Fpn on what terms is shown. Uteroplacental insufficiency: management of pregnancy and childbirth. What threatens the failure of the placenta of the mother and fetus

For the full development of pregnancy, the condition of the placenta is very important. After all, it is through it that the fetus receives the necessary nutrients and oxygen.

Sometimes the relationship between the child and the mother's body is broken. Various adverse factors can lead to this, including diseases of a woman, contact with harmful substances, etc.

In this case, the diagnosis of FPI during pregnancy is made. How can such a condition affect the further development of the fetus and the course of pregnancy?

Features of the pathology

The placenta is an organ that forms during pregnancy. Its main functions are the delivery of nutrients from mother to fetus, gas exchange and protection of the baby from various negative factors.

What is FPN during pregnancy? So in medicine they call a set of changes in the placenta. In other words, this is a violation of blood circulation in the body, as a result of which the baby may not receive the amount of oxygen or nutrients he needs.

If a this pathology progresses, there may be a delay prenatal development or even fetal death.

There are no specific symptoms of placental insufficiency. The only thing you should pay attention to is a sharply increased or, on the contrary, reduced fetal activity.

Know! Normally, it is believed that during the day, you should feel his movements about 10 times. If the movements are practically inaudible or, on the contrary, they have become too active, then you need to consult with your doctor.

A doctor may suspect FPI during an examination of a pregnant woman. If the weight gain or abdominal enlargement is too small and does not match specific date pregnancy, a woman will be advised to undergo an ultrasound scan, where it will be possible to determine the condition of the placenta and the degree of development of the child.

FPN classification

Placental insufficiency during pregnancy can be classified according to several criteria. Depending on the mechanism of occurrence, it happens:

• primary - is detected in the first trimester and is associated with a violation of the implantation of the fetal egg or the mechanism of placental formation. Read about what happens to mom and baby during this period in the article 1 trimester of pregnancy >>>;
• secondary - may appear in an already formed organ, as a result of exposure to any negative factors.

Based on clinical manifestations, FPI is:

1. Acute. In most cases, placental abruption is the cause. This can happen at absolutely any stage of pregnancy;
2. Chronic. Diagnosed on different terms pregnancy. In turn, chronic placental insufficiency can be compensated (if metabolic disorders are present, but blood circulation is not impaired) or decompensated (circulatory disorders are detected).

There are several degrees of decompensated phytoplacental insufficiency:

• FPI 1a degree during pregnancy is manifested by a violation of the movement of blood in the uteroplacental circle;
• 1b degree - the violation was found exclusively in the fetal-placental circle;
• Insufficiency of the 2nd degree - the violation occurred immediately in 2 circles;
• Grade 3 - the nature of the violations is critical and this condition threatens the life of the fetus.

Causes of pathology

Before prescribing treatment and determining possible risks, the doctor will have to determine the exact causes of placental insufficiency during pregnancy. The following can lead to a violation of the formation and functioning of the body:

1. Genetic abnormalities in the fetus and endocrine pathologies in the maternal body;
2. Penetration of viruses and bacteria into the body of a pregnant woman during the first trimester (to protect yourself from possible diseases, read the related article: Cold during pregnancy >>>);
3. Chronic illness of the mother diabetes, pathology of cardio-vascular system etc.);
4. Obstetric pathologies (preeclampsia, polyhydramnios, Rh conflict, etc.);
5. Abnormal structure of the uterus (bicornuate, etc.), the presence of myomatous nodes, abortions in the past, etc.;
6. Socio-biological factors (pregnant age under 18 or over 35, frequent stress and excessive physical activity, smoking and other bad habits, contact with harmful substances).

FPI treatment

If during the ultrasound you were diagnosed with placental insufficiency, the doctor will prescribe the necessary treatment. Its purpose is:

• improvement of blood flow in the placenta;
• prevention of violations of intrauterine development of the fetus. (learn more about how the baby grows and develops in your tummy from the article Development of the baby in the womb >>>)

For this, vasodilators (Kurantil), antispasmodics (No-shpa, related article: No-shpa during pregnancy or Ginipral), sedatives (Glycine, valerian infusion) are usually prescribed. In some cases, you may need to take medications that increase blood clotting (Heparin).

Usually FPI is treated at home. Hospitalization is indicated only in cases where the prescribed therapy did not give the desired result within 10-14 days, or comorbidities were detected during the examination.

Possible consequences

Placental insufficiency is a rather dangerous pathology that requires mandatory treatment. This is due to the fact that FPI can cause a number of serious complications, including:

1. fetal hypoxia (the amount of oxygen that gets to the baby is not enough for its full development). More about fetal hypoxia during pregnancy >>>;
2. violation and retardation of intrauterine development (as a result, the size of the baby does not correspond to those established for a particular period of pregnancy);
3. fetal death;
4. insufficient body weight of the newborn during childbirth that occurred on time (after 38 weeks);
5. detection of congenital jaundice, pneumonia or other diseases in a newborn;
6. disorders of the nervous system during fetal development or during childbirth.

Doctors make a decision on the method of delivery after a comprehensive assessment of the general condition of the mother, the fetus and the readiness of the birth canal. If everything is in satisfactory condition, then you can give birth on your own.

In the case when an ultrasound revealed a delay in the development of the fetus or the birth canal was not ready, then C-section.

Prevention

To avoid the occurrence of disturbances in the state or work of the placenta, the prevention of FPI is important. And it is desirable to start it even before the onset of pregnancy. Prevention of placental insufficiency is:

• Rejection of any bad habits even at the stage of preparation for the conception of a baby;
• Quality pregnancy planning. To do this, you need to visit a doctor who can assess the state of your health. In the presence of any chronic diseases, it is important to treat them even before conception;
• It is important to register before 12 weeks of pregnancy. During this period, the doctor will conduct an examination and be able to identify any deviations in the work of your body;
• You need to visit the doctor regularly. During the first trimester, it is enough to visit the antenatal clinic at least once a month. During the second trimester, the frequency of visits is 1 every few weeks. In the third trimester, this should be done weekly;

This is necessary for the timely detection of any abnormalities in the condition or work of the placenta and, if necessary, the treatment of such a condition.

• The expectant mother must eat right;

Her diet should contain all the vitamins and minerals necessary for the development of the fetus. It is important to eat plenty of foods that contain natural fiber. You should also avoid fried foods, spicy and canned foods.

I talk about what foods you can and should eat in your position in the book Secrets of Proper Nutrition for a Future Mom >>>.

• Additionally, you need to take vitamin and mineral complexes, which are specially designed for expectant mothers;
• During pregnancy, you should take more time to rest. Sleep should also be full (at least 8 hours);
• Avoid physical and psycho-emotional overstrain;
• Do sport. There are a number of complexes of special gymnastics for pregnant women;
• Need to visit more often fresh air. At the same time, for hiking, you should choose places away from highways. How much you need to walk and how to do it correctly, you can learn from the article Walking during pregnancy >>>

Have a safe and easy pregnancy!

A mysterious diagnosis for many pregnant women: "FPN" - what is it? FPI, or fetoplacental insufficiency, is called pathology in the state of the placenta.

Disease diagnosed in almost a third of pregnant women and refers to one of the main factors complicating the course of pregnancy and leading to fetal death.

Placental dysfunction is a serious danger for pregnant women.

What is placental insufficiency?

With fetoplacental insufficiency the placenta of the uterus is not able to fully perform its functions, which leads to disturbances in the development of the fetus and an increased risk of abortion.

We should not forget that it is the placenta that is responsible for the supply of nutrients and oxygen, it also synthesizes the hormones necessary to maintain pregnancy and the development of the child.

There are two forms of FPN:

• primary developing in and characteristic of women with a history of infertility and hormonal disorders;
• secondary, arising on more later dates pregnancy.

Also, FPI can manifest itself in two stages:

• acute at which it occurs, capable of leading to termination of pregnancy;
• chronic associated with .

The chronic stage is much more common and worsens by the beginning of the last trimester.

According to the degree of negative impact on the fetus, FPI can be divided into several types:

With the latter type of FPI, severe pathologies in the development of the fetus and its death are possible.

FPI symptoms and diagnosis

With compensated FPI, a woman does not notice the symptoms of pathology problems can only be detected by ultrasound.

In other cases, dysfunction manifested by the following symptoms:

• drop in fetal activity;
• decrease and ;
• insufficient pregnant;
• manifested in placental abruption.

Timely diagnosis is of great importance, because FPI causes the most severe complications when it occurs on.

For this purpose justified detailed history taking, which allows to judge the health status of the expectant mother. The age of the pregnant woman, past gynecological and endocrine diseases, previous operations and lifestyle are important.

Much attention is paid to the regularity and age at which puberty began.

It is important to collect information about all past or current serious illnesses., such as, hypertension, etc. A woman's complaints about a deterioration or decrease in her condition are also of great importance.

To rule out pathology the following studies are being carried out:

Why is the diagnosis dangerous?

The consequences of FPI depend on its severity, in the most severe situations it is possible:

• intrauterine death of a child;
• placental abruption;

Fetoplacental insufficiency adversely affects the development of the child.:

• developmental delays are possible;
• the baby is often born underweight;
• hypoxia leads to circulatory disorders in the child's brain;
• the development of respiratory pathologies is not excluded;
• possible neurological disorders;
• severe fetal malformations are possible;
• the immunity of the child after FPI is weakened.

Treatment

It is important to pay great attention treatment of the underlying disease of the pregnant woman, which caused FPI. The best results are obtained by timely prevention of pathology.

In the first trimester

Manifestation of placental dysfunction in early pregnancy can lead to severe malformations in the child. Appropriate treatment should be started immediately, preferably in a hospital.

With timely therapy, the prognosis of the outcome of pregnancy is more favorable. Doctor's advice should not be ignored healthy eating and taking vitamins.

It is also extremely important to refuse from bad habits capable of causing great harm to the fetus.

In the second and third trimesters

FPI treatment is carried out for at least 2 weeks. The effectiveness of therapy is determined using ultrasound, dopplerography and cardiotocography.

The result largely depends on how long the placental dysfunction was detected.

At later stages, FPI is less dangerous. With prolonged insufficiency for a long time, early termination of pregnancy is possible by.

Do not forget about the need for a good rest during childbearing. Stressful situations can adversely affect the course of pregnancy.

Medications

To eliminate placental dysfunction, the following medications are prescribed:

• vasodilator drugs to improve blood circulation and oxygen supply ();
• preparations for lowering ( , );
• means for improving metabolic processes in tissues (,);
• medicines to improve blood flow in the uterus (Trental,);
• sedatives (, etc.).

Prevention

Timely preventive measures taken during pregnancy will help to avoid such a dangerous condition as fetoplacental insufficiency during pregnancy.

Take care of your health follows even at the planning stage of conception:

• undergo a complete medical examination before pregnancy;
• get rid of bad habits;
• start leading a healthy lifestyle;
• lose excess weight;
• give preference to foods high in vitamins.

During the period of bearing a child, do not forget about proper rest, try to avoid stressful situations if possible.

Not a single expectant mother is immune from placental insufficiency. Despite the fact that the pathology is treatable, you should not treat it carelessly - the consequences for the child can be very serious.

Trust Pregnancy Care qualified specialists and do not forget about the expediency of conducting healthy lifestyle life.

Despite the rather high level of development of the obstetric-gynecological and perinatal fields of medicine, uteroplacental insufficiency remains the main cause of not only high mortality in children in the perinatal period, but also their morbidity in subsequent periods of development.

This pathology has not lost its relevance for a long time and is one of the priority areas in modern medical science.

Summary of statistics

Uteroplacental insufficiency is diagnosed on average in 3.5% of pregnant women without other concomitant pathology and in 45% with its presence. It occurs on average in more than 60% of those women who have had a bacterial-viral infection of the internal genital organs, in 50-75% - with, in 32% - with, in 35% - with extragenital diseases.

The relevance of the problem is also evidenced by the consequences of this pathology - high perinatal mortality, which is about 50% among premature newborns and 10.3% among full-term ones, symptoms of maladjustment in the early postpartum period - in 30% of newborns, a high risk of damage to the central nervous system - almost at half. The degree of these disorders in the perinatal period determines the level of lag in the psychomotor and physical development newborns.

What is placental insufficiency

The placenta is a temporary organ that develops during pregnancy and provides a connection between the fetus and the mother's body. Thanks to the "mother's body - placenta - fetus" system, the latter is provided with oxygen, nutrients, hormones, and immune protection through a complex circulatory system. Through it, carbon dioxide and metabolic products are removed in the opposite direction.

The placenta also serves as a barrier preventing many toxic and harmful substances, bacteria and viruses, some hormones and immune complexes are produced in it, etc.

That is, the entire inextricable system "mother - placenta - fetus" fully provides normal growth and fetal development. Insufficiency of uteroplacental blood flow, the development mechanisms of which are based on microcirculatory disorders, can lead to disruption of fetal gas exchange, delay in its development, damage to the central nervous, immune and endocrine systems or its death.

Placental insufficiency is a clinical syndrome caused by various morphological and functional changes, as well as violations of adaptive compensatory mechanisms that ensure the usefulness of the organ (placenta) in functional terms.

Thus, this pathology is the result of a complex reaction of the placenta and fetus to pathological changes in the maternal body, which is manifested by a complex of disorders of placental functions - metabolic, endocrine and transport.

Causes of pathology and mechanisms of its formation

Numerous causes of placental insufficiency are combined into two large groups - endogenous and exogenous.

I. Endogenous

These include genetic and endocrine, viral and bacterial infections, enzymatic deficiency of the tissue of the decidual (falling off) membrane, which is a layer of the endometrium changed during pregnancy and takes part in the protection and nutrition of the fetal egg.

As a result of the impact of these factors, prior to the 16th week of pregnancy, primary placental insufficiency is formed, which manifests itself in violations of the anatomical structure, attachment and location of the placenta, defects in its blood supply, and disturbances in the processes of maturation of the chorion.

With primary insufficiency, congenital malformations of fetal development are formed or an undeveloped pregnancy occurs. The latter clinically manifests itself in the early stages of spontaneous miscarriage, and in the later stages of pregnancy - the threat of its interruption.

II. Exogenous (external)

In relation to the fetus, they cause placental insufficiency after the 16th week of pregnancy, that is, after it has already formed (secondary insufficiency), which leads to a limitation in the supply of energy and plastic materials to the fetus.

Clinical manifestations of secondary placental insufficiency - the development of a chronic form of hypoxia and intrauterine growth retardation of the fetus. The reasons may be various obstetric and gynecological diseases and complications of the course of pregnancy, leading to disorders of the fetal-placental and/or utero-placental circulation.

However, as a result of research, the conditionality of such a division was proved, since primary disorders in a significant percentage of cases can transform into secondary ones, and the latter can form already in the early stages of pregnancy against the background of latent pathological changes.

Endogenous causes of placentation-related disorders not diagnosed in the first half of pregnancy can lead to placental insufficiency in the second half of pregnancy and a severe course of the latter.

Due to the multiplicity, diversity and ambiguity of the influence of causative factors, it turned out to be more appropriate to identify and combine risk factors that contribute to the formation of pathology into four groups:

1. Anamnestic obstetric and gynecological features - the presence of malformations or genetically determined diseases in existing children, menstrual disorders, diseases (in the past) of a gynecological nature and surgical interventions associated with them spontaneous miscarriages and recurrent miscarriage, perinatal mortality and primary infertility, complications during previous pregnancies and childbirth.
2. Features of this pregnancy. The leading places are given to chronic viral-bacterial infection of the internal genital organs of the mother and infection of the fetus. Of particular importance is attached, capable of spreading both ascending and hematogenously. In addition, this group includes gestosis, threatened miscarriage, maternal and fetal incompatibility by Rh factor, antiphospholipid syndrome, abnormal location or attachment of the placenta, hereditary or congenital diseases in the fetus or mother, including genital infantilism.
3. The presence of somatic pathology in a woman - endocrine (thyrotoxicosis or hypothyroidism, diabetes mellitus, dysfunction of the adrenal cortex), cardiovascular (hypertension and heart failure), hematopoietic, chronic diseases of the lungs or urinary system (chronic glomerulonephritis and pyelonephritis).
4. Social and domestic and other factors - the age of a pregnant woman is less than 18 or more than 30 years old, nutritional deficiencies, smoking, the use of drugs and alcoholic beverages, psycho-emotional and physical overload, occupational hazards associated with ionizing radiation, electromagnetic radiation, chemical, including medicinal substances.

As a rule, several factors are involved in the development of pathological processes, one of which plays a leading role at a certain stage of placental development and functioning.

Disease pathogenesis

The formation of placental insufficiency under the influence of risk factors is due to the following interrelated mechanisms:

• Pathological changes in the uteroplacental blood flow, which lead to disorders in the inflow of arterial blood and / or outflow of venous blood from the space between the chorionic villi of the placenta, a slowdown in the rate of capillary blood flow in them, a change in the rheological and coagulation properties of maternal and fetal blood.
• Disturbances in the fetal-placenta circulatory system and oxygen delivery to the fetus, as a result of which a pathological chronic process develops. It consists in the consistent development of adaptive reactions in the fetal body in the form of stimulation of hematopoiesis and gluconeogenesis processes, in the gradual redistribution of blood in order to supply oxygen to vital organs (brain, heart, adrenal glands).
• Placental membrane disorders - a violation of the structure, a change in the permeability, synthetic and metabolic functions of cell plasma membranes, the functioning of which depends mainly on the composition of lipids in them and the balance between the processes of peroxidation of the latter and the degree of antioxidant protection of the fetus and pregnant woman.
• Insufficient development of the chorionic villi, due to a violation of the formation of the vascular network of the villi or / and tissue base (stroma). The result of this is a decrease in the area of ​​those structures due to which gas exchange between maternal and fetal blood is ensured. In addition, it is also possible to increase the distance of the intervillous space, in which maternal blood and capillaries of the fetal circulatory system are located. All this leads to ischemia, microcirculation disorders, etc.
• A decrease in the compensatory-adaptive capacity of the "mother - placenta - fetus" system. With the further development of placental insufficiency, "hypoxic stress" occurs, which is accompanied by a compensatory increase in the flow of biologically active substances into the blood of the fetus. As a result, the blood is redistributed even more, the development of the fetus slows down, the metabolic processes of glucose in order to release energy occur along the anaerobic pathway, which is no longer able to compensate for the lack of the latter, the mechanisms that ensured the centralization of blood in vital organs gradually fade away, etc. fetal asphyxia occurs.

Forms of the pathological process and some possibilities of instrumental diagnostics

Depending on the expected nature of the placental lesion and the predominant localization of pathological processes, insufficiency can be:

• hemodynamic, characterized by a decrease in blood flow velocity in the uteroplacental and fetal-placental bed;
• placental-membrane, which consists in a reduced possibility of transporting metabolic products by the placental membrane;
• cellular-parenchymal, associated with a decrease in the degree of functional activity of trophoblastic cells.

In clinical practice, isolated disorders in one of the listed structures are extremely rare due to their close relationship. A change in one of them almost always causes pathological changes in the other. Therefore, when making a diagnosis, some practitioners still use terminology that takes into account the causative factor - primary or secondary placental insufficiency.

In accordance with the clinical course, there are forms:

1. Acute, in the development of which the main role is given to circulatory disorders in the "womb - placenta" system.
2. Chronic.

Acute placental insufficiency

It is manifested by the formation of extensive, with retroplacental hemorrhage and the formation of a hematoma. The acute form very often ends with the death of the fetus and termination of pregnancy.

Chronic

A relatively more common form is chronic placental insufficiency, which occurs in every third pregnant woman who belongs to the risk group of people with perinatal pathology. In its occurrence, late preeclampsia of pregnant women, isoserological incompatibility of the blood of the pregnant woman and the fetus, prolongation of pregnancy, the threat of its termination, anemia, and somatic diseases are of primary importance.

The chronic course can develop in the first half of pregnancy or from the beginning of the second half and last from weeks to several months. It is manifested by disorders of the trophic function, followed by hormonal and then gas exchange disorders of the placental function. The main mechanisms are chronic uteroplacental perfusion and microcirculatory disorders.

How to define placental insufficiency?

According to clinical manifestations, the following forms of chronic course are distinguished:

1. Compensated, characterized by the absence of violations of the fetus. Pathology can be detected only through special subtle studies - determining the concentration of specific placental enzymes and hormones of the placenta in the blood of a pregnant woman, conducting radioisotope placentastincigraphy, and others. These studies make it possible to identify a disorder of some individual functions of the placenta.
2. Subcompensated - the general condition of the fetus does not suffer, but only in the absence of any stress on the fetal-placental complex. As a result of diagnosis using testing with various stress tests or a stress test, as well as contractions and attempts in childbirth, signs are revealed oxygen starvation(hypoxia) of the fetus, which can be diagnosed using cardiotocography.
3. Chronic decompensated placental insufficiency, in which the impaired state of the fetus is detected even without the use of additional stress tests and in the absence of labor activity.

The most informative objective method for diagnosing a disease and elucidating the possibilities of the compensatory nature of the maternal-placental-fetal system is considered to be ultrasound in the corresponding vessels.

Approximately at week 28, it is possible to determine the amniotic index, the degree of maturity of the placenta and its early aging, the compliance of the growth and body weight of the fetus with the age norm, as well as the presence of malformations (for example, heart defects).

At 36 weeks after the final full formation and maturation of the placenta, not only anatomically, but also functionally, special importance is attached to its thickness, degree of aging and the position of the fetus.

Any deviations from the norm at these stages of pregnancy serve as an indication for an ultrasound examination with dopplerometry. Most often, the blood flow velocity in the uterine arteries, umbilical cord and middle cerebral artery of the fetus is determined, after which the character of the curve is calculated according to one of such indicators as the pulsation index, resistance index, but more often - in terms of the systolic-diastolic ratio.

Based on this technique, by means of a comparative evaluation of the constructed graphs of curves of Doppler parameters of blood flow velocity in the corresponding vessels, a classification of arterial hemodynamic disorders in the functional system "mother-placenta-fetus" was proposed. In accordance with it, hemodynamic disorders are distinguished:

• 1a degree - only uterine blood flow changes;
• 1b degree - only blood flow in the vessels of the fetus;
• 2 degrees - violations of the uterine and fetal circulation without critical values ​​of these indicators;
• Grade 3 - a critical level of blood flow disturbance in the umbilical artery, which is expressed by a zero or even negative value of the diastolic component.

How to treat pathology in these cases? At degrees 1a, 1b and at 2 degrees, only dynamic monitoring of a pregnant woman is necessary with cardiomonitoring and Doppler control. At grade 3, which characterizes placental insufficiency as decompensated, a woman needs early delivery.

Treatment of placental insufficiency and management of childbirth

This pathology is associated with cellular and tissue changes occurring in the placenta, as a result of which hemodynamic disorders develop. Therefore, the main goals of therapy are:

1. With a period of up to 34 weeks - the preservation and extension of the gestational age in cases of severe immaturity of the fetus and the impossibility of providing him with the necessary assistance in the postpartum period.
2. After 34 weeks - the choice of the optimal method of delivery and its timely implementation.

To achieve the first goal, timely hospitalization in the obstetrics and gynecology department is necessary in accordance with the following indications:

• Presence of fetal growth retardation.
• The presence of decompensated insufficiency (regardless of degree), identified by Doppler study.
• Impaired functional state of the fetus, identified using other methods.

Carrying out complex treatment is aimed at correcting blood circulation and microcirculation, preventing or treating violations of the rheological properties of blood and metabolic processes.

A woman in a hospital is recommended to limit physical activity, magnesium iontophoresis, physiotherapy on the adrenal glands, electrorelaxation of the uterus are prescribed. All this helps to relax the latter and improve blood supply and hemoperfusion in the placenta. Reasonable therapy for hypertension, heart failure, antiphospholipid syndrome, diabetes mellitus, etc. is also mandatory.

Medical therapy

One of the factors leading to habitual miscarriage and the development of congenital pathology in the fetus is elevated level the content of homocysteine ​​in the blood of a woman, which contributes to damage to the vascular wall, the development depression etc.

The decrease in the concentration of this amino acid is facilitated by the drug Angiovit, which includes vitamins "B 6", "B 12" and folic acid (vitamin "B 9"). It is available in tablets and is intended for daily (1 time per day) intake for 1 month.

Trental (Pentoxifylline) has pronounced vasodilating, angioprotective, antiaggregatory and microcirculation-improving properties. It also helps to activate the functioning of collateral vessels and reduce vascular resistance. It is used in tablets in a daily dose of up to 400-800 mg or as an intravenous drip.

Of the vasoactive agents, Actovegin is also used in combination with hexoprenaline. The latter has a stimulating effect on the beta-2-adrenergic receptors of the uterus, causing it to relax (tocolytic effect).

The first drug is prescribed in solution intravenously, up to 10 injections (depending on the results of a repeated Doppler study), while the second drug is administered orally in tablets at a daily dose of 0.25 mg-1.5 mg. In the future, both drugs can be administered orally (Actovegin - 0.2 g each).

In the presence of a severe form of diabetes mellitus or antiphospholipid syndrome, drugs with anticoagulant, fibrinolytic, antiadhesive, hypolipidemic effects (Sulodexide, Fraxiparin, Heparin, Acetylsalicylic acid) are used.

In recent years, drugs such as Pentoxifylline and Dipyridamole have been widely used not only for treatment purposes. With antiplatelet and angioprotective effects, these drugs included in the complex therapy program help prevent placental insufficiency. The appointment of Dipyridamole is possible at any stage of pregnancy in combination with anticoagulants, as well as with salicylic acid and with drugs that lower and normalize blood pressure.

Also in recent years, preference has been given to agents whose active ingredient is characterized by combined activity in relation to blood vessels and metabolic processes at the same time. So, for example, in cases of violation of the uteroplacental-fetal circulation, a solution of Trimethylhydrazinium propionate is widely used intravenously.

It restores balance in the processes of oxygen delivery and consumption by cells under ischemic conditions, has a neuroprotective effect, promotes the expansion of small vessels, stimulates glycolysis without increasing tissue oxygen demand, etc.

Conducting childbirth in placental insufficiency and prevention of pathology

It consists in the timely diagnosis of functional disorders of the fetus, the correct determination of their severity and the readiness of the birth canal for childbirth. natural childbirth possible when the birth canal is ready for the passage of the fetus, the satisfactory condition of the woman and the fetus. The state of the latter is determined using ultrasound, functional stress tests, cardiotocography and dopplerometry.

In the absence of readiness of the birth canal, at the first birth in an aged pregnant woman with a burdened obstetric and gynecological history and in the presence of intrauterine growth retardation with symptoms of a violation of its condition, delivery by surgery is indicated.

Prevention of placental insufficiency consists, first of all, in the elimination or correction of risk factors. In addition, it includes recommendations for proper nutrition, the appointment of complex vitamins and minerals, mild sedatives of plant origin, and, if necessary, the aforementioned drugs.

Obstetric pathology is an important problem that does not lose its relevance even despite the development of modern medicine. And serious conditions observed during pregnancy include those associated with a risk to the fetus. And in many cases we are talking about fetoplacental insufficiency (FPI). What it is, why it develops, how it is diagnosed and treated - these are the main questions that concern expectant mothers.

General information

The placenta is an organ vital for the fetus, which begins to form from the 5th week of gestation, and fully matures by the second trimester. Through it, the child receives blood with oxygen and nutrients, giving back metabolic products. Plexuses of small vessels are an additional barrier that protects the fetus from foreign agents. The placenta also plays an endocrine role. The normal course of pregnancy depends on it, since important hormones are synthesized in the tissues: chorionic gonadotropin, progesterone, estiol, lactogen. Consequently, the insufficiency of this organ affects all its functions: transport, trophic, endocrine and metabolic.

The main part of the placenta is represented by chorionic villi, combined into lobules or cotyledons. Each such formation has its own vessel from the wall of the uterus. The terminal villi are immersed in the decidua and seem to float in the mother's blood. Up to 200 spiral arteries open into this space, which support uteroplacental blood flow. Nearby are the veins through which carbon dioxide and fetal metabolic products leave. The most intense blood flow in the intervillous space at the end of pregnancy - its speed is up to 700 ml per minute.

Causes and mechanisms

Placental insufficiency is a multifactorial concept. There is a wide list of phenomena that can cause pathology. First of all, we are talking about the adverse impact of endogenous (internal) conditions - from female body in general and the uterus in particular. But there are also reasons associated with the fetus or the placenta itself, as well as external factors affecting the body of a pregnant woman.

Based on the reasons, in obstetrics it is customary to distinguish between primary and secondary placental insufficiency. If the function of the placenta is disturbed even at an early stage of pregnancy, then the source of violations can be:

• Genetic pathology of the fetus (trisomy, deletion).
• Infections carried by the mother in the first trimester (viral and bacterial).
• Luteal insufficiency (hypofunction of the corpus luteum in the ovary).
• Insufficient proteolytic activity of chorionic villi.
• Structural changes in the uterus and endometrium (anomalies, scars, adhesions, inflammation, tumors).

These factors lead to deviations in the attachment, formation and maturation of the placental complex. Morphological abnormalities, defects in vascularization and differentiation of villi are observed. They develop primarily, i.e., the organ receives a deterioration in work initially. If these processes were not violated, and adverse factors acted later, then another variant of the pathology develops. Secondary insufficiency is formed with the assistance of causes entirely related to the maternal organism. These include numerous obstetric and extragenital conditions. The former affect the current pregnancy or previous periods:

• Low attachment and placenta previa.
• Polyhydramnios.
• Late toxicosis (gestosis).
• Threatened abortion.
• Rhesus conflict.
• Bleeding.
• antiphospholipid syndrome.
• Throw out in the past.
• The birth of children with low birth weight.
• Menstrual dysfunction.
• History of infertility.

The already formed placenta disrupts its work under the influence various diseases pregnant. Extragenital pathology that is significant in this regard includes diseases of the kidneys, cardiovascular system, lungs, diabetes mellitus, anemia and thrombotic conditions. And external factors are considered smoking, alcohol and drug use, poor nutrition, intensive exercise stress, harmful working conditions, radiation exposure, taking certain medications.

The division into primary and secondary placental pathology is rather arbitrary. It happens that violations that have arisen in the early stages are unrecognized. And supplemented by others in the second period of pregnancy, they lead to obvious placental dysfunction. Therefore, most often we are talking about a mixed origin of disorders. All of these factors provoke disturbances in oxygenation or blood flow velocity in the intervillous space, gas exchange, biochemical and trophic processes suffer, which ultimately affects the functional state of the fetus - hypoxia occurs and intrauterine development slows down.

The causes of placental insufficiency during pregnancy are very diverse. They include obstetric, gynecological, extragenital pathology and external factors.

Classification

The pathology under consideration has certain varieties and types. The classification criteria are the timing of development, the nature of the course, the severity of placental dysfunction. As mentioned above, in the early stages of gestation (up to 16 weeks of pregnancy), primary insufficiency is formed, and later - secondary. Based on the progression of disorders, it happens:

• Acute - develops suddenly (most often with placental abruption or in childbirth).
• Chronic - appears as a result of prolonged hemodynamic disorders.

If the blood flow in the mother-placenta-fetus system is sufficient, and only biochemical processes are disturbed, then they speak of compensated insufficiency. And deeper and more pronounced disorders with a decrease in hemodynamics are evidence of decompensation.

Clinical picture

The detection of FPI during pregnancy seems to be an extremely important aspect of diagnostics in obstetrics. The complexity of the pathology lies in the fact that the woman herself will not feel the violation. The only thing she can notice is a change in the motor activity of the fetus due to distress syndrome (hypoxia) or a decrease in the size of the abdomen compared to previous measurements (due to growth retardation). But only a doctor can more accurately diagnose placental insufficiency.

Clinical examination includes auscultation - a method that allows you to assess the condition of the fetus in terms of frequency, sonority of the heartbeat and the presence of pathological noises.

The adverse effects of placental insufficiency are not limited to these conditions. As a result, the fetus may be born prematurely, get nervous system damage or other diseases, such as pneumonia and jaundice. But there may be more serious situations ending in fetal death of the child.

Additional diagnostics

Additional methods play a key role in the diagnosis of FPI. They allow you to assess the nature of blood flow, the structure, size and position of the placenta, biometric and functional indicators of the state of the fetus, metabolic processes, the composition of amniotic fluid. A comprehensive examination of a pregnant woman is necessary to clarify the pathology, so the doctor prescribes the following studies:

1. Complete blood count (erythrocytes, platelets, hemoglobin, color indicator).


2. Biochemical blood test: hormonal spectrum (chorionic gonadotropin, progesterone, estriol, lactogen, cortisol), alpha-fetoprotein, trophoblastic p-glycoprotein and beta-globulin, placentospecific alpha-macroglobulin, coagulogram, transaminases, oxygenation.
3. Cardiotocography.
4. Functional tests (non-stress test).
5. Assessment of the biophysical profile of the fetus.
6. Ultrasound (fetometry, placentography, actography, echocardiography).
7. Dopplerography of vessels.
8. Amnioscopy.
9. Amnio- and cordocentesis.

The best results are shown by a combination of laboratory and instrumental tools. But invasive manipulations, for example, amnio- or cordocentesis, are not indicated for all women, but in cases that are especially difficult for diagnosis, requiring qualitative differentiation.

It is possible to diagnose placental insufficiency thanks to laboratory and instrumental methods that register structural and functional disorders and their consequences for the fetus.

Therapeutic correction

The main goals of therapeutic measures are considered to be the improvement and normalization of utero-placental-fetal blood flow, the prevention of hypoxic disorders and intrauterine growth retardation, the assessment of the timing and methods of further delivery. Treatment is conservative with medication. The most common schemes with the use of the following drugs:

• Antispasmodics (No-shpa).
• Tocolytics (Partusisten).
• Antiaggregants (Kurantil).
• Vascular (Actovegin).
• Sedatives (Persen).
• Vitamins and antioxidants.

It is also necessary to correct concomitant obstetric and extragenital pathology, which initiates and maintains placental insufficiency. During treatment, it is important to dynamically monitor the condition of the fetus. If the indicators of the cardiotocogram or biophysical profile are assessed as pathological, then the woman needs hospitalization.

Childbirth through natural routes is possible in cases where there is no fetal distress syndrome. An emergency caesarean section is performed if critical changes in the umbilical arterial blood flow are recorded, acute hypoxia is observed, and the cervix is ​​still immature.

Preventive measures

Of great importance during pregnancy is the prevention of placental insufficiency. To prevent this pathology, a woman should follow simple recommendations:

1. Plan your pregnancy ahead of time.
2. Be registered in the antenatal clinic in a timely manner (up to 12 weeks).
3. Regularly undergo examinations by an obstetrician-gynecologist.
4. Fully eat and rest.
5. To refuse from bad habits.
6. Avoid stressful situations and physical overexertion.
7. Do exercises for pregnant women.

If necessary, the doctor will advise the woman to take vitamin and mineral complexes. Combined with a change in lifestyle and a careful attitude to one's own health, this will have a very good effect, ensuring the normal course of pregnancy and protecting against placental insufficiency.

Fetoplacental insufficiency (FPI)- one of the most common complications of pregnancy. In 50-77% of pregnant women, it becomes the main cause of miscarriage, in 32% it occurs as a result, in 25-45% of cases it develops in the presence of extragenital pathology, after a viral or bacterial infection it manifests itself in more than 60% of cases.

Fetoplacental insufficiency, or placental insufficiency (PN), is characterized by morphological (structure), as well as functional disorders in the placenta, the progression of which can lead to hypoxia, developmental delay, and even antenatal death of the fetus.

The placenta is an extremely important organ, it becomes an "intermediary" in the creation of a single functional system "mother-placenta-fetus", and performs a number of vital functions for the fetus:

• Respiratory (oxygen delivery, carbon dioxide removal);
• Nutrition of the fetus and excretion of metabolic products;
• Protective (a kind of barrier and filter that protects the fetus from the adverse effects of harmful factors that have entered the mother's body: some drugs, toxic substances, microorganisms);
• Hormonal (produces hormones necessary for normal flow pregnancy and fetal development).

dangerous With the appearance of FPI, all these functions are violated, and there is a threat to the further normal course of pregnancy and fetal development.

Classification

According to the time and mechanism of occurrence, two types of PN are distinguished:

• Primary(up to 16 weeks), is associated with a violation of the processes of placentation and implantation;
• Secondary(after 16 weeks), develops under the influence of external factors affecting the fetus and / or mother, in an already formed placenta.

According to the clinical course, PN is distinguished:

• Acute- most often occurs against the background of detachment of a low or normally located placenta. Acute PI occurs predominantly in childbirth, but its occurrence at any gestational age is not excluded;
• Chronic- occurs at different stages of pregnancy. In turn, it is divided into:

Compensated form of PI - in which the metabolic processes in the placenta are disturbed, but the blood circulation in the "mother-placenta-fetus" system is not disturbed. Due to the compensatory capabilities of the maternal organism, the fetus adapts to these changes and does not experience discomfort;

Subcompensated form of PN - if the causes of PN have not been eliminated, the compensatory mechanisms of the body experience a load and gradually begin to deplete, reaching the next stage;

Decompensated form of PI - the progression of the pathological process leads to the occurrence of hemodynamic disorders in the "mother-placenta-fetus" system at the level of the fetal-placental and / or utero-placental circulation.

When using the Doppler method, 3 degrees are determined decompensated form of FPI:

• I degree
  • FPI Ia degree - hemodynamic disturbance occurs only in the uteroplacental blood flow;
  • FPI Ib degree - a violation occurs only in the fetal-placental blood flow;
  • II degree - there is a violation of blood flow at two levels, but they do not reach critical values;
  • III degree - the level of disturbances in the fetal-placental blood flow is critical, the life of the fetus is at risk.

In 60% of cases, FPI leads to intrauterine growth retardation (IGR), so it is also divided into:

• Placental insufficiency with IGR;
• Placental insufficiency without IGR.

The reasons

The causes of placental insufficiency are multiple.

Primary PN results from:

• genetic disorders;
• After bacterial and viral infections transferred in the early stages of pregnancy;
• Endocrine pathologies (hormonal ovarian insufficiency, etc.).

Secondary FPI develops as a result:

• Primary PN;
• Obstetric and gynecological diseases (menstrual disorders, infertility, preeclampsia, miscarriage, uterine fibroids, multiple pregnancy, etc.);
• Extragenital diseases (diabetes mellitus, hypertension, diseases of the blood, lungs, kidneys);
• Congenital and hereditary pathology in the fetus or mother;
• Unfavorable social and domestic factors (mother's age is more than 30 or less than 18, psycho-emotional overload, hard physical labor, harmful working conditions, and drugs);
• The impact of external environmental factors (ionizing radiation, the use of drugs).

The most significant risk factors for the development of FPI are the presence of extragenital pathology and preeclampsia, accompanied by vascular lesions.

Symptoms

Information The compensated form of chronic FPI most often does not manifest itself. The woman's condition is satisfactory, violations in the mother-placenta-fetus system can be determined only through additional studies (ultrasound, dopplerometry).

Symptoms of fetoplacental insufficiency begin to appear only with decompensated form of PN. However, at first, a pregnant woman may present only complaints characteristic of extragenital and obstetric diseases, against which FPI develops, for example, headache with hypertension or edema with preeclampsia. But in parallel with this, she may note that the number of fetal movements has decreased. Remember that regular, but not too frequent movements fetus - important feature his condition!

If intrauterine growth retardation occurs during PI, then there is some discrepancy between the height of the uterine fundus and the gestation period (an indirect sign), which can be detected at the next visit to the antenatal clinic doctor.

The appearance of bloody discharge from the vagina at different stages of pregnancy - dangerous symptom. He says that there was a premature detachment of the placenta, which can lead to acute FPI and fetal hypoxia. In this case, it is better to seek medical help immediately!

Diagnostics

Particular attention should be paid to women who are at risk for developing FPI. Such pregnant women require regular clinical monitoring. At each obstetric examination, the doctor should pay attention to weight gain, measure the height of the fundus of the uterus (FH) and the circumference of the abdomen. The discrepancy between the difference between the numerical value of the gestational age and the MDM, a decrease in the number of movements, a change in the frequency and deafness of the fetal heart tones is a signal for additional research.

FPI can be determined using 3 main methods:

1. Ultrasound procedure. This method allows you to assess the condition of the placenta (thickness, location, degree of maturity, etc.) and the fetus (size, presence of malformations, correspondence of growth rates to gestational age), as well as to measure the amount of amniotic fluid;
2. Doppler. Using this diagnostic method, the blood flow in various vessels of the mother and fetus is examined, which makes it possible to more accurately determine the degree and level of disturbances in the mother-placenta-fetus system, and also allows you to select rational therapy;
3. Cardiotocography. A study that allows you to assess the cardiac activity of the fetus and indirectly judge its condition.

Timely diagnosis of FPI helps to recognize and respond with adequate treatment to deviations in the development of the fetus and the course of pregnancy.

Treatment

With a compensated form of FPI, outpatient treatment is allowed under the condition of constant monitoring (the number of visits to the antenatal clinic increases). In other cases, hospitalization is necessary. Unfortunately, everything existing methods treatment does not allow to fully restore the normal functions and structure of the placenta. They only contribute to the stabilization of the process and prevent its further progression.

Risks and consequences

Fetoplacental insufficiency during pregnancy often leads to the following complications:

• termination of pregnancy;
• fetal hypoxia;
• Delayed development and growth of the fetus;
• There is a risk of antenatal (intrauterine) fetal death.

important The presence of FPI during pregnancy does not mean that the child will be born with FGR or ahead of schedule. With a small degree of hemodynamic disturbances in the mother-placenta-fetus system, early detection and adequate treatment, the prognosis for pregnancy and the fetus is favorable. Of course, with severe hemodynamic disorders, a positive outcome of the disease is questioned.

Prevention

Prevention of FPI during pregnancy should be aimed at eliminating adverse risk factors and include:

• Leading a healthy lifestyle: complete rejection of bad habits;
• Full sleep;
• Rational and proper nutrition;
• Taking vitamins;
• Exclusion of heavy physical labor,;
• Treatment of chronic diseases and sexually transmitted infections at the stage of pregnancy planning.