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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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Will the gestational sac shrink if the embryo stops developing?
Embryo arrest, also known as missed abortion, refers to a condition in the early stages of pregnancy where the gestational sac does not develop normally due to various factors. Generally, the gestational sac will not begin to shrink until the embryo has been arrested for a considerable period. In the initial stages of embryo arrest, since the duration is relatively short, the trophoblastic cells within the gestational sac can still secrete estrogens, progesterone, and chorionic gonadotropin. These hormones stimulate the possible continued growth of the gestational sac in the short term. However, as the duration of the embryo arrest extends, the proliferation of the trophoblastic cells decreases, leading to a decline in hormone levels in the body. This reduces the stimulation to the gestational sac, causing it to gradually shrink, decrease in size, and possibly leading to a natural miscarriage.
Can an ultrasound detect an embryonic arrest?
Embryonic arrest refers to a condition in early pregnancy where no fetal heartbeat appears in the gestational sac. The diagnostic criteria mainly include the lack of observable primitive heart tube pulsation via ultrasound after two months of pregnancy, at which point embryonic arrest can be confirmed. The definitive diagnosis of embryonic arrest is primarily through ultrasound. The following situations observed during an ultrasound can lead to a diagnosis of embryonic arrest: 1. If the diameter of the gestational sac exceeds three centimeters without a clear fetal heartbeat or embryo visible inside, it can be diagnosed as embryonic arrest. 2. If an embryo is already present and approximately 10 days after the appearance of the embryo, an ultrasound still does not show a fetal heartbeat, this situation can also be determined as embryonic arrest.
Can a threatened miscarriage have a transvaginal ultrasound?
Whether or not to perform a transvaginal ultrasound during a threatened miscarriage mainly depends on the symptoms of the threatened miscarriage. A threatened miscarriage refers to the signs of a potential miscarriage, with common symptoms including vaginal bleeding and severe abdominal pain. If there is significant abdominal pain, a transvaginal ultrasound can be performed to determine the position of the gestational sac, or an abdominal ultrasound can also be done. If there is vaginal bleeding, performing a transvaginal ultrasound in this case may aggravate stimulation to the uterus and can easily lead to vaginal inflammation. In such cases, an abdominal ultrasound is generally recommended. Therefore, a transvaginal ultrasound can be performed if there is only abdominal pain during a threatened miscarriage, but it should not be done if there is concurrent vaginal bleeding.
Is embryonic arrest related to emotions?
Embryonic arrest refers to a condition during early pregnancy, around 9-10 weeks, where no fetal heartbeat is detected. In clinical practice, there are many causes of embryonic arrest, including chromosomal abnormalities, uterine malformations, infections, immune factors, and coagulation factors. However, many women do not investigate these reasons after experiencing embryonic arrest. Instead, they look for causes in their daily lives, such as dietary factors or emotional factors. In reality, embryonic arrest is generally not closely related to everyday life factors. Even if emotions fluctuate, such as becoming irritable or easily provoked, which might affect the gestational sac, such impacts usually manifest as symptoms of threatened miscarriage, but generally do not lead to embryonic arrest. Therefore, there is generally no correlation between embryonic arrest and emotional states.
Does postpartum hemorrhage require a blood transfusion?
The definition of postpartum hemorrhage is bleeding greater than 500 milliliters approximately 24 hours after vaginal delivery. Whether blood transfusion is necessary for postpartum hemorrhage mainly depends on the specific amount of bleeding. For average women, if the hemoglobin level is normal before delivery and the bleeding is between 500-1000 milliliters, the body can compensate for the anemia through normal adjustments, and generally, a blood transfusion is not required. However, if the bleeding exceeds 1000 milliliters, this situation is considered massive hemorrhage and must be treated with a blood transfusion, otherwise it may lead to hemorrhagic shock or DIC (Disseminated Intravascular Coagulation).
Can a miscarried embryo be expelled naturally?
Embryonic arrest refers to the lack of natural development of the gestational sac in early pregnancy, characterized by the absence of a fetal heartbeat. If there is still no fetal heartbeat or embryo detected during an ultrasound at 8-9 weeks of pregnancy, it should be diagnosed as embryonic arrest. After embryonic arrest occurs, the vast majority require medical intervention. Of course, some cases of embryonic arrest can resolve naturally, leading to a miscarriage. However, this is not a reliable occurrence and is relatively rare in clinical practice. Moreover, the longer the wait, the greater the potential harm to the woman's health. For embryonic arrest, once diagnosed, it is urgent to intervene medically to remove the gestational sac from the uterus, minimizing harm to the woman. Common methods include medical abortion or a dilation and curettage surgery, either of which can be chosen.
Can you have intercourse with an arrested embryo development?
It is not recommended to have sexual intercourse when embryo arrest occurs. Embryo arrest, also known as missed miscarriage, refers to the abnormal development of the gestational sac during early pregnancy, and no fetal heartbeat is detected on an ultrasound by the ninth week of pregnancy. Once embryo arrest is diagnosed in clinical practice, a dilation and curettage surgery should be performed as soon as possible to minimize the impact on the fetus. However, during embryo arrest, since the gestational sac itself is not developing normally and is unstable, it is not advisable to have sexual activity. Sexual activity could stimulate the uterus to contract, leading to bleeding, which is not conducive to managing the embryo arrest. Moreover, sexual activity can easily lead to gynecological inflammation. If sexual activity causes gynecological inflammation, it is necessary to treat the inflammation before proceeding with the abortion, which can delay the process. Therefore, it is not recommended to have sexual intercourse during embryo arrest.
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.