placental insufficiency

Placental insufficiency: description

Physicians understand insufficient placental insufficiency of the unborn child with nutrients and oxygen via the placenta.

The placenta is a disk-shaped organ that nestles in the uterine wall. In it maternal and childish vessels meet, in order to allow a mass transfer between mother and child. The child is connected to the placenta via the umbilical cord. The unrestricted function of the placenta plays a crucial role in the development of the child in the womb. If this function is limited (insufficiency), it can have serious consequences for the child.

Forms of placental insufficiency

There are different forms of placental insufficiency:

• Acute placental insufficiency: develops within minutes to hours
• Subacute placental insufficiency: develops within a few days
• Chronic placental insufficiency: develops over weeks to months

They have partly different causes and symptoms. What they have in common is that they can be life-threatening for the unborn child (fetus).

Placental insufficiency: symptoms

During pregnancy screening, placental insufficiency is manifested by symptoms in the fetus. Due to the persistent lack of care, the unborn child is often too small for the corresponding week of pregnancy. In addition, it is often less active than unborn children of the same age, in which the cakes fulfill their full function. In addition, the amount of amniotic fluid in case of placental insufficiency is in many cases lower than expected (oligohydramnios).

In acute placental insufficiency, the fetus suffers from a sudden lack of oxygen. This situation is life threatening for him. A premature birth or stillbirth can be the result.

Many expectant mothers often notice nothing of placental insufficiency. In others, symptoms of pre-eclampsia with high blood pressure and loss of protein via the urine often appear. In addition, chronic placental insufficiency may cause the pregnant woman to be less abdominal and weight-bearing than would be expected.

Placental insufficiency: causes and risk factors

The reasons for placental insufficiency are many. Possible causes and risk factors for chronic placental insufficiency include:

• Investment and education errors of the placenta
• maternal diseases (such as diabetes, hypertension, heart disease)
• intrauterine infections (pathogens pass from the mother via the placenta to the child)
• pregnancy-specific diseases such as preeclampsia / eclampsia)
• chronic low blood pressure (hypotension)
• chronic deficiency or malnutrition
• Smoke

The acute placental insufficiency is based on an acute circulatory disorder and usually occurs during childbirth. Possible causes are:

• Complications in the umbilical cord (such as umbilical cord prolapse)
• premature placental solution
• Vena cava compression syndrome
• Wehensturm (too strong or too frequent labor)

In the Vena Cava Compression Syndrome, the inferior vena cava of the mother is pinched by the enlarged uterus when the woman lies on her back. This affects the return of the blood to the heart. The consequences: The woman collapses, and the unborn child is underprivileged.

Placental insufficiency: examinations and diagnosis

During pregnancy you should visit your gynecologist regularly. Preventive medical examinations will check both your own health and those of the unborn child. If your gynecologist suspects placental insufficiency, he first asks you in detail about your medical history (anamnesis). Possible questions include:

• Do you suffer from high blood pressure or are you diabetic?
• Do you smoke?
• Is this your first pregnancy?

Subsequently, your doctor will examine you. In an ultrasound of the uterus, a growth deficiency of the child can be detected in a possible chronic placental insufficiency. To do this, your doctor measures the size of the child and compares it to the average that would be expected for your child in accordance with your pregnancy week. In addition, the placenta usually appears unusually small and abnormally shaped in ultrasound insufficiency.

If there is a suspicion of acute placental sufficiency, cardiotocography (CTG) is performed. The heart rate of the fetus and the labor activity are recorded.

In addition, in a Doppler ultrasound (special form of ultrasound) the blood flow in the umbilical cord can be displayed. In acute placental insufficiency this is greatly reduced.

Placental insufficiency: treatment

A treatment of placental insufficiency with elimination of the cause (causal therapy) does not exist. The aim of the treatment is therefore the timely delivery. This means that the pregnancy should be carried out as long as there is no danger to mother and child. In severe symptoms such as dwarfism of the child or eclampsia of the mother (life-threatening form of pre-eclampsia), the risks of premature birth are accepted.

Your doctor will advise you to bed rest in case of chronic placental insufficiency. Reduce all stress and physical activity. To prevent a premature birth before the 37th week of pregnancy, your blood sugar and your blood pressure should be optimally adjusted. This is especially true if you have diabetes mellitus or high blood pressure. This may prevent the placental insufficiency from further deteriorating. In addition, you should not smoke (as with a normal pregnancy).

After the 37th week of pregnancy and worsening placental insufficiency, the child should be born – either pregnant women are given birth induction medication or a cesarean section is taken.

Placental insufficiency requires swift action. Eventually, a change of position of the mother (in case of vena cava compression syndrome) can defuse the situation. Otherwise an immediate childbirth is necessary.

Placental insufficiency: disease course and prognosis

Disease course and prognosis may be very different in the placental insufficiency from patient to patient. This depends on the severity and type of placental disease.

Acute placental insufficiency is often more fulminant as sudden and immediate deficiency of the fetus occurs. The child is threatened with an acute lack of oxygen, which can end fatally.

Chronic placental insufficiency, on the other hand, is more likely to result in deficiency of the fetus in the sense of insufficient growth (intrauterine growth restriction, IUGR). Chronic placental insufficiency can turn into a (sub-) acute and then also lead to a sudden onset of emergency.

If a placenta suffix has been diagnosed, the attending physician should work with the expectant mother to develop a birth plan. It is important to clarify how to act in an acute situation. Overall, the affected babies have a higher risk of dying or developing other diseases. Thus, children who develop in the womb of one placental insufficiency were often exposed at later ages:

• Diabetes (diabetes mellitus)
• Obesity (obesity)
• Hypertension (arterial hypertension)
• Vascular calcification (arteriosclerosis)