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Zhang Yin Xing
Obstetrics
About me
Deputy Chief Physician, engaged in obstetrics and gynecology clinical, teaching and other work for more than 12 years, with abundant experience in obstetrics and gynecology clinical work and teaching. A member of the Obstetrics and Gynecology Medical Association of Huangshi City, has published multiple articles and monographs in domestic journals and holds patents.
Proficient in diseases
Mastering the diagnosis and treatment of common obstetrics and gynecology diseases, prevalent diseases, and difficult and critical diseases; specializing in the management of high-risk pregnancies, such as the diagnosis and treatment of hypertension in pregnancy, prenatal diagnosis, recurrent miscarriage, pregnancy complications/comorbidities, and rich experience in managing critical, urgent, and severe cases.
Voices
Does postpartum breastfeeding cause bleeding?
Bleeding caused by postpartum breastfeeding generally occurs within 42 days after delivery, during which the mother has lochia secretion. Breastfeeding promotes the secretion of oxytocin, which acts on the uterus and causes it to contract, facilitating the expulsion of lochia and aiding in the recovery of the uterus. Typically, by 42 days postpartum, the uterus has returned to its non-pregnant size and the expulsion of lochia is essentially complete. Subsequent breastfeeding is not directly related to vaginal bleeding. Another situation is due to the increase in prolactin during lactation; menstrual periods may not have fully resumed in women who are breastfeeding, and abnormal uterine bleeding may occur. As long as the amount and duration of bleeding do not exceed normal menstrual flow, no special treatment is needed.
Does vomiting and breast swelling indicate pregnancy?
In the early stages of pregnancy, common symptoms such as nausea, vomiting, fatigue, and dizziness, known as early pregnancy reactions, typically appear around six weeks after missed menstruation. Around eight weeks of missed menstruation, due to the increase in estrogen and progesterone, one might experience breast tenderness, but these are not the main criteria for diagnosing pregnancy. The first clinical symptom of pregnancy is missed menstruation. For women of childbearing age with regular menstrual cycles, a noticeable delay in menstruation of ten days should initially prompt a consideration of pregnancy. This can be confirmed through elevated levels of blood HCG, followed by an ultrasound that reveals a visible gestational sac in the uterus to confirm the diagnosis.
Frequent urination and breast pain, is this pregnancy?
Frequent urination and breast pain are not necessarily symptoms of pregnancy. During pregnancy, the forward tilting of the uterus presses on the bladder, which can cause frequent urination. Breast pain generally occurs around the eighth week of pregnancy due to an increase in estrogen and progesterone, promoting the growth of mammary ducts and tissue. However, these are not exclusive symptoms of pregnancy. To confirm pregnancy, detection through blood and urine HCG tests, as well as ultrasound scans can be used. For blood HCG levels, they can be detected as elevated about ten days after intercourse, and urine HCG can be detected about 14 days after intercourse using a pregnancy test. Around six weeks after missing a period, an ultrasound can determine if there is any pregnancy tissue in the uterus.
What to do about a threatened miscarriage?
Threatened miscarriage refers to the occurrence of a small amount of vaginal bleeding before 28 weeks of pregnancy, often dark red, with no pregnancy tissue expelled, and may include pain in the lower abdomen and back. During a gynecological examination, the cervix is closed and the membrane is unruptured, and the pregnancy can continue if the symptoms disappear after rest and treatment. In handling a threatened miscarriage, it is first necessary to analyze the causes of the miscarriage. Common causes include embryonic factors, mainly chromosomal abnormalities. If the miscarriage is caused by chromosomal abnormalities, it is mostly unavoidable. Maternal factors, such as systemic diseases in pregnant women, include increased blood pressure, severe anemia, high fever, etc. Pregnancy can mostly continue with treatment of the cause. Abnormalities in the reproductive organs, such as uterine malformations, submucous and intramural fibroids, adenomyosis, etc., can lead to miscarriage. With appropriate treatment to preserve the pregnancy, there is hope to continue the pregnancy. If due to endocrine abnormalities, such as luteal phase deficiency or hypothyroidism, supplementing with progesterone and thyroid hormones can mostly allow the pregnancy to continue. Identifying the cause of a miscarriage is extremely important, as different causes can lead to different pregnancy outcomes.
Symptoms of Gestational Diabetes
The symptoms of gestational diabetes differ from those of non-pregnancy diabetes; non-pregnancy diabetes is mainly characterized by excessive drinking, eating, urination, and weight loss. During pregnancy, excessive drinking and eating may be physiological responses due to increased appetite, and frequent urination may be caused by the enlarged uterus pressing on the bladder during early pregnancy. Weight loss is generally not apparent in gestational diabetes due to the growth of the fetus, the uterus, and the increase in amniotic fluid. For women who had a higher body mass index before pregnancy and a family history of diabetes, it is recommended to start glucose tolerance screening from the time of planning to conceive. For those who gain weight rapidly after becoming pregnant and have a significant increase in amniotic fluid, we typically conduct routine diabetes screening between 24 to 28 weeks of pregnancy. Gestational diabetes has severe impacts on the pregnant woman, the fetus, and the newborn, thus early detection and treatment are advised.
Is moxibustion useful for breech presentation and nuchal cord?
Fetal breech presentation and nuchal cord can be effectively addressed with moxibustion. Breech positions are common in early pregnancy but typically resolve to a head-first position by 32 weeks and become relatively stable. Higher incidences of breech positions are noted in cases of fetal abnormalities, twin pregnancies, abnormal amounts of amniotic fluid, uterine abnormalities, and narrow pelvis. If a breech position is still present after 32 weeks, moxibustion treatment can be considered. Moxibustion is applied at the Zhiyin acupoint (located 0.1 inches beside the nail corner on the outer side of the little toe) and is generally recommended once daily for 15 to 30 minutes, with one week constituting a treatment course. Afterward, the improvement in the fetal position can be evaluated. The purpose of using moxibustion is to promote fetal activity, which may help resolve nuchal cord entanglement during fetal movements.
Can pregnant women with gestational diabetes eat grapes?
Fruits are natural vitamins, and consuming fruits appropriately during pregnancy is extremely significant for supplementing vitamins, which can promote fetal growth. Patients with gestational diabetes are not entirely forbidden from eating fruits; however, it's essential to control the intake of fruits, ideally between 100 to 150 grams per day. Grapes are not completely off-limits, but since grapes have a high sugar content, if consumed, the quantity should be controlled to avoid eating too much. Opting for fruits like kiwis and apples, which have lower sugar content, is a better choice for those with gestational diabetes during pregnancy. Gestational diabetes can affect both the pregnant woman and the fetus. For the pregnant woman, it can increase the rate of miscarriages and is likely to complicate with gestational hypertension. Lowered immunity can lead to infections, particularly urinary and reproductive system infections, may cause excessive amniotic fluid, and increase the likelihood of difficult labor due to a larger baby. The impact on the fetus can lead to congenital disabilities, a significantly large baby, or restricted fetal growth, so it is crucial to control blood sugar levels during pregnancy. While ensuring the pregnant woman is not hungry, insulin can be used when necessary to maintain stable blood sugar levels during pregnancy.
What are the symptoms of gestational diabetes?
Diabetes during pregnancy, compared to diabetes outside of pregnancy, still presents symptoms such as polydipsia, polyphagia, and polyuria, but does not manifest as weight loss. Due to the increase in body weight from the enlarging uterus, fetus, and amniotic fluid during pregnancy, signs of weight loss are not evident. There are generally two types of diabetes in pregnancy. One is when diabetes pre-exists before pregnancy, which is termed diabetes mellitus with pregnancy; the other is when blood sugar levels were normal before pregnancy and diabetes develops during pregnancy, known as gestational diabetes. Over 90% of pregnant women with diabetes have gestational diabetes. Those with gestational diabetes have abnormal glucose metabolism, but most can return to normal after childbirth; however, the risk of developing Type 2 diabetes in the future increases.
How to prevent umbilical cord entanglement in late pregnancy
There are no effective prevention methods for nuchal cord, which is the most common form of umbilical cord entanglement where the cord wraps around the fetus's neck, limbs, or trunk. Nuchal cord occurs in 90% of these cases, frequently involving the cord wrapping around the neck once. This phenomenon can be observed in 20% of deliveries and is associated with factors such as an overly long umbilical cord, a small fetus, excessive amniotic fluid, and frequent fetal movements. An excessively long umbilical cord is mostly a physiological occurrence since the cord floats in the amniotic fluid and its actual length cannot be accurately measured, with no effective methods to prevent its occurrence. Excessive amniotic fluid and a small fetus are linked to certain pregnancy complications, such as diabetes-induced polyhydramnios and restricted fetal growth. Actively controlling blood sugar during pregnancy can prevent such issues. Frequent fetal movements are physiological for some pregnant women. Women who experience more frequent fetal movements throughout pregnancy are likely to encounter nuchal cord. Clinically, nuchal cord does not require special management unless it leads to obstructions in fetal descent, fetal distress, or variations in fetal heart rate. It does not impact delivery or fetal development.
What should I do if I get vaginitis during pregnancy?
Vaginitis during pregnancy should be actively treated, generally choosing vaginal medications. Vaginal medications typically do not enter the bloodstream and are not absorbed by the fetus, thus not affecting the growth and development of the fetus. Vaginitis during pregnancy can lead to chorioamnionitis, and intrauterine infection of the fetus may lead to premature rupture of membranes, subsequently causing preterm birth or miscarriage. During pregnancy, the vaginal environment undergoes changes. There is an increase in the number of vaginal epithelial cells and secretions, which appear as white, paste-like substances. The glycogen level in the vaginal epithelial cells rises, the lactic acid content increases, and the pH decreases, making it prone to fungal vaginitis. However, this environment is unfavorable for the growth of other pathogenic bacteria and is beneficial in preventing bacterial infections.