Uteroplacental circulation. How does blood flow between mother and fetus work? Violation of the uteroplacental blood flow: danger and signs of pathology, diagnosis and treatment

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

vital organ

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

The layout of the placenta

The main tasks of this temporary body:

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

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

What causes blood flow problems

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

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

Classification and symptoms

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

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

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

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

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

Main diagnostic options:

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

Complications and how to deal with them

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

Complications from a pregnant woman:

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

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

Fetal complications:

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

Specific treatment of fruit- placental insufficiency absent. The problems with blood circulation revealed during the ultrasound examination should alert the expectant mother. It is necessary to follow the doctor's recommendations:

Observe the regime of work and rest, bed rest if necessary.
Visit the antenatal clinic more often to adequately monitor the condition of the fetus.
Eat more vitamins, stop smoking or drinking alcohol.
Monitor fetal movements and report to medical staff if the baby's activity is reduced.

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

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

A bit of theory

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

In this case, a woman who is at the 30th week of pregnancy must necessarily undergo a special ultrasound 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 a very dangerous state of the body, as oppression occurs. respiratory function, and the development of the fetus is suspended.

Degrees of violation

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

The second degree is characterized by a deterioration in the blood supply to the fetus. In 50% of cases, there is a decrease in the maximum velocity of blood moving through all the valves of the heart, and such a violation is observed both in the fetus and in 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 more later dates. 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;
adrenal disease 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. The necessary nutrients and oxygen, and there is a slowdown in the excretion of metabolic products. 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 a violation uterine blood flow during pregnancy of 1 A or 1 B degree, 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 are 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.

In pregnancy that occurs with deviations, are used various means improving the condition of the fetus. Mostly conservative methods of treatment are used. Surgical intervention is 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.

Used for treatment the following drugs:

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

Preventive measures

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

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

Conclusion

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

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

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

How is the circulatory system between mother and fetus arranged?

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

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

Levels of the uteroplacental system:

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

Video: Fetal Circulation Lecture Series

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

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

Why is NMPK dangerous for the fetus?

- one of the main consequences of NMPK

Reduced fetal blood supply can cause the following obstetric complications:

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

Degrees of violation of uteroplacental circulation

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

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

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

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

Diagnostic methods

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

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

What are the benefits of doppler sonography?

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

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

case from practice

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

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

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

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

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

Secondary diagnostic methods

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

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

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

Treatment of uteroplacental blood flow disorders

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

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

Conclusion

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

Video: about fetal hypoxia - a consequence of NMPK

Pregnancy is accompanied various changes in the body of a woman, which are aimed at full development child. There is an adaptation of many processes and systems to new conditions of existence, a woman notes the appearance of previously unknown sensations. Any expectant mother wants the baby to be born healthy, and naturally worries about his condition if any violations are detected.

The main factor that supports intrauterine growth and development of the child, is the uteroplacental-fetal blood flow (MPCC). It is a comprehensive system that supports normal flow pregnancy. If the blood flow in the uterus is disturbed, then they speak of placental insufficiency. It is dangerous primarily by miscarriage, and other negative consequences indicated pathology for the expectant mother and child.

The lack of blood flow through the placenta should be detected in time, and therapeutic measures should not be postponed.

Causes

Violation of hemodynamics between the fetus and the woman's body is provoked by many factors. They affect the placenta both during its formation and later in pregnancy. Accordingly, primary and secondary circulatory insufficiency are distinguished. As a result, there is a violation of all functions of the placenta, as a separate organ: transport, metabolic, protective, immune and endocrine. This is triggered by the following conditions:

Tumors of the uterus.
Structural anomalies.
genetic defects.
Hormonal dysfunctions.
The consequences of abortion.
late toxicosis.
Infectious diseases.
Atherosclerosis, thrombosis.
Hypertonic disease.
Diabetes.
Diseases of the thyroid and adrenal glands.

Most often, a woman has an underlying risk factor that can cause placental insufficiency. Often there is a combination of several similar states when carrying a child.

To identify the causes of impaired placental blood flow, it is necessary to conduct periodic screenings at various stages of pregnancy.

Symptoms

Each pathology has its own clinical picture, which allows us to draw a preliminary conclusion. Hemodynamic insufficiency is manifested by changes in all functions of the placenta, and as a result, the fetus suffers mainly. It receives all the nutrients and oxygen in insufficient quantities, and the excretion of metabolic products may slow down. There are signs of fetal hypoxia, which further leads to intrauterine growth retardation. As a result, the following symptoms are noted:

Acceleration of the heartbeat.
Increasing activity and then decreasing it.
Inconsistency of the volume of the abdomen with the gestational age.

Usually, similar signs appear with decompensated form of placental insufficiency. If the violation of blood flow has a degree 1a or 1b, detected during a timely examination, then there are no indicated symptoms yet, since hemodynamics is compensated.

Classification

Symptoms depend on the severity of changes in MBPC, which are recorded during an additional examination. Based on clinical and gynecological examination it is impossible to say for sure about this, however, it is possible to preliminarily judge hemodynamics by indirect data. So, impaired blood flow during pregnancy is classified according to the degree:

Grade 1a - changes affect only the uteroplacental part of the blood flow.
1b degree - only the fetal-placental blood flow is weakened.
Grade 2 - violations relate to all hemodynamic processes, but diastolic blood flow is still preserved.
Grade 3 - a situation where the fetal-placental blood flow has critical disturbances while maintaining or changing uteroplacental hemodynamics.

This classification is based on the ratio between the speed of the uterine and umbilical blood flow. In addition, violations are isolated according to individual branches of the afferent artery.

Signs of impaired blood flow from the fetus may not be noticeable to the woman, but the doctor must pay attention to them.

Consequences

Placental insufficiency is a danger to the development of the fetus. Therefore, the main obstetric complications just relate to the condition of the unborn child. The greatest danger is expressed by blood flow disorders, which can have both chronic and acute course. In this context, 1a and 1b degrees of hemodynamic disturbances are not mentioned, as the mildest.

Placental abruption

Sudden violations of blood flow can be provoked by trauma, thrombosis or embolism of the uterine artery. Then a situation arises when the placenta exfoliates in one of the areas. Depending on its location, the pathology proceeds according to the central or peripheral type. In this case, the following symptoms appear:

Pain in the area of detachment.
Local protrusion of the uterine wall.
Bloody issues.
Deterioration of the fetus.

If the detachment goes according to the central type, then there may not be any external secretions at all, however, the blood seeps into the wall of the uterus, due to which it loses its contractility. This is fraught with atonic bleeding and disseminated blood coagulation (DIC).

When placental complications are mild, they can be eliminated with adequate therapy.

Miscarriage

In turn, placental abruption causes spontaneous abortion or premature birth that is included in the concept of miscarriage. This is a situation that, obviously, all women are afraid of, because losing a child is the worst thing that can happen during this period. Then the following signs are revealed:

Pain in the lower abdomen, in the sacrum, rectum.
Bloody discharge of varying intensity.
Frequent urination.
Hypertension of the uterus.
Gradual dilatation of the cervix.

If the process is stopped at the threat stage, then the child can be saved. But when the placenta is completely exfoliated, and an abortion is diagnosed in progress, unfortunately, it is no longer possible to fix something. In the future, the pathology may be complete or incomplete. When parts of the fetus or membrane linger in the uterine cavity, there is a risk of infection and heavy bleeding, which often ends in hemorrhagic shock or DIC.

Frozen pregnancy

In addition, the fetus may die, remaining in the uterine cavity. Then the so-called frozen pregnancy is formed. A woman herself can note some symptoms that indicate what happened:

Fetal movements stop.
His heartbeat is not felt.
The abdomen does not increase in volume.
Periodically there are bleeding.
Disturbed by pain in the abdomen.
The body temperature rises.
Infection joins.

Frozen pregnancy must be removed. If this is not done on time, then there is a danger to the life of the woman herself.

Diagnostics

To determine placental blood flow disorders during pregnancy, it is necessary to use additional diagnostic methods. They allow you to establish the type and degree of changes, as well as determine the condition of the fetus. For this, the following procedures are used:

Blood test for hormones (estrogen, progesterone, human chorionic gonadotropin).
Ultrasonography.
Cardiotocogram.
Doppler.

Some data can also be obtained after a doctor's examination - the child's condition can be judged by the heart rate calculated during auscultation. But the most reliable results are obtained after instrumental and laboratory studies.

Treatment

In case of violation of the uteroplacental blood flow of any severity, therapeutic measures are indicated. This is mainly aimed at preventing the progression of the pathology, while the normalization of hemodynamics, according to observations, is possible only at stage 1b. At the same time, they try to use all possible means to improve the condition of the fetus. Of course, conservative measures come first. Surgical intervention is used only in case of complications and according to vital indications. In addition, great importance is given to the prevention of placental insufficiency.

Treatment of blood flow disorders during childbearing is complex - etiotropic, pathogenetic and symptomatic.

Medical therapy

The main means of correcting placental blood flow is the use of medications. When only detected initial signs disorders can be treated on an outpatient basis. If the insufficiency is more pronounced, then hospitalization is necessary. Such a need also exists with extragenital pathology in a woman. The following drugs are mainly used:

Antispasmodics (No-shpa, Eufillin).
Tocolytics (Ginipral, Partusisten).
Vascular (Actovegin).
Improving microcirculation (Trental).
Antiaggregants (Kurantil).
Antihypoxants (Instenon).
Vitamins and trace elements (Magne B6, ascorbic acid).
metabolic (ATP).
Hepatoprotectors (Essentiale, Hofitol).

As a rule, it is recommended to undergo two courses of therapy - immediately after the diagnosis and in the period of 32-34 weeks. After that, the issue of childbirth is decided. This is especially important in severe circulatory disorders. If violations are fixed at stage 1a or 1b, then childbirth takes place naturally.

During pregnancy, only proven drugs are used that have proven their safety and effectiveness.

Operation

When placental insufficiency is severe, emergency delivery is necessary. In case of ineffectiveness of conservative measures, even with mild violations, the decision should be made within 2 days. Most often, a caesarean section is used. If it is planned before 32 weeks of pregnancy, then you need to proceed from the condition of the fetus and its viability.

When it is necessary to state that a spontaneous abortion has occurred, it is necessary to carry out curettage of the uterine cavity or vacuum extraction of the fetus. With a frozen pregnancy surgical intervention depends on the gestational age and the condition of the woman.

Prevention

To avoid many unpleasant situations during pregnancy, including placental insufficiency, it is necessary to follow preventive recommendations. They are mainly about lifestyle and include the following principles:

Healthy food.
Rejection bad habits.
Outdoor walks.
Elimination of stress factors.
Implementation of all doctor's recommendations.
Timely treatment of concomitant diseases.

If you take care of your own health during pregnancy, you can prevent a violation of blood flow in the mother-placenta-fetus system. And if this pathology is detected, it is necessary to carry out timely treatment that will save the child.

In the process of managing a pregnant woman, it is very important to timely diagnose such a pathology as impaired uteroplacental blood flow of the 1a degree. To take timely necessary measures to eliminate this problem and determine its extent, is carried out ultrasound screening on equipment designed for this purpose. Based on the results of the examination, specialists select tactics for monitoring the pregnant woman. also in individually means and methods of treatment are selected to save the life of the baby.

Of course, it is the placenta that is considered the central link in uterofetal circulation, but the circulatory system between the fetus and mother is supplemented blood vessels. Therefore, it can be argued that the uteroplacental system consists of the following components:

Placenta

Ensures the transfer of blood from mother to fetus in such a way that their blood does not mix. This is achieved as a result of the complex anatomical structure of the system. The placenta is attached to the wall of the uterus by means of villi intended for this, which, as it were, are immersed in the uterine mucosa. In fact, these villi directly penetrate the walls of the uterine vessels, where all the necessary nutrients are transferred from the mother's blood to the fetal blood. And back from the blood of the child is the return of decay products.

Such metabolic processes are carried out at the cellular level, and only the hemoplacental barrier separates them - several layers of cells that form a kind of barrier between the placenta and the mother's blood. And two blood flows: from the child to the mother and vice versa, are found precisely in the placenta.

Terminal branches of the uterine arteries

Their main feature is that, until the moment of fertilization, they include muscle cells that have the ability to contract in order to close the opening of the vessel. Thanks to this phenomenon, uterine bleeding stops during menstruation. But during pregnancy, the muscle layer disappears (this happens at 4-5 weeks), resulting in an increase in blood flow to the placenta. And by the end of the fourth month of pregnancy, a complete transformation of these arteries occurs.

Vessels of the umbilical cord

It is one vein and two arteries. The blood circulation of the fetus is carried out as follows: the arteries carry blood (and with it useful material) towards the tissues and organs of the child, and the vein provides the process of reverse transmission of blood towards the placenta. In situations where a violation of blood flow occurs at this level, it is called fetal-placental, and there are grounds for an unfavorable prognosis for the fetus.

Causes that can lead to impaired blood flow

Experts have found that a violation of the uteroplacental 1a degree of blood flow can provoke the following factors:

Development of anemia in pregnancy. The bottom line is that a decrease in hemoglobin levels inevitably entails an increase in blood flow in the vessels, including the uterine arteries. This is explained by the fact that in such a situation, all the reserves of the body are aimed at increasing the rate of transportation of oxygen volumes into the blood. This is done by increasing the speed of circulating blood.
Deviations concerning the attachment of the placenta. It could be placentation or low presentation due to decreased blood flow. This is possible in a situation where the placenta is attached to the area of the scar on the uterus, left as a result of previous births by caesarean section. For this reason, it is impossible to ensure a full blood flow, and for normal development Fetal incoming blood is usually not enough.
late toxicosis. With gestosis, small vessels are damaged, which leads to impaired blood flow in the uteroplacental system.
Infectious diseases. The reason is that pathogenic microorganisms can cause various types pathological changes in the tissue of the placenta. As a result of this phenomenon, placental insufficiency may develop.
Increased arterial pressure. Increases the speed of blood movement through the vessels, which can cause a violation of blood flow.

Multiple pregnancy. In most situations, it is characterized by a violation of the blood supply process. This is due to the fact that the development of several fruits is carried out. Also, in some cases, most of the blood flow is transferred to one of the fetuses, due to which, respectively, in the other (or others) it decreases.
Diabetes. Its inevitable consequence is pathological changes in the inner walls of the arteries, which negatively affects blood flow.
Myoma of the uterus. During pregnancy, myomatous nodes tend to increase in size, which, in turn, entails an increase in their blood supply. Thus, the fetus gets much less blood than in a situation where the myoma is absent.
Immune conflict pregnancy. In some cases it may develop hemolytic disease fetus, hemoglobin decreases and anemia develops in the fetus.
Pathology at the level of the endometrium. This phenomenon may be preceded by inflammatory diseases (endometritis), as well as surgical interventions (multiple abortions), and the presence of bad habits, such as smoking and alcohol abuse, also contributes to this.
Pathology of the vessels of the umbilical cord. In some situations, the results diagnostic tests indicate a change in the number of vessels, as a result of which blood flow may be disturbed.
Anomalies in the development of the uterus. Among the most common pathologies include a bicornuate uterus. IN similar situations the uterine cavity is divided by a kind of septum, dividing it into two parts. In this case, the process of fetal development is localized in one of these parts, which entails a violation of its blood supply. This is due to the fact that in a bicornuate uterus there are no connections between the uterine arteries, there is no expansion of the arterial network, as a result of which an insufficient amount of blood enters the placenta.

All of these reasons are the basis for examining a pregnant woman through dopplerography.

The main symptoms of the disease

Dopplerography is the main method for detecting FPC and BPC during pregnancy. But, nevertheless, there are a number of external signs that allow you to recognize a violation of blood flow in pregnant women on early stages. The most common symptoms of this disease include:

Unsatisfactory fetal heart rate results. Listening to heart sounds is done with a stethoscope. As a result of this type of examination, one can observe muffled tones, a change in the frequency of heart contractions.
Insufficient level of growth (or its complete absence) for the main indicators according to the results of measuring the belly of a pregnant woman. As a rule, a specialist measures the circumference of the abdomen, as well as the height of the uterine fundus.
Unsatisfactory results of cardiotocography. Checking the electrical activity of the fetal heart is carried out from the 30th week of pregnancy. If any negative changes are observed, there is a need to conduct an ultrasound examination of the fetus.

The above phenomena give the right to talk about impaired blood flow in the uterine and umbilical arteries, placenta or umbilical cord vessels. There are also a number of indications when it is required to determine whether the uteroplacental blood flow is normal, by weeks, months and trimesters. These are the risk factors listed above, which include multiple pregnancy, anemia of pregnant women, cardiovascular diseases, a tendency to clot formation and other reasons for which ultrasound is prescribed.

Degrees of violation of uteroplacental circulation

There are three main degrees of violation of the uterine fetal blood flow:

The first degree implies the presence of minor violations, contains the following varieties:

1a - at this degree, the violation of uteroplacental blood flow occurs in the system of uterine arteries, while the feto-placental blood flow remains normal.
Violations of the 1b degree - here there are no violations of the utero-placental blood flow (this blood circulation is preserved), and the pathologies affect the post-placental level, which may be evidence of a violation of the fetoplacental fetal blood flow.

At grade 2, a violation of uteroplacental blood flow is observed at two levels at once: fetoplacental and uteroplacental. At the same time, there are no critical deteriorations, which indicates that there is no serious threat to the development of the fetus in the near future. The danger is that negative changes can occur at any moment. Therefore, this state requires close attention by the doctor.
The third degree implies the presence of critical changes in the fetoplacental circulation, while the uteroplacental blood flow can be impaired or preserved. Violations of this kind require immediate action. medical care and constant monitoring of the expectant mother until the moment when the condition is completely stabilized.

Depending on the degree of violation, the tactics of managing a pregnant woman and the type of treatment measures used are selected.

Diagnostic methods

Most effective way dopplerometry is considered to diagnose utero-placental fetal blood flow. This method is the most effective and allows you to identify the smallest changes in the process of blood circulation between the fetus and mother.

In addition, secondary methods for diagnosing pathology are widely used, which allow obtaining complete picture fetal condition and prevent possible negative consequences. Of course, they can only indirectly indicate the presence of blood flow disorders, but in some situations they cannot be dispensed with.

dopplerography

Dopplerography is considered as a type of ultrasound. It is carried out on a conventional device, but it requires special software. This type research makes it possible to obtain an adequate assessment of the intensity of blood circulation in various vessels (most often, the vessels of the umbilical cord and uterus are examined).

Modern equipment allows not only to assess the degree of intensity of blood flow, but also to find out the speed of blood, as well as its direction in all types of vessels (umbilical, uterine), as well as to obtain all the information related to intraplacental circulation.

This method makes it possible to make the most accurate prediction of fetal development. The fact is that disturbances in the uterine-fetal blood flow, as a rule, precede clinical changes (cardiac arrhythmia, weight loss). Identification of circulatory disorders allows you to take timely measures to prevent adverse consequences.

This method of diagnosis does not adversely affect either the pregnant woman or the baby.

At the same time, the price of dopplerography of the uterine-placental blood flow differs in each medical institution. It varies from 600 rubles and can reach 5 thousand rubles. If we talk about metropolitan clinics and medical centers, then here the average cost of a given diagnostic procedure is 2 thousand rubles.

Secondary diagnostic methods

The secondary methods for diagnosing disorders of the uteroplacental circulation include the following:

Collection and analysis of the patient's complaints - usually in the event of impaired blood flow, fetal hypoxia occurs, which manifests itself in the form of an increase in the intensity of its motor activity.
Listening to the child's heartbeat with a stethoscope - oxygen starvation may be indicated by an acceleration or decrease in the rhythm, which does not correspond to normal physiological parameters.
Cardiotocography - 40 minutes is enough to diagnose fetal hypoxia.

In addition, there are a number of ultrasonic indicators, which allow us to judge the deterioration of the fetus. Here, a study of the biophysical profile, premature aging of the placenta can be used.

What is the danger of NMPK for the fetus

In practice, it has been proven that a violation of uterine blood flow during pregnancy inevitably leads to oxygen starvation of the fetus. And the consequences of such violations can be the most unpredictable, including premature birth or even the death of the baby.

The most common consequences of impaired uteroplacental circulation include the following:

Reducing the size and weight of the fetus, which indicates the presence of intrauterine growth retardation syndrome.
The threat of abortion.
Various kinds of deviations in the work of the hormonal system of the baby.
A significant decrease in fat depots - a decrease in the body weight of the child.
Various palpitations - most often diagnosed with bradycardia and tachycardia, but arrhythmia may also occur, which occurs as a result of changes in the electrolyte composition of the blood.
Violation of the acid-base balance in the body of the baby.

To establish whether there is a violation of blood circulation between the mother and the fetus, a specialist evaluates the norm of blood flow in the uterine arteries, umbilical cord vessels in relation to the results obtained as a result of Doppler ultrasound.

Treatment of uteroplacental blood flow disorders

It should be noted that the treatment of utero-fetal circulation disorders is required in all cases. The most harmless are the states with the first degree of violations. But a critical violation of the fetoplacental blood flow requires immediate treatment. The sooner measures are taken to eliminate critical changes in blood flow, the higher the chances of saving the baby's life.

The main directions of treatment of disorders of the fetoplacental circulation are as follows:

blood pressure control;
normalization of lifestyle and diet of a pregnant woman;
antibiotic therapy and antiviral drugs in the case when intrauterine infection occurs;
with Rh-conflict pregnancy, plasmapheresis is very successfully used;
the use of magnesium preparations;
the use of antispasmodic drugs;
taking vascular drugs.

If there is acute hypoxia due to blood flow disorders, which can be attributed to the second or third degree, early delivery is used. This measure is resorted to in situations where conservative therapy does not give any results.

Prognosis and consequences of the disease

The prognosis largely depends on the degree of violation of the utero-fetal circulation, the duration of such changes, as well as the timing of pregnancy. The consequences of such violations are not as harmless as it might seem at first glance. The risk that such a condition can transform into a second degree of circulatory disorders at any time is very high.

Although it is believed that impaired utero-placental blood flow of the 1a degree is not too dangerous, it is nevertheless recommended to start treatment from the time when the changes have not become serious and can be eliminated with the least effort. This can significantly reduce the risk of threatened miscarriage and prevent fetal death.

TO possible consequences include various kinds of violations in the development of the child, which are dangerous for his life.

Prevention

Preventive measures to avoid violations of the placental-uterine circulation are primarily aimed at:

elimination of extragenital pathologies;
following healthy lifestyle life - it is necessary to monitor nutrition, which should include all the necessary nutrients, get rid of bad habits and avoid stressful situations;
refusal of excessive physical exertion;
risk reduction infectious diseases- for this it is necessary to avoid sources of potential infection.

To prevent violations of the uterine blood flow, compliance with the norm for weeks must be monitored at the first symptoms of such a pathology. If there are prerequisites for the development of disorders in the uteroplacental circulation, it is immediately recommended to conduct dopplerometry in order to determine the extent of such changes and prescribe effective treatment.