Mar 27, 2018
Fetoplacental insufficiency is a pathology that indicates placental dysfunction.It entails a serious threat to the life and health of the fetus, as it causes hypoxia and hypotrophy.The situation is aggravated by an increased risk of miscarriage, premature detachment of the placenta, gestosis.To diagnose the condition, ultrasound, CTG, studying utero-placental blood flow are used.Treatment can consist both in taking medications to improve this blood flow, as well as in emergency delivery.Table of contents: General information Causes of fetoplacental insufficiency Symptoms Classification Diagnosis Treatment of fetoplacental insufficiency Prognosis, risks, consequences Prevention
The placenta is a vital organ for the fetus that is completely formed by the 16th week of pregnancy .During this period, its vessels and membranes form a "hematoplacental barrier", which protects the future baby from bacteria, but this does not end its function.
The placenta provides:
- gas exchange - passes oxygen to the fetus, removing carbon dioxide;
- nutrition - transports vitamins and minerals;
- cleaning of waste products;
- preparation of the maternal organism for childbirth and lactation, synthesizing the hormones lactogen and progesterone;
- immunity - delivering maternal antibodies to the fetus to protect against infectious agents.
All functions of the placenta are implemented together.If, due to various causes, pathologies, at least one of the tasks ceases to be performed, the quality of performance of the others suffers.This is what is called fetoplacental insufficiency in pregnancy.
Please note! At every fifth pregnant pathology leads to perinatal fetal death.In others, it complicates the course of pregnancy and childbirth.
This is explained by the fact that the pathology is based on a blood flow disorder in the area where the mother vessels and fetal vessels converge.This entails structural disturbances in the placenta itself, as a result of which it begins to lose its functions.The area affected depends on how long the insufficiency is present.
Pathology is dangerous for both mother and fetus, because:
- provokes hypoxia and intrauterine growth retardation due to lack of oxygen;
- increases the risk of preterm labor;
- leads to abnormalities of labor, birth injuries;
- after birth, prevents the newborn from adapting;
- increases the risk of perinatal encephalopathy, torticollis, hip dysplasia and other pathologies;
- affects the immunity of children - they are more likely to suffer from cold and intestinal diseases.
Causes of fetoplacental insufficiency
Among the causes of fetoplacental insufficiency development, external and internal ones are distinguished.External influences both on a placenta, and on the woman.And in the latter case, the effect can be provided long before the fertilization of . This is:
- malnutrition, which leads to a deficiency of nutrients in the maternal body;
- stressful situations - they provoke the development of vascular spasm, increased blood pressure, and the release of stress hormones into the blood that affect the fetus negatively;
- living in an ecologically unfavorable region;
- work in harmful production;
- large physical exertion.
Internal, as a rule, boils down to the development of diseases in pregnant women, which include:
- hypertension or hypotension, circulatory disorders, heart defects and other cardiovascular ailments;
- kidney failure, pyelonephritis, kidney failure;
- bronchial asthma and other pulmonary diseases;
- diabetes, hyper or hypothyroidism, adrenal diseases, hypothalamus, other neuroendocrine diseases;
- anemia - due to iron deficiency, the amount of oxygen transported to the fetus is reduced;
- antiphospholipid syndrome, blood clotting disorders, which cause microthrombi in blood vessels to form in the placental vessels;
- inflammatory, viral and infectious diseases - influenza can cause miscarriage in the first trimester;
- genital pathologies - bicorne or saddle uterus, endometriosis, fibroma, endometritis, scar on the uterus;
- obstetric pathologies - rhesus conflict, placenta previa, pelvic presentation, gestosis, multiple pregnancies;
- abortion in history;
- addiction to alcohol, cigarettes and drugs;
- the age of the future childbirth( over 35 years);
- pregnancy delay, which is associated with the limited "life expectancy" of the uterus, after which its functions are lost.
Important! Most often, the development of pathology is affected not by one but several factors at once.
Fetoplacental insufficiency manifests itself in several ways. In the first trimester, it is often indicated:
- threat of miscarriage;
- intrauterine growth retardation.
In the absence of qualified assistance, everything can end with the fading of pregnancy.
In the future, with pathology, a delay in fetal development is observed.And notice this can be with the naked eye to reduce the circumference of the abdomen .The condition is accompanied by a discrepancy in the height of the standing of the uterine fundus.When the situation is aggravated, and the gas exchange function is disturbed, hypoxia is added to these symptoms.This may be indicated by increased motor activity of the child, which in time will slow down, until it subsides completely.
Please note! When a large area of the placenta( more than a third) is affected, dangerous pathologies begin to develop.
- early delivery;
- water retention or polyhydramnios;
- change in color of amniotic fluid;
- appearance of calcifications, cysts of the placenta;
- colpitis in a woman due to hormonal imbalance.
The development of fetoplacental insufficiency distinguishes :
- primary - manifests itself up to 16 weeks due to failures in implantation and placentation;
- secondary - is diagnosed after 16 weeks and is the result of external factors.
According to the clinical course, physicians identify:
- acute form - accompanied by a detachment of the placenta, especially low lying, and can occur at any period of pregnancy, including during labor;
- chronic form - arising on different terms, it, in turn, is divided into compensated, subcompensated and decompensated forms.
The compensated form is diagnosed in the case where the metabolism in the placenta is disturbed, but this does not affect the blood circulation of the .Despite the fact that this creates unfavorable conditions for the growth and development of the fetus, it can adapt to it.Medical treatment can correct the situation.
With the subcompensated form, the compensatory capabilities gradually run out and if the physicians can not find and eliminate the cause of the pathology, the next stage of the is developing.All is accompanied by a backlog in development, occurrence of complications.
The decompensated form is manifested at the moment when the compensatory possibilities are exhausted, and the further course of pregnancy is threatened. This affects the health of the fetus, which disrupts the heart and, in conjunction with severe hypoxia, increases the risk of fetal death.
Please note! With a decompensated form, three stages are identified.The first malfunction occurs only in the utero-placental blood flow.On the second one, the placenta-blood flow suffers, as a result of which violations are recorded at both levels, although they are not yet critical.At the third stage there is a direct threat to the life of the fetus.
For diagnosis, the physician prescribes:
- Ultrasound - during the examination, the specialist studies the thickness, location, maturity of the placenta, as well as the size, correspondence of the fetal growth rate to the gestation period.Along with this, the amount of amniotic fluid is measured.
- Dopplerometry - the study allows you to assess the quality of blood flow in the mother vessels and vessels of the fetus.On the basis of the data obtained, a conclusion is made about the degree of disturbances in the "mother-placenta-fetus" system.
- Cardiotocography is a method for evaluating the cardiac activity of a fetus, the results of which allow us to judge its state of health.First of all, the doctor may suspect the presence of fetoplacental insufficiency in women who are at risk, that is they have bad habits, live in unfavorable regions, work in harmful production or are in a state of constant stress.During each obstetric examination, they carefully calculated the weight gain, measured the circumference of the abdomen.
On the development of pathology may indicate: mismatch in the size of the fetal organs during pregnancy, the deafness of the tones of his heartbeat, abdominal pain in a woman, the tone of the uterus, the appearance of whites from the genital tract, bloody discharge from the vagina.
Treatment of fetoplacental insufficiency
Due to the fact that it is impossible to make up the placental reserves, it is impossible to completely cure fetoplacental insufficiency. Therapy is aimed at compensatory capabilities of the body, due to which it is possible to prolong pregnancy, allowing the fetus to continue to grow and develop.
The most common drug treatment, however, the choice of drugs and the timing of their admission in each case are determined separately. Most likely, the doctor will recommend a pregnant woman to go to the hospital.
Preference is given to drugs that affect blood circulation in the placenta, vascular tone.In connection with the increased risk of uterine tone, medications that remove it are prescribed.Progesterone is attributed to the detection of hormonal imbalance.In addition, vitamins and hepatoprotectors may be prescribed.
Forecast, Risks, Consequences
Fetoplacental insufficiency is not an indication for early delivery of .The latter is possible only in extreme cases, when therapy has not given results, or the condition of the fetus has worsened and threatens his life.
Important! The method of delivery depends on the effectiveness of therapy.According to statistics, with a compensated form, doctors do not exclude the possibility of natural childbirth, bending towards cesarean section with subcompensated.At the same time decompensated - a direct path to emergency surgery.
Possible complications of fetoplacental insufficiency:
- hypoxia in the child;
- delayed its growth and development;
- intrauterine death.
Prevent the appearance of pathology possible, eliminating adverse factors. In other words, it follows:
- to lead a healthy lifestyle;
- sleep at least 8 hours a day;
- eat right;
- take vitamins;
- to avoid stress, heavy physical labor;
- in a timely manner to identify and treat sexually transmitted diseases( even at the stage of pregnancy planning).
Fetoplacental insufficiency is a serious pathology that poses a huge danger to the health and life of the future baby.At the same time, it is not a guarantee of complications of .With early and competent treatment, the prognosis for the fetus is favorable.To appoint such treatment it is possible only after reception of results of full inspection.
Chumachenko Olga, doctor, medical reviewer