❶ How To Diagnose Placental Insufficiency

Placental insufficiency is a complex syndrome that occurs in various pathological conditions in the maternal and fetal organisms. It is characterized by a violation of the adaptive and homeostatic reactions of the placenta at the molecular, cellular and tissue levels. Location: Location:

Pathogenesis is determined by a violation of the main functions of the placenta: protein synthesis, ensuring the development of the embryo, gas exchange, hormonal disorders, regulation of blood pressure, regulation of blood coagulation and others. Pathology of the placenta is the leading cause of fetal mortality.

This pathology is capable of causing changes in the child's body, which for many years provoke the occurrence of mental and physical development disorders, as well as an indirect cause of increased somatic and infectious morbidity. Placental insufficiency can be divided into two types: primary, which is associated with dystrophic changes in the chorion, and secondary, which, in turn, is divided into acute, subacute and chronic. The latter is relative, compensated, decompensated and subcompensated.

Primary insufficiency is formed in the early stages of pregnancy under the influence of various factors, such as alcohol consumption by the mother, smoking, the influence of industrial production, anatomical disturbances in the structure of the chorion and its attachment. As a rule, this developmental anomaly ends in spontaneous miscarriage.

Secondary develops from the 20th week of pregnancy, when the placenta is already formed. Acute and subacute insufficiency develops in hypoxic conditions of the fetoplacental complex against the background of a sharp violation of microhemocirculation (weakness of labor, placental abruption, eclampsia, shock, hypoxia). Chronic hypoxic conditions lead to persistent placental insufficiency syndrome. Timely diagnosis makes it possible to carry out a targeted correction of violations during pregnancy and childbirth, is the basis for dispensary observation of the child.

Diagnostic methods are prenatal and postnatal. The gynecologist prescribes an ultrasound scan. The study gives 70-80% accuracy of the result. With a normal pregnancy, the thickness of the placenta constantly increases with the growth of the fetus in the uterus. The most intense increase is observed after 30 weeks. By the time of delivery, the thickness either does not change in size, or it decreases. Thinning up to 2 cm or increase up to 5 is considered placental insufficiency.

A decrease in the thickness of the placenta is observed with post-term pregnancy, the presence of diabetes mellitus in the mother, and the establishment of Rh-conflict. In some cases, a diagnosis of infant malnutrition is made. Placental calcification is diagnosed as small areas of increased acoustic density, in this case, the placental septa have a lobular structure.

With partial premature detachment of a normally located placenta, its atrophy is often found. For diagnostics, you can use a gamma scintillation camera. The pregnant woman is placed on a couch so that the placenta and the woman's heart are projected into the registration field. 2 ml of serum albumin is injected intravenously. Registration of changes is made. The volumetric blood flow is calculated. The method is absolutely harmless, radiation exposure to the fetus and the mother is minimal. The disadvantage of this method is the possibility of its application in large laboratories with gamma cameras.

Prenatal diagnosis of placental insufficiency consists in establishing the amount of progesterone, estrogen, according to the results of urine tests and the level of blood flow in the blood of the mother and fetus. A Doppler study may additionally be prescribed, the essence of which is to study the normal or pathological supply of the fetus with the necessary nutrients from the mother's body.

If a pathology is detected, an urgent consultation with a specialist and treatment are required, often in stationary conditions under the round-the-clock supervision of doctors.