The management plan and tactics of delivery depend on this. To understand the mechanisms of the disorder, it is necessary to consider the capabilities of the circulatory system between mother and child.

The structure of the uteroplacental blood flow

Mother and child are connected not only by the placenta, but also by a complex system of blood vessels. Therefore, all joint blood circulation is usually divided into levels that cannot exist in isolation, but work only in combination.

• The central part of the system is the placenta. It ensures the “absorption” of products from the maternal blood through the villi that have grown deep into the wall of the uterus. At the same time, the blood of mother and child does not mix. Several rows of special cells form a hematoplacental barrier, which is a serious obstacle to substances unnecessary for the fetus. Through it, the waste blood returns to the mother's venous system.
• The second part of the blood flow consists of the branches of the uterine arteries. If before pregnancy in the female body they are in a collapsed state and are called spiral, then from the period of 1 month they lose the muscle layer that can cause spasm. And by four months, the arteries transform into full-fledged trunks, filled with blood and heading to the placenta area. It is this mechanism, useful for feeding the fetus, that can turn out to be fatal during uterine bleeding: the walls of the vessels can no longer contract.
• The vessels in the umbilical cord form the third pathway of blood flow. There are 2 arteries and a vein here. They connect the baby with the placenta and form the fetal-placental circle. Reduced blood flow at this level causes the most severe damage to the fetus.

How is placental circulation disrupted?

Poor blood flow associated with the placenta is called placental insufficiency. It can occur at any stage of pregnancy in two forms.

Acute appears suddenly, even during childbirth, and does not depend on the duration of pregnancy. The fetus falls into a state of hypoxia (oxygen deficiency), which threatens its death.

The main pathological mechanisms of this condition:

• premature placental abruption;
• heart attack due to thrombosis.

Chronic often complicates the course of pregnancy after 13 weeks. Symptoms appear in the third trimester. The mechanism of formation is early aging of the placenta due to the deposition of fibrin on the villi.

As a result of changes in the structure of chorionic villi (placental tissue), the functioning of the hematoplacental barrier ceases, metabolic processes between the maternal body and the fetus are disrupted

Negative consequences in such conditions, depending on the degree of violation, can lead to inevitable death of the fetus.

Causes of blood flow disorders during pregnancy

Various reasons can cause disruption of uteroplacental blood flow. These include common maternal diseases:

• pathology of the neuroendocrine system (diabetes mellitus, diseases of the thyroid gland and adrenal glands, changes in the hypothalamus region of the brain stem);
• lung diseases (emphysema, bronchial asthma);
• disorders in the cardiovascular system caused by developmental defects, the consequences of hypertension, a tendency to hypotension;
• renal pathology (chronic nephritis, pyelonephritis, especially in the stage of renal failure;
• anemia (anemia) associated with deficiency of iron and vitamins;
• conditions accompanied by increased blood clotting contribute to increased thrombus formation in the vessels of the placenta;
• acute and exacerbation of chronic infectious processes cause corresponding inflammation in the placenta, vascular edema and reduction in blood flow; in the first trimester this can result in miscarriage.

Pathology of the uterus creates local conditions for inadequate blood flow:

• any changes in the layers of the uterus (myometrium, endometrium);
• malformations (for example, “bicornuate”, “saddle-shaped” uterus);
• underdevelopment (hypoplasia);
• tumor formations from muscle tissue (fibroids), especially in a primiparous woman over the age of 35; at a younger age, small fibroids help compensate for blood flow.

The causes of insufficient blood flow include unfavorable conditions during pregnancy in the following cases:

• multiple births;
• Rhesus conflict;
• preeclampsia;
• breech presentation of the fetus;
• pathological placenta previa.

The risk of impaired blood flow occurs when:

• previous abortions;
• maternal smoking, alcoholism and drug addiction;
• constant nervous environment associated with social or everyday unsettlement;
• violation of proper nutrition of a woman.

Types of chronic placental insufficiency

Depending on the development of consequences for the fetus and the ability of the mother’s body to adapt, 4 forms or stages of chronic placental insufficiency are distinguished:

• compensation - the mother’s body fully protects the fetus by improving blood flow through other pathways, and the child does not feel a lack of oxygen, develops normally, is born on time and develops well;
• subcompensation - the mother is not able to fully compensate for the lack of nutrition, and the fetus lags behind in development, there is a risk of complications and congenital defects;
• decompensation - accompanied by a complete disruption of the adaptation mechanisms, normal pregnancy is impossible, the fetus develops serious defects that are incompatible with viability, and death in utero is very likely;
• critical - due to severe changes in the structure of the placenta, further gestation of the fetus is impossible, inevitable death occurs, any treatment is ineffective.

What degrees of blood flow disturbance does placental insufficiency cause?

A comparison of clinical manifestations and ultrasound examination results made it possible to distinguish 3 degrees of blood flow disturbance between mother and fetus.

The first is characterized by minimal changes at the uteroplacental level, provides a “reserve” of time of about a month for treatment and full recovery without consequences, there are 2 types:

• Ia - only the uteroplacental blood flow is reduced, with the fetal-placental blood flow unchanged. It manifests itself as a delay in fetal development in 90% of cases.
• Ib - fetal-placental circulation suffers, but the uteroplacental circulation remains normal. Delayed formation and development of the fetus suffers somewhat less (in 80% of cases).

The conclusion is issued after examining all components of the fetal blood flow

The second is that the disorder occurs both at the level of the uterine and umbilical vessels; hypoxia can be fatal to the fetus.

Third - blood circulation indicators are at a critical level, it is even possible that the direction of blood flow is reversed (reverse).

For clinicians, such a classification provides an opportunity to accurately determine the level of disorders and choose the most appropriate treatment tactics.

Symptoms of impaired blood flow

If the impaired blood flow is compensated, then the woman does not feel any abnormalities, but learns about them only after the examination.

Pronounced manifestations occur in acute form and chronic decompensation:

• the motor activity of the fetus increases sharply or completely disappears (at 28 weeks, normal development is accompanied by ten movements per day), this symptom requires immediate contact with an obstetrician-gynecologist;
• a slow increase in abdominal circumference, detected during monthly examination and measurement in the antenatal clinic (associated with excessive formation or lack of amniotic fluid);
• late toxicosis;
• high blood pressure;
• large weight gain;
• swelling in the legs;
• the appearance of protein in the urine.

Diagnostics

The most complete picture of blood circulation between the uterus and the fetus is obtained through Doppler ultrasound, which is performed on all women three times during pregnancy.

• measure blood flow by the speed of movement of the formed elements;
• determine its direction in arteries and veins;
• record changes before clinical manifestations.

The effect is based on the properties of ultrasonic wave reflection and is completely safe for the child and mother.

All changes are recorded on the monitor, measured with special sensors, and can be photographed in the required format.

By comparison with normal indicators, a conclusion is made about the degree of pathology. Violations can be detected at any level, in the vessels:

The doctor has time to prescribe treatment and check it at the next examination.

A type of Doppler ultrasound is Doppler ultrasound. It is prescribed for:

• maternal concomitant pathology;
• suspected premature aging and disruption of the placental barrier;
• signs of high or low water;
• preliminary data on intrauterine growth retardation, the formation of congenital malformations of the fetus;
• presence of genetic diseases in the family;
• clinical symptoms of fetal hypoxia.

The examination can reveal:

• thinning of the placenta;
• increase in growth area;
• intrauterine infection.

The method of long-term inpatient monitoring of the degree of fetal hypoxia allows you to see the results of using medications

Treatment of pathology

Treatment takes into account the pathogenesis of disorders. To achieve results it is necessary to influence all links:

• In case of mild disturbance of microcirculation, Chofitol (with a mineral-herbal composition) is prescribed, in more severe cases - Actovegin, Petoxifilin.
• If a mother’s tendency to form blood clots and disrupt the aggregation properties of blood is detected, then drugs such as Curantil, Trental are indicated. They can improve blood flow through the vessels.
• If low blood pressure is detected, Venofundin, Stabizol, ReoHES are used.
• Vasodilators - No-spa, Eufillin in injections - eliminate spastic contraction of blood vessels.
• It is recommended to reduce the tone of the uterus with the help of Magnesia, the drug Magne B6, this acts as an antihypoxic way to improve blood flow.
• A group of vitamins with antioxidant action eliminates negative consequences (vitamin E, ascorbic acid).

Medications are prescribed by a doctor. If necessary, the woman is offered hospitalization. This allows:

• provide bed rest;
• Constantly monitor the progress of pregnancy.

What to do to prevent blood flow disorders?

Gynecologists urge women at risk to prepare themselves for pregnancy in advance and prevent unplanned conception.

Choosing the right body position while sleeping helps fetal blood flow

• avoid emotional and physical overload;
• eliminate bad habits;
• organize nutritious meals for the pregnant woman;
• monitor daily walks and stay in a ventilated room;
• do special gymnastics for pregnant women, yoga exercises;
• control body weight, carry out monthly weighing and measurement of abdominal circumference;
• It is considered more beneficial to sleep on the left side; this position reduces pressure on the inferior vena cava, which runs to the right of the uterus, but in some cases, with stagnation in the kidneys, sleeping on the right side improves the outflow from these important organs.

Modern diagnostic methods and approaches to the management of pregnant women make it possible to prevent severe disorders. However, many possibilities depend on the woman herself and her desire to have a healthy heir.

Drugs for placental insufficiency

What is placental insufficiency - treatment and prevention

According to medical statistics, placental insufficiency develops in approximately 24% of expectant mothers. There are a number of special medications available to treat this pregnancy complication.

The placenta (the so-called baby's place) is the organ through which nutrition, respiration of the fetus and the removal of processed metabolic products occur. Two complex systems of blood vessels converge in this organ. One of them (maternal) connects the placenta with the vessels of the uterus, the other (fetal) passes into the umbilical cord arteries leading to the fetus. Between the two vascular systems there is a membrane (one layer of cells), which acts as a barrier between the body of the mother and the child; Thanks to this membrane, the blood of the mother and fetus does not mix.

The placental barrier is impenetrable to many harmful substances, viruses, bacteria. At the same time, oxygen and substances necessary for life pass without problems from the mother’s blood to the child, just as waste products from the fetus’s body easily enter the mother’s blood and are then excreted through her kidneys. The placental barrier performs an immune function: it allows the protective proteins (antibodies) of the mother to pass through to the child, ensuring its protection, and at the same time delays the cells of the mother’s immune system that can cause a reaction of rejection of the fetus, recognizing it as a foreign object. In addition, the placenta produces hormones that are important for successful pregnancy, and enzymes that destroy harmful substances.

What is placental insufficiency?

During an unfavorable pregnancy, the function of the placenta may be impaired. So-called placental insufficiency occurs, in which the process of placental maturation is disrupted, uteroplacental and fetal-placental blood flow is reduced, gas exchange and metabolism in the placenta is limited, and the synthesis of its hormones is reduced. All these changes determine the insufficient supply of oxygen and nutrients to the fetus, slow down its growth and development, and aggravate existing pregnancy complications.

Placental insufficiency syndrome occurs at different levels, so several forms of this disease are defined:

• hemodynamic, caused by disturbances in the vessels of the utero-placental-fetal blood flow;
• placental-membrane, characterized by a decrease in the placenta’s ability to transport various substances and oxygen;
• cellular, associated with metabolic disorders in the cells of the placenta. There are primary and secondary placental insufficiency.

Primary (early) placental insufficiency develops before 16 weeks of pregnancy, occurring during the formation of the placenta. Its causes are often uterine pathology: uterine fibroids (benign tumor), uterine malformations (saddle-shaped, small, bicornuate), previous abortions, hormonal and genetic disorders. In some cases, primary placental insufficiency becomes secondary.

Secondary (late) placental insufficiency, as a rule, occurs against the background of an already formed placenta after 16 weeks of pregnancy. In the occurrence of late placental insufficiency, infections, gestosis (complications in which the work of all organs and systems of the body of a pregnant woman is disrupted, most often they are manifested by an increase in blood pressure, the appearance of edema, protein in the urine), the threat of abortion, as well as various diseases of the mother are of great importance. (arterial hypertension, dysfunction of the adrenal cortex, diabetes mellitus, thyrotoxicosis, etc.).

Regardless of the factors contributing to the development of placental insufficiency, it is based on circulatory disorders in the uterine-placental complex, leading to disruption of all functions of the placenta.

The change in the respiratory function of the placenta is evidenced by the symptoms of fetal hypoxia - insufficient oxygen supply to it. At the same time, at the beginning of the disease, the woman pays attention to the increased (erratic) motor activity of the fetus, then to its decrease. Chronic hypoxia of the fetus and violation of the nutritional function of the placenta lead to a delay in its intrauterine development. A manifestation of intrauterine growth retardation is a decrease in the size of the pregnant woman's abdomen (abdominal circumference, standing height of the fundus of the uterus) compared with the indicators characteristic of this period of pregnancy. Violation of the protective function of the placenta leads to intrauterine infection of the fetus under the action of pathogenic (pathogenic) microorganisms penetrating the placenta. The fetus, the development of which occurs in conditions of placental insufficiency, is much more at risk of trauma during childbirth and morbidity during the newborn period.

For the diagnosis of placental insufficiency are used:

• Evaluation of fetal cardiac activity. In addition to simple listening with an obstetric stethoscope, the most accessible and common method for assessing fetal cardiac activity is cardiotachography, which is based on recording changes in fetal heart rate depending on uterine contractions, the action of external stimuli or the activity of the fetus itself in the period after 28 weeks of pregnancy.
• Ultrasound examination (ultrasound). At the same time, the size of the fetus and its correspondence to the gestational age are determined, the location and thickness of the placenta, the correspondence of the degree of maturity of the placenta to the gestational age, the volume of amniotic fluid, the structure of the umbilical cord, and possible pathological inclusions in the structure of the placenta are assessed. In addition, the anatomical structure of the fetus is studied to identify abnormalities of its development, as well as the respiratory and motor activity of the fetus.
• Doppler. This is a variant of ultrasound examination, which evaluates the speed of blood flow in the vessels of the uterus, umbilical cord and fetus. The method allows you to directly assess the state of blood flow in each of the vessels in the second half of pregnancy.
• Laboratory methods. They are based on determining the level of placental hormones (estriol, human chorionic gonadotropin, placental lactogen), as well as the activity of enzymes (oxytocinase and thermostable alkaline phosphatase) in the blood of pregnant women at any stage of pregnancy.

Based on a comprehensive examination, a conclusion is made not only about the presence or absence of placental insufficiency, but also about the severity of such a disorder. The tactics of pregnancy management for different degrees of severity of placental insufficiency are different.

Prevention and treatment

At present, unfortunately, it is not possible to completely relieve a pregnant woman from placental insufficiency using any therapeutic interventions. The means of therapy used can only help to stabilize the existing pathological process and maintain compensatory and adaptive mechanisms at a level that allows for the continuation of pregnancy until the optimal date of delivery. Therefore, it is very important to carry out prevention in women who have risk factors for developing placental insufficiency.

The leading place in prevention is the treatment of the underlying disease or complication, which may lead to placental insufficiency. An important condition is for the pregnant woman to follow an appropriate regimen: adequate rest (sleeping on the left side is preferable), elimination of physical and emotional stress, staying in the fresh air for 3-4 hours a day, and a rational, balanced diet. The course of prevention includes multivitamins, iron supplements, breathing exercises to increase oxygen delivery through the lungs, the use of amino acids, glucose, Galascorbine, potassium orotate, ATP, which serve as a direct source of energy for many biochemical and physiological processes.

With initial signs of placental insufficiency, treatment is possible in a antenatal clinic with a repeat ultrasound examination with Doppler measurements the day after the start of treatment. With more severe placental insufficiency, especially in combination with other complications of pregnancy or general diseases of the mother, hospitalization in a hospital is required. The duration of therapy should be at least 6 weeks (in a hospital, with continuation of therapy in a antenatal clinic). If this pathology is detected and appropriate therapy is carried out in the second trimester, to consolidate the effect of the first course, treatment should be repeated within a week of pregnancy.

If indicators deteriorate during treatment, signs of decompensation of placental insufficiency appear, determined by a sharp deterioration in the condition of the fetus and the possibility of its death, emergency delivery by cesarean section is indicated, regardless of the gestational age.

Special drug therapy

Currently, for the treatment of placental insufficiency, there are a large number of medications aimed at eliminating disturbances in the uteroplacental-fetal blood flow and increasing the fetus’s resistance to oxygen starvation. Each of these drugs has its own point of application, its own mechanism of action.

Drugs that help relax the uterine muscles (tocolytics) - Partusisten, Ginipral, Magne-B 6. Periodic increases in uterine tone contribute to circulatory disturbances in the placenta, while small doses of tocolytics reduce vascular resistance at the level of small arteries and lead to a significant increase in uteroplacental blood flow . When using Ginipral and Partusisten, an increase in the mother's heart rate (tachycardia), a decrease in blood pressure, tremor of the fingers, chills, nausea and anxiety are possible. To prevent tachycardia, Verapamil and Isoptin are prescribed in parallel with medications. Contraindications to the use of Ginipral and Partusisten are thyrotoxicosis (increased thyroid function), heart disease, and bronchial asthma.

Eufillin and no-spa have a vasodilating effect and reduce peripheral vascular resistance. Trental (pentoxifylline), in addition to its vasodilating effect, can improve the rheological properties (fluidity) of blood and circulation in small capillaries (microcirculation). Side effects of these drugs are heartburn, nausea, vomiting, and headache. Contraindications to the use of pentoxifylline are low blood pressure (hypotension), Euphylline - increased thyroid function, heart disease, epilepsy.

With placental insufficiency, there is a chronic disorder of blood coagulation (increased activity of platelets and plasma clotting factors). Therefore, for treatment, drugs are used that prevent the formation of blood clots in blood vessels - antiplatelet agents (Aspirin, Curantil). These drugs, in addition to improving blood rheology, have a dilating effect on small arteries, causing a significant increase in blood flow speed. They do not cause dilation of all blood vessels and the associated relative drop in blood pressure, and at the same time increase metabolism without a simultaneous increase in oxygen consumption. Curantyl can be taken from the first trimester of pregnancy. Antiplatelet agents are contraindicated in women with gastric and duodenal ulcers, bleeding and recent surgical interventions. Due to the risk of bleeding during childbirth, these drugs are discontinued during the weeks of pregnancy.

Actovegin increases the resistance of the brain and fetal tissues to hypoxia, activates metabolism, increases glucose consumption, and stimulates the renewal of fetal cells. In addition, the drug increases blood circulation in the mother-placenta-fetus system and promotes better tolerance of the birth act to the fetus. Treatment with Actovegin has a pronounced effect on the condition of the fetus. This is reflected in improved blood flow and improved fetal growth, which reduces the incidence of forced early delivery. The drug is obtained from the blood of calves, has a minimum of side effects, and allergic reactions are quite rare. Contraindications to the use of the drug are heart failure and pulmonary edema. In women with recurrent miscarriage and serious diseases (diabetes mellitus, arterial hypertension, pathology of the thyroid gland, heart, liver), Actovegin is prescribed to prevent placental insufficiency in courses of 2-3 weeks, 2-3 times per pregnancy.

Considering the most important neutralizing function of the liver, as well as its decisive role in the production of proteins and blood coagulation factors, in the complex treatment of placental insufficiency it is advisable to use hepatoprotectors - drugs that protect the liver (Essential-ale, Hepatil). They have a normalizing effect on the metabolism of fats, proteins and liver function. The drugs have minimal side effects; some patients report discomfort in the stomach and liver. Chophytol is a purified extract of field artichoke leaves. In addition to its hepatoprotective properties, Hofitol contains many macro- and microelements, including iron, manganese, phosphorus, vitamins A, B and C. In addition, the drug has pronounced antioxidant properties. Hypoxia, which occurs against the background of placental insufficiency, leads to an increase in the number of free radicals, which have a damaging effect on cells. Hofitol improves protection against free radicals, which has a positive effect on placental function. Hofitol is contraindicated in case of cholelithiasis, acute diseases of the liver, biliary and urinary tract.

Instenon is a combination drug that improves cerebral circulation, heart function and metabolism in the fetus under hypoxic conditions. It is used in combination with other drugs for the treatment of placental insufficiency in order to avoid the negative consequences of hypoxia on the fetal nervous system. While taking the drug, you should avoid drinking coffee and tea, as they weaken its effect. The most common side effect with its use is headache. Instenon should not be used in a state of severe agitation and convulsions, manifestations of increased cerebral pressure (its signs: prolonged headache, vomiting, blurred vision), epilepsy.

The indications for choosing a particular drug are determined by the doctor, based on the form of placental insufficiency. If the main cause is circulatory disorders, then drugs that affect blood vessels are prescribed. If the basis is cellular disorders, then medications that affect tissue metabolism. Combinations of several drugs are often used.

In conclusion, I would like to emphasize: placental insufficiency is a serious complication of pregnancy, in which independent use and withdrawal of even the most harmless medications is unacceptable. This pathology requires close medical supervision.

Blood flow during pregnancy

During pregnancy, it is very important to constantly monitor the condition of the mother and fetus and their performance of vital functions. One of the most significant studies is the analysis of blood flow in the arteries of the uterus, the woman’s umbilical cord, as well as in the aorta and cerebral vessels of the child.

Among the main causes of perinatal mortality and morbidity, disruption of uterine blood flow (uteroplacental and fetal placental) is not the least important.

Blood flow in the placenta

The placenta, in which the fetus is located, supplies it with nutrition and oxygen from the mother’s blood and removes metabolic products from the child’s body. It is this organ that unites two complex vascular systems - the maternal one, which connects the vessels of the uterus and the placenta, and the fetal one, which passes into the umbilical arteries and leads to the fetus.

The above-mentioned circulatory systems are separated by a membrane that does not allow the blood of the mother and child to mix. The placenta acts as a kind of barrier, resistant to many viruses and harmful substances.

In some cases, for completely different reasons, placental insufficiency may develop, which inevitably affects the performance of the trophic, metabolic, transport, endocrine and other vital functions of the placenta. In this condition, the metabolism between the body of mother and child deteriorates significantly, which is fraught with consequences.

Causes of uterine blood flow disorders

Poor blood circulation in the uterus can be caused by increased pressure, pneumonia, intrauterine infection and insufficient oxygen supply to the fetus (hypoxia).

To diagnose the blood flow system in obstetric practice, three-dimensional ultrasound (Doppler) is used, with the help of which the vessels are visible in the so-called 3D (three-dimensional) image. With the help of this modern diagnostic method, there is a prospect of diagnosing retroplacental bleeding and assessing cardiac malformations by monitoring blood flow. This method is indispensable, since with its help you can see defects even in the smallest vessels that form the microvasculature, monitor the development and formation of intraplacental hemodynamics, and also control the amount of oxygen and nutrients that should enter the fetal body. New opportunities have opened up for the early detection of obstetric complications, and if correction or treatment is started without wasting time, then circulatory disorders and further associated pathologies can be practically avoided.

The risk increases in the presence of bad habits, household and social instability, and a history of abortion.

Classification of placental insufficiency

In medical textbooks you can find various classifications of FPN. Based on the time of development, primary and secondary placental insufficiency are distinguished. The first type occurs during the week of pregnancy. It is associated with disruption of the processes of placentation and implantation. The second type is characterized by the fact that a normal placenta is initially formed, but for some reason its functions are disrupted later in pregnancy.

The clinical course of FPN can be of 2 types:

Acute deficiency can occur at any stage of pregnancy and even during childbirth. First of all, the gas exchange function of the placenta is disrupted. As a result, acute fetal hypoxia occurs, which can lead to the death of the child. Acute placental insufficiency is most often caused by premature placental abruption, thrombosis of its vessels, placental infarction, and hemorrhages in the marginal sinuses.

Doctors encounter chronic deficiency much more often than acute deficiency. Typically, this type of FPN occurs in the 2nd trimester of pregnancy, and is clearly detected a little later - from the beginning of the 3rd trimester. The placenta begins to age prematurely. In increased quantities, a substance called fibrinoid is deposited on the surface of the villi, which interferes with transplacental exchange. Thus, chronic fetoplacental insufficiency is based on processes associated with the occurrence of circulatory disorders in the uteroplacental circle.

Chronic FPN is divided into 3 types:

The most favorable form is chronic compensated placental insufficiency. The fetus does not suffer and continues to develop normally. Pathological changes, which are minor, are compensated by protective and adaptive mechanisms that contribute to the progression of a woman’s pregnancy. A child can be born healthy if the doctor chooses adequate therapy and manages the birth correctly.

The decompensated form is characterized by overstrain and disruption of compensatory mechanisms. Pregnancy cannot progress normally. Decompensated placental insufficiency leads to fetal suffering, which is manifested by developmental delay, severe cardiac dysfunction, and hypoxia. Intrauterine death of the child is possible.

In the subcompensated form, protective-adaptive reactions cannot ensure the normal course of pregnancy. There is a significant delay in fetal development. With subcompensated chronic placental insufficiency, the risks of various complications are high.

The critical form is very dangerous. It is characterized by morphofunctional changes in the fetoplacental complex, which cannot be influenced. In a critical form, fetal death is inevitable.

Depending on the circulatory disorder, FPN is classified as follows:

• 1a degree – uteroplacental insufficiency. Fetal-placental blood flow is preserved;
• 1b degree – fetal-placental FPN. Uteroplacental blood flow is preserved;
• 2nd degree of placental insufficiency during pregnancy - fetal-placental and uteroplacental blood flows are disturbed. End-diastolic blood flow is preserved;
• 3rd degree - fetal-placental blood flow is critically impaired, and uteroplacental blood flow is either impaired or preserved.

Symptoms of placental insufficiency

Signs of FPN depend on its type. In the chronic compensated form, there are no symptoms of placental insufficiency. The expectant mother feels well. A representative of the fair sex learns about the presence of FPN only thanks to the results of an ultrasound.

Symptoms are more pronounced in chronic decompensated and acute forms. A woman may notice that her fetus is actively moving for a certain period of time. Then the child's activity decreases sharply. It should be noted that the expectant mother, starting from the 28th week of pregnancy, should feel at least 10 movements of the child per day. If the baby’s activity is less than the specified figure, then it is worth visiting a gynecologist. Perhaps this is a sign of some problem (for example, FPN).

Additional signs of fetoplacental insufficiency of the decompensated form are slow growth of the woman’s tummy, delayed fetal development. It is almost impossible to independently identify these changes. Only a doctor during a routine examination can record this.

The most dangerous sign of FPN is the appearance of bloody discharge from the vagina. If you notice this, you should immediately consult a doctor, since this symptom indicates premature placental abruption.

Diagnosis of placental insufficiency

It was already mentioned above that the occurrence of FPN can occur for various reasons. That is why the diagnosis of placental insufficiency should be a comprehensive examination of a pregnant woman.

The doctor, collecting anamnesis, finds out the main factor that contributed to the occurrence of this problem (age, living and professional conditions, bad habits, the presence of extragenital and gynecological diseases, etc.). A woman in a position with FPN may complain of abdominal pain, the presence of bloody discharge from the vagina, excessive fetal activity or lack of movement, and increased uterine tone.

The gynecologist, conducting a physical examination before determining placental insufficiency, measures the abdominal circumference of the expectant mother, assesses the position of the fundus of the uterus, and determines the woman’s weight. Thanks to the data obtained, you can find out whether the fetus is developing normally or whether there is a delay in development.

Based on the results of a gynecological examination, it is possible to assess the nature of the discharge, detect inflammation, and collect material for microscopic and bacteriological studies.

Ultrasound plays a huge role in identifying fetoplacental insufficiency. Thanks to it, it is possible to determine fetometric indicators (sizes of the head, limbs, body of the fetus) and compare them with normal values ​​​​characteristic for a given period of pregnancy, measure the thickness of the placenta and determine the degree of its maturity.

If FPN is suspected, the doctor performs cardiotocography and phonocardiography to assess the child’s cardiac activity. Arrhythmia, bradycardia, tachycardia may be signs of hypoxia.

Dopplerography of uterine blood flow allows you to evaluate blood circulation in the vessels of the uterus, umbilical cord, and fetal part of the placenta.

Treatment of placental insufficiency

Considering that the occurrence of FPN can be triggered by various reasons, there is no standard treatment regimen for placental insufficiency. The doctor first of all strives to eliminate the main etiological factor and direct all measures to maintain compensatory mechanisms.

If the form of deficiency is compensated and there is no threat to the life of the fetus, then treatment is carried out on an outpatient basis. Other forms require hospitalization and intensive therapeutic measures.

If, with low placental insufficiency, there is a threat of termination of pregnancy, then the doctor prescribes medications related to tocolytics. In case of disturbances in vascular tone in the placenta and the presence of microcirculatory disorders in a pregnant woman, the attending physician prescribes anticoagulants and antiplatelet agents. If hemodynamic disturbances are detected, medications are prescribed that normalize the contractile function of the myocardium, improve organ perfusion, and have a hypotensive effect. If myometrial hypertonicity is detected, then the prescription of antispasmodic drugs is required. To normalize the transport function of the placenta and antioxidant protection, various vitamins are prescribed.

An expectant mother should not take medications on the recommendation of friends or other people without a doctor’s prescription, because other people’s advice can lead to dire consequences. The doctor determines the treatment regimen individually. You just need to follow his recommendations.

Many pregnant women are interested in treating placental insufficiency with folk remedies. Here it is difficult to advise something specific, because for one representative of the fair sex a specific remedy can help, but for another woman, on the contrary, it will only aggravate the situation. That is why it is not recommended to follow the advice of traditional healers. Only a doctor with a medical education can advise something specific.

Methods of delivery for FPN

The method of delivery is determined by the doctor depending on the effectiveness of the treatment. With a compensated form, a woman can give birth on her own. In the subcompensated form, a caesarean section is most often performed. Decompensated insufficiency is an indication for emergency surgical delivery. Learn more about caesarean section surgery >

Prevention of placental insufficiency

One of the main and very important preventive measures is pregnancy planning. Unfortunately, many couples do not understand the importance of this. Often pregnancy occurs unexpectedly. Even before conception, the expectant mother must undergo the necessary examinations, thanks to which all risk factors will be identified. The detected problems will need to be eliminated or their impact minimized. Thus, planning a pregnancy will protect against the occurrence of FPN in the future.

It is imperative to exclude the influence of harmful factors: smoking, drinking alcohol and medications not prescribed by a doctor. Before and during pregnancy, you need to treat chronic diseases and protect yourself from infections. With the onset of an “interesting situation,” women are advised to eat a balanced diet and get adequate sleep (at least 8 hours a day).

During the weeks of pregnancy, preventive medication courses may be prescribed. Prevention of placental insufficiency during complicated pregnancy - increased medical supervision over the course of the “interesting situation”, constant monitoring of the condition of the fetus and its development.

In conclusion, it is worth noting that FPN is a serious problem faced by many pregnant women. Why is placental insufficiency dangerous? This question cannot be answered unambiguously. The consequences depend on many factors. A child may be born healthy or with various problems, or may even die in the womb. In order not to encounter FPN and give birth to a healthy baby, it is recommended to plan your pregnancy in advance and reconsider your lifestyle, because for modern women it is fundamentally wrong.

Blood flow disorders during pregnancy

A pregnant woman must monitor her health and the development of the fetus. The connection between mother and unborn child is carried out with the help of the placenta and is a single, well-functioning system in which fetal and placental types of blood circulation can be distinguished. In cases of disturbance of the uteroplacental blood flow, the system fails. Impaired blood flow during pregnancy can lead to the development of various types of diseases, including complications during childbirth, peritonitis and even mortality.

Cerepro drug, instructions. Traumatic brain injury and ischemic stroke

The fetus located in the placenta is nourished and supplied with oxygen from the mother’s blood. It unites the maternal and fetal systems. They are separated by a membrane that prevents the blood of mother and child from mixing. The placenta protects the fetal system from all kinds of viruses and harmful substances. But for a number of reasons, placental insufficiency may occur and this negatively affects its functions.

Causes of blood flow disorders

Placental insufficiency can develop for a number of reasons:

Early sexual life and a large number of partners lead to chronic inflammatory processes in her body. Bad habits: alcohol, smoking, drugs have a negative effect on the development of the placenta. As a result, vasospasm may occur, which causes a violation of blood flow in the body of a woman during pregnancy. genetic inheritance. A normal placenta is formed by a good set of chromosomes. Various gynecological and extragenital diseases, they greatly increase the possibility of developing placental insufficiency.

Also, a violation of blood flow can be caused in women who have had miscarriages, abortions, placental abruption and other pathologies. Today, it has been scientifically proven that placental insufficiency is the main cause of premature births and miscarriages.

We wrote in more detail about premature babies in the article:

Modern medicine makes it possible to detect possible complications at an early stage of pregnancy. Therefore, the outcome of bearing a child will depend on how quickly treatment is started.

Hemodynamic disorders

There are 3 degrees of hemodynamic disturbances. The first degree is conditionally divided into 2 subtypes:

1A – The cause of disruption of uteroplacental blood flow is mainly intrauterine infection. With such a violation, fetal-placental blood circulation is preserved. 1B – With this disorder, the uteroplacental blood flow is preserved, and pathology is detected in the fetoplacental blood flow.

In grade 2, disturbances are observed in both systems, but no fundamental changes occur. The 3rd degree is characterized by circulatory disorders at the utero-fetal level, which occurs in the utero-placental system.

With timely detection of the first degree of disorder and proper treatment, the fetus can be saved. With the second and third degrees of impairment, the risk of fetal death increases, and it can range from 14 to 47% of the total, respectively. In some cases, caesarean section helps avoid losses.

Treatment and prevention

There is no single technique that would effectively prevent disruption of blood flow in the body during pregnancy and completely relieve a woman from this pathology without consequences. Therefore, treatment is prescribed comprehensively and is aimed at avoiding premature birth. During this period, it is very important to prevent blood flow disorders in women at risk. To do this, you need to rest more, get full sleep, and avoid physical and emotional stress. You should think about eating a properly balanced diet and constantly monitor your weight. According to experts, during pregnancy, the expectant mother should not gain more than 10 kg. Walking in the fresh air and taking vitamins are helpful.

To reduce the tone of the uterus and normalize blood circulation, doctors prescribe appropriate drugs that must be taken in accordance with the prescription.

The role of the transport system, which supplies nutrients with oxygen from the mother to her baby, is played by the placenta. It acts as a special link connecting two separate vascular systems - uterine and umbilical blood flow - together. The well-being and safety of the baby depends on the quality of the work of this unique organ. That is why during the ultrasound examination, not only the level of physical development of the fetus is checked, but also possible violations of the uterine blood flow during pregnancy are determined. What indicators should normal blood flow in the placenta meet, what symptoms can be used to suspect a pathology, and how can this disease be treated?

Impaired blood flow during pregnancy. The structure of the uteroplacental blood flow

The blood flow between the woman and the fetus is provided not only through the placenta. In addition to it, a complex network of blood vessels is involved in the uteroplacental circulation system, working in conjunction with the placenta, which help it fully supply the fetus with everything necessary and at the same time prevent oxygen starvation of the fetal tissues.

The circulatory system between mother and baby consists of three levels, which change with increasing gestational age and perform certain functions. Under the influence of many factors, “breakdowns” can occur on any of them. And depending on their location and severity, the entire subsequent treatment plan and tactics of childbirth depend.

• The central link of the system is the placenta. As it grows, the villi grow tightly into the uterine walls and “suck” from the mother’s blood a set of all the necessary elements for the development of the fetus. In this case, incest between mother and baby does not occur. The multilayer hematoplacental barrier plays the role of a strong “sponge” that allows only beneficial substances to pass through, while filtering out all dangerous compounds and viruses and sending them back into the mother’s venous bloodstream.
• The second level of blood flow is considered to be the branch of the spiral arteries of the uterus. They are intended solely to support pregnancy and remain dormant until conception. When the embryo is four weeks old, the arteries gradually begin to lose muscle tissue and the ability to contract. Closer to the fourth month of gestation, they fill with blood and connect to the placenta. Disruption of blood flow in the uterine artery during pregnancy leads to blockage of blood circulation at all other levels.

In addition to the benefits for the child, these arteries carry a certain risk for the life of the mother. Their rupture can cause severe bleeding during delivery as they lose their ability to contract.

• The third level of blood flow is formed by the umbilical vessels. A vein and two arteries connect the embryo and the placenta and therefore play the most important role in the development of the baby. Violation of the fetal-placental system most often causes congenital abnormalities in the development of a child.

Impaired blood flow during pregnancy: causes

Factors of primary failure are:

• Genetic predisposition.
• Infection with viral or bacterial microflora.
• Endocrine disorders (inferiority of the corpus luteum, ovarian dysfunction, hypothyroidism).
• Insufficiency of tissue that serves as the basis for the further development of the fertilized egg and placenta.

All these factors lead to improper development and attachment of the placenta, and its subsequent inferiority.

The causes of secondary placental insufficiency include:

• Obstetric diseases (fibroids, endometriosis).
• Diseases of the endocrine system (diabetes, hyperthyroidism).
• Chronic diseases (hypertension, renal pathologies, thrombophlebitis).
• Complications of pregnancy (abnormal placenta previa, Rhesus conflict, multiple pregnancy).
• Factors of the external unfavorable environment.
• Bad habits.
• Social conditions.

Impaired blood flow during pregnancy. Classification of placental insufficiency

Violation of blood flow is a common pathology, which is caused by violations of the structure of the placenta and umbilical cord, and in 60% causes a delay in the mental and physical development of the baby. The following classifications are generally accepted and most common.

Depending on the time of appearance, there are:

• Primary placental insufficiency - manifests itself before the 16th gestational week and is associated with a violation of the mechanism of implantation of the fetal egg and subsequent abnormal formation of the placenta.
• Secondary placental insufficiency - is diagnosed after the 16th week of pregnancy, when the placenta is already fully formed. The cause of the disorder is the influence of various negative factors of external origin.

In accordance with the clinical picture of the disease, placental insufficiency is divided into the following forms:

• Compensation - metabolic disturbances in the functioning of the placenta are recorded, but the blood flow between the uterus and placenta or between the placenta and the baby is not impaired. In this condition, partial blockage of blood flow may occur, for example, disruption of the umbilical cord blood flow through one of the vessels or disruption of the right blood flow of the uterus during pregnancy. The female body is able to completely compensate for the baby’s oxygen deficiency by increasing blood flow in other ways. This ensures optimal development of the child without the risk of hypoxia. The baby develops normally and is born at the scheduled time without congenital anomalies.
• Subcompensation - the mother's body cannot resume the flow of oxygen to the baby, since all links of the blood flow system do not fully function. This causes some difficulties due to oxygen deficiency, which causes deterioration of the fetus and can provoke congenital malformations.
• Decompensation - during the Doppler diagnostics, a complete violation of blood flow is determined, which is difficult to eliminate with drug treatment. This condition often results in complex heart defects or death after birth.

Violation of placental blood flow during pregnancy can be acute and occurs against the background of premature detachment of the placenta or its incorrect location in the uterus. Chronic blood flow disorder can fail at any gestational age and is most common.

According to ultrasound data, three degrees of fetal hemodynamic disorders are distinguished.

Grade 1 - involves minor changes in blood circulation between a woman and her baby, which is effectively treated with special medications. At this stage, there is a violation of only one part of the circulatory system, for example, only in the uterine artery. Timely diagnosis of pathology and its subsequent treatment completely eliminates the risk of violations in the child.

Depending on which part of the bloodstream is affected, there are two varieties of the first degree:

• Stage 1a blood flow impairment during pregnancy indicates that the patency between the uterus and the placenta is reduced, while the connection between the placenta and the fetus is not disrupted. Improper treatment in 90% of cases can be accompanied by a slight delay in fetal development, which is characterized by insufficient body weight and general growth indicators.
• impaired blood flow of 1b degree during pregnancy indicates that the uteroplacental blood flow is normal, and the fetal-placental circulatory system is disrupted. In 80% of expectant mothers, pregnancy proceeds with signs of delayed normal fetal development.

Degree 2 - diagnosed if there is placental insufficiency at all levels. In this case, it is almost impossible to compensate for the oxygen deficiency, since the fetal aorta, uterine artery and umbilical cord artery are unable to fully pass blood flow. This degree is detrimental to the baby and often becomes the cause of his death.

Stage 2 blood flow impairment during pregnancy is very unstable and quickly progresses to the last, most critical degree.

Degree 3 - characterized by centralization of blood flow. The baby's condition becomes critical because his intracardiac hemodynamics are completely disrupted. Doppler measurements often show reverse diastolic blood flow. This degree is often diagnosed with obvious signs of developmental delay and is practically not amenable to drug treatment.

Diagnosis of placental insufficiency

To preventively detect possible problems with blood flow, all pregnant women undergo diagnostics three times, which includes Doppler testing. Recommended periods for ultrasound examination: from 11 to 14 gestational weeks, from 20 to 24, and from 32 to 34 weeks.

Obstetric examination

Pregnant women who are at risk for the formation of placental insufficiency are subject to regular clinical monitoring. Particular attention is paid to the following indicators:

• Woman's weight. Exceeding this value often indicates hidden gestosis.
• Abdominal circumference and uterine fundus height. Deviation from the norm of these indicators in 50% of cases indicates a delay in fetal development.
• Uterine tone and bleeding.
• Fetal movement and heart rate. A decrease in these indicators indicates possible fetal hypoxia.

Laboratory research

This diagnosis is used to determine the condition of a pregnant woman in the third trimester with compensated blood flow impairment. For this purpose, monitoring of the woman’s hormonal status is carried out, provided that the fetus has no signs of malnutrition (intrauterine retardation).

Laboratory tests include the following:

• Calculation of the amount of alkaline phosphatase in venous blood.
• Determination of oxytocin levels.
• Study of estradiol concentration in urine.

Doppler examination

This complex name belongs to a painless diagnostic procedure that allows:

• measure the speed of blood flow in the veins and arteries connecting mother and child;
• determine the direction of blood flow;
• diagnose pathological changes before the appearance of external symptoms.

Additionally, you can evaluate the following indicators:

• The degree of aging of the placenta.
• Much or little water.
• Possible developmental defects.
• Fetal hypoxia.
• Genetic anomalies.
• Signs of intrauterine infection.
• Finesse of the placenta.

Such an examination is carried out using additionally equipped ultrasound machines or special portable devices. Thanks to sensors that measure indicators, all data is reproduced on the monitor. During the diagnosis, a Dopplerogram is compiled, which shows the systolic-diastolic ratio of blood flow. In other words, it shows the difference between the blood flow sent and the blood flow received back, which helps determine the degree of patency of the vessels that connect the uterus, placenta and baby.

The most favorable position for Doppler testing is lying on your side. It is also possible to conduct the study on the back, but in this position, many women may experience uterine hypertonicity, which significantly distorts the results obtained.

What symptoms indicate blood flow problems during pregnancy?

It is very difficult to suspect problems with blood flow in the placenta without examination. But there are several symptoms, if they occur, it is better to consult a doctor:

1. Pathological motor activity of the baby. If it is overly active or, conversely, practically does not move, this signals hypoxia.
2. Severe toxicosis in the second half of pregnancy. Late gestosis often accompanies pathology of placental blood flow.
3. Too slow increase in abdominal circumference. It is difficult to notice this on your own, so the gynecologist usually pays attention to this during a routine visit to the patient.
4. Bloody vaginal discharge. This is the most dangerous symptom that indicates placental abruption.

Impaired blood flow during pregnancy: consequences

Even the most minor deviations in blood circulation between mother and fetus reduce the amount of incoming nutrients, vitamins and oxygen. If such “fasting” is prolonged, the following complications may occur:

• Pathological termination of pregnancy.
• Fetal hypoxia.
• Congenital heart defects.
• Increased risk of intrauterine and perinatal death.
• Placental abruption or premature aging.
• Preeclampsia.

When diagnosing the first degree of compensated blood flow disturbance during pregnancy, the consequences for the child are not critical and over time, a slight lag in growth or development is smoothed out, and the baby catches up with his peers.

If a woman is given a more severe diagnosis of decompensated placental insufficiency of the last degree, the prognosis is less optimistic and the pregnancy often ends in fetal death or the birth of a defective child.

Blood flow disorders during pregnancy: treatment

The most favorable period for conservative treatment is considered to be the first degree of pathological blood flow. The second degree is extremely rarely correctable, but the third is a direct indicator for emergency delivery by cesarean section, if the gestational age allows.

Treatment tactics are based on the pathogenesis of the disease and provide for a complex effect on all links in the blood flow chain:

• To improve microcirculation in case of minor deviations, women are prescribed the homeopathic drug Hofitol, and if it does not have the desired effect, medications with more active ingredients are prescribed, for example, Pentoxipharm or Actovegin.
• If a woman has a history of thrombophlebitis, she is prescribed medications to restore the ability of blood to flow through the vessels. Such remedies include Curantil.
• Drotaverine or No-Shpa is used as a vasodilator.
• To reduce uterine tone and improve blood flow, magnesium in the form of droppers and oral Magnesium B6 are prescribed.
• To provide an antioxidant effect, taking vitamin C and tocopherol is mandatory.

If the woman’s condition does not improve and the results of control studies do not restore blood flow, the woman is offered hospitalization. This provides more careful monitoring of the fetal condition.

To avoid possible complications on the side of the uteroplacental blood flow, it is better to prevent this pathology. Walk more in the fresh air, eat right, give up bad habits and, most importantly, undergo all scheduled examinations in a timely manner. Then you will be able to prevent, and if they occur, begin to treat blood flow disorders in a timely manner.

Video “Blood circulation between mother and child”

During pregnancy, a woman's body undergoes strong hormonal changes. A new circle of blood circulation appears, through which the fetus receives nutrition and oxygen, and also removes waste products. It is the placenta that protects the baby from infections and viruses, and connects two complex circulatory systems: mother and child. A special membrane between these systems prevents the blood in them from mixing with each other. Sometimes, for various reasons, this interaction is disrupted, placental insufficiency occurs, which can lead to negative consequences both for the body of the expectant mother and for the health of the child. That is why it is important to timely analyze the movement of blood in the umbilical cord and uterine arteries of a pregnant woman, check blood circulation in the baby’s vessels and aorta, receive timely treatment and lead a healthy lifestyle. What are the consequences of impaired blood flow during pregnancy, what is its cause and how to avoid it?

Causes of poor blood flow in the uterus

There are several reasons why placental insufficiency occurs. They can both affect the formation of the placenta and appear at later stages of gestation:

• uterine tumors
• genetic defects
• hormonal disorders
• gestosis
• infectious diseases
• structural features
• consequences of abortion
• diabetes
• atherosclerosis
• hypertension
• problems with the adrenal glands and thyroid glands
• multiple births
• Rhesus conflict

Most often, one main risk factor manifests itself. But there may be several reasons at the same time.

Types and degrees of disturbance of uterine blood flow
There are three degrees of impairment:

1st degree

Occurs with the smallest changes in placental blood flow, which are not of a dangerous nature for the child. Within a month, with early detection and proper treatment, there is a high probability of complete recovery without consequences. Divided into two types:

• 1a - failure occurs only in uteroplacental hemodynamics
• 1b - problems arise in the fetoplacental area. The uterine uterus remains complete

2 degree

In the second degree, both blood flow systems fail. The fetal death rate is about 13%. In a short time, usually up to 10 days, it enters the third stage.

3rd degree

The fetal blood supply is in critical condition. Premature birth is often artificially induced, since the probability of death of an unborn baby is almost 50%.

For the second and third degrees, a caesarean section is most often prescribed. At the first birth, birth occurs naturally, under the careful supervision of a doctor.

Treatment of placental circulatory disorders

Since the main consequence of insufficient blood flow is hypoxia, doctors prescribe drugs that increase the resistance of the fetal tissues and brain to oxygen starvation. In combination, agents that improve heart function and blood microcirculation can be used. If necessary, antiviral and antibacterial drugs are prescribed, as well as agents that prevent the formation of blood clots. The doctor prescribes medications based on the severity of the blood circulation disorder. Sometimes a pregnant woman is offered hospitalization in order to provide her with bed rest, and so that treatment takes place under the close supervision of specialists.

Prevention of pathologies

For timely detection of pathological changes in blood flow between the uterus and the fetus, all future mothers are prescribed Doppler ultrasound three times during pregnancy. It is carried out together with a routine ultrasound and helps to assess the general condition and development of the child, and also gives a complete picture of the state of blood flow in the vessels of the umbilical cord, uterus and fetus. Early detection of disturbances in the functioning of the placenta and blood flow will help to prescribe the drugs necessary for treatment in a timely manner and avoid negative and dangerous consequences for the baby in the future. Doppler sonography is a mandatory test for expectant mothers with bleeding disorders.

It must also be remembered that the health of the baby largely depends on the condition of the mother. Therefore, with food, the body should receive a maximum of macro- and microelements, a sufficient amount of fats, proteins, carbohydrates and liquids. In the absence of swelling, you need to drink at least one and a half liters of water per day. It is necessary to completely eliminate bad habits and try to avoid unnecessary physical and emotional stress. It is important to monitor your weight gain, weigh yourself and measure your abdominal circumference. It is advisable to walk in the fresh air more often and not stay in stuffy rooms for a long time. For pregnant women at risk, prevention is carried out with medication, which helps mother and child interact fully.

The placenta in the body of the expectant mother not only plays the well-known role of a transport channel for supplying the fetus with nutrients. Its functionality extends much wider - up to providing complete protection of the child from the effects of negative substances and substances that may be present in the maternal nutritional environment. Impaired blood flow during pregnancy is a direct threat of intrauterine fetal death due to deterioration of blood circulation in the complex communicating apparatus of two closed vascular systems.

The blood of the fetus and mother should not mix at any stage of the complex multi-level movement. The first mechanism of maternal-fetal blood circulation provides barrier functions - the hematoplacental barrier, which is a kind of unique filter that works only in one direction: to remove waste substances from the fetus along with the blood flow.

The reverse movement of blood, from mother to child, occurs through arteries that are fully formed by the 16th week of pregnancy. This is the second mechanism of the system. Due to the high tone of the arteries, starting from this period, the risk of fetal loss increases.

The vessels of the uteroplacental circle, isolated by the umbilical cord, are the third important mechanism of blood circulation between two organisms - the nourisher and the feeder. Impaired blood flow during pregnancy at this stage has the most serious and irreversible consequences for the fetus.

Causes

The causes of impaired blood flow during pregnancy can be found in the following pathological conditions:

• Anemia (anemia) of the expectant mother. cause high blood flow rates. This occurs by compensating for the lack of oxygen and cannot but affect the processes in the development of the fetus and the quality of blood exchange;
• The nature of the position of the placenta. If presentation is diagnosed, which can be justified by a previous caesarean section, then the blood supply will definitely be reduced due to thinning of the uterus at the site of the scar;
• Late toxicosis, causing pathological changes in the functioning of small vessels. This is one of the most common signs of blood flow disorders during pregnancy;
• Viruses and infections, present in the mother’s body during gestation. Some of them can cause damage to placental tissue and contribute to the development of placental insufficiency;
• – may be complicated by the anemic condition of the fetus;
• Defects of the uterine organ. The most significant of them, which can change the course of fetal development for the worse, is the two-cavity structure of the uterine sac. The uterine space, divided into two parts, in itself is not an obstacle to the normal growth and formation of the child. However, the blood supply system does not adequately supply such a two-chamber cavity;
• Serious quantitative or configurational umbilical cord;
• Damage to the inner wall of the uterus received as a result of surgical interventions, or as a consequence of bad habits;
• Tumors such as fibroids, especially dangerous in previously nulliparous women after thirty-five years of age. This also applies to uterine fibroids, which are abundantly saturated with blood during perinatation. Against the background of an increase in size and formation of the myomatous node, a persistent lack of blood flow to the placenta is formed;
• that do not allow maintaining a uniform blood flow rate;
• Pregnancy complicated by multiple pregnancy. Since the placenta is forced to adapt to maintaining several feeding organisms in proper conditions at once, errors in the blood supply such as the donor position of one of the fetuses cannot be ruled out. Often, there is underdevelopment of the feeding fetus, a significant lack of weight and physiological normal signs. The child, involuntarily acting as a recipient, also seriously suffers from, on the contrary, an overly abundant blood supply;
• Mother's illness, sometimes developing precisely during pregnancy, loosens the walls of blood vessels, which does not have the best effect on blood circulation.

The degrees of disturbance of the uteroplacental circulation during pregnancy, at which significant changes in the development of the fetus are likely, formed the basis for the following classification list:

• Impaired blood flow during pregnancy 1A - all diagnostic indicators of the uteroplacental apparatus are normal, except for an insignificant change in blood flow in any of the uterine arteries;
• Impaired blood flow during pregnancy 1B – there are disturbances in blood flow in the vessels of the umbilical cord, despite the fact that the condition of the vessels of the uterus is unchanged;
• 2 – comprehensive violation of both uterine and umbilical vessels;
• 3 - changes at the global level, characterized by the most extreme rates of deviation.

Degrees of blood circulation 1 (A and B) allow you to maintain pregnancy and give birth to a healthy child, subject to the prescribed treatment and all doctor’s recommendations. Grade 2 allows for fetal preservation, but this will require hospitalization. Stage 3 requires immediate surgical intervention to remove the fetus in order to preserve the life and health of the mother.

The main diagnosis of blood flow disorders during pregnancy, at the moment, is. The most insignificant, at first glance, changes in one of the early stages of disorders are clearly visible on the screen, since Doppler imaging provides a picture in color and has a high degree of resolution in terms of picture clarity.

The very analysis of the frequency of ultrasonic waves reflected from objects in motion makes it possible to determine the speed of blood flow through the arteries, in the umbilical vessels, as well as blood circulation inside the placenta. Then the indicators taken during the examination are checked against the table of normative data and the result is recorded.

The biggest advantage of Doppler ultrasound, in addition to the safety of the study, is the accurate prediction of any form of abnormality, detecting them at a stage when it is still possible to save the fetus and not cause harm to the mother’s body.

In addition, classical measures to confirm or refute pathology are mandatory:

• Analysis of fetal activity based on the mother’s words;
• Stethoscopic listening to the baby's heartbeat in the womb;

Treatment

It is impossible to treat disorders of the uteroplacental blood flow, acting only in one direction, or eliminating problems as they arise.

A complete cure necessarily includes a set of measures aimed at:

• Increased blood microcirculation;
• Achieving optimal blood pressure;
• Vasodilation with spasmodic manifestations in the arteries;
• Reducing uterine tone due to relaxation of blood vessels;
• Preventing the consequences of oxygen starvation (hypoxia);
• Saturation of placental tissue with the phospholipids it needs.

Consequences

Depending on the degree and nature of circulatory disorders during pregnancy, difficulties in the development of the fetus arise, in rare cases leading to the death of the child.

The consequences of impaired blood flow during pregnancy are characterized by such nuances as:

• Inhibition of fetal development at some stage, or significant delays in its intrauterine formation;
• Critical indicators of weight and size;
• Fast, slow, or intermittent heartbeat;
• Floating blood pH level;
• Incorrect course of hormonal processes;
• Risk of miscarriage.

It must be remembered that only a cumulative assessment of the baby’s development, but not the results of one study, can provide complete information about compliance with standard indicators, or lagging behind them. At the moment, the Doppler ultrasound procedure, which is the basis of examinations of the perinatal period, in no way detracts from the need for proven methods of the old school of medicine.

According to medical statistics, placental insufficiency develops in approximately 24% of expectant mothers. There are a number of special medications available to treat this pregnancy complication.

The placenta (the so-called baby's place) is the organ through which nutrition, respiration of the fetus and the removal of processed metabolic products occur. Two complex systems of blood vessels converge in this organ. One of them (maternal) connects the placenta with the vessels of the uterus, the other (fetal) passes into the umbilical cord arteries leading to the fetus. Between the two vascular systems there is a membrane (one layer of cells), which acts as a barrier between the body of the mother and the child; Thanks to this membrane, the blood of the mother and fetus does not mix.

The placental barrier is impenetrable to many harmful substances, viruses, bacteria. At the same time, oxygen and substances necessary for life pass without problems from the mother’s blood to the child, just as waste products from the fetus’s body easily enter the mother’s blood and are then excreted through her kidneys. The placental barrier performs an immune function: it allows the protective proteins (antibodies) of the mother to pass through to the child, ensuring its protection, and at the same time delays the cells of the mother’s immune system that can cause a reaction of rejection of the fetus, recognizing it as a foreign object. In addition, the placenta produces hormones that are important for successful pregnancy, and enzymes that destroy harmful substances.

What is placental insufficiency?

During an unfavorable pregnancy, the function of the placenta may be impaired. So-called placental insufficiency occurs, in which the process of placental maturation is disrupted, uteroplacental and fetal-placental blood flow is reduced, gas exchange and metabolism in the placenta is limited, and the synthesis of its hormones is reduced. All these changes determine the insufficient supply of oxygen and nutrients to the fetus, slow down its growth and development, and aggravate existing pregnancy complications.

Placental insufficiency syndrome occurs at different levels, so several forms of this disease are defined:

• hemodynamic, caused by disturbances in the vessels of the utero-placental-fetal blood flow;
• placental-membrane, characterized by a decrease in the placenta’s ability to transport various substances and oxygen;
• cellular, associated with metabolic disorders in the cells of the placenta. There are primary and secondary placental insufficiency.

Primary(early) placental insufficiency develops before, occurring during the formation of the placenta. Its causes are often uterine pathology: uterus (benign tumor), uterine malformations (saddle-shaped, small, bicornuate), previous abortions, hormonal and genetic disorders. In some cases, primary placental insufficiency becomes secondary.

Secondary(late) placental insufficiency, as a rule, occurs against the background of an already formed placenta after. In the occurrence of late placental insufficiency, infections, gestosis (complications in which the work of all organs and systems of the pregnant woman’s body is disrupted, most often they are manifested by increased blood pressure, the appearance of edema, protein in the urine), pregnancy, as well as various diseases of the mother (arterial hypertension, adrenal cortex dysfunction, diabetes mellitus, thyrotoxicosis, etc.).

Regardless of the factors contributing to the development of placental insufficiency, it is based on circulatory disorders in the uterine-placental complex, leading to disruption of all functions of the placenta.

A change in the respiratory function of the placenta is indicated by symptoms of fetal hypoxia - insufficient oxygen supply to it. At the same time, at the beginning of the disease, the woman pays attention to increased (erratic) motor activity of the fetus, then to its decrease. Chronic hypoxia of the fetus and violation of the nutritional function of the placenta lead to a delay in its intrauterine development. Manifestation of intrauterine retention fetal development is a decrease in the size of the pregnant woman’s abdomen (abdominal circumference, height of the uterine fundus) compared with indicators characteristic of a given period of pregnancy. Violation of the protective function of the placenta leads to intrauterine infection of the fetus under the action of pathogenic (pathogenic) microorganisms penetrating the placenta. The fetus, the development of which occurs in conditions of placental insufficiency, is much more at risk of trauma during childbirth and morbidity during the newborn period.

Diagnosis of placental insufficiency

For the diagnosis of placental insufficiency are used:

• Evaluation of fetal cardiac activity. In addition to simply listening with an obstetric stethoscope, the most accessible and common method for assessing the fetal cardiac activity is cardiotachography, which is based on recording changes in the fetal heart rate depending on uterine contractions, the action of external stimuli or the activity of the fetus itself in the period after.
• Ultrasound examination (ultrasound). At the same time, the size of the fetus and its correspondence to the gestational age are determined, the location and thickness of the placenta, the correspondence of the degree of maturity of the placenta to the gestational age, the volume of amniotic fluid, the structure of the umbilical cord, and possible pathological inclusions in the structure of the placenta are assessed. In addition, the anatomical structure of the fetus is studied to identify abnormalities of its development, as well as the respiratory and motor activity of the fetus.
• Doppler. This is a variant of ultrasound examination, which evaluates the speed of blood flow in the vessels of the uterus, umbilical cord and fetus. The method allows you to directly assess the state of blood flow in each of the vessels in the second half of pregnancy.
• Laboratory methods. They are based on determining the level of placental hormones (estriol, human chorionic gonadotropin, placental lactogen), as well as the activity of enzymes (oxytocinase and thermostable alkaline phosphatase) in the blood of pregnant women at any time.

Based on a comprehensive examination, a conclusion is made not only about the presence or absence of placental insufficiency, but also about the severity of such a disorder. The tactics of pregnancy management for different degrees of severity of placental insufficiency are different.

Prevention and treatment

At present, unfortunately, it is not possible to completely relieve a pregnant woman from placental insufficiency using any therapeutic interventions. The means of therapy used can only help to stabilize the existing pathological process and maintain compensatory and adaptive mechanisms at a level that allows for the continuation of pregnancy until the optimal date of delivery. Therefore, it is very important to carry out prevention in women who have risk factors for developing placental insufficiency.

The leading place in prevention is the treatment of the underlying disease or complication, which may lead to placental insufficiency. An important condition is for the pregnant woman to follow an appropriate regimen: adequate rest (sleeping on the left side is preferable), elimination of physical and emotional stress, staying in the fresh air for 3-4 hours a day, and a rational, balanced diet. The course of prevention includes multivitamins, iron supplements, breathing exercises to increase oxygen delivery through the lungs, the use of amino acids, glucose, Galascorbine, potassium orotate, ATP, which serve as a direct source of energy for many biochemical and physiological processes.

With initial signs of placental insufficiency, treatment is possible in a antenatal clinic with a repeat ultrasound examination with Doppler 10-14 days after the start of treatment. With more severe placental insufficiency, especially in combination with other complications of pregnancy or general diseases of the mother, hospitalization in a hospital is required. The duration of therapy should be at least 6 weeks (in a hospital, with continuation of therapy in a antenatal clinic). If this pathology is detected and appropriate therapy is carried out in the second trimester, in order to consolidate the effect of the first course, treatment should be repeated at a later date.

If indicators deteriorate during treatment, signs of decompensation of placental insufficiency appear, determined by a sharp deterioration in the condition of the fetus and the possibility of its death, emergency delivery by cesarean section is indicated, regardless of the gestational age.

Special drug therapy

With initial signs of placental insufficiency, treatment is possible in a antenatal clinic.

Currently, for the treatment of placental insufficiency, there are a large number of medications aimed at eliminating disturbances in the uteroplacental-fetal blood flow and increasing the fetus’s resistance to oxygen starvation. Each of these drugs has its own point of application, its own mechanism of action.

Drugs that help relax the uterine muscles (tocolytics) - Partusisten, Ginipral, Magne-B 6. Periodic increases in uterine tone contribute to circulatory disturbances in the placenta, while small doses of tocolytics reduce vascular resistance at the level of small arteries and lead to a significant increase in uteroplacental blood flow . When using Ginipral and Partusisten, an increase in the mother's heart rate (tachycardia), a decrease in blood pressure, tremor of the fingers, chills, nausea and anxiety are possible. To prevent tachycardia, Verapamil and Isoptin are prescribed in parallel with medications. Contraindications to the use of Ginipral and Partusisten are thyrotoxicosis (increased thyroid function), heart disease, and bronchial asthma.

Eufillin and no-spa have a vasodilating effect and reduce peripheral vascular resistance. Trental (pentoxifylline), in addition to its vasodilating effect, can improve the rheological properties (fluidity) of blood and circulation in small capillaries (microcirculation). Side effects of these drugs are heartburn, nausea, vomiting, and headache. Contraindications to the use of pentoxifylline are low blood pressure (), Euphylline - increased function of the thyroid gland, heart disease, epilepsy.

With placental insufficiency, there is a chronic disorder of blood coagulation (increased activity of platelets and plasma clotting factors). Therefore, for treatment, drugs are used that prevent the formation of blood clots in blood vessels - antiplatelet agents (Aspirin,). These drugs, in addition to improving blood rheology, have a dilating effect on small arteries, causing a significant increase in blood flow speed. They do not cause dilation of all blood vessels and the associated relative drop in blood pressure, and at the same time increase metabolism without a simultaneous increase in oxygen consumption. Curantyl can be taken from the first trimester of pregnancy. Antiplatelet agents are contraindicated in women with gastric and duodenal ulcers, bleeding and recent surgical interventions. Due to the risk of bleeding during childbirth, these drugs are discontinued in.

Actovegin increases the resistance of the brain and fetal tissues to hypoxia, activates metabolism, increases glucose consumption, and stimulates the renewal of fetal cells. In addition, the drug increases blood circulation in the mother-placenta-fetus system and promotes better tolerance of the birth act to the fetus. Treatment with Actovegin has a pronounced effect on the condition of the fetus. This is reflected in improved blood flow and improved fetal growth, which reduces the incidence of forced early delivery. The drug is obtained from the blood of calves, has a minimum of side effects, and allergic reactions are quite rare. Contraindications to the use of the drug are heart failure and pulmonary edema. In women with recurrent miscarriage and serious diseases (diabetes mellitus, arterial hypertension, pathology of the thyroid gland, heart, liver), Actovegin is prescribed to prevent placental insufficiency in courses of 2-3 weeks, 2-3 times per pregnancy.

Considering the most important neutralizing function of the liver, as well as its decisive role in the production of proteins and blood coagulation factors, in the complex treatment of placental insufficiency it is advisable to use hepatoprotectors - drugs that protect the liver (Essential-ale, Hepatil). They have a normalizing effect on the metabolism of fats, proteins and liver function. The drugs have minimal side effects; some patients report discomfort in the stomach and liver. Chophytol is a purified extract of field artichoke leaves. In addition to its hepatoprotective properties, Hofitol contains many macro- and microelements, including iron, manganese, phosphorus, vitamins A, B and C. In addition, the drug has pronounced antioxidant properties. Hypoxia, which occurs against the background of placental insufficiency, leads to an increase in the number of free radicals, which have a damaging effect on cells. Hofitol improves protection against free radicals, which has a positive effect on placental function. Hofitol is contraindicated in case of cholelithiasis, acute diseases of the liver, biliary and urinary tract.

An important condition is adequate rest.

Instenon is a combination drug that improves cerebral circulation, heart function and metabolism in the fetus under hypoxic conditions. It is used in combination with other drugs for the treatment of placental insufficiency in order to avoid the negative consequences of hypoxia on the fetal nervous system. While taking the drug, you should avoid drinking coffee and tea, as they weaken its effect. The most common side effect with its use is headache. Instenon should not be used in a state of severe agitation and convulsions, manifestations of increased cerebral pressure (its signs: prolonged headache, vomiting, blurred vision), epilepsy.

The indications for choosing a particular drug are determined by the doctor, based on the form of placental insufficiency. If the main cause is circulatory disorders, then drugs that affect blood vessels are prescribed. If the basis is cellular disorders, then drugs that affect tissue metabolism. Combinations of several drugs are often used.

In conclusion, I would like to emphasize: placental insufficiency is a serious complication of pregnancy, in which independent use and withdrawal of even the most harmless medications is unacceptable. This pathology requires close medical supervision.

Ekaterina Svirskaya,
obstetrician-gynecologist, Minsk