Fetoplacental insufficiency is a complex of disorders resulting from various gynecological pathologies, as well as complications of pregnancy. The presence of such a pathology can threaten a miscarriage, a delay in the physical development of the fetus, as well as oxygen starvation.
It is important to carry out timely diagnosis and subsequent comprehensive treatment in order to prevent the development of complications. When carrying out therapy, it is important to eliminate the underlying disease, which is why a complex of medications is used to normalize uterine blood flow, correct fetal oxygen deficiency. If necessary, early delivery is indicated.
Feature of violation
Fetoplacental insufficiency during pregnancy often leads to fetal death, and also significantly worsens the course of pregnancy and delivery. The manifestation of violations, as well as complications, are largely due to factors such as:
- degree of change in the functioning of the placenta;
- duration andintensity of violations;
- percolation period.
When fetoplacental insufficiency occurs, fetal hypoxia, a delay in its growth and development, may develop. In addition, the likelihood of premature delivery, birth injuries of the fetus, as well as violations of labor activity increases. In a newborn child, as a result of the occurrence of such a disorder, congenital anomalies are much more often diagnosed. Also, these babies are much more prone to intestinal and respiratory infections.
Disease classification
According to the period of occurrence, placental insufficiency can be primary and secondary. The primary disorder occurs in early pregnancy. This occurs mainly under the influence of endocrine, infectious causes. Secondary fetoplacental is formed with an initially normal placenta under the influence of negative factors, as well as a complicated pregnancy.
The clinical course of pathology can be acute or chronic. In an acute course, which can occur during pregnancy or delivery, first of all, placental gas exchange is disturbed, which is accompanied by acute oxygen starvation and even fetal death. It is often caused by placental abruption, hemorrhage, placental infarction and thrombosis.
Chronic placental insufficiency occurs much more often than the acute form of the disorder. Its course and prognosis is determined by the reactions taking place in the body, in connection with which such types are distinguished as:
- compensated;
- subcompensated;
- decompensated;
- critical.
The most favorable is compensated chronic fetoplacental insufficiency, since during its course the fetus practically does not suffer. In this case, the ongoing pathological changes are somewhat softened due to the activation of protective mechanisms that contribute to the normal course of pregnancy. Comprehensive treatment and proper management of childbirth guarantee the possibility of bearing a completely he althy child.
Subcompensated type of placental insufficiency during pregnancy occurs when there are not enough protective resources to ensure the normal development of the fetus. With this form, there is a lag in its development, and there is also a high risk of complications.
In obstetrics, placental insufficiency of the decompensated form is characterized by significant overstrain and the impossibility of a normal pregnancy. As a result, there are dangerous disorders in the fetus, namely developmental delay, deterioration of cardiac activity, severe hypoxia. His death is not ruled out. In the presence of a critical form, the changes become irreversible and lead to the death of the child.
Causes of occurrence
There are a variety of causes of placental insufficiency during pregnancy. Violations can be formed when women have diseases:
- cardiovascular system;
- liver;
- kidney;
- blood;
- endocrine system;
- lungs.
In addition, pathologies can be caused by a number of other dangerous conditions and diseases. With anemia in a pregnant woman, there is a decrease in the level of iron in the body, which leads to a violation of respiratory activity and the flow of iron to the fetus.
In the presence of diabetes, metabolism is significantly worsened, hormonal disorders occur, as well as a decrease in immunity. Sclerotic vascular disease provokes a deterioration in blood flow to the placenta. At the same time, delayed and premature maturation of the placenta is observed.
Among the fundamental causes of placental insufficiency, one can single out the presence of infectious diseases, especially those that occur in an acute form, or worsen during pregnancy. The placenta can be affected by viruses, bacteria, and other pathogens.
In the 1st trimester, an infectious lesion is often accompanied by an abortion. At later dates, local changes may be observed, which largely depend on the nature of the pathogen and the characteristics of its distribution.
Of great importance in the formation of a functional disorder are various kinds of uterine pathologies, in particular, such as malformations, myometrial hypoplasia, endometriosis. Among the risk factors, uterine fibroids can be distinguished.
The degree of placental insufficiency largely depends on the severity and duration of preeclampsia. All these factors lead to circulatory disorders. As a result, there areirreversible processes, and the functioning of the placenta is deteriorating.
Main symptoms
The disease can manifest itself in several forms. Most often, this condition is accompanied by the likelihood of a miscarriage, a delay in the physical development of the fetus, as well as oxygen deficiency. Very often this leads to spontaneous abortion, and sometimes there is a miscarriage.
At a later date, signs of fetoplacental insufficiency appear as a delay in the formation of fetal organs. In this case, there is a decrease in the abdomen. You can determine the developmental delay using ultrasound diagnostics.
The severity of complications is largely due to the size of the affected area of the placenta. With a significant violation of blood circulation, critical disorders for the fetus develop. Among the signs of hypoxia, one can distinguish an increased motor activity of the child at the very beginning, and then a sharp decrease in the number of movements, up to their complete cessation.
Disorder of intrasecretory function can lead to over-maturity of the child or, conversely, to premature delivery. In addition, during the course of such a pathology, the volume of amniotic fluid can change significantly. Changes in the placenta may be accompanied by the deposition of calcifications, the formation of placental cysts. Against the background of ongoing disorders of hormonal function and insufficient activity of the epithelium, colpitis often develops.
Diagnostics
To make a diagnosis, the doctor collects the history of the pregnant woman and determines the factorsrisk, in particular, such as age, presence of concomitant diseases, complication of previous pregnancies. When conducting an inspection, special attention should be paid to:
- weight control;
- to tone the uterus;
- measuring the height of the uterine fundus;
- presence of secretions from the genital tract;
- fetal movement and heartbeat.
The most important sources of diagnosis are ultrasound, dopplerometry, CTG. In each trimester of the course of pregnancy, it is imperative to carry out screening, on which it is absolutely possible to determine the course of the pathology. In addition, it is quite possible to determine the possible delay in the physical development of the fetus and the volume of amniotic fluid available. According to the results of CTG, oxygen starvation can be detected.
After the diagnosis, the doctor selects the method of treatment to prevent the development of complications.
Features of treatment
Treatment of placental insufficiency of a compensated form, provided that the therapy is carried out correctly and there is no threat to the course of pregnancy, can be carried out on an outpatient basis. In especially dangerous and severe cases, immediate hospitalization to a hospital with various therapeutic measures is necessarily indicated. Given the many reasons for the development of such a pathology, there can be no single treatment regimen.
The main place in the therapy is given to the elimination of the provocative factor and the maintenance of protective mechanisms for the continuation of the development of the fetus. Atdeterioration of the tone of the vessels of the placenta, anticoagulants and antiplatelet agents are prescribed, in particular, such as Dextran, Heparin, Pentoxifylline, Dipyridamole. To correct malnutrition and delay in the development of a child, transfusion of protein and plasma-substituting solutions is required.
In the presence of hemodynamic disorders accompanying the course of the disease, calcium antagonists are prescribed, such as Verapamil, Nifedipine, as they normalize myocardial contraction, and also have a hypotensive effect. If hypertonicity of the myometrium is observed, antispasmodic drugs are prescribed, in particular Drotaverine, a glucosone-vocaine mixture.
To normalize the antioxidant protection and functioning of the placenta, vitamin complexes are prescribed, as well as hepatoprotectors. Metabolic therapy requires the use of folic acid, multivitamins, thiamines, and glucose. In case of a threatened miscarriage, tocolytics are prescribed, for example, Hexoprenaline, Fenoterol.
The decision on the time and method of delivery is made purely individually, taking into account the effectiveness of the therapy.
Pregnant woman must ensure proper rest. Night sleep must be complete and be at least 9-10 hours, and it is also important to protect a woman from psycho-emotional overstrain. A he althy diet is of great importance, as it is important to get enough protein, as well as vitamins and minerals. With fetoplacental insufficiency of the 1st degree, the correct treatment will achieve very good results.results and quickly normalize well-being. To eliminate the signs of hypoxia, special therapeutic oxygen cocktails can be prescribed. Now you can buy a kit for their manufacture and do it yourself. The cocktail is mainly made with water or juice.
Feature of delivery
In placental insufficiency, the treatment protocol largely depends on the stage and course of the disease. It is very important to choose the right tactics for conducting childbirth, which depends on many different factors. Choosing the optimal period and method of delivery will help to significantly reduce the risks.
The doctor selects the method of childbirth strictly individually, depending on the severity of the violation, the condition of the woman in labor and the child. Among the indications for caesarean section for up to 37 weeks, it is necessary to highlight the absence of positive dynamics after the course of therapy, as well as fetal growth retardation. In the presence of significant violations, a caesarean section may be indicated for a period of 30-32 weeks.
Placental insufficiency is not always an indication for surgery. Natural delivery is also possible, under conditions such as:
- positive obstetric environment;
- normal condition of woman and fetus;
- good performance of ultrasound, CTG and Doppler.
If the doctor decides that the delivery will take place naturally, then the pregnant woman is given "Oxytocin" for additional stimulationor amniotomy. The danger of the passage of the fetus through the natural birth canal is that in the process of labor, the placental blood flow worsens, which, against the background of the pathology, can provoke the death of the fetus. For natural childbirth, you need to comply with such conditions as:
- head presentation of the fetus;
- preparation of the body for childbirth;
- proportionality of the pelvis of the pregnant woman and the head of the fetus.
Sufficient cervical maturity is of great importance for a successful delivery. The decision regarding the method of giving birth to a child is taken only by the attending doctor after a comprehensive diagnosis.
Possible Complications
Quite often there can be various complications of placental insufficiency. These include such as:
- fetal oxygen starvation;
- delayed child development;
- signs of prematurity at term;
- pathology of newborns;
- damage to the nervous system.
Pregnant women with similar disorders must be regularly monitored by a doctor, as well as take all prescribed vitamins and medications. With strict adherence to the rules, the risk of complications and disorders is significantly reduced.
Forecast
With mild placental insufficiency, the prognosis is quite positive. In order for the delivery to be most successful and the fetus not to have serious problems and disorders, it is imperative to carry out timelytreatment of ongoing infectious diseases. In addition, early registration for pregnancy is important, as this will allow timely identification of the presence of pathologies.
Be sure to undergo a regular examination by a gynecologist, taking vitamin complexes. In addition, you need to give up bad habits, as they only aggravate the course of disorders and pathologies. If all the doctor's requirements are met, positive dynamics can be achieved.
Prophylaxis
Prevention of fetoplacental insufficiency is the thorough preparation of a woman for the process of bearing a child. To do this, it is necessary to timely identify and correct possible risk factors that can provoke the development of pathology. More careful monitoring of pregnant women who are at risk of developing the disease is required.
In addition, the doctor may prescribe periodic preventive medication courses. In pregnant women with a compensated form of the disease, constant monitoring of the condition and development of the fetus should be carried out using ultrasound and laboratory studies.
