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147
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
Can premature rupture of membranes heal?
Premature rupture of membranes refers to the rupture of the membranes before labor, causing the leakage of amniotic fluid. In clinical practice, once premature rupture of membranes is confirmed, it is impossible for the membranes to heal again, as currently, there are no methods available to repair or suture the membranes. The treatment for premature rupture of membranes mainly involves preserving the pregnancy, suppressing contractions, and anti-infection therapy, without any expectation of curing the condition by healing the ruptured membranes. Once ruptured, the membranes cannot be healed again. Some patients, after experiencing premature rupture of membranes, may suddenly find that they are no longer leaking amniotic fluid and believe that it has healed. This scenario could be possible for several reasons: the first is that premature rupture of membranes may have not occurred in the first place, and the previous vaginal discharge could have been vaginal secretions; the second is that the amniotic fluid volume might be very low, with little amniotic fluid leaking out, which is a dangerous situation that requires prompt termination of the pregnancy.
Can you have a bowel movement if the membranes rupture early?
Premature rupture of membranes refers to the rupture of the amniotic sac before the onset of labor. After the premature rupture of membranes, amniotic fluid continuously leaks out, and there is a possibility of complications such as umbilical cord prolapse, placental abruption, and fetal intrauterine hypoxia. After the premature rupture of membranes, whether it is immediate delivery or treatment to prolong the pregnancy, the patient generally must not engage in out-of-bed activities. It is necessary for women with premature rupture of membranes to rest in bed, and one of the most important requirements is to manage urination and defecation while in bed. Although using a bedpan is uncomfortable and many women find it hard to adapt, it is unavoidable. This is because standing after the rupture of membranes can lead to excessive loss of amniotic fluid and increase the risk of umbilical cord prolapse and placental abruption; therefore, it is necessary to use a bedpan for bowel movements while remaining in bed.
Can an intrauterine device be removed if there is endometritis?
When endometritis occurs, because there is inflammation locally, intrauterine operations cannot be performed, thus the intrauterine device (IUD) cannot be removed. The symptoms of endometritis can include the discharge of purulent secretions from the vagina and tenderness in the lower abdomen, and it can even lead to systemic infection symptoms such as fever. If one wishes to remove the IUD, it is essential to carry out standard anti-inflammatory treatment using antibiotics to treat the inflammation, and the IUD can only be removed after the symptoms have alleviated. The alleviation of symptoms primarily includes the following aspects: First, there is no longer pus discharge from the vagina. Second, there is no longer tenderness or rebound pain in the lower abdomen. Third, there are no symptoms of systemic fever or others. When removing the IUD, comprehensive disinfection should be noted to avoid causing a recurrence of endometritis or spreading the inflammation.
The harms of premature rupture of membranes infection
After premature rupture of membranes, because the amniotic cavity is open, some pathogens can cause intrauterine infections through ascending infections. If an infection occurs after premature rupture of the membranes, the harm caused mainly affects the mother and fetus, divided into the following two aspects: First, the impact on the fetus is that it is easy for the fetus itself to become infected, which can lead to congenital neonatal infections after birth, and in severe cases, it may cause fetal death. Second, it can cause maternal infection. If the infection is only limited to the amniotic cavity, sometimes the impact on the mother is not significant. However, if the infection spreads locally, such as into the pelvic cavity, or spreads through the bloodstream, it can cause a systemic inflammatory response, sometimes causing high fever, and in severe cases, it can lead to septic shock.
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.