse. Uterine prolapse can be assessed in the following ways: First, a gynecological examination can be conducted. Through this examination, the condition of the uterine prolapse and the position of the cervix can be clearly identified and staged. Second, performing a perineal ultrasound can generally assess the condition of uterine prolapse and the state of pelvic floor function. Third, in cases of severe uterine prolapse, it is also necessary to perform a urinary system examination, such as urodynamic testing, because uterine prolapse often occurs simultaneously with bladder prolapse.
Premature birth is how many weeks?
Premature birth refers to childbirth occurring before full-term pregnancy. In contrast, the terms miscarriage, full-term birth, and post-term birth are used, differentiated mainly by the gestational weeks. Miscarriage refers to the expulsion of a fetus before 28 weeks of pregnancy, premature birth refers to expulsion between 28 and 36 weeks plus 6 days, full-term birth refers to expulsion between 37 and 41 weeks plus 6 days, and post-term birth refers to expulsion after 42 weeks of pregnancy. The definition of premature birth being set between 28 and 36 weeks plus 6 days mainly stems from the fact that during this time period, the fetus already has a significant chance of survival. However, the overall survival rate is lower than that of a full-term birth. It is crucial to promptly treat the newborn in cases of premature birth, while also preventing complications in the mother.
Is premature rupture of membranes prone to infection?
After premature rupture of membranes, various aspects of impact on both the mother and the fetus can occur, but the most important is the risk of infection. After the rupture of membranes, since the amniotic cavity is connected to the vagina through the cervix, the bacteria present in the vagina can potentially enter the amniotic cavity through the cervix and cause an infection inside the amniotic cavity. Therefore, after the rupture of membranes, the most crucial action is to prevent infection, primarily using antibiotics for treatment and closely monitoring indicators of infection. Monitoring for infection after premature rupture of membranes can be done in the following ways: first, pay attention to the characteristics of the amniotic fluid, which often has an odor in case of infection; second, monitor infection indicators, including white blood cells and C-reactive protein; third, observe if the pregnant woman exhibits any symptoms of fever.
How to recover from urinary incontinence after natural childbirth
Vaginal delivery refers to childbirth through the vagina, and while it has many benefits, it also has certain drawbacks. The biggest disadvantage is that it can cause damage to a woman's pelvic floor, leading to conditions such as uterine prolapse and bladder prolapse, which manifest as urinary leakage or incontinence. If urinary incontinence occurs after vaginal delivery, it can be addressed through the following methods: First, one can perform Kegel exercises at home. Kegel exercises are a set of movements that contract the muscles of the pelvic floor, which can help alleviate urinary incontinence, though the effect may be weak. Second, for patients with significant urinary leakage or incontinence, it is recommended to seek hospital treatment with machine-assisted therapy, primarily using electrical stimulation of the pelvic floor muscles to promote contraction and improve symptoms of incontinence. Third, if the above methods are ineffective, an evaluation of pelvic floor function should be conducted, and if necessary, pelvic floor repair surgery should be performed.
Will early engagement of the fetus lead to premature birth?
Fetal engagement refers to the leading part of the fetus having entered into the woman's pelvis. There isn't a necessary correlation between fetal engagement and preterm birth; however, fetal engagement could indicate a possibility of preterm birth or an upcoming labor. It is important to pay attention to the timing of fetal engagement and the expectant mother's sensations post-engagement. Firstly, for the vast majority of pregnant women, fetal engagement should occur after week 32 or 34. Early engagement should prompt attention to the presence of other clinical symptoms. Secondly, be mindful if there are feelings of descent or abdominal pain after the fetal engagement. Regular checks of the cervical canal length should be conducted if these sensations frequently occur. If the cervical canal is progressively shortening, it may suggest a risk of preterm birth. If there is no shortening of the cervical canal, it means that the fetal engagement and these clinical symptoms are unlikely to cause preterm birth.
Premature rupture of membranes how is it shown on ultrasound?
Ultrasound is a commonly used auxiliary method for diagnosing premature rupture of membranes. After the membranes rupture prematurely, amniotic fluid intermittently leaks out from the uterine cavity, but the production of amniotic fluid often cannot keep up with the leakage. Therefore, the majority of pregnant women with premature rupture of membranes will experience a reduction in amniotic fluid volume. Ultrasound will reveal that there is still a small amount of amniotic fluid in the amniotic cavity, but the volume is much lower than the normal range; the maximum depth of the amniotic fluid should be less than three centimeters, and the amniotic fluid index should be less than eight centimeters, which is a common occurrence. However, sometimes, if not much amniotic fluid leaks out after premature rupture of membranes, the ultrasound may sometimes show that the amniotic fluid volume is normal. In such cases, it is necessary to combine this finding with the patient's clinical symptoms to jointly determine the presence of premature rupture of membranes.
Is excessive amniotic fluid likely to cause premature birth?
Polyhydramnios is relatively common during pregnancy and can have a certain impact on the fetus. There are many reasons that can cause polyhydramnios, but regardless of the cause, polyhydramnios tends to lead to preterm birth. When there is an excessive amount of amniotic fluid, it puts significant pressure on the amniotic sac, which can easily lead to premature rupture of membranes. Premature rupture of membranes itself can stimulate the cervix, release inflammatory mediators, thereby causing contractions and symptoms of preterm labor. After the membranes rupture prematurely, infection within the uterine cavity is likely to occur, generally meaning that the possibility of keeping the pregnancy going for a long duration is unlikely. Therefore, polyhydramnios is associated with a higher risk of preterm labor. In clinical practice, if excessive amniotic fluid is detected during prenatal check-ups, it is advised to control the diet, engage in appropriate physical activities, or use other methods to keep the amniotic fluid level within the normal range.
Can postpartum hemorrhage be treated?
Postpartum hemorrhage refers to bleeding exceeding 800 or 1000 milliliters within a short period after childbirth. It is currently the leading cause of maternal mortality in clinical practice. With the improvement of clinical treatment levels and the enhancement of diagnostic capabilities for postpartum hemorrhage, the vast majority of such cases can be well-managed. The keys to addressing postpartum hemorrhage effectively are early diagnosis and early intervention, which can lead to favorable outcomes. The main causes of postpartum hemorrhage include uterine atony, retained placenta and membranes, injuries to the soft birth canal, and coagulation disorders. When significant postpartum bleeding occurs, it is crucial to carefully investigate these four aspects to identify the cause and intervene accordingly, often leading to successful treatment outcomes.
Signs of premature birth
Preterm birth refers to childbirth occurring between 28 and 36 weeks plus six days of pregnancy. The signs of preterm birth include the following aspects. First, regular contractions occur, generally defined as four contractions within 20 minutes or eight contractions within 60 minutes. Second, there may be a small amount of "show," mainly due to minor bleeding caused by the separation of the fetal membrane from the uterine wall. Third, many women experience a significant feeling of heaviness in the lower abdomen, which is caused by the descent of the fetal head. Fourth, upon examination, it can be found that the cervical canal has shortened and the cervical opening has dilated. When the above symptoms occur, there should be a high suspicion of the risk of preterm birth, and medications should be used promptly as an intervention to try to avoid the occurrence of preterm birth.