Uterine placental insufficiency during pregnancy. Why does placental insufficiency occur during pregnancy?

Fetus, developmental delay or some other pathology of pregnancy.

The placenta is an organ that forms at the site of implantation ovum to the endometrium of the uterus, and which grows with the fetus throughout pregnancy. The placenta performs an important function in supplying the fetus with oxygen and nutrients. This happens due to blood circulation through the vessels of the umbilical cord, which stretch from the placenta to the fetal body. On the other side of the placenta there are blood vessels of the uterus, which bring all the necessary substances.
As a result, nutrients are transferred to the fetus through the placenta. However, it should be understood that the mother's blood is filtered through the placenta, but does not mix with the baby's blood.

The placenta performs the following functions:

• enriches the fetal blood with oxygen;
• removes carbon dioxide from the fetal blood;
• enriches the fetal blood with nutrients;
• removes waste products from the fetal blood.

Thus, when placental function is impaired, an insufficient supply of nutrients and oxygen to the fetus occurs, and a condition with an increased concentration of decay products and carbon dioxide develops, which leads to many pathologies of pregnancy.

A healthy placenta grows throughout pregnancy to meet the growing needs of the fetus. By the time of birth, her weight is about 600 grams. If for some reason the growth of the placenta slows down, the volume of blood flowing to it decreases or the area of ​​contact with the uterus decreases ( as with premature placental abruption), then placental insufficiency occurs.

Placental insufficiency develops when the placenta ceases to cope with its function and a state of lack of oxygen and nutrients develops. In most cases, this pathology occurs due to blood flow disorders, which can be caused by maternal diseases of the blood and blood vessels.

Reasons placental insufficiency can be:

• arterial hypertension ( high blood pressure);
• some medicines;
• drug use ( especially cocaine, heroin, methamphetamine).

Also, placental insufficiency can develop if the fertilized egg is not correctly attached to the uterine wall ( with subsequent disruption of placenta formation) or if a condition of placental abruption has occurred.

Placental insufficiency is a pathology that poses the main danger to the fetus. However, in some cases, this disease can threaten the life of the mother.

Placental insufficiency is dangerous for the mother in the following cases:

• Arterial hypertension. High blood pressure, against the background of which placental insufficiency has developed, is a condition that can threaten the life of the mother. Against the background of high blood pressure, hemorrhage in the brain, rupture of blood vessels and many other dangerous consequences can occur.
• Preeclampsia. Preeclampsia is a pathological condition that precedes eclampsia, and which is one of the forms of late toxicosis of pregnancy. With this pathology, blood pressure increases, peripheral edema develops, and excess proteins appear in the urine. Without treatment, this condition can develop into eclampsia, which is accompanied by seizures, and which can only be treated by eliminating the pregnancy.
• Premature abruption of a normally located placenta. The placenta should detach from the wall of the uterus only after the birth of the fetus. If this occurs before delivery, a condition known as abruptio placenta occurs. In this case, massive uterine bleeding usually occurs, which threatens the life of the mother and fetus.

Placental insufficiency is the most dangerous early stages pregnancy, since in this case there is a gradual progression of the disease associated with the constant growth of the fetus, up to complete decompensation.

Placental insufficiency can cause the following pregnancy pathologies:

• intrauterine fetal death;
• oxygen deprivation during birth ( may cause damage to the central nervous system);
• intrauterine developmental delay ( in severe cases – up to 90% of normal);
• hypothermia ( low temperature body);
• hypoglycemia ( low blood sugar);
• hypocalcemia ( low blood calcium);
• polycythemia ( excess red blood cells, causing the blood to become more viscous);
• premature birth;
• the need for a caesarean section.

In the vast majority of cases, chronic placental insufficiency causes damage to some vital organs or disruption of their development.

Placental insufficiency can cause damage to the following organs:

• brain;
• gastrointestinal tract.

Unfortunately, in most cases, placental insufficiency is not accompanied by any symptoms or signs and occurs hidden. This leads to the fact that at the time of diagnosis, the fetus may already have severe developmental pathologies. Only in some cases, mothers who have already given birth may notice delayed growth of the uterus, as well as low activity of fetal movements. However, today there are quite a lot effective ways early diagnosis of this disease.

Placental insufficiency can be detected in the following ways:

• ultrasonography ( Ultrasound) and measuring the size of the placenta and fetus;
• ultrasound examination and Doppler measurement of placental blood flow;
• measuring the level of alpha-fetoprotein in the mother's blood;
• fetal condition monitoring.

Placental insufficiency is a pathology that cannot be cured, but which can be corrected. At the same time, it is extremely important early diagnosis and initiation of adequate therapy. This can significantly increase the child’s chances of normal development and birth.

Fetoplacental insufficiency during pregnancy (FPI) occurs in 7 out of 10 expectant mothers. This frightening statistic has many reasons, such as pathological condition has a multifactorial etiology. As gynecologists emphasize, such a problem can appear in any trimester. The term FNP refers to a number of disorders in the “mother-placenta-fetus” system.

General information

A woman's body changes in many ways while bearing a child. Normally, by 15–16 weeks, the “baby place” – the placenta – is formed. This organ exists only during pregnancy and serves as a link between mother and fetus. The importance of the placenta is difficult to exaggerate:

• Provides an influx of oxygen and removes carbon dioxide;
• Supplies nutrients and removes “waste”;
• Protects against infections;
• Produces active substances necessary for the growth and development of the fetus.

Thus, any pathological changes in the placenta harm the unborn baby.

The essence of FNP is the disruption of blood circulation in the part of the body where fetal maturation occurs.

The nature and course of the pathology depend on the age and health status of the woman. Medical practice shows that most often FNP develops in young girls (under 17 years old) and mature women (after 35 years old). In 20% of cases, placental insufficiency leads to spontaneous abortion and fetal death due to hypoxia (oxygen starvation), in 10% - to the fact that the child is born with physical and mental disabilities.

Nature of origin of FNP

Experts say that the cause of placental insufficiency can be almost any disease of the expectant mother. Infectious diseases are a source of danger, since microbes and viruses can have a detrimental effect on the “children’s place.” If a pregnant woman has anemia, iron deficiency leads to poor blood flow. Problems from outside of cardio-vascular system provoke damage to the placenta due to the formation of microthrombi.

Negative factors influencing the development of FNP include:

• Anatomical abnormalities of the uterus;
• Multiple pregnancy;
• Asthma;
• Diabetes and other endocrine diseases;
• Kidney failure;
• Toxicoses;
• Uterine fibroids;
• Mismatch between the Rh factor of the woman and the fetus.

The danger increases many times over if the expectant mother has had abortions and STDs, has bad habits, and leads an antisocial lifestyle.

Signs of FNP

Symptoms of fetoplacental insufficiency at the stage of the onset of disorders and during the transition to the chronic form do not clearly appear. Doctors strongly recommend that pregnant women listen to their bodies and immediately seek professional help in the following situations:

• Ankles and feet swell;
• Worried about pain in the lower abdomen;
• The uterus is regularly tense;
• Colic torments;
• Appeared bloody issues from the vagina.

IMPORTANT! From the 28th week of fetal ripening, a woman should normally feel its movements at least 10 times a day. IN otherwise ordered to urgently report to a gynecologist for an unscheduled examination.

Classification

There are acute and chronic forms of FNP depending on the course of the pathological process. The first option is rarely observed. It is characterized by the fact that a rapid deterioration in blood circulation causes placental abruption and leads to spontaneous abortion.

Chronic placental insufficiency is of two types: compensated and decompensated. In the first case, damage to the placenta does not affect the maturation and development of the fetus, since it adapts to these changes due to the protective and compensatory abilities of the maternal body. Competent and timely treatment of fetoplacental insufficiency of this form ends successfully in 99% of patients, without complications.

Decompensated FNP is characterized by a persistent deterioration in blood flow. In this condition, the placenta is unable to perform its functions. As a result future baby does not receive enough oxygen, which results in delay intrauterine development or death.

Severe consequences of FNP most often occur if disorders appear at an early stage of pregnancy. As gynecologists note, fetoplacental insufficiency, the development of which began in the last trimester, does not cause such complications. Thus, primary FNP (up to 4 months) and secondary (in the later months of pregnancy) are classified according to timing. The primary form of pathology, developing during the period of structure and attachment of the placenta, in many cases provokes the death of the embryo, since the incorrectly formed “baby place” is not able to perform its functions and the embryo does not develop. Most often, this type of placental system disorder is caused by hormonal imbalances, anomalies and diseases of the uterus.

The secondary form of FNP in most patients is associated with external factors. Under the influence of inflammatory processes, physical activity, stress, and exacerbation of chronic diseases, the normally maturing placenta becomes damaged and ceases to function fully.

Diagnostic methods

Considering that pathology appears for a number of reasons, complex dynamic examinations are necessarily carried out to establish the form and stage of FPN. This is especially true for patients at risk:

• Primipara after 35 years;
• Women under 18 years of age;
• Expectant mothers with a history of gynecological and cardiovascular diseases, problems with endocrine system, STD;
• Pregnant women leading an unhealthy lifestyle.

The doctor’s main task is to determine the degree of fetal development and rule out (or confirm) low or polyhydramnios. To do this, the weight of the expectant mother is determined, the abdominal circumference is measured, and the level of the uterine fundus is assessed.

If fetoplacental insufficiency is suspected, diagnosis includes the following manipulations:

• Examination on a gynecological chair;
• Collection of material for laboratory research(blood, smear);
• Ultrasound - allows you to determine the degree of maturity and thickness of the placenta, whether the size of the fetus is normal, its motor activity, the volume of amniotic fluid;
• Dopplerography of utero-fetal blood flow - helps to establish how blood circulates in the vessels of the umbilical cord, uterus and placenta;
• Phonocardiography and cardiotocography (CTG) of the fetus - the frequency and rhythm of the heartbeat of the unborn child are determined.

IMPORTANT! CTG is performed daily if a diagnosis of FNP is made.

Treatment

Treatment of fetoplacental insufficiency depends on the severity, form and stage of the disorder. With compensated FNP, when it is precisely determined that there is no risk of miscarriage and threat of fetal growth retardation, there is no need for hospitalization. Treatment is aimed at eliminating the specific factor that caused the deterioration of blood flow in the placental system. The main task is to correct the development of the fetus and restore the condition and functionality " children's place».

To avoid complications, the following medications are prescribed:

• Medicines and vitamins that improve microcirculation and blood circulation;
• Means for activating metabolism;
• Drugs to reduce uterine tone;
• Sedatives to normalize sleep and stabilize the nervous system.

IMPORTANT! Take medications strictly according to the doctor's instructions. Self-medication, use traditional methods is strictly contraindicated.

Drug therapy should be combined with proper nutrition and good rest.

If no positive dynamics are observed, the patient is hospitalized and treatment continues in a maternity hospital. If there are no further results, the possibility of caesarean section.

The decompensated form of FNP requires immediate hospitalization of the pregnant woman. The complex of therapeutic measures includes taking “Curantil” (improves microcirculation, eliminates fetal hypoxia), oxygen cocktails. Among the procedures, droppers with magnesium, aminophylline, and a glucose-novocaine mixture are prescribed. There is no standard treatment regimen, it all depends on individual characteristics patients (age, medical history), root causes of FNP, condition of the placenta and fetus.

In many cases it is possible natural childbirth with a diagnosis of “fetoplacental insufficiency”. Subject to constant monitoring of the condition of the pregnant woman and the development of the baby, and in the case of a positive prognosis, doctors allow such an outcome of events. As a rule, obstetrics proceeds without complications, and a full-fledged child is born.

Preventive measures

Pregnancy is an exceptional time in the life of every woman. It is advisable to prepare for it in advance. This will be the most effective prevention any complications, including FNP.

If the expectant mother is suffering chronic diseases, you need to make every effort to cure them or bring them to the stage of compensation.

1. Try to undergo a full examination before becoming pregnant (ophthalmologist, endocrinologist, cardiologist, etc.);
2. Get rid of bad habits(smoking, alcohol abuse);
3. Lead a healthy lifestyle, play sports, get your immune and nervous system in order;
4. While carrying a child, avoid hypothermia, stress, and excessive physical activity;
5. Observe personal hygiene extremely strictly;
6. Stick to a daily routine, get enough rest, go to fresh air, get a good night's sleep ( night sleep should be 9–10 hours);
7. Eat right, providing your body with proteins, vitamins, and microelements;
8. During pregnancy, regularly visit your obstetrician-gynecologist, carefully monitor your health, undergo examinations and tests on time;
9. During pregnancy, take a mineral-vitamin complex (as recommended by your doctor);
10. Visit together with the child’s father special courses for future parents.

These rules and restrictions will help you bear and give birth to a healthy baby.

Let's sum it up

Placental insufficiency is a common complication during pregnancy. Causes of placental dysfunction may include various factors, as a result of which the intrauterine development of the baby may be defective. Only by doing everything possible for her own health can the expectant mother reduce the danger to zero. Even with the development of strong FNP resources, healthy body will be enough to compensate for the pathology.

We wish easy pregnancy and successful birth!

Placental insufficiency is a consequence of the alarming mortality rate of babies shortly before birth, as well as in the first week after birth. Despite the enormous developments in the field of reproductive medicine, the question of this pathology is still open, and its research is a priority for domestic and foreign scientists. Next, we’ll look at how to treat placental insufficiency during pregnancy.

Placental insufficiency is confirmed in approximately 3.5% of healthy expectant mothers and in 4.5% of pregnant women suffering from any other concomitant illness. As a result of this serious defect, about 50% of newborns die in the first days of life, and the surviving children subsequently suffer from damage to the central nervous system and lag behind their peers in terms of psychomotor and physical development.

Placental insufficiency: the essence of pathology

The organ that is formed exclusively during pregnancy and is a kind of bridge between the mother and the fetus is called the placenta, or the baby's place. Thanks to the placenta, the fetus is surrounded by a reliable immune barrier and receives required amount nutrients, hormones and oxygen, and in return gives off carbon dioxide and decay products. Fencing little man from the toxic effects of harmful substances and the influence of pathogenic microorganisms, a child’s place gives him the opportunity to fully develop and grow.

Placental insufficiency is based on a disorder of microcirculation and compensatory mechanism, due to which the placenta becomes functionally defective. The fetus also suffers due to impaired gas exchange, damage to the central nervous system, endocrine and immune systems.

Causes of placental insufficiency during pregnancy

There are a lot of factors that provoke the development of placental insufficiency. They are conventionally divided into 4 large groups:

1. Features of an obstetric and gynecological nature: the presence of genetic abnormalities and various developmental defects in the first child, violation monthly cycle, serious gynecological diseases and surgical operations in the reproductive system before pregnancy, spontaneous abortions and established recurrent miscarriage, previous premature births, primary infertility, complications during pregnancy and childbirth of previous children.
2. Features of the current pregnancy. The lion's share of cases of placental insufficiency occurs due to infection of the mother and fetus with viral and bacterial infections (for example, chlamydia). Also included in this group are late toxicosis, threat of miscarriage, Rh incompatibility, multiple births, improper attachment of the placenta, pathological immaturity of the genital organs.
3. Somatic pathologies in the expectant mother. The risk of developing placental insufficiency increases endocrine diseases ( diabetes), cardiovascular ( arterial hypertension), hematopoietic, respiratory and genitourinary (pyelonephritis) systems.
4. Social and everyday factors: expectant mother under 18 or over 30 years old, bad habits, poor nutrition, stress, harmful production factors (for example, the influence of radiation or chemicals).

Often placental insufficiency develops as a result of a complex of several factors belonging to different groups risk.

Forms of placental insufficiency during pregnancy

Depending on the nature and location of the pathological process in the placenta, insufficiency is classified into several forms:

• hemodynamic - blood flow slows down in the uteroplacental and fetal-placental circulatory system;
• placental-membrane - the properties of the placental membrane for transporting metabolic products are disrupted;
• cellular-parenchymal - the performance of trophoblastic cells of the placenta decreases.

The listed structures are closely related to each other, so most often placental insufficiency is the result of complex disorders.

Depending on the nature of the hemodynamic disorder in pathology, the following forms are distinguished:

• stage 1a placental insufficiency during pregnancy - disturbances occur only in the bloodstream of the uterus;
• 1b degree - the blood flow in the child’s vascular system changes;
• 2 degrees - both uterine and fetal blood circulation is disrupted, but in general the situation remains not critical;
• 3 degrees - there is a critical disruption of blood flow in the umbilical artery, there is a threat to the life of the fetus. The patient is indicated for early delivery.

According to the clinical picture, two forms of pathology are distinguished - acute and chronic.

Acute placental insufficiency during pregnancy

The acute form of insufficiency is associated with disorders such as placental infarction and premature detachment, which entails retroplacental hemorrhage and hematoma formation. The acute course of the pathological process usually leads to fetal death and forced termination of pregnancy.

Chronic placental insufficiency during pregnancy

This form of pathology is more common than acute, and is diagnosed in every third expectant mother, who is at risk for women with perinatal abnormalities. Chronic failure placenta develops in the first half of gestation or from the beginning of the second half and lasts from several weeks to several months. Clinical picture pathology includes a violation of trophic function, which entails hormonal and gas exchange abnormalities in placental function.

Symptoms of placental insufficiency during pregnancy

The following signs usually serve as the reason for a thorough examination of the expectant mother for placental insufficiency:

• slow increase in size of the uterus. The fetus receives insufficient oxygen and nutrients, so its development is suspended. As a result, the growth of the uterus significantly lags behind the normative indicators. At healthy pregnancy the fundus of the uterus reaches the symphysis pubis by the 12th week of gestation. With the onset of the 13th week of pregnancy, the uterus can already be felt through the abdominal wall. The height of its fundus in centimeters is equal to the week of pregnancy;
• decline motor activity fetus A decrease in the quantitative indicator of movements occurs due to hypoxia. If the fetus “goes quiet” suddenly, the pregnant woman herself may notice this symptom;

• increased blood pressure and peripheral edema. This indicator has important during advanced pregnancy. When signs of hypertension are combined with peripheral edema or the presence of protein in the urine, the expectant mother is likely to develop preeclampsia. In this condition, the pregnant woman should immediately seek medical help;
• painful sensations in the lower abdominal segment. In the diagnosis of placental insufficiency, such ailment is considered indirect sign pathology. The pain may be caused by another abnormality that provokes the development of placental insufficiency. Typically, pain in the lower abdomen is one of the symptoms of uterine artery thrombosis, premature placental abruption, uterine hypertonicity, tubal and uterine infections. All these diseases are potential factors for the development of placental insufficiency;

• discharge of blood from the vagina. Throughout the entire 9 months of pregnancy, such a symptom does not bode well for a woman. If we talk about the placenta, the appearance of blood indicates its detachment, incorrect location with damage, injury to the placenta or uterus itself. Any of these disorders may form the basis of placental insufficiency.

Let us clarify that the symptoms listed above cannot be called direct evidence of the presence of placental insufficiency in a pregnant woman. In most cases, they may not exist at all. Placental insufficiency tends to hidden development. While the fetus suffers due to the small volume of metabolic processes, the mother usually does not experience any discomfort. The only correct tactics for timely detection of pathology and its treatment are regular check-ups with a doctor.

Consequences of placental insufficiency during pregnancy

Pathology can radically affect the course of pregnancy and lead to subsequent complications:

• placental abruption;
• post-term pregnancy;
• high probability of fetal death in the womb.

What is the danger of placental insufficiency during pregnancy for the baby:

• fetal malnutrition or low birth weight of a child;
• pathologies of cerebral circulation in an infant;
• pneumonia;
• mental retardation;
• neurological abnormalities;
• disturbances in the functional activity of the intestines;
• frequent colds;
• various developmental defects.

Diagnosis of placental insufficiency during pregnancy

There are several ways to detect pathology:

1. A physical examination of the expectant mother, during which they give an accurate assessment of the size, tone of the uterus, abdominal circumference and compare these indicators with the established norm. Deviations in the number of fetal movements and heart rate can also be detected.
2. Ultrasound. The method allows you to accurately determine the size of the child, the volume of amniotic fluid and the size of the placenta. Using Doppler, blood flow indicators are assessed in the vessels of the uterus, baby's place, umbilical artery and vein.
3. Research in the laboratory. As part of this diagnosis, the hormonal parameters of the placenta are studied.

Treatment of placental insufficiency during pregnancy

Treatment tactics depend on the stage of pregnancy:

• up to 34 weeks - the immaturity of the fetus is still very pronounced, and therefore it is impossible to provide assistance after its birth, so they try to maintain and prolong the pregnancy;
• after 34 weeks, the fetus is already quite viable, so doctors choose a method of delivery and set a due date.

To maintain the pregnancy until 34 weeks, the expectant mother is hospitalized in the obstetrics and gynecology department. There she is prescribed complex treatment to normalize blood circulation and microcirculation, as well as to prevent or correct metabolic processes.

The woman is shown complete rest. In order for the patient to relax and fully rest, she will benefit from procedures such as ion therapy, physiotherapy for the adrenal glands, and electrical relaxation of the uterus.

Of course, drug therapy is of great importance in correcting insufficient child space. The development of this pathology, as well as excessive miscarriage and damage to the walls of blood vessels, contributes to a large number of amino acid homocysteine ​​in the blood of a pregnant woman. To reduce the level of this substance, the drug Angiovit is used, which contains B vitamins and folic acid. The expectant mother is recommended to take it for 1 month.

Pentoxifylline is another mandatory pharmaceutical drug. The drug has a pronounced vasodilator and angioprotective effect, improves microcirculation and reduces vascular resistance. It is prescribed at 400 - 800 mg per day or through an IV.

As vasoactive agents, a combination of Actovegin solution (up to 10 droppers) and hexoprenaline tablets (0.25 - 1.5 mg per day) is prescribed.

The drugs Pentoxifylline and Dipyridamole have recently been used not only for treatment. According to doctors, these antiplatelet agents and angioprotectors help prevent the development of placental insufficiency during pregnancy. Dipyridamole is approved for use at any stage of gestation. It is used in combination with anticoagulants and drugs intended to normalize blood pressure.

Childbirth with placental insufficiency and methods of preventing the development of pathology

Successful completion of pregnancy due to placental insufficiency consists of prompt diagnosis of any functional abnormalities in the development of the baby, professional risk assessment and timely preparation of the birth canal for the birth of the child.

Natural childbirth with placental insufficiency is possible. The main thing is that the condition of the birth canal of the woman, the woman in labor and the fetus is satisfactory. The degree of readiness of the baby for birth is determined using Doppler ultrasound, cardiotocography and various functional stress tests.

Doctors resort to surgical delivery of a patient via cesarean section in case of visible irregularities in the patient’s obstetric and gynecological medical history, as well as in the presence of abnormalities in the child’s intrauterine development.

To prevent placental insufficiency during pregnancy, timely normalization or complete elimination of factors that provoke pathology is important. The pregnant woman will also be given advice on healthy eating, will prescribe complexes of essential vitamins and minerals, sedatives, and, if necessary, medications.

FPN during pregnancy is the most common pathology, during the development and formation of which the embryo does not receive enough nutrition and oxygen due to impaired functioning of the placenta. The severity of complications largely depends on the reasons that caused fetoplacental insufficiency, so it is important to conduct a thorough diagnosis.

Reasons for the formation of FPI (fetoplacental insufficiency)

FPN during pregnancy is a functional insufficiency of the placenta, hypoxia occurs, the fetus lacks oxygen, which causes varying degrees of developmental delay and other pathological processes in the embryo.

Formation occurs under the influence of many factors that influence the compensatory possibility between the mother, placenta and fetus. Diseases contribute to the development of placental insufficiency internal organs, chronic inflammation or pathologies of the reproductive system. A high risk of a pathological condition of the placenta always remains with women who have been diagnosed with gestosis at later gestation.

The risk group also includes the following categories of pregnant women:

• women under 18 years of age or after 35 years of age;
• at antisocial way life (tobacco smoking, alcoholism, drug addiction);
• difficult working conditions;
• the presence of endocrine diseases;
• deviations associated with disruption of the monthly cycle and constant failure to bear a child, fibroids and others;
• after infections on early stage gestational period;
• if there are any systemic diseases– diabetes mellitus, pulmonary or renal failure, high blood pressure;
• associated hereditary or congenital factors.

The causes of fetoplacental insufficiency are associated with various pathologies and abnormal structure of the uterus (bicornuate, saddle-shaped) or with its functional features as a result of damage to the endometrium due to previous curettages and abortions. Often the cause of FPI is anemia, when the blood is significantly deficient in iron, an element that performs the transport function of delivering oxygen to intrauterine development.

Degrees of fetoplacental insufficiency

Classification of FPN at the gestation stage is made according to severity, duration and time of formation. Depending on the gestation period, a distinction is made between primary (incorrectly implanted membrane) and secondary pathology (with a normally formed placenta, insufficient functioning is observed under the influence of negative factors).

Clinical development involves two types of pathology:

1. Acute placental insufficiency - the membrane begins to detach at any stage of gestation. The cause is mainly thrombosis and impaired gas exchange function.
2. Chronic FPN is diagnosed more often and occurs in mid-pregnancy. The pathology is characterized by placental aging ahead of time and, in turn, is divided into the following forms:

• compensated - considered the most favorable, with impaired metabolic processes, but with preserved blood circulation between the uterus and the fetus;
• decompensated - blood flow is disrupted either between the baby and the placenta, or between the uterine cavity and the placental membrane;
• subcompensated chronic fetoplacental insufficiency is caused by a significant decrease in the functional abilities of the placenta, and a significant delay in fetal development is observed.

Additionally, there are criteria for distinguishing by the degree of FPN. 1st degree is subdivided depending on the location of the deficiency:

• FPN grade 1a – there is a lack of hemodynamics of blood flow between the uterine cavity and the placenta;
• FPN degree 1b - is caused by poor blood flow between the fetus and the membrane.

Signs of fetoplacental insufficiency of the 2nd degree are characterized by impaired blood circulation at all levels, but at the same time, the indicators do not reach a critical level, unlike pathology of the 3rd degree, a threat to the baby’s life arises.

Treatment of fetoplacental insufficiency

The treatment protocol for FPN includes, first of all, therapy for the initial pathological factors. If the child does not feel discomfort, then prophylaxis and gradual stabilization of blood circulation are prescribed.

Treatment of placental insufficiency in pregnant women with a threat to the life of the child involves the use of medications in a hospital setting. During therapy, drugs are used that improve the quality of blood circulation and activate metabolic processes (Curantil, Eufillin, Troxevasin and others). To reduce the tone of the uterus, Magnesia, Ginipral or No-Shpa are prescribed.

Clinical recommendations consist of constant dynamic monitoring when diagnosing FPN using ultrasound, CTG and Doppler sonography. A woman needs to maintain absolute peace and avoid stressful situations so as not to cause an increase in the tone of the uterus. In order to prevent and improve blood flow, the diet should consist of many fruits and vegetables so that the fetus receives maximum amount vitamins and microelements.

Placental insufficiency causes the risk of developing most intrauterine pathologies. In especially severe decompensated cases, it leads to miscarriage. Most often, placental insufficiency during pregnancy is caused by steal syndrome; this may be a consequence of the growth of uterine fibroids. With a long-term process of redistribution of blood flow through the intrauterine vessels, oxygen starvation of tissues is observed developing fetus. In this case, chronic placental insufficiency can cause retardation of intrauterine development of the brain and central nervous system. No less dangerous is acute placental insufficiency, in which the threat of premature termination of pregnancy is at a very high level.

This article talks about chronic placental insufficiency during pregnancy complicated various forms uterine fibroids. Recommendations are given for the management of such women throughout the entire period of waiting for the baby.

Causes and risk of placental insufficiency during pregnancy

The main causes of placental insufficiency are, first of all, a decrease in blood supply to the placenta and blood flow in the spiral vessels of the uterus and umbilical cord. The risk of placental insufficiency arises if the functional reserves of the placenta, its hormonal and metabolic functions are reduced, and the selectivity of the barrier is impaired. Prevention of placental insufficiency is carried out from 14-16 weeks of pregnancy in the group of patients with uterine fibroids at high risk. If the risk is low, use any medications without specific justification is undesirable.

By eliminating the causes of placental insufficiency during pregnancy, you can reduce the risk of its development to zero. For prevention in high-risk groups, the following drugs are prescribed: vitamin C from the 16th to the 37th week of pregnancy; if necessary (malnutrition, chronic gastritis), multivitamins with microelements for pregnant women are additionally prescribed.

Pathogenesis of primary and myomatous placental blood flow insufficiency

Primary placental insufficiency has no clearly defined causes and develops most often in the form of destructive diffuse tissue damage of vascular origin. The most pronounced disturbances in the physiological course of pregnancy are observed when the placenta is located in the projection of a large intermuscular myomatous node (“placenta on a node”). The anatomical coincidence of the placental bed with a large intermuscular myomatous node causes a number of pathological changes in the uterus and placenta. The pathogenesis of placental insufficiency of a myomatous nature is that the arrangement of blood vessels is disrupted. Spiral vessels become less convoluted and short. In certain areas of the placental bed, the occurrence of blood clots and hemorrhage is observed.

Insufficiency of placental blood flow entails Negative consequences for the health of the unborn baby. Therefore, both acute and chronic forms of this condition require immediate medical care. In the presence of risk factors, there is often insufficient development of the functional activity and size of the placenta, which is clinically manifested as placental insufficiency.

Symptoms and signs of placental insufficiency in pregnant women

Unfortunately, signs of placental insufficiency rarely manifest as visible clinical symptoms. And when they become noticeable, it is no longer possible to save the fetus. See placental insufficiency in pregnant women early stages Its development is possible only with the help of special examinations. The following symptoms of placental insufficiency are observed, expressed in changes in the structure of the placenta:

• Partial cessation of villi development.
• In 56%, there is only a partial restructuring of the arterial vessels of the placenta, characteristic of normal pregnancy. The degree of severity depends on the size of the fibroids. The larger the node, the less pronounced the necessary transformations of the uteroplacental arteries.
• Pathological immaturity and randomness of sclerotic villi predominate.
• Areas of infarction (death) of areas of the placenta form. Along with this, the signs of compensatory reactions intensify, the number of villi increases and the number of “buds” from which new villi are formed increases.
• As the myomatous node grows towards the uterine cavity, thinning of the muscular membrane between the membrane of the fertilized egg and the fibroid is observed. True ingrowth of placental villi into the wall of the uterus is possible.
• It has been established that the most severe circulatory disorders in the placenta develop immediately before childbirth, when the tone and excitability of the uterus increase. In this regard, in pregnant women considered to be at high risk, the optimal time for delivery by cesarean section is gestational age 38-39 weeks.

Treatment of placental insufficiency of the fetus during pregnancy

Treatment of placental insufficiency must be carried out in a hospital setting. Steps to assist if fetal placental insufficiency is suspected include:

• Hospitalization.
• In-depth examination of the condition of the mother and fetus.
• Assessing the condition of myomatous nodes (exclude node necrosis!).

Drugs are administered intravenously to restore the volume of circulating fluid and at the same time improve blood flow. Vitamins C and E, which have antioxidant activity, are introduced. Medicines that relax the uterus are used, since when the tone of the uterus decreases, blood flow in its walls improves.

The course of treatment for placental insufficiency during pregnancy with such droppers is 3-4 weeks.

It is very important to prevent fetal hypoxia. It has now been revealed that hypoxia, even short-term, can lead to disruption of the development of the fetal brain (delayed maturation of brain structures, focal brain damage, inhibition of the biosynthesis of specific mediator proteins, metabolic changes).

During ultrasound, you should pay attention to the tone, movement, and behavioral reactions of the fetus, because tumor nodes growing towards the uterine cavity can affect the neurological status of the fetus.

Consequences of placental insufficiency during pregnancy

In the presence of myomatous nodes large sizes, deformation of the uterine cavity, oligohydramnios - fetal movements may be limited, which may have adverse consequences for the development of the child.

By the 38th week of intrauterine development, all organs and regulatory systems are practically formed and actively functioning in the fetus. In the placenta, from this period, a physiological decrease in the number and size of chorionic villi begins (physiological reverse development of the placenta). In this case, the consequences of placental insufficiency are no longer as destructive as in the early and middle stages of fetal development.

By the end of pregnancy, the placental-fetal coefficient, reflecting the ratio of the amount of placental mass to a unit of fetal mass, decreases by more than 70 times (from 9.3 at 8 weeks to 0.13 at 40 weeks).

The differences between the physiological reverse development of the placenta (38-41st week of pregnancy) from the aging of the placenta are:

• satisfactory condition of the fetus and normal biophysical characteristics;
• fetal heart rate within 120-130 beats per minute;
• normal uteroplacental-fetal blood flow;
• preservation of the proliferative potential of the trophoblast (the presence of individual cambial Langhans cells and immature intermediate villi).

The consequences of placental insufficiency during pregnancy are that there is a decrease in uteroplacental blood flow (blockage of the main villi, opening of arteriovenous bypass circulatory pathways, a decrease in the number of functioning small vessels in the terminal villi of the placenta), signs of fetal hypoxia appear and intensify, and the number of amniotic fluid decreases. water

In patients with uterine fibroids who are at high risk, the processes begin from the 37th week premature aging, and not just the physiological reverse development of the placenta. Therefore, it is advisable to carry out delivery by cesarean section at 38-39 weeks of pregnancy, which to a certain extent helps to avoid fetal hypoxia. Calcareous deposits, microthrombosis and microhemorrhages are often found in the placenta. Further growth of the fetus is limited by rationally reducing blood flow through the uterine arteries and in the intervillous space of the placenta.

Many factors that affect the developing fetal brain can delay brain maturation. This may cause problems in the future neuropsychic development child. These factors primarily include hypoxia as a consequence of insufficient blood supply to the fetus in patients with uterine fibroids who are at high risk. Damaging factors are also the acidity of the body’s environment, the accumulation of cellular poisons, which reduce the possibility cellular respiration, oxidants appear. The increasing oxygen-free pathway of glucose breakdown leads to the accumulation of lactic acid in the blood and brain tissue of the fetus, which is most unfavorable for the child’s health.

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