Violation of the placental fetal blood flow stage 1a. Causes of uterine blood flow disorders. Problems with placental and uterine blood flow

Violations and their causes in alphabetical order:

impaired fetal placental blood flow -

Violation of the fruit placental blood flow in a single functional system mother-placenta-fetus plays a major role in the pathogenesis placental insufficiency, which is one of the leading causes of perinatal morbidity and mortality. Numerous works have shown the fundamental role of the syndrome of hemodynamic placental insufficiency in the clinic of miscarriage.

The bloodstream of the placenta includes two closely interconnected, but not interconnected, blood flow systems - the fetal and placental. Three-dimensional ultrasound makes it possible to get an idea of ​​the three-dimensional organization of the vascular system in the placenta. When evaluating the results of a 3D study of the selected area of ​​the placenta, it is necessary to pay attention to the nature of the distribution of the vascular component and the organization of the vessels in the area under study, which makes it possible to obtain the necessary data to understand the features of its physiology. A three-dimensional Doppler study makes it possible to obtain the spatial relationships of the fetal-placental and utero-placental blood flow systems, as well as to diagnose placental blood flow disorders.

At what diseases there is a violation of the fetal placental blood flow:

Placental insufficiency is expressed in violation of the transport, trophic, endocrine, metabolic and other important functions of the placenta, which leads to a decrease in its ability to maintain an adequate exchange between the mother and fetus. The basic sign of fetal placental dysfunction (41.9% of all cases of chronic placental insufficiency) are the prevailing blood flow disorders in the arteries of the umbilical cord, chorionic plate and supporting villi, confirmed by the results of Doppler.

The outcome of decompensated placental insufficiency is a delay prenatal development fetus, due to inhibition of the respiratory, hormonal and trophic functions of the placenta. The severity of the delay intrauterine growth fetus tends to correlate with the severity of placental insufficiency.

The method of ultrasonic dopplerometry, which allows direct measurements of blood flow in various vascular zones of the mother-placenta-fetus system in dynamics, allows assessing the state of fetal placental blood flow and therefore has an important diagnostic and prognostic value in the group of pregnant women with high perinatal risk. Numerous studies have shown that a comprehensive assessment of blood circulation in the mother-placenta-fetus system can improve the diagnosis and choice of optimal obstetric tactics in case of placental disorder.

A classification of uteroplacental and fetal placental blood flow disorders was developed based on the assessment of blood flow velocity curves in the uterine and umbilical arteries. According to this classification, three degrees of severity of hemodynamic disorders of uteroplacental blood flow are distinguished:
I degree:
A - violation of the uteroplacental blood flow with intact fetal-placental blood flow.
B - violation of the fetal-placental blood flow with intact utero-placental blood flow.
II degree: simultaneous violation of the uteroplacental and fetal-placental blood flow, not reaching critical changes (end-diastolic blood flow is preserved).
III degree: critical disorders of fetal-placental blood flow (lack of blood flow or reverse diastolic blood flow) with intact or impaired uteroplacental blood flow.

There was a direct proportional relationship with a high correlation coefficient between the degree of hemodynamic disorders of the fetal placental blood flow in the mother-placenta-fetus system and the frequency of fetal growth retardation, intrauterine hypoxia, operative delivery by caesarean section, severe condition of the newborn and perinatal losses. It should be noted that during dynamic observation, normalization or improvement in hemodynamic parameters was not noted in IA, II and III degree disorders of the uteroplacental fetal blood flow. Normalization of the fetal-placental blood flow was noted only in grade I B, usually in pregnant women with a threatened miscarriage.

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There are many reasons that contribute to impaired blood flow during pregnancy. Consider the most common factors that provoke a violation of blood flow.

1. Diseases of the uterus: bicornuate uterus, endometriosis, uterine hypoplasia, the presence of fibroids, etc.
2. Mother's health problems: kidney failure, diabetes, hypotension, pyelonephritis, diseases endocrine system, bronchial asthma and etc.
3. Unfavourable conditions gestation: Rhesus conflict, multiple pregnancy, preeclampsia, malpresentation fetus, etc.
4. External factors: drinking alcohol during pregnancy, smoking, constantly being in a nervous environment, first birth (and a woman over 35), poor (limited) nutrition of the mother.

Classification of blood flow disorders in the placenta

Placental insufficiency negatively affects the functioning of the placenta. It can be acute and chronic.

Clinical symptoms of PN depend on the nature of the pathology. acute form insufficiency can develop in any trimester of pregnancy.

There is a violation of the gas exchange function of the placenta, which can lead to fetal hypoxia. The acute form develops due to premature detachment placenta or vascular thrombosis.

Causes of impaired uterine blood flow

The causes of impaired blood flow during pregnancy can be found in the following pathological conditions:

• Anemia (anemia) of the expectant mother. Low levels of hemoglobin cause a high rate of blood flow. This occurs due to compensation for the lack of oxygen and cannot but affect the processes in the development of the fetus and the quality of blood exchange;
• The position of the placenta. If presentation is diagnosed, which may be justified by the surgery caesarean section, then the blood supply will be clearly reduced due to the thinning of the uterus at the site of the scar;
• Late toxicosis calling pathological changes in work small vessels. This is one of the most common signs of blood flow disorders during pregnancy;
• Viruses and infections present in the mother's body during the period of gestation. Some of them can cause damage to the placental tissue and contribute to the development of placental insufficiency;
• Rhesus conflict - may be complicated by the anemic condition of the fetus;
• Jumping blood pressure indicators, which do not allow maintaining the uniformity of the blood flow rate;
• Defects of the uterus. The most significant of them, capable of changing the course of fetal development in the worst side, is a two-cavity structure of the uterine sac. The uterine space, divided into two parts, in itself is not an obstacle to normal growth and the formation of the child. However, the blood supply system does not adequately supply such a two-chamber cavity;
• A serious quantitative or configurational change in the vessels of the umbilical cord;
• Damage to the inner wall of the uterus resulting from surgical interventions, or, as a consequence bad habits;
• Tumors, such as fibroids, are especially dangerous in nulliparous women after thirty-five years. This also applies to uterine fibroids, which are abundantly saturated with blood during perinatation. Against the background of an increase in size and the formation of a myomatous node, a persistent lack of blood flow to the placenta is formed;
• Pregnancy complicated by multiple pregnancy. Since the placenta is forced to adapt to the maintenance of several feeding organisms in proper conditions at once, such errors in the blood supply as the donor position of one of the fetuses are not excluded. Often at the same time, there is an underdevelopment of the feeding fetus, a significant lack of weight and physiological normal signs. A child who unwittingly acts as a recipient also suffers seriously from, on the contrary, too abundant blood supply;
• The disease of the mother with diabetes, sometimes developing precisely against the background of pregnancy, loosens the walls of blood vessels, which affects blood circulation in a bad way.

Violation of blood circulation in the uterus can be caused by increased pressure, pneumonia, intrauterine infection and insufficient supply of oxygen to the fetus (hypoxia).

To diagnose the blood flow system in obstetric practice, three-dimensional ultrasound (Doppler) is used, with the help of which the vessels are visible in the so-called 3D (three-dimensional) image.

With the help of this modern diagnostic method, the prospect of diagnosing retroplacental bleeding, assessing malformations of the heart by monitoring the blood flow has appeared.

This method is indispensable, since it can be used to see defects even in the smallest vessels that form the microvasculature, to monitor the development and formation of intraplacental hemodynamics, and also to control the amount of oxygen and nutrients that must enter the fetal body.

Opened up new opportunities for early detection obstetric complications, and if the correction or treatment is started without loss of time, then it is possible to practically avoid circulatory disorders and further pathologies associated with it.

Symptoms of pathology

Like any other pathology, violation of the IPC has a number of features in the manifestation. If you know exactly the signs of this deviation, a woman will be able to identify her illness in the early stages, which will allow her to see a doctor in time. The main danger of impaired uteroplacental blood flow of the 1a degree is that the fetus experiences oxygen starvation. This hypoxia prevents normal development his internal organs, can cause miscarriage or fading of pregnancy. Pathology can be recognized by the following changes:

• the child's heart rate is significantly accelerated;
• the fetus periodically becomes either active or sluggish;
• the volume of the abdomen does not correspond to normal indications - it is ahead of them.

Signs of violation of the IPC 1a degree usually appear in the decompensated form. However, in some cases, the manifestations of this pathology are completely absent. It is possible to find out about its presence only after the next examination.

The manifestations of FPI depend on their type. With compensated chronic placental insufficiency, there are no symptoms. A woman learns about abnormalities during an ultrasound examination.

Acute and chronic decompensated forms of pathology are characterized by severe symptoms. A woman can note periods of rapid motor activity of the unborn child, which are replaced by periods of complete rest.

There are certain norms, in accordance with them, a pregnant woman for a period of more than 28 weeks should feel at least 10 fetal movements per day. With more low rates a woman should seek advice from a gynecologist.

Additional signs of impaired blood flow may be a slowdown in the increase in abdominal circumference. It is difficult to identify this on your own, therefore it is necessary to visit the antenatal clinic, where such measurements are regularly carried out.

by the most dangerous symptom FPN are bloody issues from the vagina. This may be a sign of placental abruption. This condition requires urgent medical attention.

Diagnosis of pathology

It has already been said earlier that during pregnancy, a violation of blood flow can be diagnosed by means of dopplerometry. It is an ultrasound examination that can detect any pathological abnormalities in blood flow. During the diagnosis, a pregnant woman takes a horizontal position on her back or side. The specialist conducts a study by the transabdominal method. Usually dopplerometry is prescribed twice:

• at 20–22 weeks, in order to make sure that there are no deviations in the development of the fetus;
• at 32 weeks.

Identification of pathological disorders of placental blood flow is carried out by comprehensive survey, But huge role in the diagnosis plays ultrasound, which is combined with Doppler. This method allows you to identify not only blood flow disorders, but also the complications caused by them.

Doppler is prescribed in such cases:

• maternal diseases that can provoke blood flow disorders in the placenta;
• premature aging placenta;
• syndrome intrauterine delay fetal development;
• polyhydramnios or oligohydramnios;
• signs of fetal hypoxia;
• birth defects And genetic diseases at the fetus.

Depending on the complexity pathological process, disturbances can be observed in the umbilical, uterine or fetal vessels. According to the results of the examination, a diagnosis is made of the uteroplacental, placental or fetoplacental form of blood flow disorders.

Atypical blood circulation in the placenta may indicate such indirect sign, as its thinning or increase in area, symptoms intrauterine infection and changes in amniotic fluid.

The main diagnosis of blood flow disorders during pregnancy, on this moment, is a Doppler examination. The most insignificant, at first glance, changes on one of early stages violations are clearly visible on the screen, since dopplerometry provides a picture in color and has a high degree resolution by the level of clarity of the picture.

The very analysis of the frequency of ultrasonic waves reflected from objects in motion makes it possible to determine the speed of blood flow through the arteries, in the umbilical vessels, as well as the blood circulation inside the placenta.

Then the indicators taken during the survey are compared with the table of normative data and the result is recorded.

The biggest plus of dopplerography, in addition to the safety of the study, is the accurate prediction of any form of abnormality, detecting them at the stage when it is still possible to save the fetus and not harm the mother's body.

In addition to ultrasound examination, without fail classical measures are used to confirm or refute the pathology:

• Analysis of the activity of the fetus, based on the words of the mother;
• Stethoscopic listening to the baby's heartbeat in the womb;
• Cardiology examination.

Treatment Methods

If the disease occurs in mild form(first degree), then the doctor may prescribe drugs that improve blood circulation.

The dynamics of the state of the fetus is carried out, weekly, until the indicators normalize, the pregnant woman is given dopplerometry and the fetal heartbeat is checked. If the indicators stabilize, then the woman will continue to bear the child further.

In the second degree, the pregnant woman is hospitalized and treated under the strict supervision of the medical staff. If the condition worsens, an unscheduled operation is performed.

As for the third degree, it cannot be treated, since irreversible changes begin in the development of the fetus. Therefore, in order not to risk the life of the child, doctors insist on an urgent cesarean.

It is impossible to treat disorders of the uteroplacental blood flow, acting only in one direction, or eliminating problems as they arise.

A complete cure necessarily includes a set of measures aimed at:

• Increased blood microcirculation;
• Achievement of optimal blood pressure;
• Vasodilation with spasmodic manifestations in the arteries;
• Decrease uterine tone due to relaxation of blood vessels;
• Prevention of consequences oxygen starvation(hypoxia);
• Saturation of the placental tissue with the phospholipids it needs.

In conclusion about prevention

Prevention actions should be aimed at organizing conditions for healthy growth and intrauterine development of the child. To do this, a woman must:

• watch your diet;
• rest more often;
• visit regularly fresh air;
• to refuse from bad habits;
• minimize emotional stress.

The main thing is to regularly visit a doctor and follow his recommendations.

To give birth healthy baby, a pregnant woman needs to be more careful and listen to her body. Try to watch your diet: it should be nutritious, rich and healthy.

You can also take vitamin complexes or Ginipral, which will eliminate the deficiency of some element. Also try to drink as much as possible. clean water- at least 2 liters per day.

Do not forget to control your body weight - during pregnancy, it should not increase by more than 10 kg.

In case of violation of normal blood flow, a woman can be put on preservation. Remember that you should not prescribe yourself a treatment based on the advice of friends or data from the network.

So you provoke the development of serious complications.

Preventive actions aimed at timely identification of risk groups among pregnant women. Currently, there is no single method for treating this condition. As a rule, therapy is complex and is aimed at stabilizing the condition in order to avoid premature birth.

Doctors recommend sleeping on the left side, drugs containing amino acids, ATP, glucose are often prescribed to stabilize metabolic processes. May also be recommended medicines, reducing the tone of the uterus, normalizing blood circulation, vasodilators and drugs that reduce blood clotting.

Only a doctor can prescribe treatment, sometimes hospitalization is required for a full examination, control and therapy. With a significant deterioration in placental blood flow, an emergency caesarean section is prescribed.

In order not to face placental insufficiency during the period of bearing a child, it is necessary to reconsider your lifestyle during pregnancy planning and eliminate all possible risks.

Every woman who wants to give birth to a child must remember that the state of the mother is completely transmitted to the unborn baby. Therefore, in order for the fetus to develop without complications, she needs to make up her diet from food containing a maximum of vitamins, micro- and macroelements, as well as rich necessary quantity carbohydrates, proteins and fats.

If the pregnant woman is not concerned about swelling, then fluid intake should be at least 1-1.5 liters.

It is important to control changes in body weight, since by the end of pregnancy, weight gain should not exceed 10 kg.

There are risk groups that need to be applied drug prevention, which promotes the interaction of the body systems of the fetus and mother and prevents dysfunction of the uteroplacental circulation.

Significantly reduce perinatal morbidity and mortality will help timely corrected methods of conducting childbirth and drug therapy. But a high risk of severe neurological complications is still not excluded.

Especially for beremennost.net Elena Zhirko

Such a diagnosis as “Violation of the uteroplacental blood flow” is made to pregnant women quite often, but not every gynecologist finds time to explain to the expectant mother what it is. Let's see in this article why this conclusion is dangerous and for what reason there are violations in the uteroplacental blood flow.

In the body of a pregnant woman, there is an established system that allows the baby in the womb to receive all the necessary nutrients. An approximate scheme of this system consists of three components: "the mother's body - the placenta - the fetus's body." If any part of this relationship is violated, then this leads to complications in the condition and development of the baby with simultaneous complications in the course of pregnancy.

There are three levels of violations:

The first degree, when the development of the fetus is satisfactory, and the violations are not of a dangerous nature and concern exclusively the uteroplacental blood flow. In the absence of a response from specialists and proper treatment, this stage can last 3-4 weeks on average and goes to the next level 2. It is divided into 2 types:

1A) When the fetal-placental circulation is normal, and abnormalities are seen in the uteroplacental circulation. Fetal growth retardation syndrome develops in approximately 90% of cases.

1B) It is characterized by normal uteroplacental circulation, but complications in the fetal-placental circulation. Fetal growth retardation syndrome develops in approximately 80% of cases.

• The second degree is characterized by impaired blood flow through the vessels both in the fetus and in the uterine blood flow. This degree very quickly (sometimes within 1 week) can go to 3 degrees.
• The third degree means that the blood supply to the fetus is at a critical level.

What complications and diseases lead to the risk of placental insufficiency

• hypertension of varying severity;
• threat of interruption;
• pyelonephritis;
• birth in the past of children with fetal growth retardation syndrome;
• previously transferred severe form of preeclampsia.

Table. The course of pregnancy depending on the degree of uteroplacental blood flow disorders

Degrees of violation	Multiplicity of dopplerometric control	Direction of treatment	Method of delivery
1	Up to 30 weeks - 1 time in three weeks; 30-34 weeks - 1 time in two weeks; 35-40 weeks - 1 time per week. If the obstetrician-gynecologist suspects that the condition of the fetus has worsened, then doplerometry is performed unscheduled	Elimination of complications from the pregnant woman, which are associated with diabetes, preeclampsia and other pathologies. Mandatory treatment of placental insufficiency.	Antenatal hospitalization will be performed at 37 weeks. Childbirth takes place naturally with an early artificial puncture of the fetal bladder.
2	Every 3-4 days	The pregnant woman is immediately sent to the hospital. The treatment is aimed at the maturation of the child's lungs, the elimination of complications from the woman's side, and the intensive restoration of placental insufficiency.	Cesarean section with epidural anesthesia.
3	In dynamics	Determination of the cause and treatment	Immediately perform a caesarean section. If the pregnancy is premature, then the decision is made based on the wishes of the pregnant woman.

Treatment of disorders of the uteroplacental blood flow of the 1A degree is carried out in a complex manner, based on the reasons that caused it. Preparations: Actovegin, Ginipral, Curantil, Pentoxifylline and others.

Attention! This article contains information only general and is not intended to replace the advice of a qualified professional.

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 of the uterine-fetal blood flow", since the blood circulation in the "mother-fetus" system can be conditionally divided into two components:

1. Uteroplacental circulation.
2. 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 perinatal ultrasound diagnostics, since the main function for determining direct violations 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. The presence of diabetes in the mother can lead to circulatory disorders in the system "mother-fetus"

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. Every visit future mother 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 motor activity fetus will test "Count to ten". 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 each time in antenatal clinic starting at 28-30 weeks. CTG is a very sensitive method for assessing the condition of the fetus, therefore, in case of violations of the cardiotocogram, an obligatory ultrasound examination of the fetus and its blood flow is necessary.

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:

1. 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 in late pregnancy.
2. Anomalies in the structure of the placenta - hypoplasia of the placenta, rolled placenta, as well as its premature aging.
3. Anomalies in the structure of the umbilical cord or the presence of its true nodes - such nodes are formed when active stirring fetus.
4. The presence of intrauterine infection - viral, bacterial or others.
5. Rh-conflict of the mother and fetus according to the Rh factor or blood group. Such a conflict is primarily diagnosed by the presence of antibodies in the mother's blood.
6. Maternal gestational diabetes mellitus during an existing pregnancy or pre-existing diabetes mellitus.
7. Gestosis is a complication late dates pregnancy, characterized by increased blood pressure, edema and the appearance of protein in the urine.
8. Maternal hypertension.
9. Any cardiac or vascular pathology of the mother.
10. 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 indicators of the uterine arteries are given 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:

1. The gestation period is up to one week.
2. The number of fetuses and placentas - for twins and triplets, their Doppler indicators.
3. Maternal blood pressure - an ultrasound doctor is always interested in a pregnant woman with her pressure numbers.
4. Maternal hemoglobin levels - with anemia, blood flow indicators can change significantly.
5. Smoking and other bad habits of the mother.
6. Medicinal preparations.
7. 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 during 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:

1. 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 at the moment the 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 measures on the part of physicians, in a matter of hours will lead to severe intrauterine hypoxia of the fetus and its 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 with 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 effect on the central nervous system fetus. 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 blood flow disturbances of II and III degrees, 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.

With untimely diagnosis and inadequate response to circulatory disorders, the situation can sharply worsen - acute hypoxia of the fetus occurs, fraught with its death or severe damage to 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.

The placenta in the body of a future mother plays not only the well-known role of a transport channel for supplying the fetus with nutrients. Its functionality extends much more widely - up to ensuring the complete protection of the child from the effects of negative substances and that may be present in the feeding maternal environment. Violation of blood flow during pregnancy is a direct threat of intrauterine death of the fetus due to poor blood circulation in the complex communicating apparatus of two closed vascular systems.

The blood of the fetus and mother should not mix at any stage of the complex multi-level movement. The barrier functions are provided by the first mechanism of the blood circulation of the mother-fetus - the hematoplacental barrier, which is a kind of unique filter that works in only one direction: by removing waste substances from the fetus along with the blood flow.

The movement of blood in the reverse order, from mother to child, is carried out through the arteries, which are fully formed by the 16th week of pregnancy. This is the second mechanism of the system. Due to the high tone of the arteries, starting from this period, the risk of fetal loss also increases.

The vessels of the uteroplacental circle, isolated by the umbilical trunk, are the third important mechanism of blood circulation between two organisms - feeding and feeding. Violation of blood flow during pregnancy at this stage, has the most serious and irreversible consequences for the fetus.

Causes

The causes of impaired blood flow during pregnancy can be found in the following pathological conditions:

• Anemia (anemia) of the expectant mother. cause high blood flow. This occurs due to compensation for the lack of oxygen and cannot but affect the processes in the development of the fetus and the quality of blood exchange;
• The position of the placenta. If presentation is diagnosed, which can be justified by a cesarean section, then the blood supply will be clearly reduced due to the thinning of the uterus at the site of the scar;
• Late toxicosis causing pathological changes in the work of small vessels. This is one of the most common signs of blood flow disorders during pregnancy;
• Viruses and infections present in the mother's body during the period of gestation. Some of them can cause damage to the placental tissue and contribute to the development of placental insufficiency;
• - may be complicated by the anemic condition of the fetus;
• Defects of the uterus. The most significant of them, capable of changing the course of fetal development for the worse, is the two-cavity structure of the uterine sac. The uterine space, divided into two parts, in itself is not an obstacle to the normal growth and formation of the child. However, the blood supply system does not adequately supply such a two-chamber cavity;
• Serious quantitative or configurational umbilical cord;
• Damage to the inner wall of the uterus obtained as a result of surgical interventions, or as a result of bad habits;
• Tumors such as fibroids, especially dangerous in women who have not given birth before after thirty-five years. This also applies to uterine fibroids, which are abundantly saturated with blood during perinatation. Against the background of an increase in size and the formation of a myomatous node, a persistent lack of blood flow to the placenta is formed;
• , which do not allow maintaining the uniformity of the blood flow rate;
• Pregnancy complicated by multiple pregnancy. Since the placenta is forced to adapt to the maintenance of several feeding organisms in proper conditions at once, such errors in the blood supply as the donor position of one of the fetuses are not excluded. Often at the same time, there is an underdevelopment of the feeding fetus, a significant lack of weight and physiological normal signs. A child who unwittingly acts as a recipient also suffers seriously from, on the contrary, too abundant blood supply;
• Mother's disease, sometimes developing precisely against the background of pregnancy, loosens the walls of blood vessels, which affects blood circulation in a bad way.

The degrees of violation of the uteroplacental circulation during pregnancy, in which significant changes in the development of the fetus are likely, formed the basis of the following classification list:

• Violation of blood flow during pregnancy 1A - all diagnostic indicators of the uteroplacental apparatus are normal, except for an insignificant change in blood flow in any of the uterine arteries;
• Violation of blood flow during pregnancy 1B - there are violations of blood circulation in the vessels of the umbilical cord, despite the fact that the state of the vessels of the uterus is unchanged;
• 2 - a comprehensive violation of both the uterine and umbilical vessels;
• 3 - changes at the global level, characterized by the most extreme rates of deviation.

Degrees of blood circulation 1 (A and B) allow you to save the pregnancy and give birth healthy child, subject to the prescribed treatment and all the recommendations of the doctor. Grade 2 allows for fetal preservation, but this will require hospitalization. Grade 3 requires immediate surgical removal of the fetus to save the life and health of the mother.

The main diagnosis of blood flow disorders during pregnancy, at the moment, is. The most insignificant, at first glance, changes at one of the early stages of violations are clearly visible on the screen, since Doppler provides a picture in color and has a high degree of resolution in terms of the clarity of the picture.

The very analysis of the frequency of ultrasonic waves reflected from objects in motion makes it possible to determine the speed of blood flow through the arteries, in the umbilical vessels, as well as the blood circulation inside the placenta. Then the indicators taken during the survey are compared with the table of normative data and the result is recorded.

The biggest plus of dopplerography, in addition to the safety of the study, is the accurate prediction of any form of abnormality, detecting them at the stage when it is still possible to save the fetus and not harm the mother's body.

In addition, classical measures to confirm or refute the pathology are mandatory used:

• Analysis of the activity of the fetus, based on the words of the mother;
• Stethoscopic listening to the baby's heartbeat in the womb;

Treatment

It is impossible to treat disorders of the uteroplacental blood flow, acting only in one direction, or eliminating problems as they arise.

A complete cure necessarily includes a set of measures aimed at:

• Increased blood microcirculation;
• Achievement of optimal blood pressure;
• Vasodilation with spasmodic manifestations in the arteries;
• Reduction of uterine tone due to the relaxation of blood vessels;
• Prevention of the consequences of oxygen starvation (hypoxia);
• Saturation of the placental tissue with the phospholipids it needs.

Consequences

Depending on the degree and nature of circulatory disorders during pregnancy, there are also difficulties in the development of the fetus, in rare cases leading to the death of the child.

The consequences of impaired blood flow during pregnancy are characterized by such nuances as:

• Inhibition of fetal development at some of the stages, or significant delays in its intrauterine formation;
• Critical indicators of weight and size;
• Rapid, slow, or intermittent heartbeat;
• Floating blood pH;
• Improper course of hormonal processes;
• Risk of miscarriage.

It must be remembered that only a cumulative assessment of the development of the baby, and not the results of a single study, can provide full information on compliance with regulatory indicators, or lagging behind them. At the moment, the Doppler procedure, which is the basis of examinations of the perinatal period, in no way detracts from the need for tried and tested methods of the old school of medicine.