Menu
homeBirthday

How to improve uteroplacental blood flow. Violation of the uteroplacental blood flow. How to recognize high blood pressure

The placenta is responsible for transferring nutrition and oxygen from the mother to the fetus. Thanks to her, two complex vascular systems are combined. One of them connects the placenta with the uterine arteries, and the other with the umbilical cord. In this case, the placenta serves as a barrier that protects the baby from viruses and harmful substances. It happens that during an ultrasound scan, there is a violation of blood flow during pregnancy, which can affect the development of the baby.

Doppler

Such an unusual name diagnostic procedure, revealing any pathology of blood flow in the arteries and veins. As a result, a Dopplerogram is built on specialized equipment, which displays the frequency difference between the sent and reflected signals. The study is carried out in a standard mode or with color mapping, that is, the movement of blood through the arteries is displayed in color. The latter option allows you to quickly and accurately detect even a slight violation of the uteroplacental blood flow.

Dopplerometry is carried out lying on your back or side. At the same time, a more truthful result can be obtained on the side, since on the back of many pregnant women a tone begins that provokes various pathologies. The specialist covers the area to be examined with gel and begins to drive the sensor over it.

This study is prescribed to all pregnant women along with the first (18-22 weeks) and second (32-34 weeks) screening. It can be carried out at intermediate dates if there are indications.

Causes of impaired blood flow

To identify a failure in the blood flow system, experts conduct ultrasound with Doppler ultrasound for women. This allows you to see defects in the vessels, track the amount of oxygen and useful substances coming to the fetus.

Very often, expectant mothers are interested in why there is a violation of blood flow during pregnancy. The main reasons for this condition:

  • The age of the woman (too early or, conversely, late).
  • Small interval between births.
  • Gestosis ( late toxicosis during pregnancy).
  • Neoplasms in the uterus (for example, fibroids), pathologies of the myometrium, endometriosis.
  • Diabetes.
  • Hypertension.
  • Kidney problems.
  • Intrauterine infection due to viral diseases of a woman.
  • Numerous abortions or miscarriages.
  • Anemia (lack of iron).
  • Placenta previa.
  • Rhesus conflict.
  • Problems with blood clotting leading to the formation of blood clots.

Degrees of blood flow disturbance

On this moment There are three degrees of pathology. The first degree is divided into two subspecies: 1A (impaired uteroplacental blood flow) and 1B (problems with blood circulation between the fetus and the placenta). In the second degree, there are problems with both systems ("uterus - placenta" and "placenta - fetus"). The third degree is given to those women who have serious complications with blood circulation.

The first stage of the disease can be corrected with drugs, and as a result, healthy child. In other cases, there is a risk of perinatal death.

Types of placental insufficiency

If, when carrying a baby, a violation of blood flow is detected, then doctors usually make a diagnosis. During pregnancy, such a pathology occurs quite often and can be acute or chronic form. The acute form can appear suddenly, at any moment, as a result, the fetus experiences hypoxia and may die. This is possible with premature detachment of the placenta, placental infarction, the formation of blood clots.

The chronic form is much more common than the acute form. It usually occurs after 13 weeks, and manifests itself in the third trimester. As a result, it happens premature aging placenta. Depending on the severity of the disease is compensated, decompensated, subcompensated, critical.

At the compensated stage, the baby continues to develop normally, as these changes are eliminated defense mechanisms female body. With decompensated pathology, it ceases to cope with problems, as a result of which the fetus experiences growth retardation and the subcompensated stage of the disease leads to a delay in the development of the baby, as well as to its possible death. The most difficult form is considered to be critical placental insufficiency. It does not occur very often, but its onset leads to the inevitable death of the child.

The main symptoms of the disease

Depending on the type of blood flow disorder, various symptoms may appear. Compensated placental does not manifest itself in any way, so they learn about it only during an ultrasound scan. In the acute and decompensated form, changes appear in the movements of the baby: he moves either too much, or very little. In this case, it is important to monitor this indicator (the fetus should move at least 10 times per day).

As additional features there may be slow growth of the abdomen, deficiency or excess amniotic fluid. You won’t be able to monitor this on your own, so you need to visit a doctor so that he tracks changes in measurements. It happens that a violation of blood flow accompanies preeclampsia - late toxicosis during pregnancy. To the existing symptoms, an increase in pressure, a sharp weight gain, swelling, and the excretion of protein in the urine can be added.

Most danger sign placental insufficiency- the appearance of blood from the birth canal, associated with placental abruption. In such a situation, only ambulance specialists.

Treatment of pathology

If a woman has an increased or tendency to thrombosis, most often she has a violation of blood flow. During pregnancy, treatment is prescribed only by a doctor, because you will have to take serious drugs. Most often prescribed drugs such as Curantil, Trental and Hofitol. They thin the blood and improve its movement through the arteries.

Most often, pregnant women are prescribed "Kurantil", which has been used in obstetrics for more than 15 years. The drug does an excellent job with its tasks - it normalizes blood circulation due to its thinning, prevents blood clots from forming, helps to form new vessels, and improves immunity.

Also in demand is Trental, a drug that is similar in action to Curantil. However, it has serious advantages: the drug does not dilate the vessels of the heart and continuously releases the active substance for 12 hours.

It happens that a woman has a slight violation of blood flow during pregnancy. Treatment in this case is carried out by "Hofitol" - a preparation with mineral and plant components (for example, juice of field artichoke leaves). It has a slight diuretic effect and does not harm the liver.

Methods of treatment for different degrees of pathology

The first degree of the disease involves taking drugs that improve blood circulation. Doctors will also perform dopplerometry and cardiotocography in dynamics. Research should be carried out 1-2 times in 7 days. With positive dynamics, the woman will continue to bear the baby until his birth. If the indicators worsen, it is necessary to conduct daily studies in order to prevent irreversible changes and to conduct an emergency caesarean section on time. With the normal development of the fetus, childbirth can occur naturally.

Violation of the blood flow of the 2nd degree during pregnancy is also treatable. Usually the same drugs are used as in the first case, however, the woman will be offered hospitalization. Doctors will monitor changes in the body and, if necessary, will carry out early delivery.

The third degree is not treated in any way, since irreversible consequences begin to appear. In this case, the specialists do not risk the life of the child and prescribe an emergency operation.

Prevention

Any woman can make sure that the baby develops and grows without complications. To do this, she will have to monitor her diet: it should contain a lot of vitamins, trace elements, proteins and other important substances. If a pregnant woman does not suffer from edema, then she must drink at least 1 liter of fluid daily (preferably water).

It is very important to control your weight - an increase in carrying a baby can be a maximum of 10 kg. Some women need drug prophylaxis improves blood circulation between mother and fetus. It will prevent blood flow disorders during pregnancy. It should be remembered that the life of the child will help to maintain the correct method of conducting childbirth and the timely connection of drugs.

Fibrinogen is a protein produced by the liver. It is a precursor to the synthesis of fibrin, a substance that forms a clot during blood clotting.

There is a lot of blood loss during childbirth, and this important protein helps prevent heavy bleeding. That is why a woman is prescribed a coagulogram and, if necessary, a hemostasiogram, with the help of which other serum indicators are determined.

Norm in pregnant women in the first, second and third trimester

Normal levels in expectant mothers differ from those in non-pregnant women and also vary by trimester.

If in non-pregnant women this indicator averages 3 g / l, then in expectant mothers, the norms of fibrinogen during pregnancy in trimesters look like this:

  • 1 trimester - 2.98 g / l;
  • 2 trimester - 3.1 g / l;
  • 3rd trimester - 6 g / l.

Usually, an analysis is taken from a vein for research. Don't forget that this procedure always carried out on an empty stomach, and it is also recommended to exclude physical exercise, avoid stressful situations.

Increasing the normal level and its causes

Exceeding the norm of fibrinogen during pregnancy shows that a woman has thick blood. The danger of this phenomenon is that blood clots can occur in the vessels. This also applies vascular system placenta, which can lead to fetal malnutrition and developmental delay. The child may develop signs of hypoxia.

If fibrinogen is elevated during pregnancy, this most likely happened as a result of:

  • inflammatory processes caused by infections;
  • decreased function thyroid gland;
  • tissue necrosis;
  • development of neoplasms;
  • pneumonia;
  • heart attack;

In some cases increased concentration this indicator may be an individual feature of the body, and also be the result of long-term use hormonal drugs based on estrogen before pregnancy.

In some cases, exceeding the value is possible after relatively recent operations, burns.

Sometimes an increase can be observed with improper preparation to research. As mentioned above, the level of coagulation can be affected by stress and overexertion, fatty food taken the day before, the wrong water regime.

Danger and effects on the cardiovascular system

Despite various reasons increased fibrinogen in pregnant women, too thick blood leads to the same consequences that affect both the health of the woman herself and prenatal state child.

Blood clots can lead to:

  • the development of thrombosis and thrombophlebitis;
  • placental abruption on early dates, and as a result, to a miscarriage;
  • frozen pregnancy;
  • premature birth;
  • the occurrence of gestosis;
  • blockage of the vessels of the umbilical cord and death of the fetus.

Treatment tactics: how to reduce the content

If a deviation from the norm is detected, the doctor prescribes additional examinations to identify the cause high level fibrinogen during pregnancy. Treatment is carried out in without fail. The specialist prescribes both vitamin therapy and serum-thinning drugs. In some cases, injections of drugs are carried out in the abdomen.

Adjusting your diet can also help reduce whey density.

For this (provided there is no allergic reactions) expectant mothers are recommended to consume beets daily, sea ​​kale, grapefruit, pomegranate, cranberry decoction, green tea, grape juice, sunflower seeds, red peppers, tomatoes, cucumbers. You can also prepare a decoction of chestnut, an infusion of peony root.

If a pregnant woman has serious violations associated with blood clotting, a woman is sent for observation and for childbirth in specialized perinatal centers, in which future mother prepare for childbirth and, if necessary, for surgery.

The level of this protein in the blood of pregnant women is always increased compared to those of women who do not bear a child. But if fibrinogen during pregnancy is significantly higher than normal, this is a dangerous signal that requires timely treatment. Lack of therapy and non-compliance by the expectant mother with all the doctor's prescriptions can lead to fetal growth retardation, miscarriage, and death of the pregnant woman herself.

Violation of the uteroplacental blood flow during pregnancy

Pregnant women and their relatives usually expect one answer from an ultrasound examination - what is the sex of the child. For an obstetrician-gynecologist, a research method is necessary in order to identify a violation of blood flow during pregnancy, abnormal development of the fetus in time.

The management plan and tactics of delivery depend on this. To understand the mechanisms of the disorder, it is necessary to consider the possibilities of the circulatory system between mother and child.

The structure of the uteroplacental blood flow

Mother and child are connected not only by the placenta, but also by a complex system of blood vessels. Therefore, all joint blood circulation is usually divided into levels that cannot exist in isolation, but work only in combination.

  • The central part of the system is the placenta. It provides "absorption" of maternal blood products through the villi that have grown deep into the wall of the uterus. It does not mix the blood of mother and child. Several rows of special cells form a hematoplacental barrier, which is a serious obstacle to substances unnecessary for the fetus. Through it, the spent blood returns to the venous system of the mother.
  • The second part of the blood flow is made up of branches of the uterine arteries. If before pregnancy female body they are in a collapsed state and are called spiral, then from a period of 1 month they lose the muscle layer that can cause spasm. And by four months, the arteries are transformed into full-fledged trunks filled with blood and heading to the placenta zone. It is this mechanism, useful for feeding the fetus, that can be fatal in uterine bleeding: the walls of the vessels can no longer contract.
  • Vessels in the umbilical cord form a third pathway for blood flow. There are 2 arteries and a vein. They connect the child with the placenta and form the fetal-placental circle. A decrease in blood flow at this level causes the most severe damage to the fetus.

How placental circulation is disturbed

Poor blood flow associated with the placenta is called placental insufficiency. It can occur at any stage of pregnancy in two forms.

Acute appears suddenly, even in childbirth, does not depend on the gestational age. The fetus falls into a state of hypoxia (oxygen deficiency), which threatens him with death.

The main pathological mechanisms of this condition:

  • premature detachment of the placenta;
  • myocardial infarction due to thrombus formation.

Chronic more often complicates the course of pregnancy after a 13-week period. Symptoms appear in the third trimester. The formation mechanism is the early aging of the placenta due to the deposition of fibrin on the villi.

Negative consequences in such conditions, depending on the degree of violation, can lead to the inevitable death of the fetus.

Causes of impaired blood flow during pregnancy

Various reasons can cause a violation of the uteroplacental blood flow. These include common diseases mothers:

  • neuropathology endocrine system (diabetes, diseases of the thyroid gland and adrenal glands, changes in the hypothalamus of the brain stem);
  • lung diseases (emphysema, bronchial asthma);
  • violations in cardiovascular system caused by malformations, the consequences of hypertension, a tendency to hypotension;
  • renal pathology (chronic nephritis, pyelonephritis, especially in the stage kidney failure;
  • anemia (anemia) associated with deficiency of iron, vitamins;
  • conditions accompanied by increased blood clotting contribute to increased thrombus formation in the vessels of the placenta;
  • acute and exacerbation of chronic infectious processes - cause corresponding inflammation in the placenta, vascular edema and reduced blood flow, in the first trimester this can result in a miscarriage.

The pathology of the uterus creates local conditions for inadequate blood flow:

  • any changes in the layers of the uterus (myometrium, endometrium);
  • malformations (for example, according to the type of "bicornuate", "saddle-shaped" uterus);
  • underdevelopment (hypoplasia);
  • tumor formations from muscle tissue (fibroids), especially in a nulliparous woman over the age of 35, in more young age small fibroids allow you to compensate for blood flow.

Causes of insufficient blood flow include unfavourable conditions ongoing pregnancy in the following cases:

  • multiple pregnancy;
  • Rhesus conflict;
  • preeclampsia;
  • pelvic presentation of the fetus;
  • pathological placenta previa.

The risk of impaired blood flow occurs when:

  • previous abortions;
  • smoking, alcoholism and drug addiction of the mother;
  • constant nervous situation associated with social or domestic disorder;
  • violation proper nutrition women.

Types of chronic placental insufficiency

Depending on the development of the consequences for the fetus and the ability of the mother's body to adapt, there are 4 forms or stages of chronic placental insufficiency:

  • compensation - the mother's body completely protects the fetus by improving blood flow in other ways, and the child does not feel a lack of oxygen, develops normally, is born on time and develops well;
  • subcompensation - the mother is not able to fully compensate for the lack of nutrition, and the fetus lags behind in development, there is a risk of complications, birth defects;
  • decompensation - accompanied by a complete violation of the mechanisms of adaptation, normal pregnancy impossible, the fetus has serious defects that are incompatible with viability, death in utero is very likely;
  • critical - due to severe changes in the structure of the placenta, further gestation is impossible, inevitable death occurs, any treatment is ineffective.

What degree of blood flow disturbance causes placental insufficiency?

Mapping clinical manifestations and the results of an ultrasound examination made it possible to distinguish 3 degrees of blood flow disturbance between the mother and the fetus.

The first is characterized by minimal changes at the utero-placental level, provides a "reserve" of time for about a month for treatment and full recovery without consequences, there are 2 varieties:

  • Ia - reduced only uterine placental blood flow, with unchanged fetal-placental. Manifested by a lag in the development of the fetus in 90% of cases.
  • Ib - the fetal-placental circulation suffers, and the uteroplacental circulation remains normal. The delay in the formation and development of the fetus suffers somewhat less (in 80% of cases).

The second - the violation occurs both at the level of the uterine and umbilical vessels, hypoxia can be fatal to the fetus.

The third - blood circulation indicators are at a critical level, even the reverse direction of blood flow (reverse) is possible.

For clinicians, such a classification provides an opportunity to accurately determine the level of disorders, to choose the most appropriate treatment tactics.

Symptoms of impaired blood flow

If the disturbed blood flow is compensated, then the woman does not feel any deviations, but finds out about them only after the examination.

Severe manifestations occur in acute form and chronic decompensation:

  • the motor activity of the fetus increases sharply or completely disappears (with a period of 28 weeks, normal development is accompanied by ten movements per day), this symptom requires an immediate appeal to an obstetrician-gynecologist;
  • slow increase in abdominal circumference, detected during monthly examination and measurement in antenatal clinic(associated with excessive formation or lack of amniotic fluid);
  • late toxicosis;
  • high blood pressure;
  • large weight gain;
  • swelling on the legs;
  • the appearance of protein in the urine.

Diagnostics

The most complete picture of blood circulation between the uterus and the fetus is obtained with a Doppler study, which is performed for all women three times during pregnancy.

The technique allows:

  • measure blood flow by the speed of movement of uniform elements;
  • determine its direction in the arteries and veins;
  • fix changes before clinical manifestations.

All changes are recorded on the monitor, measured by special sensors, and can be photographed in the required format.

By comparing with normal indicators, a conclusion is made about the degree of pathology. Violations can be detected at any level, in the vessels:

  • umbilical cord,
  • uterus,
  • fetus.

The doctor has time to prescribe the treatment and check it at the next examination.

Doppler sonography is a type of Doppler sonography. It is assigned for:

  • concomitant pathology of the mother;
  • suspicion of premature aging and violation of the placental barrier;
  • signs of a lot or oligohydramnios;
  • preliminary data on intrauterine retention development, the formation of congenital malformations of the fetus;
  • availability genetic diseases in family;
  • clinical symptoms of fetal hypoxia.

The examination can reveal:

  • thinning of the placenta;
  • increase in growth area;
  • intrauterine infection.

Treatment of pathology

Treatment takes into account the pathogenesis of disorders. To achieve results, it is necessary to influence all links:

  • With a slight violation of microcirculation, Hofitol is prescribed (with a mineral and plant composition), in more expressed cases- Actovegin, Petoxifylline.
  • If the mother's tendency to thrombosis and a violation of the aggregation properties of the blood is revealed, then drugs such as Curantil, Trental are indicated. They are able to improve the permeability of blood through the vessels.
  • Upon detection of a low blood pressure use Venofundin, Stabizol, ReoHES.
  • Vasodilators - No-shpa, Eufillin in injections - eliminate spastic contraction of blood vessels.
  • It is recommended to reduce the tone of the uterus with Magnesia, the drug Magne B6, this acts as an antihypoxic way to improve blood flow.
  • A group of vitamins with antioxidant action eliminates Negative consequences(vitamin E, ascorbic acid).

Medications are prescribed by a doctor. If necessary, the woman is offered hospitalization. This allows:

  • provide bed rest;
  • constantly monitor the course of pregnancy.

What can be done to prevent blood flow disorders?

Gynecologists urge women from risk groups to prepare themselves for pregnancy in advance, to prevent unplanned conception.

  • avoid emotional and physical overload;
  • eliminate bad habits;
  • organize good nutrition for a pregnant woman;
  • monitor daily walks, stay in a ventilated room;
  • study special gymnastics for pregnant women, yoga exercises;
  • control body weight, conduct monthly weighing and measurement of abdominal circumference;
  • considered more beneficial sleep on the left side, this position allows you to reduce pressure on the inferior vena cava, which runs to the right of the uterus, but in some cases, with stagnation in the kidneys, sleeping on the right side improves the outflow from these important organs.

Modern methods of diagnostics and approach to the management of pregnant women can prevent severe disorders. However, many opportunities depend on the woman herself and her desire to have a healthy heir.

Causes and treatment of high lower pressure

Cardiologists and therapists take into account the indicators of upper and lower blood pressure. To make a diagnosis of essential hypertension or essential hypertension requires a simultaneous increase in both indicators. Treatment of hypertension is carried out with the help of drugs that regulate not only upper, but also increased lower pressure.

What is lower blood pressure?

To understand the pressure indicators, you need to know how both numbers are formed:

  • upper pressure or systolic pressure illustrates the pumping function of the heart. The indicator is formed at the moment of expulsion of blood from the left ventricle, so it is higher than the lower pressure;
  • lower pressure or diastolic is fixed by the device at the time of diastole, or relaxation of the heart muscle. It is formed at the moment of closing of the aortic valve and illustrates the state of elasticity of the vessels, their tone and response to the cardiac ejection fraction.

The lower pressure is normally at the level of 60 - 89 mm. rt. Art. It can rise or fall, which characterizes different pathologies. For example, lower pressure is reduced in renal artery stenosis. It is often called "renal", since the condition of this indicator is often associated with kidney pathologies. And the upper pressure is called cardiac.

Blood pressure is determined by indicators of systolic (upper) and diastolic pressure (lower)

High lower pressure: what is the danger of the condition?

The danger of increased lower pressure lies in the pathogenetic mechanisms of the process. Gradually, the state of the body changes:

  1. The heart pumps blood in an enhanced mode, then both indicators of pressure rise or the heart pumps blood in a normal mode, then the lower pressure rises.
  2. Normal functioning of the heart and an increase or decrease in lower pressure indicate that changes in the walls have occurred in the aorta and other blood vessels. The circulatory system is in a state of tension, which leads to wear of the vessels.
  3. The wear of the vascular wall leads to the fact that it breaks and becomes the cause of a stroke or heart attack.
  4. A gradual change in the wall causes the deposition of atherosclerotic plaques on it, which also leads to strokes and heart attacks. Atherosclerosis also becomes an impetus for the development of senile dementia, a decrease in intelligence and cognitive abilities, and the appearance of type 2 diabetes mellitus.
  5. Over time, along with atherosclerotic plaques, calcifications and blood clots are deposited on the vessels. Thrombosis and thromboembolism are possible.
  6. In the kidneys, stenosis of the artery develops over time, which provokes a gradual wrinkling of the tissue or atrophy of the parenchyma of the organ. The kidneys do not remove metabolic products in the same volume, which is characterized by the development of chronic renal failure and intoxication of the body.

Diastolic pressure measures the level of blood flow pressure on the vascular membrane when the heart muscle is relaxed, when the volume of blood in the vessels decreases.

How to recognize high blood pressure?

If the lower pressure is increased, then the patient will not complain about the direct manifestations of this condition. An isolated increase in lower pressure will not manifest itself in the form of a headache or asthma attacks. Such symptoms are typical only for increased upper and lower pressure.

diastolic pressure in elevated state can be detected incidentally during the examination of the patient.

And also, over time, complaints about comorbidities and the consequences of increased lower indicators are possible in the form of:

  • memory and cognitive impairments;
  • frequent urination in small volumes (pollakiuria);
  • thromboembolism or thrombosis.

The loss of vascular elasticity is accompanied by a violation of the blood supply to organs, namely, it becomes difficult for oxygen in the composition of erythrocytes to penetrate through the vascular wall. Organ ischemia develops. This can cause the development of coronary artery disease, which in the future will provoke a heart attack against the background constant voltage in the work of the myocardium.

Raise normal indicators speaks of a constant state of tension of the vessels

Why does high blood pressure develop?

An essential increase in lower pressure occurs no more than in 25% of cases. If only the lower indicators increase, then the reason is more often in secondary diseases. An increase in lower pressure will provoke an increase in the systolic parameter in the future.

The doctor should suspect changes and examine body structures such as:

  • adrenal glands and kidneys;
  • organs of the endocrine system;
  • pituitary;
  • heart and malformations of its development;
  • neoplasms in the body that produce hormones.

It is important to determine the level of hormones, namely:

  • aldosterone;
  • cortisol;
  • thyroxine;
  • vasopressin;
  • renin.

More often, the increase occurs due to a decrease in the lumen of the renal artery, and main function kidneys - maintaining blood balance in vessels and arteries

An increase in systolic and diastolic pressure requires drug treatment. More specifically, about the pathologies that cause pressure surges:

  • Diseases of the kidneys, adrenal glands.

The kidneys contain receptors that affect the body's blood pressure. In the organs, the renin-angiotensin-aldosterone system (RAAS) is activated with the help of electrolytes and hormones, which ensures the interaction of renin, angiotensin and aldosterone. Due to them, the amount of urine excreted varies, the level of fluid and BCC in the body is regulated. Some substances are produced by the adrenal glands, for example, cortisol, corticosteroids. Mineralocorticoids of the aldosterone type have a hypertensive effect and remove potassium from the body, increasing the amount of sodium. To investigate the function of these structures, CT, excretory urography is prescribed.

  • Pathology of the thyroid gland.

Thyroid diseases are characterized not only by the influence on pressure, but also by changes in the central nervous system. Pathologies with an excess of thyroid hormones can increase lower pressure. Substances have a hypertensive effect, and also affect the state of the heart, changing the structure of the myocardium. They increase both upper and lower pressure. Influence on tonometer indicators is one of the first symptoms of thyroid damage, it appears before other signs.

  • Diseases associated with the musculoskeletal system.

An increase in upper and lower blood pressure can be explained not only by vascular pathologies. If the holes in the spine, through which the arteries pass, narrow due to pathology or injury, then the indicators on the tonometer increase, and the elasticity of the vascular wall is lost due to squeezing of the structures.

In medicine, such factors of increase are distinguished: improper functioning of the thyroid gland

  • Excessive amount of fluid in the body.

This condition is explained by the intake of excess water or the restriction of excretion of fluid associated with the kidneys. The increase in lower pressure is affected by aldosterone and the amount of sodium ions. Water is retained in the tissues of the body if you eat salty foods. Water helps dilute excess salt in the body and is not excreted in the urine. To reduce the lower pressure, you can remove the water using physical activity, the use of diuretic decoctions and drugs.

  • Atherosclerosis.

Pathology in which the elasticity of blood vessels decreases due to the deposition of lipid plaques on the vascular wall, which eventually turn into calcifications. Pathology develops over the years and does not manifest itself on early stages. Increased lower pressure is detected when there are changes on the aortic wall and hypertension joins the pathology with an increase in systolic pressure.

Changes in the vascular wall and an increase in lower pressure indicators can be provoked by autoimmune vasculitis, systemic lupus erythematosus. Diseases manifest more often in girls aged 20-25 years.

Ways to lower high diastolic pressure

If the patient is not worried about the symptoms of increased diastolic pressure, but only cares about the tonometer readings, then you can take metabolic drugs, as well as angioprotectors. Effective for cardiac and vascular activity such means as "Asparkam", "Panangin", ATP, "Tonginal". Potassium preparations nourish the myocardium and prevent it from depleting. It is important to take these drugs according to the instructions, with interruptions in the courses. Potassium in excessive amounts can cause fibrillation of the heart chambers and even stop them in systole.

Medicines are prescribed exclusively by the attending physician after a comprehensive examination

Together with potassium preparations, diuretics can be used. They are prescribed if the patient is concerned about swelling. You can make your own diuretic teas based on:

  • field horsetail;
  • bearberry;
  • raspberries and currants;
  • lingonberry leaves.

Pharmacies sell diuretic decoctions with instructions for brewing teas and how to use them. Such funds will reduce both lower and upper pressure. As diuretic medications, aldosterone antagonists are most often prescribed - Spironolactone, aka Veroshpiron. The drug begins to act after three to four days of regular use.

Often used drugs "Hypochlorothiazide", "Sidnokarb", "Torsid". They are potent, so the dosage is calculated strictly by a specialist. Means such as Triamteren, which saves potassium, increases the amount of the mineral in the body, therefore, it also requires a doctor's consultation and testing for electrolytes. Diuretics are not prescribed during pregnancy.

High blood pressure therapy

If there is an isolated or combined elevated lower pressure (from 95 mm Hg and above), then doctors prescribe centrally acting antihypertensive drugs:

  • Moxonidine is an alpha2 blocker and imidazoline receptor antagonist.

Medications are taken after a comprehensive examination

  • "Methyldopa" is an alpha2 blocker responsible for the inhibition of the sympathetic nervous system.
  • Albarel is an alpha2 blocker that suppresses sympathomimetic activity.

The drugs eliminate vasospasm by inhibiting the sympathetic nervous system and reducing the number of receptors that bind substances that increase pressure. As a result of the reception, both the upper and lower pressures decrease, the indicators normalize. You can buy the drug only on the basis of prescriptions written by a specialist.

Basic therapy high blood pressure supplemented with conventional antihypertensive drugs in the form of ACE inhibitors or ARA2. Before prescribing funds, it is important to check the degree of renal artery stenosis. A significant degree of narrowing is a contraindication to taking APA2 and ACE inhibitors. If stenosis of the renal artery is fixed, it is necessary to choose calcium antagonists or new drugs - renin antagonists. The representative of this group is Aliskiren.

As ACE inhibitors are used:

  • "Captopril",
  • "Enalapril",
  • "Lisinopril"
  • "Pyrindopril".

They are often combined with diuretics. You can take APA2 drugs in the absence of contraindications, namely:

  • "Losartan"
  • "Valsartan"
  • "Candesartan".

These groups have the least number of contraindications and side effects. They are well tolerated by patients with long-term therapy for two months.

To find out exactly what to do if the pressure (systolic or diastolic) is elevated, you need to contact your doctor, check the readings on the tonometer. You can independently keep a notebook and write down the results of examinations in it in order to track the indicator in dynamics. It is required to measure up to five times a day and at the time of ailments.

Post navigation

Blood flow disorders in the uterine arteries, umbilical cord, placenta during pregnancy (NMPK)

Currently, the assessment of uteroplacental blood flow is a mandatory study in the generally accepted standards for the management of pregnant women. Thanks to the triple ultrasound screening, which is performed on expert-class devices, obstetrician-gynecologists are able to recognize the degree of uteroplacental blood flow disorder (UTPC) in time, and, most importantly, choose the necessary tactics for managing the patient.

How is the circulatory system between mother and fetus arranged?

Many people mistakenly think that only the placenta is responsible for blood flow in the mother-fetus system. In fact, this is too superficial a judgment, because everything is much more complicated.

The uteroplacental blood flow system is an anatomically complex complex of the placenta, as well as the blood vessels of the mother and fetus.

Levels of the uteroplacental system:

  1. The main vessels that bring blood to the placental complex are the terminal branches of the uterine arteries. An interesting fact is that before pregnancy, these arteries are called “spiral”, since they contain muscle cells that can contract and close the lumen of the vessel. It is necessary during menstruation in order to quickly stop uterine bleeding. But what happens during pregnancy? Starting from 4-5 weeks of gestation, the walls of the spiral arteries undergo changes, namely, the muscle layer disappears in them. Thanks to these processes, a full blood flow to the placenta is maintained. It has been proven that already by the 16th week of pregnancy, the spiral arteries are completely transformed. However, it is precisely for this reason that obstetric bleeding is so massive, and it is so difficult to stop them, because the terminal branches of the uterine arteries no longer spasm.
  2. The placenta is the central link in the uteroplacental system. It is here that the most complex processes of blood transfer from mother to child take place. Everyone has long known the postulate that maternal and fetal blood do not mix. But how does it happen? All this is achieved due to the complex anatomical structure. The placenta is very firmly attached to the inner wall of the uterus with the help of the so-called villi. These “outgrowths” of placental tissue are, as it were, immersed in the thickness of the uterine mucosa. Placental villi penetrate into the walls of the uterine vessels and are practically “washed” by maternal blood. It is here, at the cellular level, that complex processes of diffusion of maternal and fetal blood take place, separated from each other by only a few layers of cells. This is called the "blood-placental barrier", which literally means "the barrier between the mother's blood and the placenta". In addition, it is in the placenta that two blood flows “meet”: from mother to child and vice versa. Such a complex and fragile system cannot but cause admiration!
  3. The umbilical cord vessels are the third layer in the complex system of blood flow between mother and child. The umbilical cord contains three vessels: two arteries and one vein. The hemodynamics (circulation) of the fetus is arranged in such a way that the arteries bring blood to the organs and tissues of the baby, and the vein, on the contrary, performs the function of returning blood to the placenta. Violation of blood flow at this level is called "fetal-placental", it is the most severe option for the fetus in terms of prognosis.

Video: Fetal Circulation Lecture Series

Causes that can lead to impaired blood flow in the mother-placenta-fetus system

  • in a pregnant woman. The decrease leads to an acceleration of blood flow in all vessels, including the uterine arteries. This happens for one simple reason: with anemia, the body tries to increase the delivery of oxygen to the tissues by increasing the speed of circulating blood. This is a compensatory response. The same thing happens in the utero-placental system.
  • Pathology of placental attachment (low placentation, presentation) is characterized by reduced blood flow, since in the region of the lower segment of the uterus the muscle layer is much thinner than in other areas. Similar situation develops when the placenta attaches in the area of ​​the scar on the uterus (usually after the previous caesarean section). The thinned area of ​​the scar cannot fully provide blood flow, so the amount of blood that enters the fetus may not be enough for the normal functioning of the developing organism.
  • (late toxicosis) is one of the most common causes, causing violation blood supply to the uteroplacental system, since with this obstetric complication, damage occurs small vessels.
  • Various infectious diseases transferred during pregnancy. Some microorganisms infect the placenta and cause pathological changes in its tissue, which can cause placental insufficiency.

Why is NMPK dangerous for the fetus?

– one of the main consequences of NMPK

Reduced blood supply to the fetus can cause the following obstetric complications:

  1. Decrease in weight and size (syndrome of delay prenatal development);
  2. Violation, in addition to tachycardia (rapid rhythm) and bradycardia (slow rhythm), arrhythmia can also develop as a result of a violation of the electrolyte composition of the blood;
  3. Violation of the acid-base balance in the body of the fetus (change);
  4. Pathological functioning hormonal system child;
  5. A pronounced decrease in fat depots, which is also manifested by a low body weight of the fetus;
  6. The threat of termination of pregnancy;
  7. A critical violation of blood flow can cause intrauterine death of the fetus.

Degrees of violation of uteroplacental circulation

Changes can occur at each of the levels of the system, which is the basis of the classification:

  • 1 A - characterized by changes in blood flow in one of the uterine arteries, while the rest of the parameters of the system are normal.
  • 1 B - blood circulation is disturbed at the fetal-placental level (vessels of the umbilical cord), while the indicators in the uterine arteries are within the normal range.
  • 2 - violation at the level of the uterine and umbilical vessels.
  • 3 - characterized by critical indicators, up to reverse (reverse) blood flow in the arteries.

This classification is extremely convenient for physicians, as it accurately reflects the level at which changes have occurred. In addition, the degree of violation of the uteroplacental circulation also affects the tactics of managing the patient.

At 1 degree (A and B), you can keep the pregnancy and carry out treatment conservative methods, 2 is borderline, and at grade 3, emergency operative delivery may be required.

Diagnostic methods

The "gold standard" of blood flow disorders in the mother-placenta-fetus system at the moment in obstetrics is. This method opens up opportunities for recognizing even the smallest changes, as it has high sensitivity and information content.

Doppler is a type of ultrasound, which is based on the use of the Doppler effect. The essence of the study is to measure the frequency of an ultrasonic wave reflected from moving objects. In the study of blood vessels, the moving particles are blood cells, in particular, erythrocytes, as the most numerous cells. Registration of the received data and their comparison with the norm is called dopplerography.

What are the benefits of doppler sonography?

  1. Modern ultrasound machines make it possible to examine the direction, speed of blood flow in the uterine arteries, and even intraplacental blood flow.
  2. Thanks to color mapping, it is possible to study the blood flow in vessels with different blood flow (arteries and veins) separately. Direction arterial blood on the device is reflected in red, and venous - in blue.
  3. It has been proven that the use of this method during pregnancy does not negative influence on fetal development.
  4. A unique feature of the method is the prediction of the development of pregnancy. What does this mean? Many studies have shown that disturbances in the blood flow of the uterine-placental system appear a little earlier than any clinical manifestations of fetal suffering appear (weight loss, changes in heart rhythm, etc.). And this means that with the timely diagnosis of fetal circulatory disorders, the doctor has a small amount of time to make the right decision. An example of this is the detection of a change in blood flow, which is called "dicrotic notch" in 90% of cases before the development of clinical manifestations of preeclampsia (edema, increased blood pressure, the appearance of protein in the urine). Dopplerography is widely used in obstetric practice, as it opens up the opportunity for doctors not only to recognize blood flow disorders in time, but even to prevent the development of certain pregnancy complications.

Recently, the results of the use of Doppler ultrasound are being published more and more often, not only during pregnancy, but during childbirth. The conducted studies prove that the effectiveness of contractions can be assessed by measuring the diastolic blood flow velocity in the uterine arteries. Thus, this method research can even predict weakness or impaired coordination labor activity already at the beginning of the first stage of labor.

case from practice

The non-standard situation that occurred in the maternity ward made obstetrician-gynecologists think about the use of Doppler ultrasound during childbirth.

A 25-year-old woman without any concomitant pathology was admitted to the genus. house with regular contractions every 3-5 minutes. Childbirth the first, urgent.

According to the anamnesis: the pregnancy proceeded without complications, no pathology was found on the part of the fetus, all ultrasound protocols with Doppler ultrasound were within the normal range.

The first stage of labor proceeded physiologically, with the full opening of the cervix, the woman in labor was transferred to the delivery room.

However, during the attempts, at first glance, inexplicable phenomena began to occur: the fetal heartbeat during the attempts was restored, and in the intervals between the attempts it slowed down significantly. Although, as a rule, everything happens the other way around. In this regard, it was decided to perform an ultrasound with a study of blood flow in the vessels during childbirth. The result of the study surprised everyone: in the intervals between contractions, the fetus clamped the umbilical cord with a pen, as a result of which the blood flow was significantly disturbed. As hypoxia increased in the child's body, his arms weakened, and he let go of the umbilical cord, meanwhile the blood flow was restored. Given the picture obtained, it was decided to force the management of the second stage of labor with the use of auxiliary aids. So, thanks to dopplerometry, doctors managed to avoid serious complications.

Secondary diagnostic methods

In addition to dopplerography, there are other research methods that indirectly indicate a violation of blood flow:

  • Collection of complaints. If blood circulation is disturbed, the fetus experiences hypoxia, which is manifested by an increase motor activity baby. Pregnant women usually complain about active stirring fetus.
  • Listening to the heartbeat with a stethoscope can also help in the diagnosis. Slowing down or speeding up the rhythm beyond the limits physiological norm may also be indicative of hypoxia.
  • . Registration of CTG within 40-60 minutes may be enough to diagnose signs of intrauterine fetal hypoxia.
  • Some ultrasonic indicators(premature aging of the placenta, study biophysical profile) can fix the unfavorable condition of the fetus.

Important! A slight decrease in the estimated fetal body weight on ultrasound does not necessarily indicate a developmental delay and impaired blood flow. An isolated measurement of fetal weight is not very informative, since this indicator is also largely influenced by genetic factors. Therefore, it is necessary to take into account the anthropometric indicators of the parents (height, weight) and their weight at birth. Only a combination of a decrease in fetal weight and impaired blood flow during Doppler sonography gives grounds for making a diagnosis of intrauterine growth retardation syndrome.

Treatment of uteroplacental blood flow disorders

In order to improve the blood supply to the fetus, it is necessary to influence several links of pathogenesis at once:

  1. Improvement of microcirculation. The following drugs have this property: "Pentoxifylline", "Actovegin".
  2. Maintaining normal blood flow in the vessels, eliminating low pressure blood is achieved through the use of medicines based on hydroxyethyl starch: "Stabizol", "Infucol", "Voluven", "ReoHES", "Venofundin". These drugs are an osmotic solution of starches that are able to retain fluid in the lumen of blood vessels. Their appointment is especially effective for preeclampsia, when it is necessary to transfer fluid from the intercellular to the lumen of the vessel. Thus, two goals are achieved at once: normalization of blood flow and a decrease in the severity of edema.
  3. Vasodilator drugs help to eliminate spasm of arteries and arterioles (smaller vessels). Particularly effective use "Eufillina", "No-shpy", "Magnesia" in the form of injections.
  4. A decrease in uterine tone also helps to eliminate vasospasm, hypoxia, and also maintain pregnancy in case of a threat. premature birth. In this situation, appoint "Magnesia", "Ginipral", "Magne B6".
  5. Antioxidant drugs help with undesirable consequences hypoxia. Usually prescribed "Tocopherol", "Ascorbic acid", "Hofitol".
  6. Useful intravenous administration 5% glucose solution which has detoxifying properties.
  7. The drug has a protective effect on the placenta “Essentiale”, which saturates placental tissue with phospholipids. This medicine is especially useful in placental insufficiency.
  8. When blood flow is disturbed, it is very effective to prescribe drugs that lead to the processes of activation of cellular respiration, for example "Cocarboxylases".
  9. With a combination of uterine fibroids and blood flow disorders good result showed the drug "Curantil", it is able to improve blood circulation in the vessels, and also prevents the formation of microclots. Many studies have shown that taking "Kurantil" with a large myoma prevents the development of secondary, inflammatory changes in the myoma nodes, due to the improvement of blood flow in them and the uterine-placental system.

Conclusion

The study of uteroplacental blood flow using dopplerography is a mandatory study during pregnancy. Practice shows that the use of this method has a positive effect on the prevention and treatment of many obstetric complications. However, do not forget that in order to obtain reliable and informative results, blood flow research should be carried out on expert-class devices by highly qualified specialists.

Video: about fetal hypoxia - a consequence of NMPK

During pregnancy, the expectant mother should be observed by a gynecologist so that the fetus develops properly. In the process of the body's work, disturbances may occur that affect the formation of the fetus, the doctor helps the woman to avoid unpleasant consequences. Appears in the mother's body extra circle blood circulation, and violations in this area can cause the death of the baby during pregnancy.

The circulatory system that connects the uterus, placenta and child has a different functional meaning: it supplies the baby with nutrition and oxygen, and removes the metabolic products of the fetus. The placenta is an obstacle for viruses that can enter through the mother's blood. If there is a violation of the blood supply to the placenta, this leads to placental insufficiency and impaired functionality of the placenta.

Why is blood flow disturbed?

There are reasons for this:

  1. Due to high pressure.
  2. On account.
  3. With inflammation of the lungs.
  4. With hypoxia.
  5. due to thrombosis.
  6. The presence of gynecological disorders.
  7. Due to miscarriages, abortions.

Violations are of the following types:

  1. Utero-placental.
  2. Placental.
  3. Feto-placental.

Diagnostic methods

Are there? To answer this question, it is necessary to define blood flow disorders. Dopplerometry and ultrasound should be performed. Blood flow is checked in different blood vessels of the mother and baby.

What the doctor pays attention to when making a diagnosis: a thin placenta, the presence of infections, abnormalities in the amniotic fluid.

With the help of doplerometry, three degrees of blood flow disturbance can be determined:

1 degree - easy is divided into categories:

1B - fetal-placental - uteroplacental blood flow is preserved;

Grade 2 - both blood flow systems are disturbed.

Grade 3 - circulatory disorders in a critical stage.

Doppler is carried out at any stage of pregnancy, especially when there is a suspicion of circulatory disorders.

In addition, laboratory methods for examining the blood of pregnant women are used.

Therapeutic methods

Treatment of circulatory disorders is carried out in a complex, so that there are no complications. If a pregnant woman falls into the risk category (abortion, gynecological diseases), preventive treatment, the future mother is constantly monitored. Methods of therapy are determined based on the degree of circulatory disorders.

The use of drugs that can reduce the tone in the uterus and improve blood circulation, for example, Magne-B6, depends on the individual state of the mother's body. No-shpa may also be prescribed in order to expand the vessels. In addition, the methods of therapy include drugs that help blood clotting, for example, Curantil.

A woman who has impaired blood flow is required to be admitted to inpatient treatment at 36 weeks in order to conduct prenatal diagnosis. natural childbirth a pregnant woman with impaired blood flow of the 1st degree is carried out under special supervision. For grades 2 and 3, a caesarean section is performed.

Prevention to reduce the risk of blood flow disorders:

  • Proper nutrition.
  • Getting rid of stress.
  • Walks in the open air.
  • Vitamins.

Impaired blood flow should be treated under medical supervision. If a pregnant woman behaves incorrectly, is not treated - this may be the cause of premature birth, or complications in the development of the fetus.

Violation of blood flow during pregnancy is determined using dopplerometry. The examination shows the movement of blood cells through the vessels from the mother through the placenta to the fetus. The further gestational period depends on these parameters, the doctor receives information about the lack of oxygen or nutrients which is so important for the normal development of the baby.

Blood flow during pregnancy

The circulatory system between the mother and the fetus is quite complex, so in medical practice it is customary to divide it into levels to understand the degree of damage. The main compartment of the entire blood flow system is the placental membrane, which supplies the embryo with all the necessary substances. At the same time, there is a hematoplacental barrier here, which is caused by the presence of special cells that do not allow various harmful cellular structures to pass through.

Next part uterine blood flow are spiral arteries in which there is no muscular layer and in case of significant blood loss they will not be able to contract properly. And the last structure of blood circulation between a woman and an embryo is called the vessels in the umbilical cord. There are only 2 arteries and 1 vein that connect the placenta with the fetus. Violation of blood flow during pregnancy in this fetal-placental circle causes the most severe consequences.

Causes of impaired blood flow during pregnancy

There are no reliable reasons that lead to impaired blood flow in the uterine artery. Only factors that predispose to disruptions in blood circulation between fetal development and the mother are known:
  • severe diseases of the endocrine system, diabetes mellitus or abnormalities in the work of the adrenal glands and thyroid gland;
  • insufficient functioning of the kidneys and lungs;
  • cardiovascular pathologies and hypertension;
  • anemia caused by a lack of iron, vitamins and anemia;
  • increased thrombus formation;
  • infectious diseases can cause inflammation and swelling of blood vessels, which threatens miscarriage at the beginning of gestation.
The causes of blood flow disorders during pregnancy are often associated with smoking, an atypical structure of the uterus, multiple pregnancies, they are detected in the presence of a tumor and even during stressful situations. The consequences are very dangerous for intrauterine formation, therefore, it is required timely diagnosis to normalize blood circulation.

Degrees of blood flow disorders during pregnancy

Blood flow analysis during pregnancy, as well as Doppler ultrasound, help determine several degrees of circulatory abnormalities in all vessels between a woman and an infant. At the same time, doctors pay attention to infectious lesions, anomalies in the composition amniotic fluid, the state of the placenta and other factors affecting the diagnosis.

Violation of the blood flow is:
1 degree - the uteroplacental circle functions with minimal deviation, which gives doctors time to apply drug therapy and restoration of circulatory health. In this case, the 1st degree has two subspecies:

  • the functioning of the blood flow between the fetus and the placenta is stable, and the uteroplacental circle is malfunctioning, which characterizes the 1a degree of violations;
  • violations for degree 1b are characterized by the opposite situation, when a lack of functioning is observed in the fetal-placental circle.
Deviations of the 2nd degree are caused by the observation of violations throughout the periphery of the blood flow, which means constant hypoxia in the fetus.

Grade 3 is characterized by critical marks during diagnostic measures. If poor blood flow is associated with the placenta, then this will be called placental insufficiency, and may be due to premature detachment or early aging shells.

Thus, due to the classification of disorders, doctors can see a complete diagnostic picture of the state of blood flow and prescribe the appropriate treatment.

The rate of blood flow during pregnancy - table

To assess the movement of blood in various vessels, several indicators are used:
  1. IR or resistive index is the difference between blood flow rates over the entire study period;
  2. PI or pulsation index - comparison of speeds in one cycle of blood circulation;
  3. SDO or systole-distal ratio implies an assessment of the speed between the contraction of the heart and during the "rest" period.
The table shows the borderline indicators of the norm for different periods gestation:
Vessel Index 28 weeks 32 weeks 36 weeks 40 weeks
umbilical artery FROM TO 3,1-3,7 2,8-3,4 2,4-3,0 2,2-2,5
IR 0,65-0,73 0,60-0,67 0,55-0,63 0,51-0,59
Pi 1,08-1,09 0,95-0,96 0,83-0,84 0,73-0,74
fetal aorta FROM TO 6,0-7,6 5,7-7,3 5,4-7,1 5,2-6,8
IR 0,82-0,88 0,80-0,86 0,77-0,83 0,75-0,81
Pi 1,79-2,24 1,76-2,20 1,74-2,17 1,72-2,13
internal carotid artery FROM TO 5,6-6,5 4,7-5,6 4,0-4,8 3,3-4,1
IR 0,78-0,88 0,74-0,84 0,71-0,81 0,69-0,78
Pi 1,98-2,39 1,7-2,06 1,44-1,77 1,22-1,51
Uterine artery FROM TO 1,7-1,9 1,7-1,9 1,7-1,9 1,7-1,9
IR 0,46-0,55 0,69-0,86 0,69-0,86 0,69-0,86
Pi 0,69-0,86 0,69-0,86 0,69-0,86 0,69-0,86

If the norm is exceeded in the arteries of the uterus, then this indicates an insufficient supply of oxygen to the baby, in the umbilical cord - indicates the presence of preeclampsia and vascular insufficiency. When observing deviations in the aorta, a diagnosis of an abnormal state of intrauterine development is made, additional tests will be required to normalize the vital signs of the fetus.

To improve blood flow, a drug is used that relaxes the muscles of the uterus in individually, most often prescribed Ginipral, Magne-B6 or Eufillin. Additionally, Verapamil or Isoptin is used to reduce tachycardia.

To normalize blood flow, it is also necessary to balance the woman's diet, food, and in general, the daily menu should contain the maximum amount of vitamins and nutrients. It is necessary to reduce the emotional and physical load of the body so that the blood circulation parameters stabilize.