Violation of the uterine-fetal blood flow 1a degree. What to do to prevent pathology - preventive measures. What symptoms indicate blood flow disorders during pregnancy

During the bearing of a child, a unique relationship “pregnant-placenta-fetus” is formed in the body of a woman. This new structure results in a separate and very important circulatory system. Dopplerometry of the uteroplacental blood flow is necessary to assess the parameters of hemodynamics and allows, on the basis of this, to identify pathology or suggest the possibility of its occurrence.

Dopplerometry (DPM) allows, during ultrasound diagnostics, to evaluate the indicators of blood movement in any vessel of interest. The method is based on the Doppler effect, which consists in the formation of a frequency shift when ultrasound is reflected from objects that are in motion. They are blood cells moving along the vascular bed. During pregnancy, ultrasound of the DPM of the uteroplacental blood flow is of particular interest. Diagnosis is based on an assessment of the nature of blood flow in the uterine (left and right) and umbilical arteries.

Features of the study

For a pregnant woman, there is no difference in the use of the usual ultrasound screening and Doppler diagnostics. It is also carried out transabdominally with a convex probe with the pregnant woman lying on her back or on her side. With a complete examination, the duration of the diagnosis increases.

It can also be done transvaginally. With this method, the search and visualization of vessels of interest is easier. But it should be borne in mind that the values obtained may differ from the results of the transabdominal measurement. For him, tabular norms are indicated and, in the case of transvaginal Doppler, one should be guided by specially developed tables of normative parameters.

Indications

Ultrasound of blood flow during pregnancy is not a mandatory study. It is done if necessary and on the recommendation of a gynecologist.

Reasons for the appointment of ultrasound:

Kidney or heart disease vascular system, anemia in pregnant women.
Diabetes. This pathology leads to a change in the structure of the vascular wall and, as a result, a violation of blood flow.
Hypertension, as well as unstable blood pressure, causes a change in the velocity values and volume of circulating blood.
Systemic diseases and callagenesis.
Rhesus conflict between a pregnant woman and a child leads to the development of anemia in the fetus.
Operated uterus, scar after caesarean section. Attachment of the placenta in this area interferes with its normal functioning and blood supply.
Delay prenatal development or a discrepancy between the size of the fetus and the gestational age.
Myoma of the uterus. This formation requires nutrition and blood supply, which leads to the "robbing" of the placental current.
Low water or polyhydramnios.
Malformations of the fetus.
Premature maturation or aging of the placenta.
Bumps and injuries to the abdomen can lead to its exfoliation and disruption of the blood supply in the mother-fetus system.
Cord entanglement, pathology (two vessels) requires regular monitoring of blood flow.
The gestation period is more than 40 weeks.
Preeclampsia leads to disruption of the structure of small vessels and then the diffusion of nutrients for the fetus becomes more difficult.

The study of blood flow in early dates pregnancy (Ⅰ-Ⅱ trimester) is not carried out and is not a diagnostically important parameter. Until the 20th week, the formation of the placenta and uterine placental circulation, which makes it meaningless to carry out such a diagnosis earlier than this period.

Contraindications

As usual, it has no absolute restrictions. History of application both types of diagnostics do not know proven cases harmful effects on mother and fetus. However, given the fact that the use of Doppler requires high power, the method should be limited and used only when recommended.

Exam parameters

The following indicators serve as standards for evaluating the results obtained:

Resistance index (IR) - calculated by the formula IR \u003d (C-D) / C, where

C - maximum speed during systole

D is the speed at the end of diastole.

Pulsation index (PI) - calculated by the formula PI \u003d (C-D) / M, where

M - the average value of the blood flow velocity.

The systolic-diastolic ratio (SDR) is the relationship between the maximum systolic and the minimum in diastole.

It is better to calculate parameters and indices for 3-5 cardiac cycles and then set the average indicator. This will allow you to get the most reliable and objective value. The calculation of IR, PI and LMS is done for the uterine and umbilical arteries. With extended Doppler, these parameters are evaluated in a larger number of vessels (middle cerebral artery, fetal aorta and venous duct).

All presented indicators are important. The pulsation index is revealed as a linear, and not parabolic, as other parameters, dependence on vascular resistance. This makes PI universal and most commonly used. In addition, PI is relevant for assessing blood supply at zero and reverse diastolic current.

Normative values in the uterine arteries.

Pregnancy period, weeks	Resistance index	Systolic-diastolic ratio	Ripple index
20	0,372-0,703	1,987-1,917	1,03-2,04
21	0,368-0,694	1,985-1,915	0,97-1,98
22	0,365-0,687	1,982-1,914	0,92-1,91
23	0,363-0,684	1,897-1,936	0,85-1,87
24	0,357-0,676	1,895-1,934	0,82-1,78
25	0,355-0,663	1,892-1,835	0,75-1,75
26	0,352-0,653	1,815-1,854	0,72-1,69
27	0,348-0,647	1,813-1,853	0,68-1,66
28	0,348-0,643	1,811-1,851	0,62-1,64
29	0,347-0,636	1,763-1,806	0,55-1,56
30	0,346-0,624	1,762-1,802	0,54-1,54
31	0,346-0,618	1,761-1,812	0,53-1,52
32	0,344-0,614	1,713-1,760	0,51-1,49
33	0,344-0,596	1,725-1,761	0,47-1,47
34	0,341-0,592	1,763-1,755	0,47-1,47
35	0,339-0,586	1,667-1,742	0,45-1,45
36	0,337-0,581	1,664-1,741	0,44-1,45
37	0,334-0,579	1,661-1,721	0,44-1,43
38	0,332-0,577	1,678-1,719	0,41-1,42
39	0,331-0,574	1,676-1,716	0,42-1,41
40	0,326-0,571	1,674-1,714	0,42-1,41
41	0,321-0,565	1,671-1,712	0,41-1,43

Normative values in the umbilical artery.

Pregnancy period, weeks	IR	FROM TO	PI
20	0,632-0,845	3,876-3,958	1,23-1,66
21	0,625-0,832	3,873-3,956	1,17-1,54
22	0,614-0,821	3,871-3,955	1,16-1,53
23	0,606-0,821	3,871-3,952	1,08-1,42
24	0,593-0,814	3,415-3,616	0,97-1,25
25	0,583-0,805	3,411-3,613	0,97-1,34
26	0,584-0,792	3,191-3,273	0,87-1,14
27	0,573-0,791	2,886-2,946	0,87-1,12
28	0,564-0,786	2,885-2,945	0,88-1,22
29	0,551-0,782	2,883-2,944	0,89-1,16
30	0,546-0,775	2,883-2,943	0,75-1,12
31	0,538-0,764	2,881-2,941	0,72-1,08
32	0,526-0,753	2,487-2,526	0,66-1,09
33	0,514-0,747	2,484-2,523	0,58-0,94
34	0,493-0,736	2,482-2,521	0,57-0,92
35	0,482-0,723	2,432-2,456	0,54-1,03
36	0,461-0,716	2,421-2,455	0,52-1,01
37	0,443-0,706	2,414-2,451	0,53-1,02
38	0,431-0,692	2,198-2,225	0,38-1,09
39	0,423-0,681	2,196-2,223	0,36-1,08
40	0,411-0,672	2,193-2,223	0,35-1,07
41	0,406-0,664	2,191-2,221	0,34-1,03

Due to the small diameter of the vessels of interest, the determination of velocity indicators is rather difficult. In this regard, the blood flow curve is important. Image in the uterine artery in the norm (a) and in pathology (b)

the arrow indicates the pathologically altered picture

Photo in the umbilical artery (in the image (a) the normal blood flow is shown, in (b) it is the same with incorrect device settings).

dynamics is normal in both images, inappropriate device settings in image b (by frequency filter)

Violation of the uteroplacental blood flow

To simplify the understanding of this pathology and its degree, a classification has been introduced, which is based on the dependence on the level of failure.

ⅠA. Caused by problems in one uterine artery. And in other vessels the blood flow is not changed.
ⅠB. It is caused by its violation in the umbilical, against the background of this, there are no changes in the uterine with Doppler.
Ⅱ. It is characterized by failures in both.
Ⅲ . Problems are expressed significantly, there is a reverse (reverse) blood flow in the uterine and (or) in the umbilical cord arteries.

the most severe (III) degree of violation for the vessels of the umbilical cord and uterus

Correct identification of the degree of blood flow disturbance allows you to make the right choice in the tactics of pregnancy management.

Evaluation of the results

The study of the uterine arteries must be carried out from two sides. IN normal condition no significant difference was found in the scores. The index of resistance from the placenta attachment may be somewhat lower.

Video dopplerometry of the uterine arteries is normal

In the process of fetal growth and the formation of the placenta, an increase in the blood supply to the uterus is required and, as a result, an increase in the diameter of the uterine arteries and blood flow by 10 times. If this does not happen (against the background of somatic pathology or anomaly), then the fetus experiences a lack of oxygen and nutrients.

Signs of impaired blood flow in the uterine arteries:

decrease in diastolic speed;
increase in resistance index;
the appearance of a dicrotic notch on the blood flow curve.

When deciphering the results, it should be borne in mind that this violation has an unstable course. This leads to the fact that the velocity curve with a difference of several days between studies may differ.

Bilateral change in parameters is a criterion for violation of uteroplacental circulation. One-sided often indicates the development of preeclampsia or a predisposition to it.

The umbilical cord contains two arteries and one vein. First, the blood flow indicators should be identical. The violation criteria are considered to be the excess of the LMS, IR and PI more than the established norms for a given gestational age. Critical indicators of the child's condition is the detection of zero or reverse blood flow. An example of diagnostics in the umbilical artery in the video.

Artifacts and optimization

When conducting dopplerometry and identifying uteroplacental blood flow, the researcher must be sure of the accuracy of the measurements.

Incorrect determination of parameters is sometimes due to a number of errors made during diagnostics:

wrong choice of research area;
incorrect angle and control volume during measurements;
displacement of the vessel in question during fetal movement.

To exclude the possibility of overdiagnosis and omission of pathology, it is necessary to follow a number of rules for optimizing dopplerometry.

During the measurements, the pregnant woman should be in a position, the movement of the fetus is minimal or completely absent. The study is carried out taking into account respiratory movements.
Color Doppler imaging helps in determining the direction of blood flow in the vessels.
Compliance to the maximum acute angle insonation to reduce the percentage of measurement error.
Use of the maximum possible values of the control volume.
All settings (pulse repetition frequency, frequency filter) for each patient must be individual.
The measurements are reproducible, in other words, the same when re-diagnosing.
It is important to carry out dopplerometry in the established segment: in the uterine arteries - before they are divided into arcuate ones, in the umbilical arteries - in the free section of the umbilical cord. In a situation multiple pregnancy the latter are checked near the mount. In this case, the parameters of vascular resistance will have overestimated values, and standard tables are not suitable for evaluation.
In the presence of congenital anomalies in the development of the genital organs or in multiple pregnancies, the values obtained with dopplerometry differ from the tabular ones. So, for example, the only umbilical artery will have a larger diameter and the resistance indicators will become lower than acceptable. In this case, the key value belongs to the estimation of the velocity curves.

Consequences of violations of the uteroplacental blood flow

Retardation of intrauterine development.
Low birth weight of the baby.
Problems at work of cardio-vascular system(tachy- and bradycardia, arrhythmia).
Hormonal changes.
Imbalance of the acid-base environment.
Threatened abortion.
Intrauterine fetal death.

Tactics of conducting in case of violation of the IPC

As mentioned earlier, the observation of a pregnant woman in the above position directly depends on the level.

In case of failures of ⅠA degree, medical intervention is not required. It all comes down to normalizing the daily routine and nutrition of a woman. Recommended physical activity, walks on fresh air, breathing exercises.

Ⅰ Degree requires the appointment of antihypoxic therapy. In addition, it is necessary to control the coagulogram, and if increased blood clotting is detected, blood-thinning drugs are also prescribed. Doppler monitoring is carried out every two weeks or, according to indications, more often.

Ⅱ degree requires hospital monitoring and treatment. A pregnant woman is monitored around the clock, antihypoxic therapy is carried out. Dopplerometry is done every two days or daily.

Ⅲ degree is critical and requires an early delivery. For him use C-section, because natural childbirth can lead to the death of the child. In case of unacceptably short gestation periods, decisions are made individually.

The study of the blood flow system is important in the timely detection of fetal malnutrition. Optimal for this is to conduct a Doppler study during the second and third screening (20-24 and 30-32 weeks of pregnancy).

Due to the fact that the price of a Doppler study is quite high, there is no possibility of constant monitoring of blood flow for all pregnant women. To do this, use a weekly recording of a cardiotocogram starting from the 30th week (and in conditions of stationary observation - a daily check). In the presence of obvious changes in CTG, ultrasound control is carried out with an assessment of blood circulation in the "mother-fetus" system.

Article publication date: 06/19/2017

Article last updated: 12/21/2018

In this article we will talk about such a concern for many pregnant girls as a violation of the uteroplacental blood flow. Causes of circulatory disorders in the "mother-fetus" system, their symptoms, the dangers of such disorders and the possibilities for treatment.

Violations of the uteroplacental blood flow are much more correctly called the term "violation uterine fetal blood flow", since conditionally blood circulation in the "mother-fetus" system can be divided into two components:

Uteroplacental circulation.
Feto-placental blood flow.

Violations of blood flow in any of these systems or in both at once is called in obstetrics disorders of the uterine-fetal blood flow.

The conditional boundary between these two systems can be called the placenta - a temporary organ of pregnancy, formed by the growth of the chorionic villi of the embryo into the mucous membrane of the uterine wall. The placenta is a filter consisting of numerous weaves of different levels of vessels in which maternal blood, without mixing with fetal blood, gives oxygen and nutrients to the fetal bloodstream, and takes it back harmful substances and exchange products.

The placenta is the most important organ for the fetus, which ensures its normal functioning.

Let's try to understand this most complex blood flow system:

From the side of the uterus, the placenta is fed by the maternal arteries - uterine arteries and spiral arteries. They are the constituent component of the first level of blood supply to the pregnant uterus and fetus.
The spiral arteries feed the placenta, forming directly the placental blood flow.
The placenta forms the umbilical cord or umbilical cord - a complex of three vessels - two arteries and one vein, surrounded by a special jelly-like substance. Through the umbilical vein, blood rich in oxygen and nutrients moves to the umbilical ring of the fetus, further supplying the liver and other vital organs of the fetus. The blood flow in the umbilical vessels forms the second component of the blood circulation in the "mother-fetus" system.
Large fetal arteries in vital important organs- aorta, cerebral artery form the third component of blood circulation.

Fetal circulation. Click on photo to enlarge

When blood flow is disturbed at any level, the fetus receives less nutrients and oxygen - intrauterine hypoxia of the fetus or its oxygen starvation is formed. Intrauterine hypoxia can be both acute and quickly leading to fetal death, and chronic - long and sluggish, the main symptom of which is fetal growth retardation (abbreviated as FGR).

Depending on the severity and degree of blood flow disorders, the condition can be observed and treated conservatively (when it is not very dangerous) or urgent delivery of a woman at any stage of pregnancy to save the life of the child.

The problem of blood flow disorders in the mother-fetus system is dealt with by obstetrician-gynecologists in close contact with doctors of perinatal ultrasound diagnostics, since the main function for determining direct disorders and their degrees belongs precisely to ultrasound doctors.

Causes of circulatory disorders in the "mother-fetus" system

Placentation disorders - the formation and functioning of the placenta. Such violations can be primary - at the stage of pregnancy formation - placental abruption, lack of progesterone, defective uterine mucosa. An already formed placenta may also suffer. This is caused by disturbances in the coagulation system, infections, trauma to the placenta.
Coagulation system disorders - spontaneous and induced thrombosis. Thrombi block large and small branches of the vessels of the uterus and placenta.
Intrauterine infections damage the placenta and trigger the formation of blood clots.
Complications of pregnancy - Rh conflict, gestosis, twin steal syndrome, placental abruption, premature birth.
Lack of nutrients and vitamins - in particular iron deficiency - anemia.
Maternal diseases - diabetes mellitus, hypertension, thrombophilia, vascular and vascular wall defects, heart and lung diseases.
Impact of harmful environmental factors - harmful conditions at work, the effect of drugs, smoking, alcoholism, drug addiction.
Stress and nervous strain.

Glucometer for measuring blood sugar levels. Availability diabetes in the mother can lead to circulatory disorders in the "mother-fetus" system

The main symptoms of the disease

These symptoms are called external, because the main method for diagnosing disorders of placental and fetal blood flow is the Doppler ultrasound method, which will be discussed below in a separate section.

How can one suspect the suffering of the fetus before an ultrasound examination?

Insufficient growth or complete absence the increase in the main indicators of measurements of the abdomen of a pregnant woman at the next admission - the height of the fundus of the uterus and the circumference of the abdomen. These two sizes measuring tape the doctor measures each reception of the pregnant woman.
Unsatisfactory results of listening to the fetal heart by a doctor during examination. Each examination of the expectant mother is accompanied by listening to the heart sounds of the fetus using a special tube - an obstetric stethoscope. If the doctor notes a change in the fetal heart rate, muffled tones, lack of heart rate response to movements, then this should alert the physician.
Unfavorable fetal movement profile. This symptom is clearly noted by the woman herself. A pregnant woman may complain of a weakening of the movements, long periods"silence" of the fetus or excessively violent stirring. The simplest test for fetal motor activity is the "Count to ten" test. In this case, a pregnant woman should count at least 10 separate fetal movements within 12 hours.
Unfavorable or disturbing types of CTG - cardiotocography. This procedure for recording the electrical activity of the fetal heart is carried out every appointment in the antenatal clinic, starting from 28–30 weeks. CTG is a very sensitive method for assessing the condition of the fetus, therefore, in case of violations of the cardiotocogram, it is necessary to ultrasonography the fetus and its blood streams.

These are the four main points under which there are objective reasons suspect a violation of the blood supply to the uterus and fetus. There are also relative indications for additional diagnostic measures regarding uterine-fetal blood flow:

Multiple pregnancy, especially in the presence of monochorionic twins. Such twins have one placenta for two, so the latter often cannot cope with such a load, especially on later dates pregnancy.
Anomalies in the structure of the placenta - hypoplasia of the placenta, rolled placenta, as well as its premature aging.
Anomalies in the structure of the umbilical cord or the presence of its true nodes - such nodes are formed when active stirring fetus.
Availability intrauterine infection- viral, bacterial or other.
Rh-conflict of the mother and fetus according to the Rh factor or blood type. Such a conflict is primarily diagnosed by the presence of antibodies in the mother's blood.
Maternal gestational diabetes mellitus that developed during an existing pregnancy, or pre-existing diabetes mellitus.
Preeclampsia is a complication of late pregnancy, characterized by an increase in blood pressure, edema and the appearance of protein in the urine.
Maternal hypertension.
Any cardiac or vascular pathology of the mother.
Blood clotting disorders - especially the tendency to thrombosis. Such disorders include hereditary thrombophilia and antiphospholipid syndrome.

All these factors significantly increase the risk of developing blood flow disorders in the mother-fetus system, and therefore are subject to close monitoring.

With the help of cardiotocography, it is possible to assess the fetal heartbeat at rest, movement and during uterine contractions.

Diagnosis of blood flow disorders

The gold standard for diagnosing disorders of perinatal blood flow is ultrasound examination of the fetus with obligatory dopplerometry. The Doppler method is based on the measurement of velocities, resistance indices and other indicators of blood flow in the vessels. The world medical community has developed a huge number of tables and diagrams of dopplerometry for each vessel.

In obstetrics, the assessment of fetal circulation is carried out in the following vessels:

Uterine arteries - assessment of the first link of the "mother-fetus" system. Close attention is paid to the indicators of the uterine arteries in pregnant women with heart and vascular diseases, anemia, arterial hypertension, preeclampsia and gestational diabetes mellitus.
Vessels of the umbilical cord - assessment of the "mother-fetus" system - indicators of blood flow from the placenta to the child. The most commonly assessed indicators of blood flow in the umbilical artery.
The middle or median cerebral artery is a powerful vessel in the fetal brain. The indicators of blood flow in this vessel are extremely important and significant in the presence of a conflict in the Rh system or blood groups, fetal anemia, and also in case of suspected fetal malformations.

The doctor measures the blood flow indicators several times and correlates the obtained values \u200b\u200bwith the tables. These are extremely variable indicators, they can fluctuate significantly depending on external and internal factors:

The gestation period is up to one week.
The number of fetuses and placentas - for twins and triplets, their Doppler indicators.
Maternal blood pressure - an ultrasound doctor is always interested in a pregnant woman with her pressure figures.
Maternal hemoglobin levels - with anemia, blood flow indicators can change significantly.
Smoking and other bad habits of the mother.
Medicinal preparations.
The tone of the uterus - both the usual hypertonicity, and regular contractions, for example, in childbirth.

Uterine tone (hypertonicity) - contraction of the muscular layer of the uterus

In addition to dopplerometry, the doctor performs the so-called fetometry - measuring the size of the fetus and calculating its estimated weight. If the fetus is significantly behind in development from the average, the doctor has the right to make a diagnosis of "fetal growth retardation", or FGR. A similar lag in fetal growth is observed with chronic hypoxia- that is, the fetus does not receive enough oxygen and nutrients for a long time several weeks and even months.

Based on the obtained indicators, the doctor of ultrasound diagnostics forms the diagnosis: “Violation of the utero-fetal blood flow” and indicates the degree. In the presence of fetal growth retardation, the diagnosis is supplemented by the wording "GRP".

Now we will talk in detail about the classification of the degrees of blood flow disorders.

Three degrees of pathology

There are three main degrees of utero-fetal blood flow disorders:

I degree - minor violations of one of the conditional circulatory systems. The first degree has two sub-degrees:

I A - violations of the utero-placental blood flow with preserved feto-placental blood flow. This means a violation of blood circulation in the system of uterine arteries.
I B - violation of the feto-placental blood flow with preserved utero-placental blood flow. In this case, the uterine arteries fully perform their function, but there are violations at the post-placental level.

II degree - a simultaneous violation in both conditional circulatory systems, not reaching critical changes. This means that on this moment blood flow is weakly disturbed and in the next day and even several days will not harm the fetus. The danger of this degree is that no one can predict how it will behave further and how quickly it will move to the next degree.

III degree - critical violations of the feto-placental blood flow with preserved or impaired uteroplacental. Such a violation speaks of the critical suffering of the fetus, which, without prompt action by physicians, in a matter of hours will lead to severe intrauterine hypoxia fetus and death.

Treatment of fetal and uterine blood flow disorders

Mandatory treatment requires almost all degrees of blood flow disorders. The question is what degree of blood flow disturbances is detected, and whether it is accompanied by fetal growth retardation.

The most "harmless" are violations of the uteroplacental blood flow at 1a degree. It is important to understand that this type of violation is sometimes an accidental finding at the next ultrasound. This condition can occur against the background of an increase in the mother's blood pressure, her excitement, fatigue, and a decrease in hemoglobin levels. This degree does not always indicate the suffering of the fetus and often disappears on its own within a few hours after rest or a walk in the fresh air. However, this does not mean that you need to “give up” on the diagnosis. A pregnant woman must definitely undergo a control ultrasound in 5-7 days, and record CTG several times during the week.

The main methods of treatment of fetal blood flow disorders:

Normalization of the lifestyle and nutrition of a pregnant woman. It is important to walk a lot in the fresh air, sleep at least 8 hours at night and try to rest at least an hour during the day, avoid long sitting in awkward posture, move a lot, eat normally and fully.
Blood pressure control is one of the most important parameters causing uterine blood flow. In the presence of arterial hypertension, you must constantly take the drugs prescribed by the doctor and independently monitor the pressure indicators.
Treatment of intrauterine infection antiviral drugs and antibiotics.
Treatment of extragenital pathology - normalization of sugar levels, normalization of hemoglobin levels, control of body weight, correction of the blood coagulation system. The latter includes medication low molecular weight heparins- Fragmina, Fraksiparina and others.
The use of antispasmodics - No-shpy, Drotaverine, Papaverine. These drugs relax the wall of the uterus and spiral arteries, increasing blood flow.
Taking magnesium preparations - magnesium has a relaxing effect on the uterine wall and a powerful protective influence on the fetal central nervous system. The last factor is important in the development of hypoxia.
The use of "vascular" drugs - large group antiplatelet agents, angioprotectors and drugs that improve microcirculation and tissue trophism. The most common drugs in obstetrics are Pentoxifylline, Dipyridamole, Actovegin and their derivatives.
In case of Rhesus conflict, plasmapheresis is prescribed - purification of the mother's blood on a special apparatus to reduce the amount of antibodies damaging the erythrocytes of the fetus.
In the case of acute fetal hypoxia against the background of impaired blood flow II and III degree, ineffectiveness of conservative therapy, as well as severe fetal growth retardation, early delivery is advisable, regardless of the gestational age. Most often, they resort to caesarean section, since the stimulation of childbirth is an additional burden on an already suffering fetus. The principle of “outside is better than inside” is the best fit for these situations.

Prognosis for the disease

The prognosis depends entirely on the degree of blood flow disorders, the duration of their course and the duration of pregnancy. The longer the duration of the course of hypoxia and the higher the degree of blood flow, and less term pregnancy, the worse the prognosis. Children born after prolonged intrauterine suffering are characterized by growth retardation and mental development especially after an emergency delivery before 37 weeks of gestation.

When not timely diagnosis and inadequate response to circulatory disorders, the situation can sharply worsen - there is acute hypoxia fetus, fraught with its death or severe lesions of the central nervous system.

Circulatory disorders are much worse against the background of extragenital pathology or preeclampsia. About 40% of preeclampsia are complicated by circulatory disorders in the "mother-fetus" system.

With adequate and timely treatment the condition can be, if not completely cured, then at least stabilized. This allows you to "grow" the baby to the maximum possible dates, after which his birth will be safe.

Small symptoms and complexity in methods for detecting pathology in the bloodstream of the vascular bed that unites the uterus with the placenta requires both the expectant mother and the doctor in charge of her to have a clear understanding of the structure of the pathology. With early diagnosis and early start Therapy significantly increases the chances of a natural termination of pregnancy for the mother and child.

Violation of the uteroplacental blood flow: danger and signs of pathology, diagnosis and treatment

Any disturbances in hemodynamics during the period of bearing a child pose a threat to the development and future health of the fetus. Pathologies of blood circulation along the vascular communication of the uterus and placenta are among the most common pathologies of pregnancy, which significantly worsen the condition of the mother and baby.

Therefore, it requires the maximum exclusion of all risk factors that can cause changes in the blood flow through the vascular system that unites the mother, placenta and fetus, and in the event of violations, it is important fast start therapeutic activities.

Violation of the uteroplacental blood flow of the fetus: how dangerous is it

Changes in blood circulation to the vascular bed that unites the uterus with the placenta is considered a rather dangerous condition, due to the fact that it can lead to a number of complications:

Hypoxia, leading to a delay in the processes of formation and development of the fetus.
Infection of the child in the womb.
Formation of anomalies in the development of the child.
Fetal death, especially with the appearance of disorders after the first trimester, when the pathology ends in spontaneous miscarriage.

Causes

The etiology of impaired blood flow through the vessels in the combined system of the uterus and placenta includes many factors that are divided into endogenous (internal) and exogenous (external). Among the endogenous causes of pathology:

Low attachment of the placenta in the uterus, which is accompanied by insufficient blood flow to the fetus.
The development of late toxicosis, which affects small-caliber vessels in the uterus and disrupts microcirculation.
Anemia in a pregnant woman, causing increased blood flow, lack of oxygen and tissue nutrition.
The conflict of Rhesus mother and fetus, provoking anemia in the child and disorders in the immune system.
Pathological development of the umbilical arteries.
Multiple pregnancy, when the fetus lacks nutrients.
Malformations of the uterus, threatening to squeeze the fetus and blood vessels that feed it and the placenta.
Endocrine pathologies like diabetes that damage blood vessels.
Diseases of a woman with a gynecological profile, such as endometriosis or uterine fibroids, requiring appropriate therapy even in the period of preparation for conception.
Diseases of the vascular system in the mother, such as hypertension.
The presence of venereal diseases in a woman.
genetic defects.

In turn, external factors that can lead to hemodynamic disorders are represented by:

Infections of bacterial and viral origin, which can penetrate the placenta.
Impact of adverse factors: stress, excessive physical activity, ionizing radiation, some drugs.
The mother has bad habits.

There are several social factors that can lead to the formation of pathological changes in the blood circulation through the communicating system of vessels of the uterus and placenta:

A woman's age over 30 or under 18.
Nutritional deficiency.
Professional hazards.
Psycho-emotional overload.

Severity classification

The main classification of changes in blood flow in the vascular bed of the uterus and placenta divides the pathology according to the severity, guided by the localization of changes in the vessels.

1 degree

It is divided into 1a and 1b. A - corresponds to a hemodynamic disorder in one artery of the uterus, in the absence of changes in other vessels. This condition is not accompanied by serious disturbances in the nutrition of the child in the womb. B - affects the blood flow in the umbilical vein, without changes in the uterine arteries.

2 degree

In this case, the entire communication system of the vessels of the fetus, placenta and mother undergoes changes, but the lack of oxygen for the child is not very pronounced.

3 degree

This is a critical degree, when hemodynamic parameters deteriorate sharply. The fetus does not receive the desired concentration of oxygen and the level of incoming useful substances. This pathology can lead to death for the fetus in the womb or spontaneous abortion.

Types of blood flow disorders in the uteroplacental system

In accordance with the period at which the child was born, a change in the blood circulation between the uterus and the placenta developed, 2 types of pathology are distinguished.

Primary

It is typical for the first trimester. The causes of the changes are pathologies of implantation, formation or attachment of the placenta in the uterus.

Secondary

It can appear at any time after the 16th week of embryonic development. Its appearance is facilitated by the impact external factors or certain illnesses of the mother, for example, high pressure, diabetes or other pathology affecting the vascular bed.

Clinical picture of blood flow disorders

The symptomatology of blood flow disorders depends on how pronounced the changes in the vascular bed are. On the part of the pregnant woman herself, there may be no signs of pathology at all, or only preeclampsia is present. Often, hemodynamic disorders are detected due to the fact that a woman is being examined because of the threat of miscarriage or premature start childbirth, which manifests itself:

Pain in the abdomen and groin.
The appearance of bloody-mucous discharge from the genital slit.

Often in pregnant women with a similar pathology during gestation, the appearance or exacerbation of colpitis occurs.

Being a complication of pathologically altered blood flow in the uterus and placenta, colpitis can lead to intrauterine infection child.

On the part of the fetus, the symptoms of hemodynamic disorders are more pronounced. With the development of hypoxia, the frequency of movements of the child decreases. During examinations at the appointment with an obstetrician-gynecologist, a specialist may pay attention to an increase or decrease in the heart rate in a child. Also, the doctor may note that the volume of the abdomen and the height of the fundus of the uterus are not correlated with the gestational age.

The pathology of blood circulation between the uterus and the placenta along the joint vascular bed can cause the formation of premature placental abruption, regardless of its location. This is one reason why it is important to pay attention to the slightest sign pathology.

Diagnosis of disorders at different levels of severity

To identify the pathology of the uteroplacental blood flow, 3 methods are used, regardless of the degree of development of changes:

Laboratory analysis of the blood serum of the expectant mother.
Ultrasound diagnostics (ultrasound).
Cardiotocography (CTG).

Laboratory diagnostics involves determining the concentration of several hormones: estriol, human chorionic gonadotropin (hCG) and placental lactogen. A study of enzymatic activity is also carried out - oxytocinase and thermostable alkaline phosphatase are evaluated.

Ultrasound helps the specialist determine the size of the fetus and how much they correspond to the gestational age. Evaluate:

Where is the placenta located, what is its thickness, does its maturity correspond to the available period of gestation.
Volume of amniotic fluid.
Is the umbilical cord formed correctly?
The presence or absence of pathological components in the placenta.

All these characteristics help to identify the presence or absence of pathologies in the bloodstream, as well as inhibition of the development of the fetus.

To assess the functioning of the heart and the entire vascular system of the child in the womb, CTG is used. Compared to listening to the heartbeat with an obstetric stethoscope, this option is more accurate. It allows you to quickly identify tachycardia or bradycardia caused by hypoxia

In doubtful situations and the presence necessary equipment the doctor may prescribe dopplerometry. This is an analogue of ultrasound, which allows you to get detailed information about the blood flow in each of the vessels that make up a single system between the mother, placenta and fetus.

Choice of time and method of delivery

If a woman is diagnosed with 1 degree of blood flow changes, regardless of whether it is subtype A or B, the pregnancy is prolonged and further births are carried out through the natural birth canal.

With pathology of the 2nd degree, the condition is considered borderline, it requires constant monitoring. If possible, they try to prolong the pregnancy as long as possible so that the respiratory system of the fetus has time to form, and the surfactant necessary for the breathing of the newborn is produced.

If the therapy is ineffective or the pregnant woman is diagnosed with a 3rd degree of violations, the choice of specialists stops at urgent delivery by surgery.

What emergencies can develop

In the pathology of the communicating vascular system of the uterus with the placenta of 2-3 degrees of severity, situations may arise that require an urgent start of therapeutic measures:

Acute fetal hypoxia.
The formation of heart defects or other anomalies in a child that are not compatible with life or endanger the life of the newborn.
Detachment or premature aging of the placenta.
Death of the fetus in the womb.

Each of these situations is decided in accordance with the condition of the woman and the child, the gestational age and the degree of threat to the fetus and mother.

Prognosis for a child

With a primary change in blood circulation between the vessels of the uterus and placenta, fetal death in utero or spontaneous miscarriage often occurs. If a violation of blood flow was detected in a timely manner and therapeutic measures were started, then the pregnancy is prolonged up to 37 weeks and this allows the woman to give birth to a healthy child.

Prevention

Preventive actions begin with preparation for conception and continue until childbirth. They include:

Throughout the entire bearing of a child, a pregnant woman should exclude any contact with infectious patients.

Women who use tobacco or alcohol products, or drugs, are included in the risk group for the formation of pathological changes in the hemodynamics of the uterine vascular system with the placenta. Therefore, the exclusion of any bad habits is included in the period of preparation for bearing a child.

Pathology of uteroplacental blood flow is a serious complication of pregnancy that cannot be cured at home, without the help of a specialist. A pregnant woman needs constant monitoring by a doctor to increase the chances of having a baby healthy newborn naturally. In the case of untimely detection, violation of the prescriptions of a specialist or refusal of therapy, the risk of developing dangerous diseases fetus and newborn or even death for the child.

Useful video

During pregnancy, the female body begins to rebuild. Therefore, during this period it is so important to keep under control the condition of both the woman and the fetus. According to medical statistics, quite a large number pregnant women observed a violation of blood flow. An additional one that has arisen in the body requires constant monitoring by specialists. Its violation can lead to the death of the fetus, and this can happen at any stage of pregnancy. Let's try to figure out why blood flow is disturbed during pregnancy.

A bit of theory

Everyone knows that the placenta acts as a link between the woman's body and the fetus. In this complex system, two types of blood circulation are distinguished - placental and fetal. Any violation of one of them can lead to rather sad consequences, including the development of various diseases. The severity of the problem is assessed only by the doctor.

In this case, a woman who is at the 30th week of pregnancy must necessarily undergo a special ultrasound diagnosis, on which the vessels of the placenta are clearly visible in a three-dimensional image. If there is any violation, the doctor will definitely see it, as there is a change in the spatial ratio of the uterine and fetal-placental circulation. This is a very dangerous state of the body, as oppression occurs. respiratory function, and the development of the fetus is suspended.

Degrees of violation

Medicine distinguishes three degrees of severity of this pathology. The first degree is considered the easiest, when insufficient blood circulation has not yet reached its critical values. In this case, the hemodynamics of the fetus is in a satisfactory condition. There is a violation of the uteroplacental blood flow of 1 A degree and insufficient fetal-placental blood circulation of 1 B degree.

The second degree is characterized by a deterioration in the blood supply to the fetus. In 50% of cases, there is a decrease in the maximum velocity of blood moving through all the valves of the heart, and such a violation is observed both in the fetus and in the uterine arteries.

Quite often, in a short period of time, the second degree passes into the third. In this case, the blood flow practically ceases to flow to the fetus, which can cause its hypoxia. There is a high probability of a decrease in diastolic blood flow in the aorta, and in some cases it may disappear completely.

Causes

If there is a violation of the blood flow of the 1st degree during pregnancy, the reasons leading to this may be different. Numerous adverse factors can affect the placenta not only during its formation, but also at a later date. Medical practice distinguishes between primary and secondary, which disrupts the functioning of the placenta, which acts as a transport, protective, immune, metabolic and endocrine organ.

Thus, impaired blood flow of 1 A degree during pregnancy can occur for the following reasons:

tumor of the uterus;
genetic defects;
consequences of abortion;
infectious diseases;
hypertonic disease;
diseases of the adrenal glands and thyroid gland;
structural anomalies;
hormonal dysfunctions;
thrombosis, atherosclerosis;
diabetes.

If this pathology is not eliminated in a timely manner, then after 6 weeks a slight violation of blood flow can go into the third stage. If a problem is detected at the 30th week, the doctor still has enough time to take appropriate measures to restore normal blood circulation.

Symptoms

Any pathology is characterized by its clinical picture so that the doctor can make an appropriate conclusion. The lack of hemodynamics leads to a change in the functioning of the placenta, because of which the fetus begins to suffer. to him in limited quantity the necessary nutrients and oxygen begin to flow, and the excretion of metabolic products slows down. Signs begin to appear, as a result of which its intrauterine development stops.

Thus, if there is a violation of blood flow during pregnancy, the symptoms of this condition are manifested as follows:

cardiopalmus;
decrease or increase motor activity fetus;
inconsistency in the volume of the abdomen specific date pregnancy.

Such signs usually occur with a decompensated form. If the violation of uterine blood flow during pregnancy is grade 1 A or 1 B, then these symptoms do not yet appear, since hemodynamics is compensated. It is usually detected during diagnostic studies.

Diagnostics

In order to identify a violation of blood flow of 1 A degree during pregnancy, it is necessary to undergo a series of examinations, with the help of which the type and degree of the changes that have occurred are established, and the condition of the fetus is also determined. In this case, the doctor prescribes the following procedures:

blood test for hormones such as estrogen, chorionic gonadotropin, progesterone;
cardiotocography;
ultrasonography;
dopplerometry.

In some cases, the doctor, already during the examination, is able to determine the violation that has arisen, focusing on the child's heart rate, which are counted during auscultation. But the most reliable results usually obtained after laboratory and instrumental studies.

Treatment

Disturbed of any degree must be treated. Basically, therapeutic measures are aimed at ensuring that the pathology does not progress further. Hemodynamics normalizes only if a violation of blood flow of 1 B degree is detected.

During a pregnancy that occurs with deviations, various means are used that improve the condition of the fetus. Mostly conservative methods of treatment are used. Surgical intervention possible only in case of complications and for vital indications. When normalizing blood flow disorders, a set of measures is used - pathogenetic, etiotropic and symptomatic treatment.

Medical treatment

Most often, impaired blood flow of 1 A degree during pregnancy is corrected with the help of medications. When identifying the initial signs of a violation, treatment is carried out on an outpatient basis. More severe circulatory failure requires hospitalization.

The following drugs are used for treatment:

antispasmodics - "Eufillin", "No-shpa";
vascular - "Actovegin";
antiplatelet agents - "Kurantil";
vitamins and microelements - Ascorbic acid"," Magne B6 ";
hepatoprotectors - "Hofitol", "Essentiale";
tocolytics - "Partusisten", "Ginipral";
improving blood microcirculation - "Trental";
antihypoxants - "Instenon";
metabolic - "ATP".

Usually, to improve the condition, two courses of therapy are carried out - immediately after the diagnosis was made and at a period of 32-34 weeks. After that, the doctor decides on the method of delivery. This is especially important if the circulatory disorder is severe. In case of violation of the blood flow of the 1st degree, childbirth is carried out naturally.

Surgery

If the violation of blood flow is bright pronounced character performing an emergency delivery. In case of failure conservative treatment, even in the case of a slight violation, the decision is made within two days. Usually a caesarean section is performed. If it is planned for a gestational age of less than 32 weeks, then the condition of the fetus and its viability are assessed.

Preventive measures

To avoid such pathological condition, as a violation of blood flow 1 A degree during pregnancy, preventive measures should be taken. A woman who is expecting a baby should eat foods that contain essential vitamins, micro and macro elements, fats, carbohydrates and proteins. Every day, at least 1.5 liters of fluid should be consumed, but only if swelling does not torment.

It is also important to keep your weight under control. During pregnancy, the recommended weight gain should not exceed 10 kg. Prevention for women at risk medicines for the interaction of the body systems of the mother and fetus and the prevention of extremely dangerous dysfunction of the uteroplacental circulation. An important role is played by the timely corrected method of conducting childbirth. But it should be remembered that even compliance with these measures does not exclude the occurrence of severe neurological complications.

Conclusion

Thus, it is important to control blood flow during pregnancy. The reasons may be different. The main thing is to monitor your health, and timely detection of pathology will help prevent severe consequences for the future child.

The placenta or "baby place", as it is popularly called, is an extremely complex organ that is a "bridge" between the body of the mother and her unborn child. Developing at the site of implantation of a fertilized egg in the wall of the uterus, it provides the fetus with oxygen and nutrients throughout pregnancy. Therefore, even a slight violation of the uteroplacental blood flow can harm the unborn child.

vital organ

From a biological point of view, the placenta is a multifunctional system. The umbilical cord, connecting the fetus with the mother's body, forms a single circulatory system "mother-placenta-fetus". However, the blood of mother and child never mixes because the placenta is also a natural filter. It allows oxygen nutrients, vitamins and microelements to enter the child's body.

The layout of the placenta

The main tasks of this temporary body:

the supply of oxygen to the bloodstream of the unborn child;
removal of carbon dioxide;
providing the fetus with essential nutrients;
elimination of waste products;
production of a number of hormones female body during pregnancy;
protection of the fetus from pathogens.

Birth" children's place” occurs 20-30 minutes after the birth of the child. The discoid organ, along with the remainder of the umbilical cord, is always sent to the laboratory for examination. After all, abnormalities of the placenta can lead to various diseases with a newly born baby.

What causes blood flow problems

Any circulatory disorders between the mother and the fetus are of great concern to obstetrician-gynecologists and the pregnant woman herself. The main causes of such circulatory problems are:

Maternal diabetes. The long course of this disease, especially with poor glycemic control, inevitably leads to vascular complications. The microcirculatory link is affected, the walls of small vessels thicken, normal metabolism is disrupted.
. Prevents adequate blood flow high blood pressure requiring medical treatment.
Blood clotting disorders. Negatively affects both the tendency to thrombosis, leading to clogging of small or even large vessels with clots, and a decrease in coagulability. Hypocoagulation due to a disease or due to medication increases the risk of hemorrhage, and hence placental disorders.
. A significant decrease in the number of red blood cells - oxygen carrier cells - causes, among other things, oxygen starvation in the fetus.
Smoking during pregnancy is strictly prohibited. However, some irresponsible future mothers do not refuse this bad habit, independently provoking situations that threaten the fetus.
Drug addiction, especially the use of opiates: cocaine, heroin, and methamphetamines, causes serious problems with blood flow through the placenta.
Poor attachment of the "children's place" to the wall of the uterus, as well as premature detachment normally located placenta.

Classification and symptoms

Unfortunately, there are no specific manifestations of uteroplacental blood flow disorders. A pregnant woman can pay attention to the volume of the abdomen - the increase is slower, the volume of the uterus does not correspond to the gestational age.

In the third trimester, the expectant mother may notice a decrease in the motor activity of the fetus. However, all the described symptoms are easier to notice in the second and subsequent pregnancies. Primigravidas simply do not pay attention to minor deviations.

When making a diagnosis, physicians rely on the following classification of circulatory disorders in the mother-placenta-fetus system:

First degree violations. It is divided into 2 subspecies: 1a - pathological changes relate to the uteroplacental blood flow, the fetal part is not involved, 1b - on the contrary, negative changes relate to the fetal-placental part.
The second degree of violations. IN pathological process the whole system "mother-placenta-fetus" is involved.
The third degree - critical changes in the fetal-placental part, extremely negatively affect the condition of the fetus.

Prevention of fetal pathology is based on timely, accurate diagnosis and treatment.

Main diagnostic options:

Regular ultrasound examination, monitoring of the placenta and fetal development.
Fetal cardiotocography - used in the third trimester of pregnancy. Special sensors are installed on the abdomen that measure the heart rate of the fetus and its motor activity.

Complications and how to deal with them

Violation of the placental circulation - a serious obstetric pathology which has a direct impact on the health of the unborn child and his mother.

Complications from a pregnant woman:

Blood flow problems in the mother-placenta-fetus system increase the risk of a severe form late preeclampsia- preeclampsia. It is manifested by severe edema, arterial hypertension, headaches, overweight and proteinuria.
Premature placental abruption for a woman is dangerous with massive life-threatening bleeding.
premature birth.

The earlier circulatory problems occur, the more risk the baby is exposed to during fetal development.

Fetal complications:

Placental insufficiency causes hypoxia or oxygen starvation of the fetus. As a result, congenital disorders of development and damage to the brain, lungs, and gastrointestinal tract occur.
Hypothermia at birth.
Low blood glucose in a newborn.
Excessive erythrocyte count and blood clotting is a compensatory response to hypoxia.
Oxygen starvation during childbirth, which can lead to damage to the nervous system and brain.

There is no specific treatment for fetal placental insufficiency. Circulatory problems identified during an ultrasound examination should alert future mother. It is necessary to follow the doctor's recommendations:

Observe the regime of work and rest, bed rest if necessary.
visit more often women's consultation for adequate monitoring of the fetus.
Eat more vitamins, stop smoking or drinking alcohol.
Monitor fetal movements and report to medical staff if the baby's activity is reduced.

It is difficult to cure the above described circulatory disorders, but you can significantly improve the situation by carefully following the recommendations of doctors. In the absence of the dynamics of the state of the fetus, delivery is indicated after 32 weeks.