Blood flow disorders in the uterine arteries, umbilical cord, placenta during pregnancy (NMPK). Violation of the uteroplacental blood flow

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

Diseases of the uterus: bicornuate uterus, endometriosis, uterine hypoplasia, the presence of fibroids, etc.
Maternal health problems: kidney failure, diabetes mellitus, hypotension, pyelonephritis, endocrine system diseases, bronchial asthma, etc.
Unfavorable conditions for gestation: Rhesus conflict, multiple pregnancy, preeclampsia, abnormal presentation of the fetus, etc.
External factors: alcohol intake during pregnancy, smoking, constant being in a nervous environment, first birth (and a woman over 35), poor (limited) nutrition of the mother.

Classification of blood flow disorders in the placenta

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

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

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

Causes of impaired uterine blood flow

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

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

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

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

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

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

New opportunities have opened up for the early detection of obstetric complications, and if correction or treatment is started without loss of time, then circulatory disorders and further pathologies associated with it can be practically avoided.

Symptoms of pathology

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

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

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

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

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

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

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

The most dangerous symptom of FPI is bleeding from the vagina. This may be a sign of placental abruption. This condition requires urgent medical attention.

Diagnosis of pathology

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

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

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

Doppler is prescribed in such cases:

maternal diseases that can provoke blood flow disorders in the placenta;
premature aging of the placenta;
intrauterine growth retardation syndrome;
polyhydramnios or oligohydramnios;
signs of fetal hypoxia;
congenital malformations and genetic diseases in the fetus.

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

Atypical blood circulation in the placenta can be indicated by such an indirect sign as its thinning or increase in area, symptoms of intrauterine infection, and changes in amniotic fluid.

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

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

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

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

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

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

Treatment Methods

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

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

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

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

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

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

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

In conclusion about prevention

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

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

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

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

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

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

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

So you provoke the development of serious complications.

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

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

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

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

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

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

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

There are risk groups that need the use of drug prophylaxis, which promotes the interaction of the body systems of the fetus and mother and prevents dysfunction of the uteroplacental circulation.

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

Especially for beremennost.net Elena Zhirko

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 diagnosis, on which the vessels of the placenta are clearly visible in a three-dimensional image. If there is any violation, the doctor will definitely see it, as there is a change in the spatial ratio of the uterine and fetal-placental circulation. This is a very dangerous condition of the body, as respiratory function is inhibited, 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. The necessary nutrients and oxygen begin to flow to it in a limited amount, 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;
discrepancy between the volume of the abdomen for a specific gestational age.

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:

a blood test for hormones such as estrogen, human 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.

During a pregnancy that occurs with deviations, various means are used that improve the condition of the fetus. Mostly conservative methods of treatment are used. Surgical intervention 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.

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 pronounced, an emergency delivery is performed. In case of failure of 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 a pathological condition as impaired blood flow of 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.

Pregnant women and their relatives usually expect one answer from an ultrasound examination - what is the sex of the child. For an obstetrician-gynecologist, a research method is necessary in order to identify a violation of blood flow during pregnancy, abnormal development of the fetus in time.

The management plan and tactics of delivery depend on this. To understand the mechanisms of the disorder, it is necessary to consider the possibilities of the circulatory system between mother and child.

The structure of the uteroplacental blood flow

Mother and child are connected not only by the placenta, but also by a complex system of blood vessels. Therefore, all joint blood circulation is usually divided into levels that cannot exist in isolation, but work only in combination.

The central part of the system is the placenta. It provides "absorption" of maternal blood products through the villi that have grown deep into the wall of the uterus. It does not mix the blood of mother and child. Several rows of special cells form a hematoplacental barrier, which is a serious obstacle to substances unnecessary for the fetus. Through it, the spent blood returns to the venous system of the mother.
The second part of the blood flow is made up of branches of the uterine arteries. If before pregnancy in the female body they are in a collapsed state and are called spiral, then from a period of 1 month they lose the muscle layer that can cause spasm. And by four months, the arteries are transformed into full-fledged trunks filled with blood and heading to the placenta zone. It is this mechanism, useful for feeding the fetus, that can be fatal in uterine bleeding: the walls of the vessels can no longer contract.
Vessels in the umbilical cord form a third pathway for blood flow. There are 2 arteries and a vein. They connect the child with the placenta and form the fetal-placental circle. A decrease in blood flow at this level causes the most severe damage to the fetus.

How placental circulation is disturbed

Poor blood flow associated with the placenta is called placental insufficiency. It can occur at any stage of pregnancy in two forms.

Acute appears suddenly, even in childbirth, does not depend on the gestational age. The fetus falls into a state of hypoxia (oxygen deficiency), which threatens him with death.

The main pathological mechanisms of this condition:

premature detachment of the placenta;
myocardial infarction due to thrombus formation.

Chronic more often complicates the course of pregnancy after a 13-week period. Symptoms appear in the third trimester. The formation mechanism is the early aging of the placenta due to the deposition of fibrin on the villi.

As a result of changes in the structure of the chorionic villi (placental tissues), the functioning of the hematoplacental barrier stops, metabolic processes between the mother's body and the fetus are disrupted

Negative consequences in such conditions, depending on the degree of violation, can lead to the inevitable death of the fetus.

Causes of impaired blood flow during pregnancy

Various reasons can cause a violation of the uteroplacental blood flow. These include common maternal illnesses:

pathology of the neuroendocrine system (diabetes mellitus, diseases of the thyroid gland and adrenal glands, changes in the hypothalamus of the brain stem);
lung diseases (emphysema, bronchial asthma);
disorders in the cardiovascular system caused by malformations, the consequences of hypertension, a tendency to hypotension;
renal pathology (chronic nephritis, pyelonephritis, especially in the stage of renal failure;
anemia (anemia) associated with deficiency of iron, vitamins;
conditions accompanied by increased blood clotting contribute to increased thrombus formation in the vessels of the placenta;
acute and exacerbation of chronic infectious processes - cause corresponding inflammation in the placenta, vascular edema and reduced blood flow, in the first trimester this can result in a miscarriage.

The pathology of the uterus creates local conditions for inadequate blood flow:

any changes in the layers of the uterus (myometrium, endometrium);
malformations (for example, according to the type of "bicornuate", "saddle-shaped" uterus);
underdevelopment (hypoplasia);
tumor formations from muscle tissue (fibroids), especially in a nulliparous woman over the age of 35; at a younger age, small fibroids can compensate for blood flow.

The causes of insufficient blood flow include unfavorable conditions of the ongoing pregnancy in the following cases:

multiple pregnancy;
Rhesus conflict;
preeclampsia;
pelvic presentation of the fetus;
pathological placenta previa.

The risk of impaired blood flow occurs when:

previous abortions;
smoking, alcoholism and drug addiction of the mother;
constant nervous situation associated with social or domestic disorder;
violation of the proper nutrition of women.

Types of chronic placental insufficiency

Depending on the development of the consequences for the fetus and the ability of the mother's body to adapt, there are 4 forms or stages of chronic placental insufficiency:

compensation - the mother's body completely protects the fetus by improving blood flow in other ways, and the child does not feel a lack of oxygen, develops normally, is born on time and develops well;
subcompensation - the mother is not able to fully compensate for the lack of nutrition, and the fetus lags behind in development, there is a risk of complications, congenital malformations;
decompensation - accompanied by a complete violation of the mechanisms of adaptation, normal pregnancy is impossible, the fetus has serious defects that are incompatible with viability, death in utero is very likely;
critical - due to severe changes in the structure of the placenta, further gestation is impossible, inevitable death occurs, any treatment is ineffective.

What degree of blood flow disturbance causes placental insufficiency?

Comparison of the clinical manifestations and the results of an ultrasound examination made it possible to distinguish 3 degrees of blood flow disturbance between the mother and the fetus.

The first is characterized by minimal changes at the uteroplacental level, provides a “reserve” of time for about a month for treatment and complete recovery without consequences, there are 2 varieties:

Ia - only uteroplacental blood flow is reduced, with unchanged fetal-placental blood flow. Manifested by a lag in the development of the fetus in 90% of cases.
Ib - the fetal-placental circulation suffers, and the uteroplacental circulation remains normal. The delay in the formation and development of the fetus suffers somewhat less (in 80% of cases).

The conclusion is issued after the study of all components of the fetal blood flow

The second - the violation occurs both at the level of the uterine and umbilical vessels, hypoxia can be fatal to the fetus.

The third - blood circulation indicators are at a critical level, even the reverse direction of blood flow (reverse) is possible.

For clinicians, such a classification provides an opportunity to accurately determine the level of disorders, to choose the most appropriate treatment tactics.

Symptoms of impaired blood flow

If the disturbed blood flow is compensated, then the woman does not feel any deviations, but finds out about them only after the examination.

Severe manifestations occur in acute form and chronic decompensation:

the motor activity of the fetus increases sharply or completely disappears (with a period of 28 weeks, normal development is accompanied by ten movements per day), this symptom requires an immediate appeal to an obstetrician-gynecologist;
a slow increase in the circumference of the abdomen, detected during a monthly examination and measurement in the antenatal clinic (associated with excessive formation or lack of amniotic fluid);
late toxicosis;
high blood pressure;
large weight gain;
swelling on the legs;
the appearance of protein in the urine.

The most dangerous is the discharge of blood from the vagina. This sign can be regarded as a starting abruption of the placenta. You can not delay in providing medical care.

Diagnostics

The most complete picture of blood circulation between the uterus and the fetus is obtained with a Doppler study, which is performed for all women three times during pregnancy.

The technique allows:

measure blood flow by the speed of movement of uniform elements;
determine its direction in the arteries and veins;
fix changes before clinical manifestations.

The effect is based on the reflection properties of the ultrasonic wave, completely safe for the baby and mother

All changes are recorded on the monitor, measured by special sensors, and can be photographed in the required format.

By comparing with normal indicators, a conclusion is made about the degree of pathology. Violations can be detected at any level, in the vessels:

umbilical cord,
uterus,
fetus.

The doctor has time to prescribe the treatment and check it at the next examination.

Doppler sonography is a type of Doppler sonography. It is assigned for:

concomitant pathology of the mother;
suspicion of premature aging and violation of the placental barrier;
signs of a lot or oligohydramnios;
preliminary data on intrauterine growth retardation, the formation of congenital malformations of the fetus;
the presence of genetic diseases in the family;
clinical symptoms of fetal hypoxia.

The examination can reveal:

thinning of the placenta;
increase in growth area;
intrauterine infection.

The method of long-term inpatient monitoring of the degree of fetal hypoxia allows you to see the results of the use of drugs

Treatment of pathology

Treatment takes into account the pathogenesis of disorders. To achieve results, it is necessary to influence all links:

With a slight violation of microcirculation, Hofitol is prescribed (with a mineral and plant composition), in more pronounced cases - Actovegin, Petoxifylline.
If the mother's tendency to thrombosis and a violation of the aggregation properties of the blood is revealed, then drugs such as Curantil, Trental are indicated. They are able to improve the permeability of blood through the vessels.
When low blood pressure is detected, Venofundin, Stabizol, ReoHES are used.
Vasodilators - No-shpa, Eufillin in injections - eliminate spastic contraction of blood vessels.
It is recommended to reduce the tone of the uterus with Magnesia, the drug Magne B6, this acts as an antihypoxic way to improve blood flow.
A group of vitamins with antioxidant action eliminates the negative effects (vitamin E, ascorbic acid).

Medications are prescribed by a doctor. If necessary, the woman is offered hospitalization. This allows:

provide bed rest;
constantly monitor the course of pregnancy.

If there is an effect of conservative treatment, the woman bears herself to the end and gives birth to a child. In the absence of results, doctors may decide on an early caesarean section. In the third stage, only operative delivery is shown.

What can be done to prevent blood flow disorders?

Gynecologists urge women from risk groups to prepare themselves for pregnancy in advance, to prevent unplanned conception.

Choosing the correct body position during sleep helps fetal blood flow

Against the background of an already occurring pregnancy, it is recommended:

avoid emotional and physical overload;
eliminate bad habits;
organize good nutrition for a pregnant woman;
monitor daily walks, stay in a ventilated room;
engage in special gymnastics for pregnant women, yoga exercises;
control body weight, conduct monthly weighing and measurement of abdominal circumference;
sleep on the left side is considered more beneficial, this position allows you to reduce pressure on the inferior vena cava, which runs to the right of the uterus, but in some cases, with stagnation in the kidneys, sleeping on the right side improves the outflow from these important organs.

Modern methods of diagnostics and approach to the management of pregnant women can prevent severe disorders. However, many opportunities depend on the woman herself and her desire to have a healthy heir.

Most women do not know about such a study as Doppler until the onset of the third trimester, and from that moment on, Doppler for pregnant women becomes quite a familiar procedure.

Doppler- this is one of the ultrasound diagnostic methods that allows you to assess the intensity of blood flow in various vessels, for example, in the vessels of the uterus and umbilical cord. It is most informative after 30 weeks, but in case of deviations during pregnancy (for example, if the fetus is lagging behind in development), Doppler ultrasound can be prescribed earlier - starting from 20 weeks.

Doppler indications

Adequate placental blood flow ensures the normal course of pregnancy. Violation of blood flow can lead to intrauterine growth retardation (IUGR), so the main reason for prescribing dopplerometry during pregnancy is precisely the discrepancy between the size of the body and / or organs of the baby.

Not necessarily with impaired blood flow, the child will lag behind in development, just the risk of an unfavorable course of pregnancy increases significantly. And vice versa, if there is a suspicion of a fetal lag in development, but the blood flow is not disturbed, then in most cases this indicates that the woman is carrying a small but healthy child.

Dopplerometry is also prescribed for:

premature maturation of the placenta;
severe oligohydramnios or polyhydramnios;
umbilical cord anomalies;
Rhesus conflict;
gestosis (late toxicosis, complicated by vomiting, severe swelling and increased pressure in a pregnant woman);
the future mother has kidney disease, hypertension, diabetes mellitus;
suspected chromosomal pathology;
non-immune dropsy of the fetus;
uneven development of babies during multiple pregnancy (when there is a difference in their body weights of more than 10%).

If the fetus has heart problems, Doppler is performed together with CTG, the so-called Doppler echocardiography.

With fetoplacental insufficiency, dopplerometry is carried out systematically every 2-3 weeks.

Also, with the development of complications during the previous gestation of the fetus, a Doppler ultrasound may be prescribed during a subsequent pregnancy.

Preparation for the study and how it is carried out

Dopplerometry in pregnant women is carried out according to indications, and is not a mandatory examination during the normal course of pregnancy. But more and more often in antenatal clinics, all women, without exception, undergo Doppler ultrasound at 30-34 weeks as an assessment of the condition of the fetus.

This procedure is painless and harmless to both mother and fetus. The principle of Doppler ultrasound is the same as conventional ultrasound during pregnancy: a special Doppler sensor is driven across the abdomen, which is equipped with every modern ultrasound diagnostic device. Therefore, this type of research does not require special preparation.

Doppler- this is a visual assessment of blood flow (when a color and graphic image of curves of blood flow velocities is observed from the monitor screen).

dopplerography- this is the same dopplerometry, only the indications are additionally recorded on the tape in order to track the change (improvement / deterioration) in blood flow after the treatment.

Interpretation of dopplerometry indicators

Uterine arteries (a. uterina dextra - right and a. uterina sinistra - left uterine arteries, respectively). The uzist must determine the nature of the blood flow both in the left and in the right uterine artery, because with gestosis it can be disturbed in only one artery. Thus, assessing the blood flow in only one artery, you can give a false conclusion, which will negatively affect the health of the baby and the expectant mother.

There is such a scientific theory that if the blood flow is disturbed in only one (mainly in the right) uterine artery, a woman has a high risk of late toxicosis (preeclampsia) with all the negative consequences.

With gestosis, the blood flow in the uterine artery is first disturbed, and when the situation worsens, the blood flow in the umbilical cord arteries worsens. Therefore, in case of violation of blood flow in the uterine arteries, it is necessary to periodically re-doppler to control the situation.

To assess blood flow in the uterine arteries, the resistance index (IR or RI) is calculated.

Often, pregnancy-induced hypertension develops due to impaired uterine blood flow. The body of the expectant mother independently increases blood pressure to increase blood flow to the intervillous space. So mom, without realizing it, helps the baby. Thus, it is necessary to improve blood flow and hypertension will disappear on its own.

Violation of blood flow in the uterine arteries is when the value of IR, PI or LMS is greater than normal.

The pulsation index (PI) of the uterine arteries should be within the following limits.

Indicators in the right and left uterine artery may differ slightly from each other. If both indicators are within the normal range, then such a picture is not considered a negative phenomenon.

Deviation of blood flow parameters from the norm in two uterine arteries at once indicates a violation of the uteroplacental circulation. This situation requires specific treatment - move more (regularly go for swimming or gymnastics for pregnant women).

Violation of blood flow in only one uterine artery indicates asymmetry of the uteroplacental blood flow. If the pregnancy proceeds normally, and the baby develops in accordance with the term, then the placenta is performing its functions.

You should be aware that at 18-21 weeks there may be a temporary violation of blood flow in the uterine arteries. This phenomenon is explained by the fact that the adaptive physiological process of cytotrophoblast invasion has not yet been finally completed. Therefore, if abnormalities in the uterine arteries are detected, a second Doppler ultrasound should be performed after 2-3 weeks, i.e. observe blood flow in dynamics.

The systolic-diastolic ratio (SDO) in the uterine arteries should be:

Umbilical cord arteries (a. umbilicalis). To obtain true results, the study should be carried out only at a time when the baby is at rest, and only when his heart rate is in the range of 120-160 beats per minute. Indeed, physiologically it is so laid down that with an increase in heart rate, there is a decrease in IR in the umbilical artery, and vice versa, with a decrease in heart rate, an increase in IR occurs.

Measurement of blood flow in the umbilical arteries should be carried out when the pregnant woman is lying on her back! An assessment of the severity of umbilical cord blood flow disorders cannot be objective when the future mother is located “on the left side”.

The umbilical cord must have two arteries and one vein. If there is an anomaly (the only artery of the umbilical cord), then the fetus may suffer from a lack of oxygen and nutrients, due to which there is a lag in its mass and growth. But it happens that the fetus adapts to such an existence and does not experience a deficiency of the necessary substances. Such children are born with low weight, but absolutely viable. Therefore, if there is one umbilical artery and the blood flow in it is not disturbed, then there is no cause for concern. But if the blood flow in a single artery is disturbed, inpatient treatment should be carried out to improve blood flow and, if necessary, early delivery (if the fetus is far behind in development).

The most widely used in assessing the nature of blood flow in the arteries of the umbilical cord was the resistance index. The readings in both umbilical cord arteries should be almost the same.

A blood flow disorder in the umbilical cord is when the value of IR, PI or LMS in the umbilical cord arteries is higher than normal.

The pulsation index (PI or PI) of the umbilical arteries must comply with the following standards:

Pathological is the registration of zero and reverse values of diastolic blood flow. This means that the fetus is in critical condition.

Only 2-3 days remain from the moment the permanent reverse values appear to the death of the fetus, therefore, it is necessary to carry out a caesarean section as soon as possible in order to save the life of the baby. This is possible only from the 28th week, when the baby is viable.

Systolic-diastolic ratio (SDO) in the umbilical arteries:

If the blood flow in the umbilical cord is disturbed, then, as a rule, there is a delay in the development of the fetus. If now there is no developmental delay, and the blood flow in the umbilical cord is disturbed, then later, without treatment, a fetal developmental lag may be observed.

Middle cerebral artery of the fetus (a. cerebri media). When the fetus suffers, there is increase in the values of PI, SDO and speed in SMA.

Maximum speed (aka V max) in the fetal middle cerebral artery:

Systolic-diastolic ratio (SDO) for the middle cerebral artery:

fetal aorta. It leaves the left ventricle of the heart, goes along the spine and ends in the lower abdomen, where the aorta divides into two iliac arteries, which provide blood supply to the human legs.

Deviations in the blood flow of the aorta can be detected only after 22-24 weeks of pregnancy.

The disruption of blood flow is increasing the values of IR, PI and SDO. Critical (talking about the death of the fetus) is considered registration of extremely low values up to their complete disappearance.

Changes in the aorta characterize the severity of intrauterine fetal hypoxia.

Systolic-diastolic ratio (SDR) for the fetal aorta:

Venous duct (VP). It is studied in the extended Doppler assessment of blood flow.

During the study, it is necessary not to take into account episodes of hiccup-like respiratory movements of the child and active movement.

Indexes are not used to assess the venous duct.

The diagnostic criterion for the pathological condition of the fetus is the presence of negative or zero blood flow values in the phase of atrial contraction. Zero or reverse values are recorded with fetal malnutrition, congenital malformations of the right heart, non-immune dropsy of the fetus.

Even with critical blood flow in the arteries of the umbilical cord, but with preserved blood flow in the venous duct in the phase of atrial contraction, it is possible to extend the gestation to the optimal time for childbirth.

Description of blood flow disorders and their treatment

1 degree

1 A degree- violation of blood flow in the uterine arteries, while in the umbilical cord the blood flow remains normal.

This degree of blood flow disturbance is not dangerous for the fetus.

Medical treatment of this condition is ineffective. Doctors still prescribe therapy with Actovegin and Curantil. Do not see on occasion!
In fact, if blood flow in the uterine arteries is disturbed, it is more expedient to simply walk in the fresh air more often (breathing deeply) + eat right + move more (hiking, special exercises for pregnant women, morning exercises, yoga, swimming). And do not sit for hours at the computer! That's all treatment.

1 B degree- violation of blood flow in the arteries of the umbilical cord, and in the uterine arteries hemodynamics is normal.

This degree of blood flow disturbance requires the use of blood-thinning drugs to avoid developmental delay and fetal hypoxia.

In this case, a treatment is prescribed aimed at improving blood circulation (Placenta compositum, Curantil or Trental). Actovegin is prescribed as an antihypoxant, which improves the supply of oxygen to the fetus.
A blood test for coagulation ability (coagulogram) is also prescribed. With increased blood clotting, it is necessary to take stronger blood-thinning drugs than Curantil (for example, heparin or an agent that includes acetylsalicylic acid).

I degree of violation does not lead to the death of the fetus. There is a systematic monitoring of the nature of the blood flow (every 2 weeks) "plus" the control of fetal CTG (after 28 weeks of pregnancy). In addition, be sure to monitor blood pressure in a pregnant woman.

2 degree- simultaneous violation of blood flow in the uterine arteries and in the umbilical cord, which does not reach critical values (when the blood flow is preserved in the venous duct).

In this condition, medical treatment is mandatory in a hospital, where round-the-clock monitoring of the fetal condition is provided. It is also necessary to monitor the state of blood flow by conducting Doppler + CTG every 2 days.

In degree II hemodynamic disturbances are rare, but there may be cases of intrauterine death.

3 degree- critical disorders of blood flow in the umbilical cord with intact or impaired blood flow in the uterine arteries. A critical violation is understood as the registration of reverse diastolic blood flow or its absence at all.

III degree of violation poses a danger to the health of the child, because in half of the cases, intrauterine death of the baby occurs. Therefore, when a 3rd degree of blood flow disturbance is detected, it is necessary to urgently perform a caesarean section in order to save the life of the baby, because at this stage of the disorder, treatment is not effective.

Conservative (natural) childbirth at grade 3 can lead to perinatal death of the child.

The cost of a doppler ultrasound in a private clinic is about 1,200 rubles.