Violation of the uteroplacental blood flow. Problems with placental and uterine blood flow

After the fertilization of the egg and the development of the embryo in the uterus, a placenta is formed, connecting the child and mother with a single unified circulatory system. Through it, the fetus receives oxygen and nutrients necessary for formation and growth. It is also used to remove unwanted substances that are formed after various biochemical reactions.

Features of blood circulation between mother and child during pregnancy

Violation of the blood flow of the placenta causes a lack of nutrition and oxygen in the child and becomes the cause of his death. The state of the placental-uterine blood flow requires close attention during pregnancy. To assess his condition, planned diagnostics are carried out, preventive and therapeutic measures are taken.

The work of blood circulation between mother and baby is based on the functioning of the umbilical artery, veins, placenta. The uterine arteries are able to contract, cutting off the flow of blood due to the thickness of the muscle layer they have. This structure of the uterine artery is provided to reduce blood loss during menstruation.

During pregnancy for a period of 4-5 weeks, during the gestation of the egg, the muscle layer in the arteries disappears under the action of hormones. At week 16, another transformation of the arteries occurs, during which they open for constant filling with blood.

What happens in the arteries:

• connection of two flows of different directions;
• diffusion of substances necessary for a growing baby;
• enrichment of the fetal blood flow with oxygen and useful substances brought by the maternal circulation.

Part of the work of blood circulation falls on the arteries and veins of the umbilical cord. Blood flows through the arteries to the baby, and through the vein returns to the placenta. Violation of the fetal-placental blood flow leads to inhibition of the growth of the child's organs, poses a threat to his health.

Why can blood circulation be disturbed

Causes of placental insufficiency (impaired blood circulation between mother and child):

1. Low placentation(attachment of the placenta to the wall of the lower uterus or "previa"). The thin muscular layer of the lower part of the uterus is not able to provide sufficient blood flow to the fetus. If there is no migration of the placenta (advancement in the upper part of the uterus), the situation threatens to aggravate the pathology.
2. Late toxicosis of pregnant women. It affects the small vessels of the uterus, which disrupts the processes of blood circulation.
3. Decreased hemoglobin levels or anemia. This condition causes an accelerated heartbeat in the mother, altering the normal circulation in the uteroplacental circuit.
4. Rh incompatibility blood of the mother and baby, causing anemia in the fetus and immune conflict.
5. High blood pressure in the mother because of problems with the heart, the formation of puffiness, stress.
6. Pathology of the umbilical arteries, for example, the presence of only one umbilical artery.
7. Multiple pregnancy requiring more nutrients.

Some diseases of the mother contribute to the spread of pathology, in particular:

• Acute infections, the pathogens of which are able to penetrate the placenta;
• Defect of the uterus ("two-horned" uterus, having a septum in the middle, dividing it into two halves). The development of the fetus in proceeds only in one of them. The threat is the squeezing factor of the growing fetus and the violation of the blood flow going to it. In such situations, there is often a violation of the uteroplacental blood flow on the left 1a degree or on the right.
• Diabetes. It affects the walls of the vessels of the uterus.
• Deviations of the uterine epithelium (endometriosis).
• Uterine tumors. The size of a benign tumor (fibroids) determines how much the fetus will suffer from insufficient blood supply. The larger the fibroids, the higher the risk of failure. Changes in the hormonal background, provoked by pregnancy, stimulate the growth of neoplasms. The presence of this disease requires constant monitoring of uterine blood supply.

Possible consequences

Serious deviations of placental blood flow lead to fetal malformations and mortality. Circulatory failure is divided into several stages. Deviations of the second and third degree represent the greatest danger.

The answer to the question of whether this is dangerous is the statistics of perinatal mortality, according to which blood flow pathologies of the 2nd degree are the cause of the death of 13% of infants over the age of 22 weeks. The third stage causes death in 48% of cases. Timely therapy and emergency delivery by caesarean section helps to reduce these indicators.

The development of a child in conditions of placental insufficiency is reflected in his physical and mental state in the postnatal period.

What is the danger to the unborn child

The main danger of placental insufficiency for growing crumbs is hypoxia.

Consequences of lack of oxygen:

• lack of baby weight (intrauterine growth retardation);
• violation of the process of formation of internal organs;
• failure in the acid-base balance and composition of electrolytes;
• development of hormonal imbalance and failure in the hormonal system;
• lack of "fat depots".

Severe deviation of placental blood flow and dysfunction of the placenta threaten the baby with death, entail termination of pregnancy.

Degrees of impaired blood flow

There are three stages of deviation of blood circulation between the baby and mother from the norm:

I - changes at this stage do not pose a serious threat to the child and are compensated, that is, there is a deviation in arterial blood flow with a preserved blood flow in the vessels of the umbilical cord and vice versa. The child is developing normally. The stage is divided into two types of changes that have their own code:

Grade 1a - problems affect only one artery, the baby's developmental indicators are normal.

1c degree - deviation of blood flow from the norm is noted in the vessels of the umbilical cord. A type of hypodynamia in which the arteries of the uterus work normally. There is a normal amount of blood in this vein.

If minor problems in supplying the fetus with nutrition and oxygen are not detected in time and do not receive the necessary therapy, after a month the pregnant woman may develop deviations of the placental-uterine hemodynamics of the second degree.

II - deterioration of blood flow affects the umbilical and uterine arteries.

III - critical deterioration of blood circulation in the uteroplacental circle, the risk of reverse blood flow in the arteries, placental bleeding.

This classification of hemodynamic abnormalities during pregnancy, established by the ICD, allows you to accurately assess the state of blood flow and make a prognosis for treatment and upcoming delivery.

Diagnostic methods

To identify violations of metabolic processes between the child and the mother, several types of diagnostics are used to determine the nature of the problems and their degree.

Diagnostic methods include:

• a blood test for the level of chorionic gonadotropin, estrogen and progesterone;
• ultrasonography;
• cardiotocography (CTG);
• dopplerometry.

The most accurate diagnosis and establish the degree of violations allows dopplerography. This method fixes even small deviations from the norm and is completely safe for a pregnant woman and her child. The results of Doppler ultrasound allow specialists to predict the further course of gestation, to choose the necessary therapeutic tactics. On the screen of the device, you can see a graphical color image of the blood flow.

Ultrasound diagnostics allows you to determine the correspondence between the size of the crumbs and the development of organs for its age. Planned in the process of gestation, it is carried out three times for a period of 12, 20 and 32 weeks. This method will allow, without harm to the child and mother, to assess the compliance of its coccygeal-parietal size with the gestational age, as well as the development of its internal organs, placental hemodynamics.

Cardiotocography allows you to listen to the child's heartbeat, evaluate heart rate, variability in the basal rate level. The data recorded by the device are checked against the table. According to the table of results, the CTG is assigned a score. The normal development of the baby corresponds to 8-10 points of cardiotocography.

Diagnosis is carried out in a planned manner, it is categorically not recommended to skip it for pregnant women.

Signs of a violation can be noticed by the pregnant woman herself, but often they indicate a serious stage of pathology. The expectant mother may be alerted by a decrease or increase in the activity of the baby's movements. On examination by an obstetrician-gynecologist, the doctor notes the rapid heartbeat of the fetus. An alarming sign is the discrepancy between the size of the abdomen and the actual gestational age (except in cases due to the structure of the woman's body).

Treatment of disorders

The tactics of treatment is determined by the degree of pathology established using diagnostic methods. It is possible to save pregnancy and level the threat to the fetus at stages ia - iv. Problems of placental blood flow 1b degree are amenable to therapy. There is no threat to the health and normal development of the crumbs. Reviews of the results of therapy for this pathology indicate an improvement, a general positive trend, and the elimination of the likelihood of a transition to the second degree.

The second degree of deviation requires constant monitoring of the child's condition. Therapy on it is considered ineffective.

The third stage of dysfunction requires urgent operative delivery.

Pathology therapy is aimed at maintaining pressure in the vessels, normalizing blood flow, reducing the tone of the uterus, stabilizing the psycho-emotional state of the mother, and normalizing the functioning of the cardiovascular system.

Medical therapy:

1. Preparations synthesized from starches that can retain fluid in the vessels help improve blood flow. These include Infukol, Stabizol.
2. Actovegin and Pentoxifylline improve microcirculation processes.
3. Medicines that relieve spasm (Nosh-Pa) of blood vessels eliminate uterine hypertonicity, facilitating microcirculation processes.
4. To reduce the degree of hypoxia, women take Mange B6, magnesium sulfate.
5. Vitamin E, Tocopherol help to eliminate the consequences of oxygen deficiency for the baby. They help to remove decay products after hypoxia, improve the condition of the crumbs.
6. If the cause of the pathology is uterine fibroids, Curantyl is prescribed, which reduces the likelihood of blood clots and has a positive effect on hemodynamics.
7. Cocarboxylase is used to restore tissue respiration.

The course of treatment is carried out twice. The first therapy is prescribed at the time of detection of pathology, the next one for a period of thirty-two to thirty-four weeks. If the hemodynamic disorder is serious, at this time the obstetrician-gynecologist determines the time and method of delivery. Natural childbirth is indicated for a pregnant woman only with problems with hemodynamics of the first degree. In other cases, emergency or planned delivery by caesarean section is recommended, depending on the severity of the abnormalities.

If stage 2-3 of the pathology is detected, conservative drug therapy is not carried out. Surgical treatment is carried out by delivery. At the age of the fetus up to 32 weeks, experts evaluate its viability and condition. A newborn child is placed in an incubator where neonatologists and other specialists monitor his condition and further development.

All decisions on how to improve hemodynamics with the help of medications are made by the doctor. Independent uncontrolled intake of drugs threatens the further development of the pathology and termination of pregnancy.

What to do to prevent pathology - preventive measures

The best preventive measure for the pathology of hemodynamics between the mother's body and the developing child is adherence to the principles of a healthy lifestyle. The bad habits that a woman had before conception must be completely abandoned.

An important factor in the healthy development of the baby is the proper balanced nutrition of the mother, the use of foods rich in vitamins and minerals, as well as trace elements that improve the functioning of the cardiovascular system.

A pregnant woman needs to monitor the amount of fluid she consumes, and also be attentive to her state of health, make sure that there are no swelling of the limbs, preeclampsia.

Performing simple gymnastic exercises will help maintain good health and optimal functioning of all body systems of the expectant mother.

What matters in preventing pathology is the rate at which a woman gains weight during pregnancy. It should correspond to the initial weight of the woman before conception, the structure of her body and the gestational age. Exceeding the norm is not desirable.

The most important of all preventive measures is considered to be timely registration, carrying out all planned diagnostic research methods to detect abnormalities in the baby's blood supply, as well as timely adjusted tactics for monitoring pregnancy and delivery.

Conclusion

The state of blood flow in the placenta and umbilical cord during gestation is subject to mandatory monitoring by the obstetrician-gynecologist observing the pregnancy.

A future young mother must be sensitive to any changes in her condition and the baby's motor activity, not ignore planned diagnostics and adhere to the treatment tactics prescribed by a specialist if she has a stage 1b problem with placental blood supply. Of great importance in resolving the situation is the mother's positive attitude and adherence to her principles of a healthy lifestyle.

Blood flow disorders in the uterine arteries, umbilical cord, placenta during pregnancy (NMPK)

Currently, the assessment of uteroplacental blood flow is a mandatory study in the generally accepted standards for the management of pregnant women. Thanks to triple ultrasound screening, which is performed on expert-class devices, obstetrician-gynecologists are able to recognize the degree of uteroplacental blood flow disorder (UTPC) in time, and, most importantly, choose the necessary tactics for managing the patient.

How is the circulatory system between mother and fetus arranged?

Many people mistakenly think that only the placenta is responsible for blood flow in the mother-fetus system. In fact, this is too superficial a judgment, because everything is much more complicated.

The uteroplacental blood flow system is an anatomically complex complex of the placenta, as well as the blood vessels of the mother and fetus.

Levels of the uteroplacental system:

1. The main vessels that bring blood to the placental complex are the terminal branches of the uterine arteries. An interesting fact is that before pregnancy, these arteries are called "spiral", since they contain muscle cells that can contract and close the lumen of the vessel. This is necessary during menstruation in order to quickly stop uterine bleeding. But what happens during pregnancy? Starting from 4-5 weeks of gestation, the walls of the spiral arteries undergo changes, namely, the muscle layer disappears in them. Thanks to these processes, a full blood flow to the placenta is maintained. It has been proven that already by the 16th week of pregnancy, the spiral arteries are completely transformed. However, it is precisely for this reason that obstetric bleeding is so massive, and it is so difficult to stop them, because the terminal branches of the uterine arteries no longer spasm.
2. The placenta is the central link in the uteroplacental system. It is here that the most complex processes of blood transfer from mother to child take place. Everyone has long known the postulate that maternal and fetal blood do not mix. But how does it happen? All this is achieved due to the complex anatomical structure. The placenta is very firmly attached to the inner wall of the uterus with the help of the so-called villi. These "outgrowths" of placental tissue are, as it were, immersed in the thickness of the uterine mucosa. Placental villi penetrate into the walls of the uterine vessels and are practically "washed" by maternal blood. It is here, at the cellular level, that complex processes of diffusion of maternal and fetal blood take place, separated from each other by only a few layers of cells. This is called the "blood-placental barrier", which literally means "the barrier between the mother's blood and the placenta." In addition, it is in the placenta that two blood flows “meet”: from mother to child and vice versa. Such a complex and fragile system cannot but cause admiration!
3. The umbilical cord vessels are the third layer in the complex system of blood flow between mother and child. The umbilical cord contains three vessels: two arteries and one vein. The hemodynamics (blood circulation) of the fetus is arranged in such a way that the arteries bring blood to the organs and tissues of the baby, and the vein, on the contrary, performs the function of returning blood to the placenta. Violation of blood flow at this level is called "fetal-placental", it is the most severe option for the fetus in terms of prognosis.

Video: Fetal Circulation Lecture Series

Causes that can lead to impaired blood flow in the mother-placenta-fetus system

• in a pregnant woman. The decrease leads to an acceleration of blood flow in all vessels, including the uterine arteries. This happens for one simple reason: with anemia, the body tries to increase the delivery of oxygen to the tissues by increasing the speed of circulating blood. This is a compensatory response. The same thing happens in the utero-placental system.
• Pathology of placental attachment(low placentation, presentation) is characterized by reduced blood flow, since in the lower segment of the uterus the muscle layer is much thinner than in other areas. A similar situation develops when the placenta is attached to the scar on the uterus (usually after a previous caesarean section). The thinned area of ​​the scar cannot fully provide blood flow, so the amount of blood that enters the fetus may not be enough for the normal functioning of the developing organism.
• (late toxicosis) is one of the most common causes of impaired blood supply to the uteroplacental system, since with this obstetric complication, small vessels are damaged.
• Various infectious diseases transferred during pregnancy. Some microorganisms infect the placenta and cause pathological changes in its tissue, which can cause placental insufficiency.

Why is NMPK dangerous for the fetus?

- one of the main consequences of NMPK

Reduced blood supply to the fetus can cause the following obstetric complications:

1. Decreased weight and size (syndrome of intrauterine growth retardation);
2. Violation, in addition to tachycardia (rapid rhythm) and bradycardia (slow rhythm), arrhythmia can also develop as a result of a violation of the electrolyte composition of the blood;
3. Violation of the acid-base balance in the body of the fetus (change);
4. Pathological functioning of the hormonal system of the child;
5. A pronounced decrease in fat depots, which is also manifested by a low body weight of the fetus;
6. The threat of termination of pregnancy;
7. A critical violation of blood flow can cause intrauterine death of the fetus.

Degrees of violation of uteroplacental circulation

Changes can occur at each of the levels of the system, which is the basis of the classification:

• 1 A - characterized by changes in blood flow in one of the uterine arteries, while the rest of the parameters of the system are normal.
• 1 B - blood circulation is disturbed at the fetal-placental level (vessels of the umbilical cord), while the indicators in the uterine arteries are within the normal range.
• 2 - violation at the level of the uterine and umbilical vessels.
• 3 - characterized by critical indicators, up to reverse (reverse) blood flow in the arteries.

This classification is extremely convenient for physicians, as it accurately reflects the level at which changes have occurred. In addition, the degree of violation of the uteroplacental circulation also affects the tactics of managing the patient.

At grade 1 (A and B), pregnancy can be maintained and treated with conservative methods, grade 2 is borderline, and at grade 3, emergency surgical delivery may be required.

Diagnostic methods

The "gold standard" of blood flow disorders in the mother-placenta-fetus system at the moment in obstetrics is. This method opens up opportunities for recognizing even the smallest changes, as it has high sensitivity and information content.

Doppler is a type of ultrasound that uses the Doppler effect. The essence of the study is to measure the frequency of an ultrasonic wave reflected from moving objects. In the study of blood vessels, the moving particles are blood cells, in particular, erythrocytes, as the most numerous cells. Registration of the received data and their comparison with the norm is called dopplerography.

What are the benefits of doppler sonography?

1. Modern ultrasound machines make it possible to examine the direction, speed of blood flow in the uterine arteries, and even intraplacental blood flow.
2. Thanks to color mapping, it is possible to study the blood flow in vessels with different blood flow (arteries and veins) separately. The direction of arterial blood on the device is reflected in red, and venous - in blue.
3. It has been proven that the use of this method during pregnancy does not adversely affect the development of the fetus.
4. A unique feature of the method is the prediction of the development of pregnancy. What does this mean? Many studies have shown that disturbances in the blood flow of the uterine-placental system appear a little earlier than any clinical manifestations of fetal suffering appear (weight loss, changes in heart rhythm, etc.). And this means that with the timely diagnosis of fetal circulatory disorders, the doctor has a small amount of time to make the right decision. An example of this is the detection of a change in blood flow, which is called "dicrotic notch" in 90% of cases before the development of clinical manifestations of preeclampsia (edema, increased blood pressure, the appearance of protein in the urine). Dopplerography is widely used in obstetric practice, as it opens up the opportunity for doctors not only to recognize blood flow disorders in time, but even to prevent the development of certain pregnancy complications.

Recently, the results of the use of Doppler ultrasound are being published more and more often, not only during pregnancy, but during childbirth. The conducted studies prove that the effectiveness of contractions can be assessed by measuring the diastolic blood flow velocity in the uterine arteries. Thus, this research method can even predict weakness or incoordination of labor activity already at the beginning of the first stage of labor.

case from practice

The non-standard situation that occurred in the maternity ward made obstetrician-gynecologists think about the use of Doppler ultrasound during childbirth.

A 25-year-old woman without any concomitant pathology was admitted to the genus. house with regular contractions every 3-5 minutes. Childbirth the first, urgent.

According to the anamnesis: the pregnancy proceeded without complications, no pathology was found on the part of the fetus, all ultrasound protocols with Doppler ultrasound were within the normal range.

The first stage of labor proceeded physiologically, with the full opening of the cervix, the woman in labor was transferred to the delivery room.

However, during the attempts, at first glance, inexplicable phenomena began to occur: the fetal heartbeat during the attempts was restored, and in the intervals between the attempts it slowed down significantly. Although, as a rule, everything happens the other way around. In this regard, it was decided to perform an ultrasound with a study of blood flow in the vessels during childbirth. The result of the study surprised everyone: in the intervals between contractions, the fetus clamped the umbilical cord with a pen, as a result of which the blood flow was significantly disturbed. As hypoxia increased in the child's body, his arms weakened, and he let go of the umbilical cord, meanwhile the blood flow was restored. Given the picture obtained, it was decided to force the management of the second stage of labor with the use of auxiliary aids. So, thanks to dopplerometry, doctors managed to avoid serious complications.

Secondary diagnostic methods

In addition to dopplerography, there are other research methods that indirectly indicate a violation of blood flow:

• Collection of complaints. In case of circulatory disorders, the fetus experiences hypoxia, which is manifested by an increase in the baby's motor activity. Usually pregnant women complain about the active movement of the fetus.
• Listening to the heartbeat with a stethoscope can also help in the diagnosis. Deceleration or acceleration of the rhythm, which goes beyond the physiological norm, may also indicate hypoxia.
• . Registration of CTG within 40-60 minutes may be enough to diagnose signs of intrauterine fetal hypoxia.
• Some ultrasound indicators (premature aging of the placenta, biophysical profile study) can fix the unfavorable condition of the fetus.

Important! A slight decrease in the estimated fetal body weight on ultrasound does not necessarily indicate a developmental delay and impaired blood flow. An isolated measurement of fetal weight is not very informative, since this indicator is also largely influenced by genetic factors. Therefore, it is necessary to take into account the anthropometric indicators of the parents (height, weight) and their weight at birth. Only a combination of a decrease in fetal weight and impaired blood flow during Doppler sonography gives grounds for making a diagnosis of intrauterine growth retardation syndrome.

Treatment of uteroplacental blood flow disorders

In order to improve the blood supply to the fetus, it is necessary to influence several links of pathogenesis at once:

1. Improvement of microcirculation. The following drugs have this property: "Pentoxifylline", "Actovegin".
2. Maintaining normal blood flow in the vessels, eliminating low blood pressure is achieved through the use of drugs based on hydroxyethyl starch: "Stabizol", "Infukol", "Voluven", "ReoHES", "Venofundin". These drugs are an osmotic solution of starches that are able to retain fluid in the lumen of blood vessels. Their appointment is especially effective for preeclampsia, when it is necessary to transfer fluid from the intercellular to the lumen of the vessel. Thus, two goals are achieved at once: normalization of blood flow and a decrease in the severity of edema.
3. Vasodilator drugs help to eliminate spasm of arteries and arterioles (smaller vessels). Particularly effective use "Eufillina", "No-shpy", "Magnesia" in the form of injections.
4. A decrease in uterine tone also helps eliminate vasospasm, hypoxia, and also maintain pregnancy in the event of a threat of premature birth. In this situation, appoint "Magnesia", "Ginipral", "Magne B6".
5. Antioxidant drugs help to cope with the undesirable effects of hypoxia. Usually prescribed "Tocopherol", "Ascorbic acid", "Hofitol".
6. Useful intravenous administration 5% glucose solution which has detoxifying properties.
7. The drug has a protective effect on the placenta "Essentiale", which saturates placental tissue with phospholipids. This medicine is especially useful in placental insufficiency.
8. When blood flow is disturbed, it is very effective to prescribe drugs that lead to the processes of activation of cellular respiration, for example "Cocarboxylases".
9. With a combination of uterine fibroids and blood flow disorders, the drug showed a good result. "Curantil", it is able to improve blood circulation in the vessels, and also prevents the formation of microclots. Many studies have shown that taking "Kurantil" with a large myoma prevents the development of secondary, inflammatory changes in the myomatous nodes, due to the improvement of blood flow in them and the uteroplacental system.

Conclusion

The study of uteroplacental blood flow using dopplerography is a mandatory study during pregnancy. Practice shows that the use of this method has a positive effect on the prevention and treatment of many obstetric complications. However, do not forget that in order to obtain reliable and informative results, blood flow research should be carried out on expert-class devices by highly qualified specialists.

Video: about fetal hypoxia - a consequence of NMPK

During the period of bearing a baby, a woman may face such a problem as a violation of the utero-placental blood flow of the 1a degree. In this case, the function of the placenta is preserved and the pathological changes are insignificant. However, without treatment, hemodynamic disorders can be dangerous to the health of the mother and child.

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Etiology of placental insufficiency

The causes of hemodynamic disorders can be divided into two groups. Endogenous factors are associated with improper villi maturation and impaired placentation. This leads to the development of an enzymatic-vascular type of insufficiency. Exogenous causes include many factors that lead to placental and uterine forms of circulatory disorders.

Violation of blood flow during pregnancy can be caused by:

• genetic factors;
• defective work of the ovaries;
• viral or bacterial infection.

These factors lead to anatomical pathologies of the placenta, namely, to pathologies of its structure, location and attachment. In this case, primary placental insufficiency develops. It is mainly observed in women diagnosed with infertility. Secondary insufficiency is caused by complications during pregnancy or the presence of gynecological diseases.

Provoke the development of uteroplacental insufficiency can be social and living conditions, for example, malnutrition, physical and psycho-emotional stress during the period of bearing a baby, smoking, drinking alcohol, early or, conversely, late pregnancy.

At risk are pregnant women with extragenital and obstetric diseases. The cause of the development of fetal-placental blood flow disorders can be diseases such as preeclampsia, uterine fibroids, alloimmune cytopenia. External provoking factors include taking certain medications, ionizing radiation, and exposure to chemicals or poisons.

During pregnancy, hemodynamic disorders can be caused by anemia. In this case, the level of hemoglobin decreases and blood circulation accelerates in all vessels and arteries, including in the uteroplacental system.

Infections are especially dangerous during pregnancy. Pathogenic microbes are capable of destroying placental tissue. The rate and volume of blood flow in the uteroplacental system can be adversely affected by a woman's unstable heart pressure. One possible cause of failure is a single artery in the umbilical cord.



In some cases, a degree 1a uteroplacental blood flow disorder can be caused by multiple abortions, surgery, or diagnostic curettage.



Severity of PN

Violation of the uteroplacental circulation has three degrees of development. With a primary placental disorder, the condition of the fetus is assessed as satisfactory. Without appropriate treatment, after a month, this stage becomes more severe.

The first stage is subdivided into 1a and 1b degrees. Grade 1a is the mildest form. In this case, the fetal-placental circulation is practically not disturbed. The causative factor of such a violation is mainly intrauterine infections. According to medical statistics, in 85-90% of cases, the fetus lags behind in development. At grade 1b, uteroplacental blood flow is preserved, but functional changes in the placental system are observed. The probability of fetal growth retardation in this case is 80%.



Secondary placental insufficiency is characterized by a violation of both circulatory systems. If medical assistance is not provided at this stage, then in a week hemodynamic disorders will become severe. Cardinal changes and defects in the uteroplacental blood flow are observed at the third stage of development. In this case, the child is in critical condition.

This classification is used by doctors to display the level of placental disorders. In accordance with the severity of the development of hemodynamic disorders, the tactics of managing the patient changes.

If the first degree of blood flow disturbance was diagnosed in a timely manner and appropriate treatment was prescribed, then the consequences are minimal. In this case, the pregnancy persists. With the help of conservative treatment, it is possible to avoid the death of the child. Drug therapy in the second or third stage is considered ineffective. The mortality rate is 50%. In order to avoid the death of the baby, doctors perform a "caesarean section".





Types and symptoms

Clinical symptoms of PN depend on the nature of the pathology. An acute form of insufficiency can develop in any trimester of pregnancy. There is a violation of the gas exchange function of the placenta, which can lead to fetal hypoxia. The acute form develops due to premature placental abruption or vascular thrombosis.

Often, women with a chronic form of insufficiency enter the clinic. She makes herself felt in the 2nd trimester. Fibrinoid is formed on the surface of the placenta, which disrupts the transplacental exchange.

In a chronic course, placental insufficiency can occur in a compensated, decompensated, subcompensated and critical form. In the first case, pathological changes are insignificant. With proper therapy, there is a high probability of having a healthy baby.



In the decompensated form, there is a violation of the heart and a delay in the development of the fetus. In this case, there is a risk of intrauterine death of the child. With subcompensated insufficiency, pregnancy is quite difficult. Placental insufficiency does not pass without a trace. The risk of developing various complications is very high. The critical form is irreversible. This form is characterized by morphofunctional pathological changes. For a child, a critical form is fatal.

The chronic form is often asymptomatic. Many mothers may not be aware of its presence. Placental insufficiency can be detected by ultrasound.

The decompensated form can be determined by the activity of the fetus. The baby begins to move actively already at 28 weeks of pregnancy. Mommy can feel up to 10 movements a day. If the fetal activity indicators are significantly lower, then you should immediately consult a doctor.

Placental insufficiency can affect the slow growth of the abdomen. This symptom is due to a delay in the development of the crumbs. This symptom is almost impossible to identify on your own. Doctors observe changes in the growth of the tummy, so a woman must undergo a routine examination.



If a woman has spotting during pregnancy, it can be life-threatening for the baby. Bloody discharge is a symptom of premature placental abruption.



Diagnostic measures

Diagnosis of uteroplacental circulatory disorders is carried out on the basis of the patient's complaints and the results of physical, laboratory and instrumental studies.

The physical examination includes assessment of such parameters as abdominal circumference, height and weight, the number of active fetal movements, uterine tone, and the presence of vaginal discharge. To determine the hormonal functioning of the placenta, a laboratory study is carried out. The assessment of placental function is determined on the basis of blood and urine tests.



As an instrumental examination, ultrasound and computed tomography are performed. Ultrasound examination and CT can determine the thickness, structure and location of the placenta, as well as the presence of edema and extragenital diseases.

Instrumental studies during pregnancy are carried out three times. The first - from 11 to 14 weeks, the second - from 20 to 24, the third - from 32 to 34.

In the presence of obstetric or extragenital pathologies, it may be necessary to consult other doctors.



With timely diagnosis and treatment, the consequences are minimized.

Pathology therapy

The treatment regimen is determined by the attending physician based on the results obtained, the form and degree of insufficiency, and the individual characteristics of the woman's health. To relax the muscles of the uterus, doctors prescribe tocolytics. This group of drugs includes Ginipral and Partusisten. These drugs reduce pressure in the vessels and arteries, normalize uteroplacental circulation. Trocolytics can cause side effects such as low heart pressure, tremors, nausea, and chills. When such symptoms appear, doctors prescribe Isoptin or Verapamil.



Vasodilating effect has No-shpa, Trental and Eufillin. In addition, they improve blood flow. Side effects may include migraine, nausea, vomiting, and heartburn. Taking these drugs is contraindicated in diseases of the heart, thyroid gland, and also in epilepsy.

To avoid thrombosis, doctors prescribe antiplatelet agents. This category of drugs includes Curantyl and Aspirin. These drugs are taken until the 34th week of pregnancy, otherwise there is a risk of bleeding during childbirth.

In case of violation of the uteroplacental circulation, conservative treatment includes taking Actovegin. This drug develops resistance to hypoxia in the fetus. In addition, it stimulates cell regeneration. This drug is also prescribed for prophylactic purposes. The course of treatment is carried out during the entire pregnancy.

With the diagnosis of "placental insufficiency", a pregnant woman is prescribed Instenon. This tool helps to improve cerebral circulation and the heart. When prescribing Instenon, doctors recommend giving up strong coffee and tea, as these drinks weaken its therapeutic effect.

The doctor determines the course of treatment and dosage of drugs purely individually.



Depending on the effectiveness of drug treatment, the doctor determines the method of delivery. In the first degree or chronic compensated form, childbirth is carried out naturally. In all other cases, doctors perform a "caesarean section".

Necessary Prevention

As a preventive measure for the development of uteroplacental circulation disorders, doctors recommend eliminating physical and psycho-emotional stress. This will help reduce pressure in the blood vessels. Otherwise, changes in the volume and speed of blood flow are possible. Non-drug prevention includes bed rest and treatment with folk remedies. Medicinal decoctions and herbal infusions that have a calming effect are considered useful. These herbs include valerian, lemon balm, motherwort, chamomile and immortelle. Herbal collection of these herbs is considered useful. Mix all the ingredients in equal amounts and pour 1-1.5 tablespoons of 200 ml of boiling water. Take the infusion throughout the day in small sips.

In addition, special attention should be paid to nutrition during pregnancy. It should be balanced and useful. Nutritional supplements that stimulate bowel function are considered beneficial.



During the period of bearing a baby, it is necessary to exclude harmful factors that can provoke the development of placental insufficiency, for example, smoking or drinking alcohol.

From the 14th week of pregnancy, medication courses can be prescribed as a preventive measure. For this purpose, the pregnant woman is prescribed antispasmodic and detoxifying drugs. Timely prevention and drug therapy reduce the risk and severity of complications of pregnancy and childbirth.

The placenta in the body of a future mother plays not only the well-known role of a transport channel for supplying the fetus with nutrients. Its functionality extends much more widely - up to ensuring the complete protection of the child from the effects of negative substances and that may be present in the feeding maternal environment. Violation of blood flow during pregnancy is a direct threat of intrauterine death of the fetus due to poor 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 barrier functions are provided by the first mechanism of the blood circulation of the mother-fetus - the hematoplacental barrier, which is a kind of unique filter that works in only one direction: by removing waste substances from the fetus along with the blood flow.

The movement of blood in the reverse order, from mother to child, is carried out through the arteries, which 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 also increases.

The vessels of the uteroplacental circle, isolated by the umbilical trunk, are the third important mechanism of blood circulation between two organisms - feeding and feeding. Violation of 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. This occurs due to compensation for the lack of oxygen and cannot but affect the processes in the development of the fetus and the quality of blood exchange;
• The position of the placenta. If presentation is diagnosed, which can be justified by a cesarean section, then the blood supply will be clearly reduced due to the thinning of the uterus at the site of the scar;
• Late toxicosis causing pathological changes in the work 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 the period of gestation. Some of them can cause damage to the placental tissue and contribute to the development of placental insufficiency;
• - may be complicated by the anemic condition of the fetus;
• Defects of the uterus. The most significant of them, capable of changing 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 obtained as a result of surgical interventions, or as a result of bad habits;
• Tumors such as fibroids, especially dangerous in women who have not given birth before after thirty-five years. This also applies to uterine fibroids, which are abundantly saturated with blood during perinatation. Against the background of an increase in size and the formation of a myomatous node, a persistent lack of blood flow to the placenta is formed;
• , which do not allow maintaining the uniformity of the blood flow rate;
• Pregnancy complicated by multiple pregnancy. Since the placenta is forced to adapt to the maintenance of several feeding organisms in proper conditions at once, such errors in the blood supply as the donor position of one of the fetuses are not excluded. Often at the same time, there is an underdevelopment of the feeding fetus, a significant lack of weight and physiological normal signs. A child who unwittingly acts as a recipient also suffers seriously from, on the contrary, too abundant blood supply;
• Mother's disease, sometimes developing precisely against the background of pregnancy, loosens the walls of blood vessels, which affects blood circulation in a bad way.

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

• Violation of 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;
• Violation of blood flow during pregnancy 1B - there are violations of blood circulation in the vessels of the umbilical cord, despite the fact that the state of the vessels of the uterus is unchanged;
• 2 - a comprehensive violation of both the 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 keep the pregnancy and give birth to a healthy baby, subject to the prescribed treatment and all the doctor's recommendations. Grade 2 allows for fetal preservation, but this will require hospitalization. Grade 3 requires immediate surgical removal of the fetus to save 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 at one of the early stages of violations are clearly visible on the screen, since Doppler provides a picture in color and has a high degree of resolution in terms of the clarity of the picture.

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 the blood circulation inside the placenta. Then the indicators taken during the survey are compared with the table of normative data and the result is recorded.

The biggest plus of dopplerography, in addition to the safety of the study, is the accurate prediction of any form of abnormality, detecting them at the stage when it is still possible to save the fetus and not harm the mother's body.

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

• Analysis of the activity of the fetus, based on the words of the mother;
• 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;
• Achievement of optimal blood pressure;
• Vasodilation with spasmodic manifestations in the arteries;
• Reduction of uterine tone due to the relaxation of blood vessels;
• Prevention of the consequences of oxygen starvation (hypoxia);
• Saturation of the placental tissue with the phospholipids it needs.

Consequences

Depending on the degree and nature of circulatory disorders during pregnancy, there are also difficulties in the development of the fetus, 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 of the stages, or significant delays in its intrauterine formation;
• Critical indicators of weight and size;
• Rapid, slow, or intermittent heartbeat;
• Floating blood pH;
• Improper course of hormonal processes;
• Risk of miscarriage.

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

Such a diagnosis as “Violation of the uteroplacental blood flow” is made to pregnant women quite often, but not every gynecologist finds time to explain to the expectant mother what it is. Let's see in this article why this conclusion is dangerous and for what reason there are violations in the uteroplacental blood flow.

In the body of a pregnant woman, there is an established system that allows the baby in the womb to receive all the necessary nutrients. An approximate scheme of this system consists of three components: "the mother's body - the placenta - the fetus's body." If any part of this relationship is violated, then this leads to complications in the condition and development of the baby with simultaneous complications in the course of pregnancy.

There are three levels of violations:

The first degree, when the development of the fetus is satisfactory, and the violations are not of a dangerous nature and concern exclusively the uteroplacental blood flow. In the absence of a response from specialists and proper treatment, this stage can last 3-4 weeks on average and goes to the next level 2. It is divided into 2 types:

1A) When the fetal-placental circulation is normal, and abnormalities are seen in the uteroplacental circulation. Fetal growth retardation syndrome develops in approximately 90% of cases.

1B) It is characterized by normal uteroplacental circulation, but complications in the fetal-placental circulation. Fetal growth retardation syndrome develops in approximately 80% of cases.

• The second degree is characterized by impaired blood flow through the vessels both in the fetus and in the uterine blood flow. This degree very quickly (sometimes within 1 week) can go to 3 degrees.
• The third degree means that the blood supply to the fetus is at a critical level.

What complications and diseases lead to the risk of placental insufficiency

• hypertension of varying severity;
• threat of interruption;
• pyelonephritis;
• birth in the past of children with fetal growth retardation syndrome;
• previously transferred severe form of preeclampsia.

Table. The course of pregnancy depending on the degree of uteroplacental blood flow disorders

Degrees of violation	Multiplicity of dopplerometric control	Direction of treatment	Method of delivery
1	Up to 30 weeks - 1 time in three weeks; 30-34 weeks - 1 time in two weeks; 35-40 weeks - 1 time per week. If the obstetrician-gynecologist suspects that the condition of the fetus has worsened, then doplerometry is performed unscheduled	Elimination of complications from the pregnant woman, which are associated with diabetes, preeclampsia and other pathologies. Mandatory treatment of placental insufficiency.	Antenatal hospitalization will be performed at 37 weeks. Childbirth takes place naturally with an early artificial puncture of the fetal bladder.
2	Every 3-4 days	The pregnant woman is immediately sent to the hospital. The treatment is aimed at the maturation of the child's lungs, the elimination of complications from the woman's side, and the intensive restoration of placental insufficiency.	Cesarean section with epidural anesthesia.
3	In dynamics	Determination of the cause and treatment	Immediately perform a caesarean section. If the pregnancy is premature, then the decision is made based on the wishes of the pregnant woman.

Treatment of disorders of the uteroplacental blood flow of the 1A degree is carried out in a complex manner, based on the reasons that caused it. Preparations: Actovegin, Ginipral, Curantil, Pentoxifylline and others.

Attention! This article contains general information only and is not intended to replace the advice of a qualified professional.