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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
What is the discharge from a natural miscarriage?
Miscarriage refers to the spontaneous expulsion of the gestational sac from the uterine cavity, without the need for human intervention. Human interventions mainly include medical abortion or painless surgical abortion. During a miscarriage, the gestational sac is expelled from the uterus, so the expelled material is primarily the gestational sac. The sac generally consists of white villous tissue, and during a natural miscarriage, it is essential to identify villous tissue in the pregnancy tissue in order to confirm a natural miscarriage. Besides the villous tissue, due to decidualization changes in the endometrium after pregnancy, the tissue expelled during a miscarriage also contains a certain amount of decidual tissue. Therefore, the material expelled in a natural miscarriage mainly includes the villous tissue, followed by uterine decidual tissue.
Can you have a vaginal birth if the umbilical cord is wrapped around the neck once?
Umbilical cord wrapping is a common physiological phenomenon during pregnancy, mainly because the length of the umbilical cord during pregnancy generally ranges from 30cm to 80cm, which far exceeds the length needed for fetal growth and development. Therefore, occurrences like the umbilical cord wrapping around the neck or limbs are quite normal. An umbilical cord around the neck is not an indication for cesarean section, and a vaginal delivery is entirely feasible, even if the cord wraps around the neck once or even twice. However, due to the special circumstance of the umbilical cord being wrapped around the neck, it is crucial to pay attention during the delivery process. First, it is important to monitor the fetal heart rate closely, as umbilical cord wrapping can lead to fetal hypoxia, which would be indicated by changes in the fetal heart rate. Second, preparations for an emergency cesarean section should be in place in case of an abnormal fetal heart rate, at which point a cesarean may be necessary to terminate the pregnancy.
Does teratoma affect the fetus?
Teratoma is a common benign ovarian tumor in women, and most teratomas do not affect the fetus. Since the majority of teratomas are smaller than 5cm, even under the stimulation of pregnancy, teratomas generally do not grow significantly large, and it is generally considered that small teratomas do not affect the fetus. However, if the teratoma is very large, more than 8cm, there is a risk of rupture and infection during pregnancy, which could potentially affect the fetus. For large teratomas during pregnancy, enhanced monitoring is necessary to avoid rupture and infection, in order to protect the fetus.
Will the embryo still grow if the embryo has ceased development?
Embryo arrest, also known as missed abortion, refers to the condition in early pregnancy where, due to congenital developmental defects in the gestational sac or other influencing factors, natural development does not occur, resulting in the absence of a fetal heartbeat. Once embryo arrest has been diagnosed, the embryo generally does not continue to grow, because embryo arrest means that the gestational sac has died and is gradually decaying. If a subsequent ultrasound check reveals that the embryo may have grown slightly since the previous examination, this should not be considered as growth continuation of the embryo, but rather attributed to measurement error. Therefore, once embryo arrest is detected and meets diagnostic criteria, timely re-examination may show some lengthening of the embryo. However, in the absence of a fetal heartbeat, it still needs to be treated as embryo arrest, and an abortion procedure should be promptly performed.
Can trichomonas get pregnant?
If a woman undergoing a vaginal secretion test is found to have trichomonas, she should be diagnosed with trichomoniasis. It is not recommended for women with trichomoniasis to become pregnant; they should first treat the trichomoniasis before attempting conception. If pregnancy occurs while trichomoniasis is present, the inflammation might spread through the cervix into the uterine cavity, affecting the implantation and later development of the gestational sac. Even if the gestational sac develops in the early stages, there might be complications such as intrauterine infection or premature rupture of membranes later on. Therefore, once diagnosed with trichomoniasis, treatment with medications should be initiated, typically healing within a week. After experiencing another menstrual cycle, it is then completely safe to try to conceive.
Should the uterus be removed due to severe postpartum hemorrhage?
Whether postpartum hemorrhage requires hysterectomy primarily depends on the severity of the hemorrhage and the specific causes of the postpartum hemorrhage. First, if the amount of postpartum hemorrhage is very substantial, leading to conditions like DIC in the pregnant woman, and if not removing the uterus may cause ongoing bleeding, it is essential to remove the uterus quickly to reduce vaginal bleeding. Second, if the postpartum hemorrhage is caused by issues like amniotic fluid embolism or poor contraction of the uterus, and conservative treatments are ineffective, it is also necessary to make a prompt decision to remove the uterus.
Causes of Infertility in Endometriosis
Endometriosis is a common gynecological disease that severely troubles women's daily lives. Besides causing painful menstruation, endometriosis is also a common cause of infertility. The reasons for infertility caused by endometriosis include the following aspects: First, endometriosis often leads to the formation of chocolate cysts on the ovaries, which can affect ovarian function and cause impaired ovarian function. Second, endometriosis can sometimes affect the function of the fallopian tubes, causing adhesions in the fallopian tubes. This may result in difficulties in egg pickup, preventing the sperm and egg from meeting and forming a fertilized egg in the fallopian tubes, leading to infertility.
How many times for endometrial cancer chemotherapy?
Post-surgical treatment for endometrial cancer often requires adjunct therapies, commonly including chemotherapy and radiotherapy. The frequency of chemotherapy primarily depends on whether the pathological results of the endometrial cancer reveal high-risk factors. If no high-risk factors are present, regular observation and follow-ups are generally advised. However, if high-risk factors are present, such as lymph node metastasis or local infiltration, this condition requires 4-6 cycles of chemotherapy after surgery, supplemented by radiotherapy. Thus, for endometrial cancer, if high-risk factors exist, chemotherapy is needed for 4-6 cycles; if no high-risk factors are present, chemotherapy is generally unnecessary, and regular follow-ups suffice.
How to preserve a pregnancy after embryonic arrest
Embryonic arrest, also known as missed miscarriage, refers to a condition during early pregnancy where if no fetal heartbeat is detected by ultrasound during weeks 8 to 9 of pregnancy, it should be diagnosed as embryonic arrest. Embryonic arrest indicates that the gestational sac has ceased to live, and in such cases, efforts to preserve the pregnancy are pointless as they are meaningless. However, it is important to analyze the reasons behind embryonic arrest to guide future pregnancies. Common causes of embryonic arrest include abnormalities in chromosomes, infections, immunity, and rheumatological markers. When embryonic arrest occurs, tests should be conducted targeting these indicators to clearly identify the abnormal factors, thereby guiding and potentially increasing the success rate of subsequent pregnancies.
What should a pregnant woman do if she has candidal vaginitis?
During pregnancy, changes occur in the vaginal flora of women, leading to decreased resistance in the vagina. Many pregnant women develop candidal vaginitis. Once diagnosed with candidal vaginitis, it is essential to undergo proper treatment. However, many pregnant women worry that medication might affect the fetus, which is a misconception. There are safe medications available for treating candidal vaginitis during pregnancy, and proper treatment generally does not harm the fetus. On the other hand, if candidal vaginitis is left untreated and allowed to progress, the inflammation might spread through the cervix into the uterine cavity, potentially leading to chorioamnionitis. In severe cases, it can cause premature rupture of membranes or intrauterine infection. Therefore, it is crucial for pregnant women diagnosed with candidal vaginitis to seek proper treatment.