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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.
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Causes of Late Postpartum Hemorrhage
Late postpartum hemorrhage refers to a significant amount of vaginal bleeding that occurs two to three weeks after a cesarean section or natural childbirth. The causes of late postpartum hemorrhage include the following aspects. First, the presence of residuals in the uterine cavity, such as when the placenta or membranes remain within the uterine cavity after childbirth, can repeatedly stimulate the endometrium causing bleeding. Second, poor healing of the uterine incision during a cesarean section can lead to post-cesarean bleeding, a condition that easily causes late postpartum hemorrhage. Third, poor healing of episiotomy or perineal laceration wounds after natural childbirth can also potentially lead to late postpartum hemorrhage.
Is it dangerous for the umbilical cord to be wrapped around the neck during the mid-stage of pregnancy?
During a mid-pregnancy ultrasound, it is sometimes indicated by the presence of a U-shaped or W-shaped notch behind the fetus's neck that the fetus may have the umbilical cord wrapped around its neck. During pregnancy, it is perfectly normal for the umbilical cord to wrap around the neck, and it generally does not affect the fetus or pose any danger. The length of the umbilical cord during pregnancy is approximately 30 to 80 centimeters, which is quite long relative to the size of the uterine cavity. Hence, many umbilical cords have excess length that can wrap around the neck or limbs of the fetus, leading to the umbilical cord being coiled around the neck or limbs. However, current research indicates that whether the umbilical cord is wrapped around the neck or limbs once or twice, it does not affect the fetus. It does not cause intrauterine hypoxia or affect the growth and development of the fetus, nor does it influence the mode of delivery. A natural childbirth can still be an entirely viable option.
Symptoms of premature rupture of membranes infection
Premature rupture of membranes refers to the breaking of the fetal membrane before the onset of labor, followed by the leakage of amniotic fluid. The greatest risk of premature rupture of membranes is the potential to cause an infection in the amniotic cavity. The symptoms of infection due to premature rupture of membranes include the following aspects: First, the smell and color of the amniotic fluid will change. The amniotic fluid may become purulent and have a foul smell, which suggests an infection within the amniotic cavity. Second, blood tests can reveal elevated infection markers, primarily an increase in white blood cells and C-reactive protein well above the normal range. Third, the patient may experience contractions or lower abdominal tenderness and rebound pain. When there is an infection in the amniotic cavity, symptoms of peritonitis may occur, along with manifestations of contractions, presenting as episodic pain in the lower abdomen. These are the symptoms of infection from premature rupture of membranes.
Does a threatened miscarriage require a uterine curettage?
Threatened miscarriage, as the name suggests, refers to signs indicating a potential miscarriage. Whether a curettage is necessary in cases of threatened miscarriage mainly depends on the pregnancy outcome. For threatened miscarriage, treatment is chosen based on the patient's wishes. If the patient desires to continue the pregnancy and try to preserve it, medication can be used initially for conservation. However, if a woman experiencing threatened miscarriage does not wish to continue the pregnancy, she can opt for artificial intervention to induce the miscarriage. Miscarriage can be induced through oral medication or through a curettage procedure. Thus, curettage is not necessarily required for a threatened miscarriage, and even if the pregnancy is to be terminated, medication can be used as an alternative. Therefore, there is no inevitable connection between threatened miscarriage and curettage.
How to Control Gestational Diabetes
During pregnancy, if the pregnant woman has diabetes, it is essential to control blood sugar reasonably. Otherwise, high blood sugar can seriously affect both the fetus and the pregnant woman, and in severe cases, it can cause diabetic ketoacidosis in the pregnant woman and fetal death in utero. Diabetes in pregnant women can be intervened in the following ways: First, through dietary control, eat less sugary foods, such as sweets, pastries, and fruits. Second, it is necessary to be moderately active during pregnancy, taking a walk or maintaining 5,000 to 10,000 steps daily, which helps in the consumption of glucose in the body. Third, if the above two methods are ineffective, insulin should be used to control diabetes.
What should I do if the fetal umbilical cord is wrapped around the neck once?
During the prenatal ultrasound, it is sometimes discovered that the umbilical cord is wrapped around the fetus's neck, which concerns many pregnant women who fear it may cause fetal hypoxia in utero or affect natural childbirth. However, this concern is not accurate. Currently, in clinical practice, an umbilical cord around the neck is considered a normal physiological phenomenon. Around 30%-40% of fetuses may have the umbilical cord wrapped around their neck. It is acceptable for the umbilical cord to be wrapped around the neck once or twice, as this neither impacts the fetus's oxygen levels nor affects the mode of childbirth; natural birth can still be considered. Therefore, when the umbilical cord is wrapped around the neck once, no intervention is required. Follow the normal prenatal check-up routine and pay attention to fetal movements in daily life. As long as the fetal movements are normal, it indicates that the fetal condition in the uterus is good.
Can an ultrasound detect premature rupture of membranes?
Premature rupture of membranes (PROM) refers to the rupture of amniotic fluid before labor. The most common diagnostic method for PROM is based on the clinical symptoms of the patient, mainly intermittent vaginal discharge. PROM can be confirmed using pH test strips specific for this condition. Ultrasound can be used as an auxiliary diagnostic method for PROM because most pregnant women with PROM will show a decreased amount of amniotic fluid during an ultrasound. However, the specificity of using ultrasound to determine PROM is not strong. Although the membranes may rupture, amniotic fluid can still be continuously produced, so some pregnant women may still have a normal amount of amniotic fluid during an ultrasound. Therefore, in most cases of PROM, a reduction in amniotic fluid can be observed through ultrasound, but there are cases where the amniotic fluid level appears normal. In such instances, it's essential to analyze the patient's clinical symptoms.
What to do if the umbilical cord is wrapped around the neck once in late pregnancy?
During the late stages of pregnancy, a B-ultrasound might sometimes reveal that the fetus has the umbilical cord wrapped around its neck once. This condition is a physiological occurrence. Having the cord wrapped once around the neck does not cause intrauterine hypoxia or harm the growth and development of the fetus inside the womb. The vast majority of cases where the cord is wrapped are physiological, and whether the cord is wrapped around once or twice, there is no need for excessive worry. In the late stages of pregnancy, the most important thing when the cord is found wrapped around the neck is to monitor fetal movements. As long as the fetal movements are good, it indicates that the fetus is in a normal condition inside the womb. It is also important to keep up with regular prenatal check-ups to assess whether the fetal growth and development are normal. Additionally, it is not advised to take any action to intervene when the cord is wrapped around the neck, as neither adopting sleeping positions nor any other methods can release the cord from the neck. These methods are futile and sometimes might even harm the fetus.
What is the blood pressure for gestational hypertension?
Pregnancy-induced hypertension refers to a series of pathophysiological changes caused by elevated blood pressure in women during pregnancy. It is a severe complication of pregnancy that can have serious effects on both the mother and the fetus. The diagnostic standard for hypertension during pregnancy is the same as in non-pregnant periods, that is, a blood pressure greater than 140/90mmHg can be diagnosed as pregnancy-induced hypertension. However, pregnancy-induced hypertension can be classified based on whether it is combined with other conditions, as well as the severity of the condition. Depending on the severity, pregnancy-induced hypertension can be divided into categories such as gestational hypertension, pre-eclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed pre-eclampsia. These classifications are mainly based on the severity of the condition, and it is essential to treat pregnancy-induced hypertension with standardized care.
Premature rupture of membranes causes
Premature rupture of membranes is a common complication during pregnancy, which can easily lead to intrauterine infection of the fetus and preterm delivery. The main causes of premature rupture of membranes include the following aspects: First, the most common cause is an infection in the vagina, which then leads to an ascending infection, triggering chorioamnionitis. When chorioamnionitis occurs, the fragility of the membranes increases, making them prone to rupture, leading to the leakage of amniotic fluid. Second, the membranes can rupture due to a blunt impact on the abdomen, such as an accidental strong hit, which can cause the membranes to suddenly break, leading to premature rupture of membranes. Third, an excessive amount of amniotic fluid, due to various reasons, can increase the pressure inside the amniotic cavity, potentially leading to spontaneous rupture of the membranes. These are the various reasons for premature rupture of membranes.