Fetoplacental insufficiency is a complex of disorders resulting from various gynecological pathologies, as well as pregnancy complications. 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 conduct timely diagnosis and subsequent comprehensive treatment to prevent the development of complications. When conducting therapy, it is important to eliminate the underlying disease, which is why a complex of medications is used to normalize uterine blood flow and correct fetal oxygen deficiency. If necessary, early delivery is indicated.
Violation feature
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:
- the degree of change in the functioning of the placenta;
- duration and intensity of violations;
- flow period.
With the occurrence of fetoplacental insufficiency, fetal hypoxia, a delay in its growth and development can develop. In addition, the likelihood of premature delivery, birth injury to the fetus, as well as violations of labor activity increases. In a newborn child, as a result of such a violation, congenital anomalies are much more often diagnosed. Also, these babies are much more susceptible 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 the early stages of 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 complicated pregnancy.
The clinical course of the pathology can be acute or chronic. In the acute course, which may occur during pregnancy or delivery, the gas exchange of the placenta is first of all 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 fetoplacental insufficiency occurs much more often than an acute form of violation. 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 compensated chronic fetoplacental insufficiency, since during its course the fetus practically does not suffer. In this case, the ongoing pathological changes are somewhat mitigated 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 healthy baby.
A 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, it is lagging behind in development, and there is also a high risk of complications.
In obstetrics, fetoplacental insufficiency of a decompensated form is characterized by significant overstrain and the inability of a normal pregnancy. As a result of this, dangerous disturbances occur in the fetus, namely, developmental delay, deterioration of cardiac activity, severe hypoxia. His death is not excluded. 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 wide variety of causes of placental insufficiency during pregnancy. Violations can form in the presence of diseases in women:
- of cardio-vascular 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, a decrease in the level of iron in the body occurs, which leads to a violation of respiratory activity and the intake of iron to the fetus.
In the presence of diabetes, metabolism worsens significantly, hormonal disorders occur, as well as a decrease in immunity. Sclerotic vascular damage provokes a deterioration in blood flow to the placenta. In this case, delayed and premature maturation of the placenta is observed.
Among the underlying causes of placental insufficiency, the presence of infectious diseases, especially those that occur in an acute form, or worsening during pregnancy, can be distinguished. The placenta can be affected by viruses, bacteria, as well as other pathogens.
In the first trimester, an infectious lesion is often accompanied by an abortion. At later dates, local changes can be observed, which largely depend on the nature of the pathogen and the characteristics of its distribution.
Of great importance in the formation of functional impairment are various kinds of uterine pathologies, in particular, such as malformations, myometrial hypoplasia, endometriosis. Among the risk factor, uterine fibroids can be distinguished.
The degree of placental insufficiency largely depends on the severity and duration of gestosis. All these factors lead to circulatory disorders. As a result, irreversible processes are observed , as well as the functioning of the placenta.
The main symptoms
The disease can occur 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 a frozen pregnancy is observed.
At later dates, signs of fetoplacental insufficiency appear in the form of a delay in the formation of fetal organs. In this case, a decrease in the abdomen is observed. 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 disturbances for the fetus develop. Among the signs of hypoxia can be identified increased motor activity of the child at the very beginning, and then a sharp decrease in the number of movements, until their complete cessation.
Disorder of intracecretory function can lead to a baby overload or, conversely, to premature delivery. In addition, with the occurrence of such a pathology, the volume of amniotic fluid can significantly change. Changes in the placenta can be accompanied by deposition of calcifications, the formation of a placental cyst. Against the background of ongoing hormonal dysfunction and insufficient epithelial activity, colpitis often develops.
Diagnostics
To make a diagnosis, the doctor collects a history of the pregnant woman and determines the risk factors, in particular, such as age, the presence of concomitant diseases, complication of previous pregnancies. When conducting an inspection, special attention should be paid to:
- weight control;
- uterine tone;
- measuring the height of the bottom of the uterus;
- the presence of discharge from the genital tract;
- the movement of the fetus and the presence of a heartbeat.
The most important sources of diagnosis are ultrasound, dopplerometry, CTG. In each trimester of the course of pregnancy, a screening must be carried out at 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 amount of amniotic fluid present. 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.
Treatment features
Treatment of fetoplacental insufficiency of the compensated form, provided that the therapy is carried out correctly and there is no threat to pregnancy, can be done on an outpatient basis. In especially dangerous and severe cases, immediate hospitalization with a variety of 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 treatment is given to the elimination of the provoking factor and the maintenance of protective mechanisms for the continued development of the fetus. With a deterioration in the tone of the vessels of the placenta, anticoagulants and antiplatelet agents are prescribed, in particular, such as Dextran, Heparin, Pentoxifylline, Dipyridamole. To correct hypotrophy and delay the development of a child, transfusion of protein and plasma substituting solutions is required .
In the presence of hemodynamic disturbances accompanying the course of the disease, calcium antagonists are prescribed, such as Verapamil, Nifedipine, since they normalize myocardial contraction and also have a hypotensive effect. If myometrium hypertonicity is observed , antispasmodics are prescribed, in particular, Drotaverinum, a glucosonocaine mixture.
To normalize antioxidant protection and the functioning of the placenta, vitamin complexes are prescribed, as well as hepatoprotectors. Metabolic therapy requires the use of folic acid, multivitamins, thiamines, as well as glucose. In case of a threat of 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.
A pregnant woman needs to ensure a good rest. A night's sleep must necessarily be complete and at least 9-10 hours, and it is also important to protect a woman from psycho-emotional overstrain. Normal nutrition is of great importance, since it is important to get enough protein, as well as vitamins and minerals. With fetoplacental insufficiency of 1 degree, the correct treatment will achieve very good results and quickly normalize well-being. To eliminate the signs of hypoxia, special therapeutic oxygen cocktails can be prescribed. Now you can purchase a kit for their manufacture and do it yourself. The cocktail is mainly prepared on the basis of water or juice.
Delivery Feature
In case of placental insufficiency, the treatment protocol largely depends on the stage and features of the course of the disease. It is very important to choose the right tactics for labor management, which depends on many different factors. Choosing the optimal period and method of delivery will help to significantly reduce risks.
The doctor selects the methodology of childbirth purely individually, depending on the severity of the course of the violation, the state of the woman in labor and the child. Among the indications for cesarean section for up to 37 weeks, it is necessary to highlight the absence of positive dynamics after the course of therapy, as well as the delay in fetal development. In the presence of significant violations, a caesarean section for a period of 30-32 weeks can be indicated.
Placental insufficiency is not always an indication for surgery. It is possible and delivery in a natural way, under conditions such as:
- positive obstetric setting;
- normal condition of the woman and the fetus;
- good indicators of ultrasound, CT scan and Doppler.
If the doctor decides that the delivery will take place naturally, the pregnant woman is given Oxytocin for additional stimulation or an amniotomy is performed. The danger of the fetus passing through the natural birth canal is that in the process of labor, placental blood flow worsens, which, against the background of the pathology, can cause fetal death. To conduct childbirth in a natural way, you must comply with such conditions as:
- fetal presentation
- readiness of the body for childbirth;
- proportionality of the pelvis of the pregnant woman and the fetal head.
Adequate cervical maturity is of great importance for successful delivery. The decision on the method of birth of a child is made only by the attending doctor after a comprehensive diagnosis.
Possible complications
Quite often, various complications of placental insufficiency can occur. These include:
- fetal oxygen starvation;
- developmental delay of the child;
- signs of prematurity during childbirth on time;
- pathology of the newborn;
- damage to the nervous system.
Pregnant women with such disorders must undergo regular monitoring by a doctor, as well as take all prescribed vitamins and medications. With strict adherence to the rules, the risk of complications and violations is significantly reduced.
Forecast
With the occurrence of fetoplacental insufficiency in a mild form, the prognosis is quite positive. In order for the delivery to be most successful and the fetus does not have serious problems and disorders, it is necessary to conduct timely treatment of ongoing infectious diseases. In addition, early registration of pregnancy is important, as this will allow timely determination of the presence of pathologies.
Be sure to undergo regular examination by a gynecologist, taking vitamin complexes. In addition, you need to abandon bad habits, as they only exacerbate the course of violations and pathologies. With all the requirements of the doctor, positive dynamics can be achieved.
Prophylaxis
Prevention of fetoplacental insufficiency is to carefully prepare a woman for the process of bearing a child. For this, it is necessary to timely identify and adjust possible risk factors that can trigger the development of pathology. Necessarily requires more careful monitoring of pregnant women at risk of the disease.
In addition, the doctor may prescribe periodic preventive drug 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 tests.