Causes of development and treatment of chronic placental insufficiency. Why placental insufficiency occurs during pregnancy
Fetoplacental insufficiency is a violation of placental function and blood flow. The placenta is formed exclusively during pregnancy, it connects mother and baby. Through it, all the vital functions that a child needs for development are carried out: respiratory, excretory; it is the most powerful protection for the child, provides the supply of microelements and nutrients. If the functions of the placenta are disturbed and have deviations from the norm, then FPI and hypoxia develop. But if the violations are minor, then negative processes will not affect the fetus.
Classification
Time type:
1. Primary.
2. Secondary.
Primary manifests itself in the early stages, at 16–18 weeks, and is caused by placental disorders.
Secondary occurs in the later stages already, when the placenta is fully formed.
By clinical course:
1. Sharp.
2. Chronic.
Acute occurs with severe disturbances in the placenta. Chronic is more common and is characterized by a gradual violation of the functions of the placenta and blood flow.
The chronic form has 4 stages:
1.Compensated.
3. Subcompensated.
4. Critical.
Compensated. With minor changes in the functions of the placenta, the fetus gets used to the changes, and this is not fatal for him, he continues to develop well, nothing threatens his development.
Decompensated is expressed by a serious deterioration in blood circulation in the placenta, the lack of oxygen necessary for the fetus increases - all this leads to a violation of cardiac activity and a delay in the development of the fetus.
Subcompensated causes serious complications under the influence of weakened protective functions.
The critical form is the most dangerous. It is impossible to influence the treatment of this type, and this leads to the death of the fetus.
Reasons for the development of FPI:
1. Diseases of the endocrine system: diabetes mellitus, hypothyroidism and hyperthyroidism.
2. Diseases of the cardiovascular system: hypertension, heart disease.
3. Anemia, especially during pregnancy.
4. Infections and all STDs.
5. The age of the pregnant woman at risk is under 18 and over 35.
6. Early abortions in history.
7. Malformations in the development of the uterus, fibroids, endometriosis.
Symptoms of FPN:
In the chronic compensated form, no symptoms are observed, and the pregnant woman feels well.
In the acute, chronic decompensated form, very active movements are noted, which then stop abruptly. Only a doctor can determine the developmental delay and dysfunction of the placenta; during a routine examination of the abdomen and comparing its size, the stomach will be smaller than it should be at this time. The woman herself will not be able to determine this.
The rate of movements at 28 weeks: the mother should feel at least 10 movements per day, if less than 10, then this should be reported to her obstetrician-gynecologist.
The most dangerous symptom is spotting from the genital tract. This is a sign of early placental abruption, and you should immediately consult a doctor.
Diagnosis of FPN:
1. Ultrasound examination (ultrasound).
2. Cardiotocography (CTG).
3. Dopplerometry.
4. Anamnesis of the pregnant woman and her condition. Complaints, uterine tone, child activity, weight and determination of the state of the uterine fundus. A smear for the microflora of the vagina, tests for genital infections, OAM and OAC, detailed blood biochemistry.
Ultrasound determines the motor activity of the child, monitors the general condition of the placenta and the baby. Measure the amount of amniotic fluid and organs of the child.
CTG is performed from the 30th week of pregnancy to assess the baby's heartbeat and register uterine contractions during childbirth.
Doppler is performed to determine the state of blood flow in the vessels.
Treatment
The compensated form can be carried out on an outpatient basis if there is no deterioration in the condition of the pregnant woman. Other forms of treatment are carried out only in a hospital under the supervision of specialists. Treatment is only medication and is prescribed individually, depending on the results of the examination.
FPI during pregnancy is the most common pathology, in the process of development and formation of which the embryo receives less nutrition and oxygen due to impaired functioning of the placenta. The severity of complications largely depends on the causes of placental insufficiency, so it is important to conduct a thorough diagnosis.
Reasons for the formation of FPI (fetoplacental insufficiency)
FPI during pregnancy is a functional insufficiency of the placenta, hypoxia occurs, the fetus lacks oxygen, which causes developmental delays of varying degrees and other pathological processes in the embryo.Formation occurs under the influence of many factors that affect the compensatory possibility between the mother, placenta and fetus. The development of placental insufficiency is promoted by diseases of the internal organs, chronic inflammation or pathology of the reproductive system. A high risk of a pathological condition of the placenta always remains with women who are diagnosed with preeclampsia in the late stages of gestation.
The risk group also includes the following categories of pregnant women:
- women under 18 or over 35;
- with an antisocial lifestyle (smoking, alcoholism, drug addiction);
- difficult working conditions;
- the presence of endocrine diseases;
- deviations associated with the violation of the monthly cycle and the constant not bearing a child, myoma and others;
- after infections at an early stage of the gestational period;
- in the presence of any systemic diseases - diabetes mellitus, pulmonary or renal failure, high blood pressure;
- concomitant hereditary or congenital factors.
Degrees of placental insufficiency
The classification of FPN at the stage of gestation is carried out according to the severity, term and time of formation. Depending on the gestation period, a primary (incorrectly implanted membrane) and a secondary pathology are distinguished (with a normally formed placenta, insufficient functioning is observed under the influence of negative factors).Clinical development implies two types of pathology:
- Acute placental insufficiency - the membrane begins to detach at any stage of gestation. The main reason is thrombosis and impaired gas exchange function.
- Chronic fpn is diagnosed more often and occurs in the middle of pregnancy. Pathology is characterized by placental aging ahead of time and, in turn, is divided into the following forms:
- compensated - is considered the most favorable, with impaired metabolic processes, but with preserved blood circulation between the uterus and the fetus;
- decompensated - blood flow is disturbed either between the baby and the placenta, or between the uterine cavity and the placental membrane;
- subcompensated chronic placental insufficiency is caused by a significant decrease in the functional abilities of the placenta, there is a significant lag in the development of the fetus.
- FPI 1a degree - there is a lack of hemodynamics of blood flow between the uterine cavity and the placenta;
- FPI 1b degree - is caused by poor blood flow between the fetus and the membrane.
Treatment of placental insufficiency
The protocol of therapeutic actions for FPI includes, first of all, the therapy of the initial factors of the pathology. If the child does not feel discomfort, then prevention and gradual stabilization of blood circulation are prescribed.
Treatment of placental insufficiency in pregnant women with a threat to the life of the child involves the use of medications in a hospital setting. During therapy, drugs are used that improve the quality of blood circulation and activate metabolic processes (Kurantil, Eufillin, Troxevasin and others). To reduce the tone of the uterus, Magnesia, Ginipral or No-Shpa is prescribed.
Clinical recommendations consist of constant dynamic monitoring when diagnosing FPI using ultrasound, CTG and Doppler sonography. A woman needs to observe absolute rest and avoid stressful situations so as not to cause an increase in the tone of the uterus. In order to prevent and improve blood flow, the diet should consist of a variety of fruits and vegetables so that the fetus receives the maximum amount of vitamins and minerals.
Fetoplacental insufficiency during pregnancy (FPI) is a complex of disorders that occur in the blood supply system of the placenta and nutrition of the developing fetus. Refers to common complications of pregnancy. It is difficult to establish the exact causes of placental insufficiency during pregnancy, but it is possible if you study the history of the pregnant woman in detail and organize a thorough diagnosis.
Possible causes of the development of the disease
The following pathologies and conditions of the pregnant woman contribute to the development of morphological and functional disorders in the work of the placenta:
All of the above conditions can, to one degree or another, cause disturbances in the blood supply to the uterus and placenta, provoking adverse consequences and even a threat to the life of the fetus.
FPI often leads to intrauterine death of the fetus and the birth of children with various abnormalities.
In such a state, a woman needs help. Treatment is selected only by specialists, depending on the degree of manifestation of placental insufficiency.
Placental insufficiency: how is it manifested?
Specialists distinguish several forms of pathology. Usually, FPI occurs with the threat of miscarriage, severe hypoxia and delayed mental and physical development of the fetus. Often this condition ends with the fading of pregnancy. A woman often does not even know about the pathological changes occurring in the placenta and her body.
Sometimes pregnant women notice changes in fetal activity: perturbations intensify, and then may abruptly stop or decrease. This symptom is typical for the second half of pregnancy, when a woman clearly feels the movements of the child and may suspect the appearance of abnormalities.
At an early stage, malnutrition and oxygen supply to the fetus occurs with virtually no symptoms. It can be detected during an ultrasound examination, and then only if high-quality and modern equipment is used.
If a woman or a gynecologist suspects the development of placental insufficiency, it is necessary to conduct ultrasound, Dopplerography AND CTG. These studies will show pathological changes, namely an increase in the thickness of the placenta, the appearance of calcifications in its composition and other signs of aging, a lag in the development of the fetus from its term.
Also, the specialist may notice a decrease motor activity unborn child, changes in the amount and degree of transparency of amniotic fluid. Dopplerography allows you to determine the violation of the uteroplacental blood flow.
Who is at risk?
Despite the fact that the disease can also develop in relatively healthy women, experts identify certain patients as a risk group. This includes pregnant women who have:
FPI treatment
Treatment is selected by specialists, taking into account the severity of violations. In the absence of signs of deterioration and at a low risk of complications, the woman is allowed to carry out therapeutic measures on an outpatient basis. If her condition worsens, there is a risk of developing concomitant diseases, it is necessary to be hospitalized.
The task of specialists is to eliminate the leading cause that causes the development of FPI. The rest of the treatment is predominantly symptomatic, aimed at fading the symptoms of the disease and preventing complications. For vascular disorders, anticoagulants and antiaggregants, intravenous drip-glucose-novocaine mixture.
If specialists detect fetal growth retardation, a blood transfusion is performed, drugs are prescribed that restore the functions of impaired organs, reduce pressure, and normalize myometrial tone. The use of vitamin preparations, hepatoprotectors is shown.
Women with FPI should take care of themselves, maintain proper sleep at night, be sure to rest during the day. Try to protect yourself from experiences, nervous shocks, meetings that can cause unexpectedly negative emotions. It is recommended to walk before going to bed so that the baby receives more oxygen, which is necessary for its development.
Give up bad habits, especially from smoking, which leads to vasospasm and exacerbation of signs of FPI. Change the diet, give preference to fresh vegetables and fruits, high-quality protein found in lean meat,
Traditional medicine for FPI and other ineffective methods not only will not bring benefits, but can also harm! With fetal hypoxia, certain medications are needed to help avoid complications and prevent the occurrence of neurological problems in the child after birth.
Possible complications of FPI
- Placental abruption;
- Frozen pregnancy;
- Delayed fetal development, slowing the growth of tissues and bones;
- Stillbirth.
Together with the blood, the fetus receives everything it needs for life. With FPI, the intake of substances, oxygen worsens, and if measures are not taken, the child will grow up with this lack of nutrition, and may even die due to the inaction of the mother and doctors!
Delivery with FPI
The method of delivery is determined individually. When making such a decision, the specialist primarily acts in the interests of the expectant mother and baby. If FPI is in the stage of decompensation, an emergency delivery is performed. The subcompensated form of the disease requires a caesarean section. And only the compensation stage gives the right to conduct independent childbirth, but not in an ordinary maternity hospital, but in one where there is a neonatologist and resuscitation equipment.
Prevention
It makes sense for women who have planned conception to prepare in advance for future motherhood. Be sure to complete a comprehensive examination. to identify chronic diseases of the kidneys, adrenal glands, urinary organs, heart and blood vessels. If serious deviations are found, it is necessary to correct the condition, if recovery is impossible, transfer the disease to the compensation stage in order to reduce the risk of its exacerbation against the background of a hormonal surge during pregnancy.
With an already confirmed pregnancy, monitor your condition, do not miss a gynecologist's examination, diagnostics. Particular attention is paid to screening ultrasound, and if there is a suspicion of hypoxia and other abnormalities, be sure to conduct a Doppler study. It will show the quality of blood flow in the placenta and brain of the child, and according to these data, doctors will treat the patient.
Follow the doctor's recommendations, especially those related to taking vitamins, correcting the regimen. If you work in a hazardous industry, you have the right to receive maternity leave ahead of schedule. Overwork, dangerous external factors, lack of sleep and neuroses can be the impetus for the development of FPI.
If signs of FPI have occurred in past pregnancies, special care must be taken in subsequent pregnancies. If necessary, specialists prescribe a preventive course of taking medications at a critical time in fetal development. Ultrasound is prescribed to such women more often.
0Fetoplacental insufficiency (FPI)- a syndrome resulting from structural changes in the placenta, which lead to a violation of the normal intrauterine development of the fetus. With this disease, the unborn child is in constant hypoxia - lack of oxygen. Clinically, the fetus has growth and developmental delay and low birth weight.
Fetoplacental insufficiency during pregnancy is characterized by disturbances in the transport, nutritional and endocrine functions of the placenta. Due to these disorders, mothers diagnosed with FPI increase the likelihood of miscarriage or preterm birth. Fetoplacental insufficiency accounts for more than 20% of infant mortality.
FPN classification
Fetoplacental insufficiency during pregnancy, depending on the period at which it appeared, is divided into 2 types. The first type is primary FPI, which occurs before the 16th week of gestational age. It is usually associated with disorders in implantation and the formation of fetal membranes. Another type of placental insufficiency is secondary, appearing after the 16th week of pregnancy. As a rule, this type of pathology occurs due to external factors acting on the formed placenta.Depending on the clinical course, two types of FPI are distinguished. The first is acute fetoplacental insufficiency that occurs when placental abruption occurs, or when it is infarcted (circulatory arrest). This type of pathology with untimely medical care leads to the death of the fetus. Chronic placental insufficiency- This is a type of pathology in which disturbances in the structure of the placenta occur gradually. This species is divided into several subspecies:
- Compensated - minor changes in the placenta do not affect the condition of the fetus.
- Subcompensated - changes in the structure of the placenta affect the condition of the fetus, expressed in a lag in its development.
- Decompensated - serious structural changes in the placenta, causing a severe lag in the growth of the fetus.
Causes
The most common causes of FPI development include:- genetic abnormalities of the fetus;
- intrauterine infection;
- diseases of the genital organs;
- extragenital diseases;
- mother's bad habits;
- multiple pregnancy;
- preeclampsia;
- mother's age is under 18 and over 35.
Signs and symptoms of FPI
The expectant mother may suspect the presence of acute and chronic decompensated placental insufficiency by observing the movements of the fetus. With these pathologies, the activity of the child increases sharply, and then subsides. The number of fetal movements less than 10 per day is a reason for consulting a doctor. Acute FPI can manifest itself as bloody discharge from the vagina, which indicates placental abruption.Compensated and subcompensated chronic fetoplacental insufficiency is almost impossible to identify on your own, so you should not skip scheduled medical examinations.
Using routine methods (measuring the height of the uterus and), the doctor may suspect a lag in the development of the fetus, the cause of which is FPI. Of great importance in the diagnosis of this pathology is the ultrasound examination of the unborn child. It allows you to determine the size of individual parts of the body and the fetus itself.
The most reliable method for studying placental blood flow is Doppler ultrasound (ultrasound dopplerography). It allows you to evaluate the rate of blood flow to the child through the vessels of the umbilical cord. CTG is another method for monitoring the condition of the fetus. This type of examination visualizes the heartbeat and motor activity of the unborn child.
Treatment and prevention
Treatment of FPI during pregnancy depends on the cause that caused this pathology and its type. In the event of an existing threat of miscarriage or premature birth (acute FPI), tocolytics (fenoterol, hexaprenaline) are used, which relieve the contractile activity of the uterus. Compensated placental insufficiency does not require special treatment. With this type of pathology, antiplatelet agents and anticoagulants (aspirin, dipyridamole, heparin), metabolic therapy (vitamins, ATP, antioxidants), drugs that improve fetal trophism (essentiale) are used.With subcompensated FPI, in addition to the above measures, beta-agonists (partusisten), protein synthesis stimulants (tocopherol), steroid hormones (premarin) are used. The action of these drugs is aimed at improving utero-placental-fetal blood flow. The decompensated form of FPI is an indication for an emergency caesarean section.
Prevention of placental insufficiency should occur at the stage. Before the intended conception, a woman should cure existing infectious diseases, pathologies of the genital and somatic organs. While carrying a child, the expectant mother should eat right, lead a healthy lifestyle, give up bad habits. In addition, with a complicated pregnancy, a woman should carefully monitor her course in order to avoid unpleasant consequences, such as FPI.
