Author of the article - an obstetrician Grigorieva Xenia S.
Fetoplacental (or placental) failure - a change in the placenta, which lead to violations of the interaction of the organism and its fetus of a pregnant. Such a state is a consequence of the pathological status of the mother.
Placental insufficiency (FPN) can lead to the development of hypoxia or delay. This pathology does not develop by itself, it is a consequence of an illness.
Placental insufficiency is very common in obstetric practice. According to statistics, this pathology develops in 50-70% of cases with miscarriage, gestoze - 30-33% maternal infections - more than 60% in pregnant women with extra-diseases (therapeutic, surgical, etc.) - 20-40%.
Causes
Causes of primary placental insufficiency:
- fetal chromosomal disorders (genetic disorder);
- transferred to the mother's infection 16 weeks of pregnancy;
- Mother hormonal disorders (insufficient progesterone hormone).
Causes of secondary NEF:
- age of the pregnant (up to 18 or over 30 years);
- bad habits (smoking, alcohol abuse, drug addiction);
- contact with hazardous substances during pregnancy;
- miscarriages and premature births in history;
- hard during the last pregnancy;
- abortion;
- pregnant disease (cardiovascular, endocrine, kidney disease, etc.);
- infectious diseases of the urinary system of the pregnant (cystitis and etc.);
- inflammation of the pelvic organs (endometritis, salpingo-oophoritis and so forth).;
- abnormalities of the uterus (saddle, etc.);
- hysteromyoma;
- placenta previa;
- polyhydramnios;
- gestosis;
- obstetrical bleeding during pregnancy;
- Rhesus conflict (incompatibility fetal and maternal blood of rhesus factor or blood group).
Signs of placental insufficiency
Placental insufficiency is divided into different types. Among them are:
In time and the mechanism of development.
- The primary (growing at 15-16 weeks is associated with impaired fetal attachment to the uterine wall).
- Secondary (placenta occurs after maturation influenced by external factors).
The clinical course.
- The acute form mainly occurs during delivery, for example, detachment placentae.
- Chronic develops at different stages of pregnancy.
There is such a classification: FPN without fetal growth retardation (ZRP) and FPN with SoG.
Some specific symptoms of placental insufficiency are absent. Pregnant women with this disorder complain of symptoms characteristic of the disease that caused the development of FPN. Also, there is increased or, on the contrary, decreased fetal activity, which speaks about the presence of hypoxia.
If a pregnant woman has any disease or disorder, it is necessary to tell about it a gynecologist, a leading pregnancy and undergo regular inspections and monitor the status of fetus.
Diagnostics
The first step is an obstetrician-gynecologist collects the history of the pregnant woman and identifies risk factors (age, comorbidities, complications of previous pregnancies, etc.).
Pregnant women at risk, should be given special attention during the inspection:
- weight control (significant increase may indicate the presence of edema, polyhydramnios, diabetes and so on.);
- measuring the sizes of height standing uterus (GMR) may be indicative of fetal growth retardation;
- tone of the uterus;
- presence of secretions from the genital tract (bleeding, infection);
- fetal movements and listening to the heartbeat.
The most reliable sources of FPI diagnosis are ultrasound, CTG and Doppler. Each trimester screening held ultrasound, which can be accurately and see the presence of pathology as well as the location of the placenta, fetal possible delay, low- or hydramnion etc. According CTG can identify fetal hypoxia.
Do not worry, the doctor may miss the pathology, screening spend all pregnant women is mandatory at time of 12-13 weeks, 22-23 and 32-33.
FPN treatment
Given that this violation can not be completely cured, treatment goals placental insufficiency are:
- improvement of blood circulation between the mother, fetus and placenta;
- prevention of hypoxia and fetal developmental delay;
- prolongation of gestation and suitable delivery (through natural paths or via caesarean section).
Upon detection of placental insufficiency pregnant shows an ultrasonic surveillance Doppler (blood flow study) every 2 weeks.
Mainly it is necessary to treat the disease, which caused poor circulation in the placenta. For example, if the FPN development arose from the threat of termination of pregnancy, it is necessary to direct treatment to reduce the tone of the uterus. Gestosis - to reduce blood pressure, eliminate edema and so on.
To improve circulation between the mother, placenta and fetus appointed Aktovegin intravenously. According to some indications doctor may prescribe antiplatelet agents (drugs that prevent blood clots), these include: Dipyridamole, pentoxifylline. This group of drugs often used in cardiovascular diseases, diseases of the kidney and liver, endocrine disorders.
Placental insufficiency in combination with fetal growth retardation or hypoxia is an indication for hospitalization.
In severe violations (by ultrasound and Doppler) it is advisable to carry out cesarean delivery starting at 32-33 weeks.
delivery
Selecting the optimal time and method of delivery will help to reduce the risks.
Method delivery physician chooses individually depending on the degree of severity of the pathology, condition of the fetus and the parturient, the presence of other obstetrical indications.
Indications for operative delivery for up to 37 weeks:
- no improvement after 10 days of treatment of placental insufficiency;
- significant delay in fetal development.
On a critical violation of blood flow can be scheduled cesarean section at term 30-32 weeks.
Placental insufficiency is not always an indication for cesarean section. Childbirth can naturally pass under the following conditions:
- favorable obstetric situation;
- the satisfactory condition of the fetus and the mother;
- satisfactory ultrasound readings, Doppler, CTG.
If the doctor decides that the delivery will be through natural ways, the pregnancy labor induction is performed (amniotomy, kelp, oxytocin, etc.).
possible complications
Complications that can occur when FPN:
- fetal hypoxia (oxygen deficiency) is the most common;
- growth retardation;
- signs of fetal prematurity at birth at term (e.g., birth with a body weight 2000 g);
- newborn disease (pneumonia, jaundice), are less common;
- fetal nervous system damage (mainly in primary FPN), disturbances occur during the formation of the brain. This complication is rare.
Pregnant women with placental insufficiency must be constantly observed by a doctor, take all prescribed drugs and vitamins to pass the necessary research, and then the risk of complications significantly decrease.
Forecast
Mild placental insufficiency favorable prognosis.
Prevention NEF:
- chronic disease before pregnancy;
- statement on the account of pregnancy up to 12 weeks;
- regular check-ups and advice from an obstetrician-gynecologist;
- vitamins;
- avoiding harmful habits (smoking, drinking).
Clinical guidelines and statistics are taken from textbooks:
"For outpatient care guide in obstetrics and gynecology", edited by VI Kulakov.
"Obstetrics: national leadership", ed. EK Ailamazyan.
Some studies in pregnancy
- Smears during pregnancy.
- Tests during pregnancy by trimester.
- Ultrasound during pregnancy.
- Urinalysis in pregnancy.
- Coagulation.
- Installing pessary.
- Glucose tolerance test.
- Homocysteine in pregnancy.
- Amniocentesis.
- Anesthesia during childbirth.
- Fetal CTG (cardiotocography)
- Cordocentesis.
- Epidural anesthesia during childbirth.