Placental insufficiency( fetoplacental insufficiency, FPN) - Causes, symptoms and treatment. MF.

Placental( or feto-placental) insufficiency( FPD) is a violation of the placenta function under the influence of various factors.

The placenta is a vital organ that forms during pregnancy. It establishes a connection between the mother and the fetus. Through it, nutrients are transferred from mother to fetus, excretory, respiratory, hormonal and protective functions of the fetus are carried out.

If the placenta does not fully perform these functions, then fetoplacental insufficiency develops. In fact, FPN is a violation of blood circulation in the mother-placenta-fetus system. If these disorders are insignificant, then they do not have a negative effect on the fetus, but if the FPN is severe, hypoxia of the fetus( lack of oxygen) develops, which can lead to its death.

Two forms of feto-placental insufficiency, acute and chronic, are isolated along the course of the current.

In acute FPN, a severe abnormality of utero-placental blood flow causes premature detachment of the normally located placenta, which can lead to abortion.

With chronic FPN( which occurs more often), there is a gradual deterioration of blood circulation in the placenta. Allocate compensated and decompensated forms of chronic FPN.

With compensated FPN, despite a slight deterioration of the blood supply, the fetus adapts to these changes and does not suffer, thanks to the compensatory capabilities of the body.

With decompensated FPN, persistent deterioration of uteroplacental blood flow occurs, which leads to oxygen starvation of the baby, delayed development and cardiac dysfunction.

To predisposing factors provoking the appearance of FPN in pregnancy, include:

- endocrine diseases( diabetes mellitus, thyroid disease), diseases of the cardiovascular system( heart disease, hypertension);
- age over 35 years;
- anemia due to iron deficiency in the blood;
- bad habits during pregnancy( smoking, drinking alcohol and drugs);
- sexually transmitted infections;
- abortions in the past;
- chronic gynecological diseases - uterine myoma, endometriosis, malformations of the uterus( saddle, two-horned).

Symptoms of placental insufficiency

When chronic compensated FPN symptoms of the disease are erased and the pregnant woman feels completely normal. About the presence of placental insufficiency a woman learns, as a rule, during an ultrasound examination.

In acute and chronic decompensated FPN symptoms of the disease are more pronounced. Initially, more active movements of the fetus are noted, then the wiggling sharply decreases.

Remember that in normal, starting from the 28th week of pregnancy, the expectant mother should feel the fetus stirring at least 10 times a day. If the fetus moves less than 10 times a day - this is the reason for immediate treatment to the obstetrician-gynecologist.

In addition, with decompensated FPN, if there is a delay in fetal development, there is a decrease in the size of the abdomen. However, it is rather difficult to identify such changes on their own, therefore usually these changes are revealed by the gynecologist during the planned admission.

Finally, the most dangerous sign of acute FPN is the appearance of bloody vaginal discharge. This is a sign of premature detachment of the normally located placenta and requires immediate attention to the obstetrician-gynecologist.

Examination for suspected fetoplacental insufficiency

For the diagnosis of fetoplacental insufficiency in obstetrics, three main methods are used: ultrasound( ultrasound), dopplerometry and cardiotocography( CTG).With any slightest suspicion of FPN, the carrying out of all these examinations is compulsory!

When ultrasound is assessed motor activity of the fetus, the condition of the placenta( its thickness and maturity), measures the size of the fetus, the amount of amniotic fluid.

In the presence of FPN, according to ultrasound, there is a decrease or increase in the thickness of the placenta by more than 5 mm, in contrast to the normal parameters of the corresponding period. In the placenta itself, signs of "premature aging" are observed, as evidenced by the deposition of calcium salts.

There is also a lag in fetal development from the corresponding gestational age, and its motor activity is reduced. There is a change in the number of amniotic fluid - they can be more than normal( polyhydramnios), or less( hypochlorism).

Doppler is used to assess the blood flow in the umbilical cord, uterus and brain of the fetus.

CTG is performed to evaluate the cardiac activity of the fetus. If the diagnosis of FPN is confirmed, then CTG is carried out every day, usually in a maternity hospital.

Treatment of fetoplacental insufficiency

It should be noted that the treatment of placental insufficiency should be carried out exclusively in a hospital. An exception is the compensated form of FPN, which requires dynamic outpatient monitoring and treatment.

Unfortunately, effective methods of treatment that can immediately cure FPN does not exist. The main goal of treatment is primarily to prevent complications of the disease.

To this end, the following groups of drugs are prescribed:

- vasodilating agents, such as Curantil, to improve microcirculation, eliminate hypoxia in the fetal tissues and to prevent further negative changes in the placenta;
- drugs that activate metabolism in tissues, such as Actovegin, ascorbic acid, vitamin E, Troxevasin;
- drugs that reduce the tone of the uterus, such as Ginipral, Magnesium sulphate, No-shpa.

To improve uteroplacental blood flow, additionally, Euphyllin, Trental, glucose-novocaine mixture is used.

With increased blood coagulation, antiplatelet agents are used( Heparin, Clexane).

To normalize the processes of excitation of the nervous system, prescribe drugs that improve sleep( tinctures of motherwort or valerian, Glycine).

These are the main drugs used in obstetrics for the treatment of placental insufficiency. On average, FPN treatment is carried out for about 2 weeks under the control of CTG, ultrasound and Doppler. The effect of the treatment directly depends on the period of pregnancy( if FPN occurs late, the prognosis is more favorable than at the early stages) and on the way of life of the pregnant woman.

If you are diagnosed with "placental insufficiency", pay attention to the lifestyle. Do not deny yourself a long sleep. A pregnant woman should sleep at least 8 hours a day, ideally up to 10 hours a day. Protect yourself from stress! Spend more time in the fresh air.

In addition, take vitamins and minerals that you will appoint a doctor. This is especially true in the cold season.

Get rid of bad habits( if any).When pregnancy is contraindicated, bad habits, and with the diagnosis of FPN it can lead to irreversible consequences for the child.

Births with placental insufficiency

A topical issue is the method of delivery with FPN.With a compensated form, if the fetus does not suffer, then the woman can give birth through the natural birth canal. In all other cases, in the presence of a viable fetus, a caesarean section is indicated.

Complications of FPN:

- premature detachment of a normally located placenta, abortion;
- delayed growth and development of the fetus;
- prolonged hypoxia of the fetus, which can lead to a decrease in cerebral blood flow in the fetus, to polycystic kidney disease, to slow growth of the bones. In far-reaching cases, this leads to the death of the fetus before delivery or immediately after birth.

Prophylaxis of placental insufficiency:

- rejection of bad habits before and during pregnancy, healthy lifestyle;
- full nutrition during pregnancy, intake of vitamins;
- examination by a gynecologist before pregnancy planning( treatment of sexual infections, chronic diseases);
- if possible, reproductive function up to 35 years.

Consultation of an obstetrician-gynecologist on the topic of FPN

Question: Can FPN occur if the ultrasound is often done?
Answer: No.

Question: Which maternity hospital should be given birth in the presence of FPN?
Answer: In the maternity hospital, where there is appropriate equipment for premature babies and a neonatologist and resuscitator is working around the clock. This is the main condition.

Question: Can there be FPN because of a strict diet?
Answer: Yes, it is better not to get involved in diets during pregnancy.

Question: For two weeks I have been lying in the hospital about FPN, and there is no effect on the data of ultrasound and doppler. What does it mean, have you given the wrong treatment or should it be?
Answer: Treatment with FPN is not always effective, but in any case it is necessary to prevent complications.

Question: If there is a delay in the development of the fetus due to FPN, can I be cured if I have a lot?
Answer: No, treatment is compulsory. There are "many" is not necessary, you need to eat fully, and a full meal should be in combination with the main treatment.

Question: If a child was born after decompensated FPN, will it be healthy in the future?
Answer: As a result of prolonged hypoxia in the womb of the mother, the child may have neurological problems( increased excitability, increased tone of pens and legs, etc.).But this is not always the case, do not tune in to the negative!

Question: I have a week to give birth. According to the data of ultrasound put "aging of the placenta".And KTG and Doppler are absolutely normal. Can I give birth to myself?
Answer: Most likely, this is the compensated form of FPN, the most favorable one. In this case, you can give birth yourself.

Obstetrician-gynecologist, Ph. D.Christina Frambos