3 degree of maturity of the placenta what to do. Premature maturation of the placenta

There are 4 degrees of maturity of the placenta, each of which has its own characteristics and is normally observed at a certain gestational age, reflecting echostructural changes in each parameter of the placenta - chorionic membrane, parenchyma and basement membrane:

degree of maturity of the placenta 0- the placenta has a homogeneous structure;
degree of maturity of the placenta 1- individual echogenic inclusions appear in the placental tissue, the chorionic plate becomes slightly wavy.
degree of maturity of the placenta 2- waviness of the chorionic plate increases; multiple small echopositive inclusions are visible.
degree of maturity of the placenta 3- pronounced tortuosity of the chorionic membrane, the placenta acquires a lobed structure.

Given the three-factor assessment of the degree of maturity of the placenta, intermediate stages were introduced: (0-1, 1-2, 2-3), since the arithmetic mean of the score of the three parameters in many cases is a fractional number.

Each degree of placental maturity normally corresponds to a certain gestational age.

If the placenta changes structure earlier due date(for example, the appearance of 1 degree of maturity before 27 weeks of pregnancy, 2 degrees before 32 weeks, and 3 degrees of maturity before 36 weeks), this indicates its premature maturation and speak of premature aging.

Therefore, when determining 1, 2, 3 degrees of placenta maturity, early deadlines, doctor ultrasound diagnostics at the end of the study, he makes a diagnosis of "premature maturation of the placenta".

This condition may be associated with impaired blood flow in the placenta due to preeclampsia, anemia, and may be individual feature body of this pregnant woman.

Premature aging of the placenta is a reason for conducting dopplerometry (monitoring the state of blood circulation in the mother-placenta-fetus system) and cardiomonitoring studies (fetal CTG). Prescribe drugs that improve blood circulation in the placenta (for example, chimes), vitamins, rest and good nutrition.

Determination of the degree of maturity of the placenta plays important role in the management of pregnancy. However, the degree of maturity of the placenta is a subjective factor, it is established only when ultrasound examination and since the estimate this indicator is determined "by eye", then the degree of maturity may differ for each diagnostician.

If there is a slight discrepancy between the degree of maturity of the placenta and the gestational age, then there is nothing to worry about. Most likely, its early maturation is a feature of a pregnant woman. If the aging of the placenta began much earlier than the due date, then this is one of the important diagnostic features fetoplacental insufficiency.

With premature aging of the placenta, a decrease or increase in the thickness of the placenta is manifested. So a “thin” placenta (less than 20 mm in the 3rd trimester of pregnancy) is typical for late toxicosis, threats of abortion, fetal malnutrition, while with hemolytic disease and diabetes about placental insufficiency evidenced by a "thick" placenta (50 mm or more). Thinning or thickening of the placenta indicates the need for therapeutic measures and requires a second ultrasound examination.

Late maturation of the placenta (prolonged immaturity) is rare, more often in pregnant women with diabetes mellitus, Rhesus conflict, and also with birth defects fetal development. The delay in the maturation of the placenta leads to the fact that it does not properly perform its functions. Often, late maturation of the placenta leads to stillbirths and mental retardation in the fetus.

The mother's womb is a small house of the future baby, in which its formation, development and growth take place. For this, first of all, breathing and nutrition are necessary. The placenta is exactly the organ that supports life developing baby protects it from infections and harmful substances entering the maternal circulation.

A temporary organ, like the human body, goes through several stages of development - formation, maturation and aging. The afterbirth is formed by the end of the first trimester (12 weeks) and leaves the mother's body with the birth of a child.

Maturity of the placenta

During pregnancy, the “baby place” changes (in thickness and structure), especially starting from the end of the second trimester. The gradual aging of the placenta affects its functioning, so it is very important that it does not begin prematurely. The degree of maturity of the placenta is determined during ultrasound monitoring:

The thickness and echographic density of the afterbirth is determined.
During maturation, children's place» there is a change in the type of border between it and the uterus.
The ability to reflect ultrasound changes.
With the onset of aging of the afterbirth, deposits of salts and calcium appear (in the form of white inclusions).

The indicator of the maturity of the placenta can help predict the onset of childbirth, in a timely manner to pay attention to the threat of premature delivery. There are 4 stages of maturation of the "children's place": zero, first, second and third, indicating complete readiness for childbirth.

Maturity of the placenta by week

Each stage of organ maturation is characterized by changes in its size and structure that occur in certain deadlines pregnancy.

Maturity 0

The stages of maturation of the "children's place" begin with degree 0, which persists from the moment the organ is formed and up to 30 weeks. During this period, the body grows, increases in thickness. The placenta has a homogeneous structure, the membrane is smooth. In some cases, starting from the 27th week, it is possible to determine the maturity as 0-1. Transition to power 1 on this period requires additional attention, as it is somewhat ahead of schedule. If deviations are found, then a treatment is prescribed that contributes to the normalization of the functioning of the organ and placental current.

1 degree of maturity of the placenta

The growth of the organ stops, thickening of its tissues occurs - this is an illustration of the next stage of maturation of the placenta. 1 degree of maturity of the placenta is the norm for pregnancy from 30 to 34 weeks. Chorionic tissues are slightly wavy, single echogenic inclusions are noted in the structure.

2 degree of maturity of the placenta

In the case of a normal pregnancy, the second degree of organ maturity is typical for the period from the end of 34 to 37 weeks. The waviness acquires a relief, numerous echogenic zones are visualized in the form of lines. If this degree of placental maturity is detected at week 32, an additional examination is required, since the development of the organ is ahead of schedule. In case of detection of a serious pathology that threatens the health and life of the child, the issue of premature delivery is resolved.

Placenta 3 degrees of maturity

This stage of maturation of the placenta is typical for full-term pregnancy (begins at 37-38 weeks). During this period, the fading of the functioning of the organ is noted, it prepares for the end of pregnancy and rejection, it begins natural aging. Pronounced depressions in the membrane reach the basal layer, the "children's place" has a lobed structure. The placenta has large echogenic areas (salt deposits), merging into spots irregular shape, its vessels dilate.

Maturity of the placenta

The maturation of the "children's place" and its functioning is directly related to the development of the baby and its condition in the womb. Therefore, it is very important that this process proceed in accordance with the course of pregnancy.

Early maturation of the placenta

Organ aging ahead of schedule, determined by nature, is dangerous because the probability of oxygen deficiency increases and nutrients baby. This condition is fraught with delay prenatal development child, malnutrition, low birth weight, hypoxia. oxygen starvation especially dangerous, as it can lead to death.

Among the reasons that increase the likelihood of early maturation of the placenta, the following are distinguished:

Bad habits of a pregnant woman - smoking, alcohol.
Diseases of the thyroid gland.
Previa, placental abruption.
Diabetes.
Hypertension.
Late toxicosis (gestosis).
Rhesus conflict.
Multiple pregnancy.

If the maturity of the placenta has a second degree for up to 32 weeks or a third degree for up to 36 weeks - we are talking O premature aging"children's place" At the same time, the timing of the development of the afterbirth is not always identical to placental insufficiency. Similar state may be an individual feature of the organism. To help the baby be born healthy and on time, it is necessary to undergo additional examinations, during which the condition of the fetus is clarified - a CTG of the fetus and the functionality of the placenta are performed - the uteroplacental blood flow is checked. In case of deviations, it is necessary to strictly follow the doctor's prescriptions.

Late maturation of the placenta

This pathology is much less common than early maturation. However, the threat developing fetus it bears no less. The lag in the development of the placenta leads to the fact that it does not adequately cope with its functions and there is a delay in the development of the child. Most common causes late ripening"children's place" - chronic diseases mothers, genetic disorders (may be reflected in the malformations of the child).

Placental maturity table

The table of placental maturity clearly illustrates the periods of maturation of the organ during pregnancy.

The maturity of the placenta is one of the determining indicators of the course of pregnancy. Timely therapy will help restore the function of the organ and safely endure the baby.

The appearance of echographic signs of maturity of the placental tissue before the gestational age, for which such changes are physiological. It does not manifest itself clinically, it is diagnosed only during routine screening. When making a diagnosis, ultrasound data are used. The study is supplemented with dopplerography of placental blood flow, CTG, fetometry, and fetal phonocardiography. Treatment involves the treatment of the underlying disease and the appointment of drugs that improve blood circulation between the pregnant woman and the child - antiplatelet agents, vasodilators, essential phospholipids, amino acid complexes.

Diagnostics

Treatment of premature maturation of the placenta

The main medical tasks in the management of a pregnant woman with PSP are the correction of disorders that caused the pathology, the normalization of blood circulation in the uteroplacental system, the choice of the optimal method and time of delivery. The tactics of managing a patient at the prenatal stage is determined by the period at which premature aging was diagnosed:

Early detection of PSP. The detection of metabolic-dystrophic changes in the placental tissue at 20-24 weeks is an indication for examination in a specialized department of pregnancy pathology. In such cases, starting from the 26th week of gestation, dopplometric blood flow control is performed at least once a week, fetal movements are calculated daily. Urgent delivery in case of critical disorders of blood flow in the umbilical cord, CTG signs of fetal hypoxia, cessation of its growth, a sharp decrease in volume amniotic fluid, the appearance of other signs of a threat to the child can be performed even for a period of 31-33 weeks.
Identification of PSP inIIItrimester. According to the results of studies, if the process of premature aging of the placenta is detected at 32-34 and, moreover, 35-37 weeks of gestational age, the probability of a pathological course of pregnancy is significantly reduced. However, for the timely detection of complications, it is necessary to ensure regular ultrasound and specialist supervision. The preferred method of delivery is vaginal delivery. Only in cases where PSP is combined with a significant delay in fetal development, is a caesarean section indicated for the prevention of acute distress syndrome in a child.

Regardless of the timing of the detection of premature maturation of the placental tissue, an obstetrician-gynecologist or a specialized specialist actively treats the underlying genital or extragenital disease using antibiotics, hormone therapy, immunocorrectors, cardiovascular and other medications. In parallel with the correction of the leading disorder, drugs are prescribed to improve the blood supply to the fetus - vasodilators, antiplatelet agents, amino acid complexes, essential phospholipids. Drug therapy supplemented by non-drug methods - rational physical activity, diet correction, normalization of sleep and rest.

Forecast and prevention

Timely screening and correct medical tactics can reduce the risks of fetoplacental insufficiency during the aging of the placenta, slow down this process and prolong the pregnancy to a time that is safe for the birth of a child. Primary prevention involves pregnancy planning for patients with genital and extragenital diseases, protected sex to protect against specific infections, reasonable prescription of invasive gynecological procedures, smoking cessation, alcohol and drug use. During gestation for normal development placenta, it is important to take care of protection against possible infection with SARS and other infectious diseases, maintaining hemoglobin levels sufficient motor activity and rational diet. Secondary prevention aims to early diagnosis disorders, includes timely registration in antenatal clinic regular check-ups and ultrasounds.

The placenta is a special organ that arises and grows in the uterine cavity during pregnancy, the main task of which is the correct connection of the blood supply systems of the fetus and matter. In the body of the placenta, biochemical processes are performed that are responsible for the normal development of pregnancy, for the production of special hormones that provide the fetus with oxygen, and also protect it from the influence of harmful factors. After the birth of a child, the child's place dies off and separates 30-50 minutes after birth.

The degree of maturity of the placenta at different stages of pregnancy

Like any organ, the placenta has its own "age", that is, it is born, develops and matures, and then ages and after childbirth - dies. This is a normal physiological process, however, early, premature maturation or aging of the placenta poses a threat to the health and life of the baby.

Currently, in obstetric and gynecological practice, four stages of placental maturation are differentiated, and each of them normally corresponds to certain period pregnancy.

However, there are so-called transitional stages when signs of adjacent degrees of maturity may appear, which is associated with a different rate of development of the fetus and placenta, which is carried out from its marginal sections to the center.

0 - zero degree of maturity (according to the classification of Grannum P.A. 1979) can be diagnosed up to the 30th week;
0 - I degree ( transition period) is typical for 29, 30 weeks;
I - the first degree of maturity is observed at 30 - 32 weeks;
I - II (transitional period) is diagnosed at 32 - 34 weeks;
II - the second degree of maturity corresponds to 34 - 40 weeks;
II - III (transitional period) can last from 35 to 40;
III - the third degree of maturity is diagnosed at 37 - 38 weeks to 40.

At proper flow Pregnancy growth of the placenta is completed by 36 - 37 weeks. After that, the thickness of the body of the child's place decreases or no longer changes. Ultrasonic method research (ultrasound) allows you to determine the thickness of the child's place and the degree of its development, which is directly related to the state of the chorionic membrane (chorionic membrane surrounding the fetus and lining the fruiting surface of the placenta), parenchyma (villous outer fetal membrane embryo) and the basal layer (connective tissue of the uterine mucosa).

Changes in the structure of the placenta at different stages of pregnancy

At 0 degree of development of the placenta, its structure is homogeneous. The chorionic membrane is flat and smooth, without undulations. The basal layer is not defined.

If the zero degree of maturity changes to degree I before reaching the 27th week, this indicates the premature development of the placenta. As a rule, this condition occurs in the presence of negative factors: viral diseases such as rubella, chickenpox, suffered during pregnancy, smoking, drinking alcohol and drugs.

During the first degree At maturity, placental growth stops, and the body of the placental substance becomes thicker, and individual hyperechoic zones can be found in it, which are clearly visible on ultrasound, the chorionic plate becomes uneven. If at this time the doctor sets the II degree of maturity, this may be a sign possible violations development. In this case, you need to take medicines, which activate the blood flow in the vessels of the children's place.

At the II degree of maturity (35-39 weeks), during ultrasound, multiple echo-positive small inclusions are observed, the roughness of the chorionic plate increases, but its depressions do not reach the basal layer. In the basal layer itself there are small echogenic zones located linearly (the so-called basal “dotted line”). This stage of pregnancy is the most calm and stable. And even if in the middle of this period a pregnant woman is determined III degree maturity, this is not often a cause for alarm.

Grade III is usually observed at 37-38 weeks, when the placenta reaches the final phase in its development and corresponds to the duration of a normal full-term pregnancy. This period is characterized by biological aging of the placenta, the structure of which becomes lobar, and the depressions of the chorionic membrane reach the basal layer. This stage requires a detailed analysis of any inconsistencies observed in the body of the placenta, since even minor deviations from normal development can be signs of threatening complications. If the diagnosis at the III degree of development indicates fetal hypoxia, then it is often recommended to conduct childbirth, using surgical intervention (C-section).

Premature aging of the placenta

Premature aging of the placenta is ascertained in cases where the II degree manifests itself before 32 weeks, and III - before 36 weeks. This is not yet evidence of the pathology of pregnancy, but requires mandatory control of the movement of blood in the vessels of the uterus and the child's place.

In the case of premature maturation of the child's place, a special protein settles on the villi, which is released from the blood circulating between them, and prevents their participation in the metabolic processes of the uterine and placental blood flow. At this stage, by the end of 39-40 weeks, a decrease in the thickness of the placental membrane from 25 to 6 microns is recorded. In the tissues of the placenta, dystrophic changes are observed, lime salts are deposited in certain areas.

If the degree of maturation does not correspond to the gestational age, for example, when it should be I according to the weeks of pregnancy, but they state II, or at the 33rd week they find the III degree, then a natural question arises: What is the danger?

The placenta, as one of the most important links in a single biological system that unites the fetus, umbilical cord and mother's body, works on many life problems:

Provides oxygen to fetal tissue cells and removes carbon dioxide from the blood;
Delivers nutrients to cells and removes metabolic products;
It is a barrier and filter that protects the embryo from negative impact harmful substances that enter the mother's body: drugs, toxins, bacteria;
Produces hormones needed for proper development pregnancy.

Therefore, premature aging or death of areas of the child's place negatively affects these functions. Deterioration of blood flow in the vessels of the uteroplacental system with a discrepancy between the maturity of the placenta and the established weeks of pregnancy is dangerous for the development of placental insufficiency, leading to hypoxia and fetal hypotrophy, and in worst case- intrauterine death.

Causes of premature aging of the placenta.

The most common reasons:

Nicotine, alcohol and narcotic substances that poison the cells of a child's place.
Diabetes mellitus, thyroid disease.
Hypertension in pregnancy.
Late toxicosis (gestosis).
Negative rhesus blood in the mother.
Presentation and early detachment placenta.
Multiple pregnancy.
endocrine disorders.
Multiple pregnancy.
intrauterine infections.

Late maturation of the placenta, causes and consequences

Such a diagnosis in the practice of pregnancy and childbirth is less common than the definition of premature maturation of the placenta. The main reasons for this status of a children's place are:

primary and secondary diabetes in a pregnant woman;
negative Rh factor leading to Rh conflict;
chronic diseases of the expectant mother;
smoking during pregnancy;
alcohol consumption;
fetal malformations.

With a delay in the development of the placenta and its late maturation, we can say that it does not fulfill its mandatory functions - providing the baby with oxygen and the nutrients necessary for its proper development. In addition, carbon dioxide and metabolic products are retained in the body of the fetus, which contributes to its intoxication and leads to developmental delays.

The prognosis for the established diagnosis of "late maturation of the placenta" in most cases is unfavorable without qualified medical treatment in a hospital setting. Otherwise, there is big risk stillbirth and the occurrence of mental retardation in the fetus.

Thus, the maturation of the placenta, its development, aging and death are natural processes, but the syndrome of premature aging and late maturation requires special attention. Modern methods studies of blood flow in the fetal-placental system have shown that an extended analysis of its circulation allows the attending physician to make an accurate diagnosis.

And this makes it possible to prescribe the most effective treatment by choosing the optimal tactics for managing pregnancy and obstetrics in order to achieve their favorable completion and birth. healthy child.

Mismatch in the degree of maturity of the placenta real term requires immediate medical attention. Inadequate functioning of the placenta leads to negative consequences for the health and life of the child.

By week 32, the baby is gaining significant height and weight. At this time, the parameters of the fetus already depend on the individual hereditary predisposition, which is transmitted from the parents.

A pregnant woman feels the baby well during periods of his activity. The weight of the fetus during this period can reach 2 kg. There are only a few weeks left before the birth, so expectant mother it is especially important to monitor your condition.

At this time, the placenta reaches a significant size, and after a month, its normal aging begins. The discrepancy between the degree of maturity and the term is an unfavorable sign.

Functions of the placenta

The placenta is a disk-shaped organ that appears exclusively during pregnancy, performing intermediary functions between a woman and her child. The placenta, supplying the child with oxygen and nutrients, simultaneously removes waste products and toxic substances.

The organ begins to form after the attachment of a fertilized egg to the wall of the uterus. The formation of the organ ends by the end of the 12th week, after which the period of its growth begins. The placenta grows until the 8th month of pregnancy (36 weeks), after which it begins to age.

The placenta performs the following functions:

protection of the fetus (from shock, damage);
nutrient supply;
oxygen supply;
removal of toxins and waste products;
protection of the uterus from infections, which prevents infection of the fetus.

stages of placental maturity

There are four levels of organ maturity: 0,1,2,3. The discrepancy between the gestational age and the level of maturity indicates the presence of disorders that can have an adverse effect on the health of the child.

The level of maturity is most often determined as a result of ultrasound diagnostics based on the following signs:

organ structure;
the thickness of the walls of the placenta;
gestational age.

Each period corresponds to a certain degree of maturity of the placenta:

If at 32 weeks the 3rd degree of maturity has already come, then we can talk about its premature aging. This state of the organ is unfavorable, since it can lead to problems in the development of the child, or the onset of childbirth before the due date is reached. Threat premature birth appears as a result of the inability of the placenta to provide an already formed and viable fetus with everything necessary.

Causes of premature aging

The reasons why the placenta ages prematurely may be related to the health of the pregnant woman or her lifestyle:

alcohol, tobacco, drug addiction (during pregnancy, or in the previous period of life);
previous abortions;
diseases of the endocrine system;
intrauterine infections;
preeclampsia;
diabetes;
viral diseases (ARVI, acute respiratory infections, influenza, etc.);
twin pregnancy;
placental abruption;
taking medications without consulting specialists (including vitamins, nutritional supplements).

Most often, the reasons why a pregnant woman experienced premature aging of the placenta remain unknown.

Consequences

Premature aging of the placenta leads to a decrease in the functionality of the organ. The loss of the ability of the placenta to fully function leads to insufficient supply of the child with oxygenated and nutritious blood. This negatively affects his condition. The baby begins to develop hypoxia (lack of oxygen).

Lack of oxygen poses a great danger to the fetus, as it may experience the following problems:

disorders in the brain;
disorders of the nervous system;
pathologies of the cardiovascular system;
diseases of the digestive system;
in the worst case, fetal death may occur.

The aging of the placenta is a signal for the woman and the attending physician, which indicates the need to take all possible medical measures to prevent a possible deterioration in the child's condition.

Treatment

It is possible to determine whether the gestational age is combined with the degree of maturity of the placenta as a result of the ultrasound procedure. If the structure of the organ and its thickness correspond to more late deadline pregnancy, the doctor concludes about the premature maturation of the placenta.

At the 32nd week, the third degree of placental maturity is considered a deviation from the norm. In this case, we can talk about its premature maturation. It is not possible to change the maturity of the placenta, but there are ways to help the baby improve its oxygen and nutrient supply.

The final diagnosis is made not only on the basis of ultrasound, but also on CTG results fetus, dopplerometry. The data obtained will allow us to conclude that there may be a lack of oxygen and nutrients supplied to the child. Also, tests for infections may be ordered. Only obtaining data on the deterioration of the fetus will be the basis for prescribing drugs.

Treatment is usually carried out in a hospital setting. A pregnant woman is prescribed medication, droppers.

Timely action will help maintain normal condition child and avoid hypoxia. Subject to all medical advice a patient with a premature aged placenta has every chance of giving birth to a healthy baby on time.

If the condition of the child is apprehensive, doctors may decide on early delivery by caesarean section.