Violation of BMD 1a degree during pregnancy. Varieties of fetoplacental insufficiency. vital organ

In the process of gestation, the mother's body is closely connected with the fetus through placental structures that provide full-fledged fetal development, as well as deliver nutrition and oxygen, produce hormonal components and remove metabolic products. In general, the placenta is responsible for all the most important processes during the gestation period. Sometimes, for various reasons, a woman develops a violation of blood flow during pregnancy. Such conditions are incredibly dangerous for gestation, they can provoke fetal pathologies and complications of gestation.

Scheduled ultrasound allows you to recognize any deviations in time

During gestation, a close relationship is established between the child and the mother, which is also called the fetoplacental system. It consists of several departments.

The central role is given to the placenta, which grows into the uterine wall with villi and through them nourishes the fetus in the uterus with the necessary substances. Moreover, maternal blood does not mix with fetal blood, since there is a hemato placental barrier through which the blood is filtered, returning back to the woman.
Part of the fetoplacental system is the arterial network of the uterine body. Before conception, these arteries are spasmodic and twisted in the form of a spiral, but already from the first month of pregnancy, the muscle layer, which provides a spasmodic state, resolves, and to fourth month gestation, the arteries are transformed into special trunks that carry blood to the placental structures, fully participating in the blood supply. A similar phenomenon was specially provided by nature for the best intrauterine nutrition of the child. If they start uterine bleeding, then the vascular walls will no longer be able to contract, which is fraught with profuse blood loss, up to and including death.
Another part of the blood supply system between the mother and the fetus is the umbilical vessels, which form another blood supply pathway. A vein and two arterial channels pass through the umbilical cord, which connect the fetus to the placenta. If blood flow disturbances occur in this part, then the fetus is subjected to severe lesions.

Causes of violation of the blood flow of the uterus

Fetoplacental insufficiency can provoke various reasons. The main thing is that such a condition pathologically affects such placental functions as metabolic and trophic, endocrine, transport, etc. similar conditions material exchange processes between the fetal and maternal organisms are seriously disturbed, which leads to serious consequences.

If you have diabetes, check your blood sugar levels regularly

Intrauterine infectious lesions, pneumonia or fetal hypoxia, hypertensive disorders, etc. can provoke a violation of the blood supply. Also, normal blood supply is disturbed in pathologies such as asthma, cardiac pathological conditions such as low blood pressure, malformations, etc. Often, the causes of pathological circulatory disorders are due to neuroendocrine ailments such as hyperthyroidism or diabetes, hypothyroidism, and hypothalamic or adrenal pathologies. Provoke circulatory disorders, kidney failure or pyelonephritis.

Also, problems with blood supply can be caused by anemia or thrombosis, which is actually the norm for such pathologies. Quite often, women suffer from exacerbations of various kinds. infectious pathologies which also lead to placental changes. A variety of infectious agents cause inflammatory lesions, which in the first weeks of gestation can cause spontaneous interruption, and on later dates various deviations in the fetal intrauterine development. No less dangerous are various uterine pathologies such as fibroids, endometriosis, hypoplasia or malformations, as well as pathological changes in the myometrial layer.

At the risk of encountering blood flow disorders are mothers after 35, pregnant women for the first time and having large fibroids. Also, placental or breech presentation, gestosis and multiple gestation, the presence of Rhesus conflict, abortions in the past and a tendency to unhealthy habits, social dissatisfaction and other factors.

Varieties of fetoplacental insufficiency

First of all, placental insufficiency is classified into chronic and acute form. An acute pathology can occur at any time and even during delivery. In the placental tissues, meanwhile, there is a violation of gas exchange, leading to acute fetal hypoxia or the death of the baby. Often a similar phenomenon occurs against the background of premature placental infarction or detachment, bleeding or thrombus formation of blood vessels.

Chronic forms of placental insufficiency are diagnosed much more often and occur mainly during the second trimester of gestation, although they are found only in the third trimester. On the surface of the villi that grow into the uterine wall, fibrin begins to be deposited, which interferes with the normal course of material exchange processes. As a result, premature placental aging begins.

Chronic insufficiency of fetoplacental blood supply is divided into the following varieties:

Critical. With this form, serious functional and morphological changes develop in the structures of the placenta, which cannot be influenced in any way, so fetal death becomes inevitable.
Subcompensated insufficiency. With such a violation, the female body cannot cope with violations of placental activity, therefore, fetal development is delayed, which leads to complications during gestation and fetal development.
Decompensated - when compensation mechanisms lose their ability to deal with pathological placental changes, therefore, the norm of indicators during the development of pregnancy is violated, the fetus begins to suffer from hypoxia, cardiac disorders, developmental delays, etc. There is a high probability of intrauterine fetal death.
Compensated insufficiency is considered the most favorable of all of the above, since the fetus continues to develop without suffering from various abnormalities. The female body with such a deficiency is able to adapt and compensate for the deviations that have occurred to the child. If a woman receives the right treatment, then such deviations will not affect the health of the baby and the timing of delivery.

Degrees of hemodynamic abnormalities

Breathing exercises are useful for the expectant mother and baby

In addition to the types of disorders described above, there are various fetoplacental degrees during pregnancy. With the initial degrees of pathological abnormalities, the fetus is in normal condition, blood flow deviations are not dangerous and affect only the uteroplacental sphere. It is important to detect such violations in a timely manner, if the patient does not receive necessary assistance, then within a month the pathological deviations are aggravated, moving to a more serious degree.

Blood flow disorders of the 1st degree are conventionally divided into two types: deviations of the 1A degree and 1B. In the latter case, the blood flow between the placenta and uterine tissues is normal, but there are deviations in the placental-fetal circulation. In about 80% of cases, the fetus with such disorders develops developmental delay. Deviations of the blood flow of the 1A degree are characterized by disturbances between the placental and uterine circulation, while in the placental-fetal blood flow the norm of indicators is observed. About 90% of cases of such disorders are accompanied by a developmental delay in the child.

In the second degree of pathology, there are serious violations in the bloodstream of the fetal vessels and the uterine body. This stage is usually short-lived, takes about a week and quickly moves on to the next stage of disorders. The third degree of hemodynamic disturbances is characterized by critical disturbances in the fetal blood supply or its complete absence. You can try to cure only the pathology of stage 1B, in other cases, the deviations are irreversible and often require premature birth.

Signs of pathology

The clinical picture of blood flow disorders is determined by their severity. Compensated disorders usually proceed latently and are detected only with ultrasound diagnostics. Decompensated and acute forms of placental insufficiency are usually accompanied by changes in the motor activity of the fetus, which is either minimized or becomes excessively pronounced. Normally, the fetus should move at least ten times a day.

Sometimes such deviations are accompanied by insufficient growth of the tummy of a pregnant woman, polyhydramnios or oligohydramnios, severe preeclampsia or hyperedema, a sharp weight gain or pressure surges, the appearance of protein compounds in urine. The most dangerous manifestation of insufficiency placental circulation uterine bleeding is considered, which usually occurs against the background of placental abruption. IN similar situation a woman can get significant help only from specialists, so you need to call an ambulance.

What is the danger of a blood flow disorder

During gestation, problems with blood flow are dangerous, because even a slight violation of blood circulation reduces the amount of nutrition and oxygen supplied to the fetus. With prolonged fasting of this kind, complications are likely to develop, such as:

When identifying initial stage there are no particularly dangerous risks for the baby; with age, the child will catch up with the development of his peers. If more severe degrees of violation are detected, the prognosis is unfavorable, such pregnancies usually end in a frozen fetus or the appearance of a child with various anomalies, inferiority and other ailments.

Diagnosis of violations

If the development of placental blood flow disorders is suspected, the patient is comprehensive examination. The leading role in the diagnosis is given to dopplerometry in combination with ultrasound examination. Such techniques allow timely detection of pathological blood flow disorders and determine the degree of complications caused by them. Usually dopplerometry is prescribed for premature placental aging, lack or excess of amniotic fluid, congenital genetic pathologies or fetal defects, with hypoxic manifestations or intrauterine retention fruitful development.

How to normalize the blood supply in the uterus

The first stage of blood flow fetoplacental abnormalities responds most positively to treatment. In the second degree, therapy is practically ineffective, and in the third degree, emergency childbirth is necessary through surgical intervention. In the process of therapy, it is necessary to influence all parts of the blood flow structures. With minor microcirculation disorders, to improve blood flow, patients are shown taking Hofitol, which belongs to the category of homeopathic remedies. If the treatment does not provide the desired effect, then resort to medications such as Actovegin or Pentoksifarm.

To expand the vascular passages, No-Shpa or Drotaverine is used, and for thrombophlebitis, Curantyl is indicated. Improves blood flow and reduces the tone of the uterine muscles Magnesium B6 and magnesium infusion. And with an antioxidant purpose, reception is indicated ascorbic acid and vitamin E.

In order not to treat blood flow disorders or their consequences, it is necessary to take preventive measures in advance to prevent these conditions. Mom should eliminate all risk factors that provoke the development of placental insufficiency. Mommy needs to control body weight, spend more time on fresh air and timely undergo all planned procedures, diagnostic tests, laboratory tests and gynecological examinations. This is the only way to detect deviations in time and prevent their further development.

The role of the transport system, which supplies nutrients with oxygen from the mother to her baby, is played by the placenta. It acts as a special link connecting two separate vascular systems - uterine and umbilical blood flow - together. The well-being and safety of the baby depends on the quality of the work of this unique organ. That is why during an ultrasound examination, not only the level of physical development of the fetus is checked, but also determined possible violations uterine blood flow during pregnancy. What indicators should normal blood flow in the placenta meet, what symptoms can be used to suspect a pathology, and how can this disease be treated?

Violation of blood flow during pregnancy. The structure of the uteroplacental blood flow

The blood flow between the woman and the fetus is provided not only through the placenta. In addition to it, a complex network of blood vessels is involved in the uteroplacental circulation system, working in conjunction with the placenta, which help it fully supply the fetus with everything necessary and at the same time prevent oxygen starvation fetal tissues.

The circulatory system between mother and baby consists of three levels, which change with increasing gestational age and perform certain functions. Under the influence of many factors, “breakdowns” can occur on any of them. And depending on their location and severity, the entire subsequent treatment plan and tactics of childbirth depend.

The central link of the system is the placenta. As it grows, its villi grow tightly into the uterine walls and “suck out” a set of all necessary elements for fetal development. In this case, incest between mother and baby does not occur. The multilayered hematoplacental barrier plays the role of a strong "sponge", which allows only useful substances to pass through, and filters out all dangerous compounds and viruses and sends them back to the mother's venous circulation.
The second level of blood flow is considered to be a branch of the spiral arteries of the uterus. They are intended solely to support pregnancy and are dormant until conception. When the embryo is four weeks old, the arteries gradually begin to lose muscle tissue and the ability to contract. Closer to the fourth month of gestation, they fill with blood and connect with the placenta. Violation of blood flow in the uterine artery during pregnancy entails a blockage of blood circulation at all other levels.

In addition to benefiting the child, these arteries carry a certain risk to the life of the mother. Their rupture may cause heavy bleeding during delivery, as they lose their ability to contract.

The third level of blood flow is formed by the umbilical vessels. A vein and two arteries connect the embryo and the placenta and therefore play the most important role in the development of the baby. Violation of the fetal-placental system most often causes congenital abnormalities in the development of the child.

Violation of blood flow during pregnancy: causes

Factors of primary insufficiency are:

genetic predisposition.
Infection with a viral or bacterial microflora.
Endocrine disorders (inferiority corpus luteum, ovarian dysfunction, hypothyroidism).
Lack of tissue that serves as the basis for further development gestational sac and placenta.

All these factors lead to wrong development and attachment of the placenta, and its subsequent inferiority.

Causes of secondary placental insufficiency include:

Obstetric diseases (myoma, endometriosis).
Diseases endocrine system(diabetes, hyperthyroidism).
Chronic diseases (hypertension, renal pathologies, thrombophlebitis).
Complications of pregnancy ( malpresentation placenta, Rhesus conflict, multiple pregnancy).
Factors of external unfavorable environment.
Bad habits.
Social conditions.

Violation of blood flow during pregnancy. Classification of placental insufficiency

Violation of blood flow is a common pathology, which is caused by disorders in the structure of the placenta and umbilical cord, and in 60% causes a delay in mental and physical development baby. The following classifications are generally accepted and most common.

Depending on the time of occurrence, there are:

Primary placental insufficiency - manifests itself before the 16th gestational week and is associated with a violation of the mechanism of implantation of the fetal egg and subsequent abnormal formation of the placenta.
Secondary placental insufficiency - is diagnosed after the 16th week of pregnancy, when the placenta is already fully formed. The cause of the violation is the influence of various negative factors of external origin.

In accordance with the clinical picture of the course of the disease, placental insufficiency is divided into the following forms:

Compensation - metabolic disturbances in the work of the placenta are fixed, but the blood flow between the uterus and the placenta or between the placenta and the baby is not disturbed. In this condition, partial blocking of the blood flow can be observed, for example, a violation of the umbilical blood flow in one of the vessels or a violation of the right blood flow of the uterus during pregnancy. The female body is able to fully compensate for the lack of oxygen in the baby by increasing blood flow in other ways. This provides optimal development child without the risk of hypoxia. The baby develops normally and is born in fixed time no congenital anomalies.
Subcompensation - the mother's body cannot resume the flow of oxygen to the baby, since all links of the blood flow system do not fully function. This causes some difficulties due to oxygen deficiency, which causes deterioration of the fetus and can provoke birth defects development.
Decompensation - during Doppler diagnostics, a complete violation of blood flow is determined, which is difficult to eliminate drug treatment. This condition often results in complex heart defects or death after birth.

Violation placental blood flow during pregnancy, it can be acute and occurs against the background of premature detachment of the placenta or its incorrect location in the uterus. Chronic blood flow disorder can fail at any gestational age and is most common.

According to ultrasound, there are three degrees of fetal hemodynamic disorders.

Grade 1 - involves minor changes in blood circulation between a woman and her baby, which is effectively treated with special medications. At this stage, there is a violation of only one part of the circulatory system, for example, only in the uterine artery. Timely diagnosis pathology and its subsequent treatment completely eliminates the risk of violations in the child.

Depending on which part of the bloodstream is affected, there are two varieties of the first degree:

impaired blood flow of the 1a degree during pregnancy indicates that the patency between the uterus and the placenta is reduced, while the connection between the placenta and the fetus is not broken. Incorrect treatment in 90% of cases may be accompanied by a slight lag in the development of the fetus, which is characterized by insufficient body weight and general growth indicators.
1b degree blood flow disturbance during pregnancy indicates that the uteroplacental blood flow is normal, and the fetal-placenta circulatory system is impaired. In 80% of future women in childbirth, pregnancy proceeds with signs of a delay in the normal development of the fetus.

Grade 2 - is diagnosed if there is placental insufficiency at all levels. In this case, it is almost impossible to compensate for the oxygen deficiency, since the fetal aorta, uterine artery and umbilical artery are unable to fully pass the blood flow. This degree is detrimental to the baby and often causes his death.

Violation of the blood flow of the 2nd degree during pregnancy is very unstable and in the shortest possible time passes into the last most critical degree.

Grade 3 - characterized by centralization of the blood flow. The baby's condition becomes critical, because his intracardiac hemodynamics is completely disturbed. Dopplerometry often shows reverse diastolic blood flow. This degree is often diagnosed with clear signs developmental delays and is practically not amenable to drug treatment.

Diagnosis of placental insufficiency

For proactive detection possible problems with blood flow, all women in the position undergo diagnostics three times, which includes Doppler. The recommended time for ultrasound is from 11 to 14 gestational weeks, from 20 to 24, and from 32 to 34 weeks.

Obstetric examination

Women in a position who are at risk for the formation of placental insufficiency are subject to regular clinical observation. Special attention give the following indicators:

Woman's weight. Exceeding this value often indicates latent gestosis.
Abdominal circumference and fundal height. Deviation from the norm of these indicators in 50% of cases indicates a delay in fetal development.
Uterine tone and bleeding.
Fetal movement and heart rate. A decrease in these indicators indicates a possible fetal hypoxia.

Laboratory research

This diagnosis is used to determine the condition of a pregnant woman in the third trimester with compensated blood flow disorders. For this, the hormonal status of a woman is monitored, provided that the fetus has no signs of malnutrition (intrauterine lag).

Laboratory tests include the following:

Calculation of the amount of alkaline phosphatase in venous blood.
Determination of the level of oxytocin.
The study of the concentration of estradiol in the urine.

Doppler study

Such a complicated name belongs to the painless diagnostic procedure which allows:

measure the speed of blood flow in the veins and arteries connecting the mother and child;
determine the direction of blood flow;
diagnose pathological changes until the onset of symptoms.

Additionally, you can evaluate the following indicators:

The degree of aging of the placenta.
Much or little water.
Possible malformations.
Fetal hypoxia.
Genetic anomalies.
Signs of intrauterine infection.
Finesse of the placenta.

Such an examination is carried out on additionally equipped devices for ultrasound examination or special portable devices. Thanks to the sensors that measure the performance, all data is displayed on the monitor. During the diagnosis, a Dopplerogram is compiled, which shows the systolic-diastolic ratio of blood flow. In other words, it shows the difference between the blood flow sent and received back, which helps to determine the degree of patency of the vessels that connect the uterus, placenta and baby.

The most favorable position for Doppler ultrasound is lying on your side. It is also possible to conduct a study on the back, but in this position, many women may experience uterine hypertonicity, which significantly distorts the results.

What symptoms indicate blood flow disorders during pregnancy

It is very difficult to suspect problems with blood flow in the placenta without examination. But there are a few symptoms that should be treated by a doctor:

Pathological motor activity of the baby. If it is overly active or, conversely, practically does not move, this signals hypoxia.
Severe toxicosis in the second half of pregnancy. Late preeclampsia often accompanies placental blood flow pathology.
Too slow increase in abdominal circumference. It is difficult to notice this on your own, therefore, as a rule, the gynecologist draws attention to this during a scheduled visit to the patient.
Bloody vaginal discharge. This is the most dangerous symptom which indicates placental abruption.

Violation of blood flow during pregnancy: consequences

Even the smallest deviations in blood circulation between mother and fetus reduce the number of incoming useful substances, vitamins and oxygen. If such "starvation" is prolonged, the following complications may occur:

Pathological abortion.
Fetal hypoxia.
Congenital heart defects.
Increased risk of intrauterine and perinatal death.
Detachment of the placenta or its premature aging.
Preeclampsia.

When diagnosing the first degree of compensated blood flow disturbance during pregnancy, the consequences for the child are non-critical and over time, a slight lag in growth or development is smoothed out, and the baby catches up with his peers.

If a woman is diagnosed with a more severe decompensated placental insufficiency of the last degree, the prognosis is less optimistic and the pregnancy often ends in fetal failure or the birth of a defective child.

Violation of blood flow during pregnancy: treatment

by the most favorable period For conservative treatment considered the first degree of pathological blood flow. The second degree is extremely rarely amenable to correction, but the third is a direct indicator for emergency delivery by caesarean section, if the gestational age allows.

The tactics of treatment is based on the pathogenesis of the disease, and provides for a complex effect on all links in the blood flow chain:

To improve microcirculation with minor deviations, women are prescribed the homeopathic drug Hofitol, and if it does not have the desired effect, medications with more active active ingredients, such as Pentoxipharm or Actovegin, are prescribed.
If a woman has a history of thrombophlebitis, she is shown drugs to restore the ability of blood to pass through the vessels. Such means include Curantil.
As a vasodilator, Drotaverine or No-Shpa is used.
To reduce uterine tone and improve blood flow, magnesium is prescribed in the form of droppers and orally Magnesium B6.
To provide an antioxidant effect, the intake of vitamin C and tocopherol is required.

If the woman's condition does not improve and, according to the results of control studies, the blood flow is not restored, the woman is offered hospitalization. This provides a more thorough control over the condition of the fetus.

To avoid possible complications from the side of the uteroplacental blood flow, it is better to take up the prevention of this pathology. Walk more in the fresh air, eat right, give up bad habits and, most importantly, go through all scheduled examinations in a timely manner. Then you will be able to warn, and in case of occurrence, start treating blood flow disorders in time.

Video "Circulation between mother and child"

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, a fairly large number of pregnant women have impaired 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 diagnostics, which clearly shows the vessels of the placenta 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 very dangerous state organism, 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 in fetal motor activity;
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. Mainly used conservative methods treatment. 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 of conservative treatment, even in the case of a slight violation, the decision is made within two days. Usually carried out C-section. 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 the necessary 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. Women at risk are given prophylaxis with drugs to interact with the systems of the mother and fetus and prevent 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 serious consequences for the unborn child.

Placenta - formed in the uterus after pregnancy. It is necessary for binding the body of mother and child with one blood circulation. With the help of the placenta, the fetus is supplied with oxygen, nutrients necessary for the development and formation of organs. IN reverse side unnecessary substances formed as a result of biochemical processes are removed.

Impaired uteroplacental blood flow causes a condition called placental insufficiency. This leads to the death of the fetus, miscarriage.

For 36 weeks, three mandatory ultrasound examinations are performed. It allows you to timely identify the violation, develop a plan for the management of pregnancy and childbirth, prescribe treatment, prevent the death and abnormal development of the child.

Modern requirements of obstetricians-gynecologists are aimed at examining pregnant women with the help of safe methods to evaluate uteroplacental blood flow by volume.

How does blood flow between mother and fetus work?

The mother-fetus circulatory system is based on such anatomical formations as the placenta, umbilical arteries, and veins.

Blood flows to the placenta through the uterine arteries. The structure of their walls is characterized by the presence of a muscle layer that can contract and block the lumen. Before pregnancy, this mechanism helps to reduce blood loss during menstruation.

At 4–5 weeks of fixation of a fertilized egg (gestation process), the muscle layer disappears. Blood flow to the placenta is no longer dependent on vascular contraction. And by the sixteenth week, the arteries are transformed for constant blood supply. This is dangerous when bleeding occurs, since it is impossible to stop it by reducing the lumen of the vessels.

IN normal conditions the placenta is fixed on the inner surface of the uterus with the help of villi penetrating deep into the thickness of the mucosa. They grow into the walls of blood vessels and directly contact with maternal blood.

Here at the cellular level is happening:

exchange between the maternal organism and the fetal blood flow;
two oppositely directed streams meet;
necessary substances are transferred (diffusion).

Another part of the general blood circulation is provided by the vessels of the umbilical cord (normally there are 2 arteries and a vein). The main volume of blood flows to the fetus through the arteries, flows through the vein towards the placenta.

With the growth of the uterus, the arteries expand, form anastomoses

Violation of the fetal-placental blood flow is the most difficult to tolerate developing child. It creates conditions for an unsatisfactory forecast of the construction of internal organs and systems, the birth of a healthy baby.

What causes can break the flow of blood between the mother, placenta and fetus?

Causes of violations of the circulatory system between the mother's body and the fetus (fetoplacental insufficiency) are well understood. Some of the factors are formed only against the background of pregnancy. Another - depends on the general health of the woman.

Pathologies of pregnancy include:

Low attachment of the placenta (obstetricians say - presentation, "placentation") - the lower sections of the uterus are distinguished by a thinner muscle layer. Not enough blood flows through it to the fetus. A similar situation develops in the case of presentation in the area of the postoperative scar (for example, from a caesarean section).
Late toxicosis - accompanied by damage small vessels uterus, a complication is the most common violation of blood flow.
Anemia - a low level of hemoglobin causes a compensatory acceleration of the heartbeat, blood flow through the uterine arteries increases in order to compensate for the lack of oxygen. The circulation in the utero-placental circle also changes.
Incompatibility between the blood of the mother and the fetus according to Rhesus - an immune conflict arises with the development of a hemolytic disease of the child, anemia. The same situation is possible when transfusing blood of different groups from a donor.
The burden on the kidneys due to toxicosis can cause an increase in blood pressure. This contributes to the change in blood flow.
Rarely, pathology of the umbilical arteries is detected. If there is only one umbilical artery, then the blood flow is insufficient for the fetus.
Multiple pregnancy - the placenta is enlarged and requires enhanced nutrition. Sometimes blood flow passes from one fetus to another.

It turns out that the first child is a constant donor for the twin, develops worse, because he transfers blood to his brother, and he himself is “malnourished”

Such changes are called fetotransfusion syndrome. The donor has a smaller body weight. And the recipient has an increased load on the developing heart. Both babies have problems.

Of the diseases of women, the most dangerous are:

Acute infections during pregnancy - pathogens can penetrate the placental barrier and destroy the vasculature.
Malformations of the uterus - the most significant is the "two-horned" uterus. Inside the cavity there is a partition dividing it into 2 parts. Pregnancy is possible only in one of them. The main violation is not the compression factor (the cavity has the ability to stretch enough), but the lack of communication between the uterine arteries, underdevelopment network of vessels, hypoxia of the placenta.
Endometriosis - changes in the inner lining of the uterus, occur after inflammatory diseases (including genital infections), frequent abortions, diagnostic curettage. One reason is smoking and alcohol.
Tumor of the uterus - if a woman has even a small fibroid (benign tumor), then pregnancy stimulates the growth of nodes. They take over part of the blood supply, and the blood flow of the fetus is “robbed”. Deficiency directly depends on the size of the tumor.
Diabetes mellitus - affects the walls of blood vessels, often occurs in women with risk factors during pregnancy.

What threatens the fetus with insufficient placental blood supply?

All violations of both uteroplacental and fetal-placental nature lead to oxygen deficiency of the fetus (hypoxia). Complications are caused precisely by this mechanism:

the formation of the internal organs of the fetus is disrupted, there is a lack of mass, this is called "intrauterine growth retardation";
the heart reacts with rapid contractions (tachycardia) or arrhythmias, bradycardia;
the composition of electrolytes and acid-base balance are disturbed;
the functioning of the endocrine system is disrupted, the fetus has a hormonal imbalance;
fat depots are not formed.

Most severe complications- fetal death, threatened miscarriage.

Myomatous nodes take part of the vascular network in the fetus for its growth

Types of blood flow disorders in the placenta

There are fetoplacental (between the fetus and the placenta) insufficiency and uteroplacental insufficiency.

Fetoplacental hypoxia can proceed as:

Acute deficiency- occurs in any period of pregnancy and during labor pains. Causes premature detachment of the placenta, vascular thrombosis, heart attack in the area of the placenta, hemorrhage. Can cause the death of a child.
Chronic - occurs more often, develops from the second trimester, but manifests itself only in the third. Placental changes are premature aging, fibrin is deposited on the surface of the villi. Permeability is sharply reduced, which provokes fetal hypoxia.

Against the background of the development of chronic placental insufficiency, stages can be distinguished:

compensation - the course is favorable, because they work defense mechanisms the mother's body and compensate the baby for the missing nutrition, the treatment is effective, the child is born on time, healthy;
subcompensation - the mother's body is not able to fully compensate for the "unprofitable" blood supply to the fetus, full treatment is necessary, the child can be born with complications, lags behind in development;
decompensation - the pathology develops rapidly, compensatory mechanisms are not enough, the activity of the heart is disturbed in the fetus, intrauterine death is possible;
critical stage- characterized by pronounced structural changes in the placenta, which violates its functions, therapy cannot change the state of the fetus, death is inevitable.

Degrees of impaired blood flow

IN joint violation fetoplacental and uteroplacental blood flow distinguish 3 degrees.

I - changes are compensated, do not threaten the fetus, they capture only the uteroplacental blood flow, the child develops normally. Depending on the level of change, there are:

degree Ia - violation of uteroplacental blood flow is limited to one of the arteries of the uterus, all hemodynamic parameters are stable, within normal limits;
degree Ib - the blood flow is disturbed at the level of communication between the fetus and the placenta due to the vessels of the umbilical cord, enough blood flows through the uterine arteries.

If small changes in the first stage were not detected and the woman did not receive treatment, then after 3-4 weeks, violations of the second degree occur.

II - the blood flow in the uterine and umbilical arteries changes.

III - indicators are critical, reverse blood flow in the arteries is possible.

How is the diagnosis carried out?

The Doppler ultrasound method helps to make the correct diagnosis and identify the level of impaired blood flow most accurately. The method is highly sensitive and very informative. Shows even small changes in the first stage to clinical manifestations. An important advantage is safety for the fetus and the expectant mother.

With the help of dopplerography, it is possible to examine the blood flow through the arteries and veins, obtain a color graphic image, and measure the hemodynamic parameters of the fetus.

This plays a significant role in predicting the course of pregnancy, creates conditions for making decisions on therapeutic measures.

Indirect diagnostic methods include:

computed tomography,

Methods allow you to identify the lack of fetal weight, the placenta is not well. These signs may be evidence of the development of hypoxia.

What does the mother feel and the doctor determines during the examination?

Hypoxia stimulates the motor activity of the fetus.

At an appointment with an obstetrician-gynecologist, the doctor listens, draws attention to a high frequency, arrhythmia or bradycardia. This necessitates referral for Doppler examination.

A pregnant woman pays attention to the increase in movements, tremors

Treatment of disorders

Establishing the degree of impaired uteroplacental blood flow is necessary for choosing the tactics of pregnancy management.

It is believed that it is possible to maintain pregnancy in the first degree (a and b), treatment will still help.
The second degree is considered as borderline, requiring constant monitoring, the effectiveness of treatment is unlikely.
In the third degree, urgent delivery by surgical methods is required.

The possibilities of therapy are aimed at all parts of the pathology:

to improve microcirculation, Pentoxifylline, Actovegin are used;
Stabizol, Venofundin, Infucol are used as support for low blood flow velocity and pressure in the vessels (synthesized on the basis of a starch solution, capable of retaining fluid in the vessels);
vasodilating drugs such as Eufillin, No-shpy eliminate spasm of medium and small arteries;
by reducing the tone of the uterus, it is possible to influence vasospasm, reduce the degree of hypoxia, use magnesium sulfate, Magne B6, Ginipral;
antioxidants eliminate the effects of hypoxia, destroy decay products, prescribe Tocopherol, combinations of vitamin E and ascorbic acid, Hofitol;
Essentiale has a protective effect by increasing the level of useful phospholipids in the blood, improving liver function;
Curantyl is prescribed during pregnancy against the background of uterine fibroids, a positive effect on microcirculation and prevention of thrombosis has been established.

In the practice of obstetricians continue to use Cocarboxylase, which was abandoned by cardiologists. But gynecologists consider the drug effective for restoring tissue respiration.

For the treatment of newborns and care for them, according to indications, incubators are used

Forecast and consequences

For statistical studies, such an indicator as "perinatal mortality" is used. It includes all deaths in the fetus from the 22nd week of pregnancy and among newborns in the first week of life. It is believed that it fully reflects the influence of the factor of pregnancy and childbirth. The calculation is based on 1000 born children.

Currently, 13.3% of children die from the second degree of violation of the uteroplacental circulation, in the third - up to 47%. Timely caesarean section can reduce mortality.

Need intensive care for:

35.5% of newborns with the first degree;
45.5% - from the second;
88.2% - from the third.

The consequences of preserving and treating children born under conditions of pathological hypoxia are unclear. Pediatricians and psychiatrists point to its unconditional influence on physical and mental development.

Only experienced specialists can diagnose and treat conditions associated with a violation of the uteroplacental barrier. Cannot be taken on its own medications or use the advice of poorly educated people. The situation can become critical not only for the fetus, but also for the woman.