Placental insufficiency

As Placental insufficiency one describes a deficiency function of the placenta, which is important for the nutrition of the unborn child. The placenta is not supplied with enough blood, so that the exchange of substances between the fetus and placenta does not function properly.

What is placental insufficiency?

The placenta is of great importance for the unborn child because it allows nutrients and oxygen to pass from the mother's circulation to the child's. In addition, hormones are formed in the placenta, including, for example, gestagens, oestrogens and human chorionic gonadotropin (hCG).

In addition, the placenta ensures the removal of waste products and keeps toxins away from the unborn child. The placental barrier is therefore a kind of filter that can be used to protect the fetus. If the placenta is unable to perform these functions, then one Placental insufficiency spoken.

causes

Acute placental insufficiency occurs when blood flow is decreased in the infant or maternal portion of the placenta. Possible causes for this can be a drop in blood pressure or a storm in labor during the course of the birth. But also the so-called vena cava compression syndrome (a circulatory disorder of the mother because the child exerts pressure on the inferior vena cava while lying down) or premature placenta loosening can cause placental insufficiency. In some cases, umbilical cord problems such as knot formation, herniation or entanglement are also the cause.

In the case of acute placental insufficiency, the child is not supplied with sufficient oxygen, so that there is a risk to life. Slowed growth in the unborn child is the cause of chronic placental insufficiency, whereby there is usually an underlying disease on the part of the mother such as high blood pressure, kidney failure, diabetes mellitus or anemia. However, circumstances that are specific to pregnancy can also cause current placental insufficiency.

These include, for example, preeclampsia (pregnancy intoxication) or rhesus incompatibility. Furthermore, nicotine or alcohol can lead to acute placental insufficiency during pregnancy. Other factors that can promote chronic placental insufficiency are also slight weight gain in the mother during pregnancy, especially if she has a low body mass index before pregnancy. A low height of the mother, drug abuse during pregnancy and other genetically determined factors also play a decisive role.

Symptoms, ailments & signs

In the case of acute placental insufficiency, no direct symptoms can actually be identified. It occurs suddenly during the birth process. The child is underserved and the heartbeat slows down. The mother may have cramps and bleeding. Another warning sign can be very infrequent child movements. In this case, it is best to consult a doctor.

With chronic placental insufficiency, the child grows very slowly and the amount of amniotic fluid is reduced. The unborn child reacts to the insufficient supply in a variety of ways. These include the following changes:

• metabolic: the release of insulin, gluconeogenesis and lactate increase and the ability to transport amino acids decreases.
• endocrine: increase in glucagon and decrease in cholesterol
• vascular: The fetal blood flow is redistributed, which leads to an increase in blood flow in the adrenal gland, coronary arteries, and liver.
• biophysical: Maturation is delayed and the heart rate changes. The physical activity decreases.
• Haematological: Changes in the immune system occur, in particular the number of B lymphocytes and T helper cells decreases.

Diagnosis & course of disease

If, for example, the mother has diabetes mellitus, the reduced growth in size of the child can be determined with the help of an ultrasound examination. In addition, the doctor can use Doppler sonography to measure the blood flow rate and thus receive an indication of possible placental insufficiency. Sometimes the mother is admitted to hospital with chronic placental insufficiency so that the baby can be monitored and treated immediately if any problems arise.

The following criteria are also used to diagnose chronic placental insufficiency, such as fetal locomotor activity and fetal heart rate, oxytocin stress test (OBT) and amnioscopy. The color of the amniotic fluid, Clifford rating and imaging procedures (sonography, MRT) to be able to detect a brain lesion postportally.

Complications

Placental insufficiency can lead to serious complaints and complications during pregnancy or childbirth. As a rule, however, this disease is only discovered by chance, so that early diagnosis and therapy are usually not possible. In most cases, the mother suffers from heavy bleeding and cramps due to placental insufficiency.

These lead to severe pain and not infrequently to irritability of the person concerned. Internal restlessness or feelings of fear can also occur due to placental insufficiency and thus significantly reduce the quality of life. The amount of amniotic fluid is reduced, so that the child suffers from a clear undersupply. In the worst case, this can lead to the development of various deformities or malformations.

In the worst case, the affected person suffers a stillbirth or the child dies shortly after birth. For this reason, patients and their relatives are often dependent on psychological treatment. As a rule, if there is placental insufficiency, childbirth must be initiated early. This can lead to different complications. The mother's life may also be endangered due to the premature birth.

When should you go to the doctor?

Acute placental insufficiency manifests itself as bleeding and cramps. If you experience these and other unusual symptoms, you should see a gynecologist. The gynecologist can determine the condition with the help of an ultrasound examination and initiate further measures. If there is a risk of premature birth, the patient must be immediately admitted to a hospital. Close medical supervision is then indicated until the premature baby is born so that any complications can be responded to quickly. Mothers who developed placental insufficiency during pregnancy must also receive additional follow-up examinations.

The child must also be examined in detail by the pediatrician and a neurologist. Chronic placental insufficiency does not produce clear symptoms. If the condition is diagnosed as part of maternity care, regular visits to the doctor are recommended. If the treatment measures do not show the desired effect, the doctor must be informed. Depending on the suspected cause, a cardiologist or nutritionist may be involved in treatment. Many patients also need therapeutic support.

Therapy & Treatment

If acute placental insufficiency occurs, immediate emergency measures are required. These include, for example, a forceps or suction cup delivery or a caesarean section. If the placenta loosens prematurely, the birth is also induced prematurely. With chronic placental insufficiency, strict bed rest is required and the condition of the unborn child is regularly checked by CTG (cardiotocography) or ultrasound examinations. A direct treatment of the restricted function of the mother cake is not possible, however.

However, causes such as diabetes mellitus or high blood pressure are treated. However, the child can suffer severe damage due to a lack of oxygen supply. In the case of extreme undersupply, it is therefore necessary to induce the birth before the due date. If the unborn child is not yet ready for birth, lung maturity can be accelerated with appropriate medication. If the baby is small but continues to develop, the causes of the chronic placental insufficiency should be eliminated, otherwise there is no urgent need for action.

prevention

If the mother has diabetes or high blood pressure, impaired placental function can be identified and treated with the help of intensive examinations. In addition, pregnant women should also refrain from cigarettes, as this can greatly reduce the failure of the mother cake.

Aftercare

In most cases, those affected with placental insufficiency have no special and direct follow-up measures available. First and foremost, a quick and, above all, very early diagnosis and subsequent treatment of the disease is necessary in order to prevent further complications and complaints. However, in many cases the placental insufficiency cannot be completely cured and the child may die.

An early diagnosis therefore usually has a very positive effect on the further course of this disease. In many cases, the child is born by caesarean section. The mother should definitely rest and take care of herself after the procedure. Exertion or physical and stressful activities should be avoided.

In many cases of placental insufficiency, the support and care of family and friends is very important. This can prevent depression and other psychological complaints from developing. Surgery is not always necessary, so that placental insufficiency does not always have to be treated when the child is developing normally.

You can do that yourself

Placental insufficiency means that the child can no longer be adequately cared for in the womb. Mothers who consume nicotine during pregnancy run the risk of the placenta becoming so calcified early on during the 40 weeks of pregnancy that the baby is no longer adequately supplied. Accordingly, in the area of ​​self-help, it is urgently advisable to give up smoking immediately during pregnancy. Mothers who smoke despite known risks should not hide this from the doctor, but speak openly about their vice.

With the help of special ultrasound examinations, the doctor can determine how the child is being looked after during the preventive care. It is therefore important in everyday life that mothers attend all check-up appointments and also address known risks such as nicotine, so that the gynecologist can pay particular attention to the supply via the placenta.

Aside from risks such as smoking, placental insufficiency is often a surprising finding that is unrelated to the mother's lifestyle or known other illnesses. Accordingly, those affected cannot treat placental insufficiency themselves. Once the insufficiency of the placenta has been determined with certainty, it is necessary to carry out close checks. If it is found that the baby is undersupplied in the stomach, therapy can only consist of ending the pregnancy and initiating the birth.