Placental insufficiency ( fetoplacental insufficiency, FPN ) - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Pregnancy And Childbirth

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

placenta - is a vital organ that is formed during pregnancy.It establishes the connection between mother and fetus.Through it, there is a transfer of nutrients from mother to fetus, made excretory, respiratory, hormonal and protective function of the fetus.

If the placenta does not comply fully with these functions, it develops feto-placental insufficiency.In fact FPN - is poor circulation in the mother-placenta-fetus.If the violations are minor, they do not exert adverse effects on the fetus, but the severity of FPN developing fetal hypoxia (lack of oxygen), which may lead to his death.

Adrift distinguish two forms of the feto-placental insufficiency - acute and chronic.

In acute FPN due to a sharp violation of utero-placental blood flow occur premature detachment of normally situated placenta, which may lead to termination of pregnancy.

Chronic FPN (which is more common)

, there is a gradual deterioration in blood flow in the placenta.There are compensated and decompensated chronic form of FPN.

When compensated FPI, despite the slight deterioration of the blood supply, the fetus adapts to these changes and does not suffer due to compensatory capacities of the organism.

In decompensated FPI occurs persistent deterioration of the utero-placental blood flow, which leads to oxygen starvation of baby to developmental delay and cardiac abnormalities.

the predisposing factors causing the appearance of FPN in pregnancy include:

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

Symptoms

placental insufficiency symptoms erased Chronic compensated FPI pregnant and feels perfectly normal.The presence of placental insufficiency woman learns, as a rule, during the ultrasound.

In acute and chronic decompensated FPI symptoms more pronounced.First observed more active fetal movements, then wiggling sharply reduced.

Remember that normally, starting with the 28th week of pregnancy, the expectant mother must feel fetal movements at least 10 times a day.If the fetus is moving less than 10 times a day - this is a cause for immediate treatment to the obstetrician-gynecologist.

addition, when decompensated FPI, if there is fetal growth restriction, there is a decrease in the size of the stomach.However, independently detect such changes is difficult, so it is usually these changes reveals gynecologist during a routine reception.

And finally, the most dangerous symptom of acute FNV - is the appearance of bleeding from the vagina.It is a sign of premature detachment of normally situated placenta, and requires immediate treatment to the obstetrician-gynecologist.

survey of suspected feto-placental insufficiency

To diagnose feto-placental insufficiency in obstetrics use three basic methods - ultrasound (US), Doppler and cardiotocography (CTG).At the slightest suspicion of any FPN conducting all these surveys must!

When ultrasound estimated fetal motor activity, the state of the placenta (the thickness and maturity) are measured fetal size, the amount of amniotic fluid.

If there FPN according to the US marked decrease or increase in placental thickness of more than 5 mm in contrast to the normal values ​​of the corresponding period.The placenta itself while there are signs of "premature aging", as evidenced by the deposition of calcium salts.

also lagging behind development of the fetus from the corresponding gestational age, reduced his physical activity.There is a change in the amount of amniotic fluid - there may be more than the norm (polyhydramnios) or less (oligohydramnios).

held Doppler to assess blood flow in the vessels of the umbilical cord condition, the uterus and the fetal brain.

CTG carried out to assess the fetal heart rate.If the diagnosis is confirmed by the FPI, the CTG is performed every day, usually in a maternity hospital.

Treatment feto-placental insufficiency

It should be noted that the treatment of placental insufficiency should be carried out only in a hospital environment.The exception is compensated FPI, which requires dynamic outpatient supervision and treatment.

Unfortunately, effective treatments that can immediately recover from the FPI does not exist.The main goal of treatment is primarily in the prevention of complications of the disease.

this purpose appointed the following groups of products:

- vasodilating agents such as chimes, to improve microcirculation, elimination of hypoxia in fetal tissue and to prevent further negative changes in the placenta;
- drugs that activate the metabolism in tissues, such as Aktovegin, ascorbic acid, vitamin E, Troxevasin;
- drugs that reduce the tone of the uterus, such as ginipral, magnesium sulfate, No-spa.

To improve the utero-placental blood flow is further used Eufillin, Trental, glucose-novocaine mixture.

antiplatelet therapy (heparin, Clexane) is applied at an elevated blood clotting.

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

These are the main drugs used in obstetrics for the treatment of placental insufficiency.On average, the treatment of FPI held about 2 weeks under the control of CTG, ultrasound and Doppler.The effect of the treatment depends on the duration of pregnancy (in case of FPI in the later stages, the prognosis is more favorable than earlier), and the lifestyle of the pregnant.

If you are diagnosed with "placental insufficiency" pay attention to lifestyle.Indulge in a long dream.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 outdoors.Additionally

take vitamins and minerals that you will appoint a physician.This is especially true during the cold season.

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

Childbirth with placental insufficiency

pressing issue is the method of delivery in FPI.When compensated form, if the fetus does not suffer, that a woman can give birth vaginally.In all other cases, if there is a viable fetus, cesarean section is shown.

Complications FPN:

- premature detachment of normally situated placenta, abortion;
- growth retardation and fetal development;
- prolonged fetal hypoxia, which can lead to a decrease in cerebral blood flow in the fetus, to polycystic kidney disease, delayed bone growth.In advanced cases, this leads to the death of the fetus before birth or shortly after birth.

prevention of placental insufficiency:

- rejection of bad habits before and during pregnancy, healthy life;
- nutrition during pregnancy, vitamins;
- examined by a gynecologist before planning pregnancy (treatment of sexually transmitted infections, chronic diseases);
- as far as possible, the implementation of the reproductive function of up to 35 years.

Consultation obstetrician-gynecologist on FPN

Question: Can there be a FPN, if often do ultrasound?
Answer: No.

Question: In which hospital is best to give birth in the presence of FPI?
Answer: In the hospital, where there is appropriate equipment for premature babies and neonatologist working around the clock and resuscitation.This is the main condition.

Question: Can there be a FPN due to a strict diet?
Answer: Yes, the diet is better not to get involved in the pregnancy.

Question: For two weeks I lay in the hospital about the FPI, and according to ultrasound and Doppler effect whatsoever.What is it means- assigned the wrong medication or the way it should be?
Answer: Treatment of FPN is not always effective, but in any case it is needed to prevent complications.

Question: If there is fetal growth retardation due to FPN, is it possible to recover if there is a lot?
A: No treatment is necessary.There are "a lot of" do not need to need to eat high-grade and high-grade food must be in a complex to the basic treatment.

Question: If the child was born after decompensated FPI whether he will continue the healthy?
Answer: As a result of prolonged hypoxia in the womb, the child may experience neurological problems (irritability, increased tone hands and feet, etc.).But this is by no means always, do not tune into negative!

Question: I have a week to give birth.According to US data put the "aging of the placenta."A CTG and Doppler absolutely normal.Can I have the most?
Answer: Most likely, this is compensated FPI, the most favorable.In this case, you can give birth to itself.

Obstetrician-gynecologist, Ph.D.Christina Frambos