Placental insufficiency withpregnancy: causes, treatment, effects, degrees,diagnostics

Update: October 2018

Both the growth and the development of the placenta depend on how the placenta works.
fetus. Placental insufficiency during pregnancy
diagnosed in 3-4% of healthy pregnant women, and
pathology in 24 – 46% of cases. Placental insufficiency by right
is the main cause of perinatal loss (intrauterine
гибель fetus, самопроизвольное прерывание беременности) и
defines a high-risk group for both pregnancy and
and childbirth, as well as the development of pathologies in the child.

About placenta

Placenta is a temporary organ that is formed
exclusively during pregnancy (from 16 weeks) and performing a series
essential functions for successful development and growth
future child. First of all, the placenta performs gas exchange
– from mother’s blood through the uteroplacental-fetal system to
Oxygen is delivered to the future baby, and, on the contrary, carbon dioxide
поступает из кровеносной системы fetus в кровоток женщины.

Also, the placenta is involved in the delivery of nutrients to the fetus,
which are necessary for its growth. In addition, the placenta plays
the role of the endocrine organ during gestation and synthesizes a number
hormones, without which the physiological course of pregnancy would be
impossible (progesterone, placental lactogen, estrogen, hCG and
other).

But do not forget that the placenta easily misses harmful
substances (nicotine, alcohol, drugs) that
adversely affect the fetus.

What is placental insufficiency

Placental insufficiency (synonym – fetoplacental
deficiency) is called a complex symptom complex, which
due to morphological and functional changes in
placenta (that is, its functions and structure are violated).

Фетоплацентарная недостаточность fetus есть ни что иное, как
blood flow disorder in the mother-placenta-fetus system. When
significant and progressive data of placental impairment
недостаточность ведет к задержке развития fetus, а в особо тяжелых
cases causes its intrauterine hypoxia and even
doom

Classification

Placental insufficiency is classified according to several
featured:

Depending on the moment and mechanism of development:

  • primary, which is diagnosed before 16 weeks of gestation and
    due to a violation of the process of implantation and / or placentation;
  • secondary, which arose already with the existing formed
    placenta, that is, after 16 weeks under the influence of external factors,
    affecting the fetus and placenta;

Depending on the clinical course:

  • acute, usually associated with either placental abruption
    normal or low localized placenta, usually develops in
    childbirth, but can happen in any period of gestation;
  • chronic placental insufficiency occurs in any
    dates of carrying and is divided into compensated when
    there are metabolic disorders in the placenta, but no disorders
    blood circulation in the mother-placenta and fetus-placenta systems, which
    confirmed by Doppler study data, and
    decompensated placental insufficiency, which they say
    with the progression of the pathological process in the system
    fetus-placenta-mother (confirmed by doppler).

In turn, the decompensated form of pathology
divided into several degrees of placental insufficiency
(see also the degree of maturity of the placenta):

  • 1a degree, when there is a violation of blood flow only in
    uteroplacental circle;
  • 1b degree, when there is a violation of blood circulation only in
    fetal-placental circle;
  • 2 degree – blood circulation disturbance occurred in both circles,
    but they do not exceed critical values;
  • 3 степень – состояние, угрожающее жизни fetus, так как уровень
    disorders in the fetal-placental circle has reached a critical
    boundaries.

Besides, известно, что в 60% и более случаев плацентарная
insufficiency leads to intrauterine delay
development of the baby, so it is divided into:

  • placental insufficiency with VZRP;
  • фетоплацентарную недостаточность задержка развития fetus не
    detected.

See Viagra helps to save a child’s life with some
pathologies during pregnancy.

The reasons

The reasons плацентарной недостаточности fetus весьма разнообразны и
conditionally they can be divided into 2 groups:

  • endogenous, that is, acting from the inside of the body (for example,
    genetic and hormonal factors, or enzyme deficiency
    decidual membrane either bacterial and / or viral
    infections;);
  • exogenous – constitute a greater number of factors affecting
    on the fetal-placental bloodstream “outside”.

So, there are 5 main groups of causes leading to the development
this pathological condition:

Socio-household and / or natural circumstances

This group of factors includes the impact of adverse
external moments (radiation exposure, gas contamination,
electromagnetic radiation) which may affect
germ cells before pregnancy and malnutrition,
stressful situations, occupational hazards, excessive
physical activity, and the use of household chemicals. In addition to
social factors include smoking, alcohol abuse
drinks, drugs, excessive craze for strong coffee or
tea

Complicated during the gestation period

First of all it is worth mentioning preeclampsia, which in 32% of cases
leads to the development of placental insufficiency and the threat of interruption
pregnancy (50 – 77%). Also contribute to the emergence
the pathologic process described may be pererashivanie
pregnancy or pregnancy is not one fetus, placenta previa
and antiphospholipid syndrome, Rh-conflict pregnancy and
urinary infections, woman’s age (over 35 and under 18
years old).

The pathology of the reproductive system now or in
anamnesis

This group of factors includes tumors of the uterus and ovaries, disorders
menstrual cycle, multiple childbirth, and especially abortion,
fetal death during pregnancy or the birth of hypotrophic children
в anamnesis, привычное невынашивание и преждевременные роды,
infertility and inflammatory processes of the genital organs.

Chronic extragenital diseases of a woman

In 25–45% of cases, placental insufficiency is due to
chronic somatic diseases mater:

  • endocrine diseases: diabetes, diseases
    thyroid gland
  • cardiovascular pathology: heart defects, hypertension and
    hypotension
  • diseases of the lungs, blood, kidneys and others.

Congenital or hereditary diseases, both mothers and
fetus

This group includes genital malformations.
(saddle uterus, intrauterine septum, two-horned uterus),
наследственные заболевания fetus.

It should be borne in mind that in the development of this pathological
syndrome is often guilty not one factor, but their totality.

Clinical picture

Clinical manifestations of placental insufficiency depend on
its forms. In the case of chronic compensated
placental insufficiency characteristic symptoms of the disease there,
and the diagnosis is established only according to the ultrasound and Doppler.

If acute or chronic decompensated
placental insufficiency, there are clear clinical signs,
primarily those that show development
внутриутробной гипоксии fetus.

  • First, the pregnant woman feels frequent and erratic perturbations.
    fetus, а врач отмечает учащение его сердцебиения (тахикардию).
  • In the future, in the absence of treatment, movements become less frequent.
    (normally, after 28 weeks of gestation, the expectant mother should feel
    not less than 10 movements of the future baby per day), joins
    bradycardia (reduction of heartbeat).

As a rule, placental insufficiency accompanies
preeclampsia and the threat of termination of pregnancy, which is not only
the cause of its occurrence, but also the consequence (the production of
hormones placenta).

  • In the first trimester, the threat of interruption may end
    miscarriage or missed abortion.
  • At a later date due to the permanent threat of interruption
    pregnancy often ends in preterm labor,
  • In the third trimester due to impaired hormone production
    function of the placenta may be prolonged pregnancy, which
    усугубляет гипоксию fetus.

In addition, a disorder of the endocrine function of the placenta leads to
development of vaginal epithelium deficiency, which creates
favorable conditions for the intensification of opportunistic
vaginal microflora and colpitis development. Inflammatory
vaginal processes contribute to the infection of the membranes,
which is fraught with the emergence of chorioamnionitis and fetal
infection of the baby.

In addition to the failure of hormonal function of the placenta, placental
deficiency causes pathology and excretory function,
as a result of the lack of water, and in some cases
(гемолитическая болезнь fetus либо сахарный диабет матери)
polyhydramnios

But the most characteristic manifestation of decompensated
плацентарной недостаточности выступает задержка развития fetus,
what contributes to progressive hypoxia. Clinically delayed
development of the unborn child is established according to the external
obstetric study (measuring the size of the abdomen).

Indicators such as the height of the uterus and the circumference
the abdomen lags behind the current gestational age. Intrauterine form
developmental delays of the unborn child set by ultrasound.

  • For the symmetric form is characterized by proportional lag.
    веса и длины fetus, то есть все показатели в той или иной степени
    reduced.
  • Evidence of an asymmetric form of developmental delay
    непропорциональное отставание fetus в развитии, то есть длина тела
    baby in the normal range, but its weight is reduced by reducing
    circumference of the chest and abdomen (due to a decrease in
    subcutaneous adipose tissue and lag in the growth of parenchymal
    organs: lungs, liver and others).

Diagnostics

Diagnostics фетоплацентарной недостаточности начинается со сбора
history and complaints. Specifies the nature of the menstrual cycle, the presence
past pregnancies and their outcome, transferred and available
extragenital diseases. Then the general and external and
internal obstetric examinations during which the mass is measured
body and height of a woman, abdominal circumference and height of uterine standing
the bottom, the uterus tone and the condition of the cervix are assessed (immature,
ripening or mature). In addition, with internal
gynecological examination, the doctor assesses vaginal whites,
presence / absence of bleeding and smears on
vaginal microflora. If necessary, assigned tests for
hidden genital infections by PCR.

From laboratory research methods matter:

  • blood clotting;
  • OAK and OAM;
  • blood biochemistry (total protein, alkaline phosphatase, glucose,
    liver enzymes);
  • placental lactogen and oxytocinase;
  • urine to determine the amount of estriol secreted.

The last 2 analyzes are needed to evaluate the hormone-producing
function of the placenta.

Leading place in the diagnosis of the described pathological
syndrome take instrumental research methods:

УЗИ матки и fetus

When conducting an ultrasound, the size of the unborn child is estimated.
(head circumference, abdomen and chest, limb length),
which compare with normal values ​​for a given term
gestation, which is necessary to confirm the delay
развития fetus. Anatomical structures are also carefully evaluated.
fetus на предмет врожденных аномалий развития. Besides,
estimated placenta, its thickness and location, relation to
internal throat and pathological structures (nodes of fibroids and
postoperative scar). Thinning or thickening of the placenta, and
the presence of pathological changes in it (calcinates, heart attacks,
cysts and others) indicate the presence of its failure. In
ultrasound scan time is important to assess the degree of maturity of the placenta:

  • zero – a homogeneous placenta with a flat “maternal”
    surface (chorionic plate);
  • the first is a homogeneous placenta with small echoic sites,
    �The “maternal” surface is sinuous;
  • the second – echogenic areas become more extensive, gyrus
    �”Maternal” surface go deep into the placenta, but do not reach
    basal layer;
  • the third – the penetration of the convolutions of the “parent” surface to
    basal layer, which form circles, and the placenta itself
    acquires a pronounced lobed structure.

If 3 degree of maturity is determined at gestational age less than 38
weeks, talking about premature aging or maturation of the placenta,
which also confirms its failure. Also determined
the amount of amniotic fluid (amniotic index is calculated
liquid) and the presence / absence of little or polyhydramnios (evidence
violations of the excretory function of the placenta).

Dopplerography

The main place in the diagnosis of the described pathological
Doppler sonography is given to the syndrome (assessment of blood flow in the system
mother-placenta-fetus), which is carried out in 2 and 3 trimesters (after 18
weeks). Doplerography is considered safe and highly informative.
method, and the blood flow is estimated in the umbilical cord and uterine vessels, and
также в сосудах головного мозга fetus.

КТГ fetus

Also to confirm placental insufficiency is used
КТГ (кардиотокография) fetus – оценка частоты сердечных сокращений,
реакция сердцебиения fetus на внешние раздражители и маточные
сокращения, а также на движения самого fetus. CTG is performed with 32
weeks of gestation, and in some cases from 28. With intrauterine
страдании fetus (гипоксии) на КТГ определяется тахикардия или
bradycardia, as well as cardiac arrhythmia.

FPI treatment

With the development of placental insufficiency, the main task
treatment is prolongation of pregnancy and adequate and
timely delivery. Obligatory hospitalization subject
pregnant women with decompensated and acute placental
недостаточности, с выявленной задержкой развития fetus и при
диагностировании нарушений функционального состояния fetus по
results of CTG, ultrasound and Doppler.

  • Pregnant women are recommended full sleep (at least 8 hours in
    day) and healthy nutrition. No less necessary and
    walks in the open air. It is also necessary to abandon harmful
    habits.
  • For normalization of blood flow in the system of the placenta-fetus are assigned
    drugs that improve tissue metabolism (actovegin intravenously
    drip on 5% glucose, then in tablets, ascorbic acid,
    tocopherol, troksevazin), re-correctors (reopolyglukine,
    reosorbilact, infukol), antispasmodics and tocolytics (no-shpa,
    ginipral, sulphate magnesia, magnet-B6).
  • The introduction of aminophylline, glucose-novocaine mixture by
    intravenous infusion.
  • To improve the rheological properties of blood assigned
    antiplatelet agents (chimes, trental) and anticoagulants (fraxiparin,
    Clexane – low molecular weight heparins), which “thin” the blood,
    improve placental-fetal blood flow and prevent development
    pathological formations in the placenta.
  • The introduction of drugs that improve
    blood circulation in the brain (nootropil, piracetam) and blockers
    calcium channel (corinfar) to reduce tone uterus.
  • In order to normalize metabolism in the placenta, a reception is shown.
    hormonal drugs (utrozhestan, dufaston), vitamins (folic
    acid, cocarboxylase, ATP) and iron preparations, especially when
    detection of anemia (sorbifer, tardiferon, see iron preparations with
    anemia).
  • To restore gas exchange in the placental system
    oxygen therapy is prescribed with moistened oxygen and antihypoxants
    (cytochrome C, cavinton, mildronate). Also shown is sedation.
    drugs for removing the excitability of the brain (motherwort,
    valerian, glycine).

Therapy of placental insufficiency in the hospital
must last at least 4 weeks followed by outpatient
treatment. The entire course takes 6 – 8 weeks. Treatment effectiveness
оценивается при помощи КТГ, УЗ-сканирования fetus и плаценты и
dopplerography

Conducting childbirth

Delivery through the birth canal is carried out at
the presence of a favorable obstetric situation, a mature uterine cervix and
compensated placental insufficiency. Childbirth recommended
with anesthesia (epidural anesthesia). In the event of
the weaknesses of the generic forces are stimulated by prostaglandins, and during
second period impose obstetric forceps or held
вакуум-экстракция fetus.

Early delivery (up to 37 weeks) is indicated in the case of
lack of positive dynamics according to ultrasound (fetometric
показатели fetus) и допплерографии после 10 дней терапии, а также
при диагностированной гипотрофии fetus. If the cervix is ​​immature,
диагностирована задержка развития fetus с расстройствами его
functional state, as well as the burdened obstetric history,
age 30 years and older, cesarean section is performed.

Consequences of FPN

Pregnancy occurring against the background of placental insufficiency,
usually leads to the development of the following complications:

  • placental abruption
  • post-pregnancy;
  • высокий риск внутриутробной смерти fetus

For a child:

  • задержка развития или гипотрофия fetus и рождение маловесного
    child;
  • интранатальная гипоксия fetus, ведущая к нарушению мозгового
    blood circulation in the newborn;
  • respiratory pathology (pneumonia and pneumopathies);
  • neurological status disorders;
  • intestinal disorders;
  • propensity for colds;
  • пороки развития fetus.

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