Placental insufficiency

Definition - what is placental insufficiency?

Placental insufficiency is a disorder of the so-called fetomaternal circulation. During pregnancy there is a constant exchange of metabolic products between mother and child, which is maintained by the placenta and the umbilical cord. For this, a functioning placenta is essential.

For various reasons, the blood flow to the placenta is disturbed in placental insufficiency and the exchange of substances can no longer take place properly. By definition, a distinction is made between acute and chronic placental insufficiency.

While in acute placental insufficiency a sudden event, such as an umbilical cord prolapse, leads to an interruption of the metabolism, chronic placental insufficiency gradually develops on the basis of general illnesses of the mother. Placental insufficiency is a threatening condition for both mother and child and must therefore be treated.

What accompanying symptoms indicate placental insufficiency?

Placental insufficiency often lacks complaints and symptoms, so that they are usually revealed during preventive medical checkups. The pregnant woman usually does not notice the placental insufficiency. There then characteristic changes in the ultrasound and CTG show, which indicate placental insufficiency.

Acute placental insufficiency or its cause can be characterized by the appearance of various symptoms. Premature detachment of the placenta can manifest itself as sudden, severe pelvic pain, anxiety, excessive contractions (throat storm) and possibly dark, vaginal bleeding. The massive blood loss can lead to shock.

Read more on the topic: Lower abdominal pain during pregnancy

A so-called Placenta previa, which can also be associated with acute placental insufficiency, usually manifests itself as a painless, bright red, vaginal bleeding with other well-being of the pregnant woman.

Inferior vena cava compression syndrome often causes dizziness or even fainting.

Read more on the topic:

• Dizziness during pregnancy
• Pregnancy Complications - What Are The Signs?

Pain in placental insufficiency

Placental insufficiency is usually painless. Chronic placental insufficiency in particular does not cause clinical symptoms such as pain and is therefore only noticeable during regular examinations by the gynecologist.

Acute placental insufficiency can cause symptoms, and pain is also rare.

Heavy labor (labor storm), during which placental insufficiency can occur, is associated with pain. Premature placenta detachment can also be associated with severe pelvic pain. However, pain is not necessarily present at the beginning of the bleeding.

Read more on the topic: Pelvic pain in pregnancy

Other conditions in which acute placental insufficiency occurs, such as vena cava compression syndrome or placenta previa bleeding, do not cause pain.

Preemplampsia and placental insufficiency

Preeclampsia is a pregnancy-associated disease that is associated with an increased risk of chronic placental insufficiency. The disease, which is one of the hypertensive pregnancy diseases, is associated with high blood pressure values ​​and so-called proteinuria.

The high blood pressure values ​​occur for the first time from the 20th week of pregnancy in women who do not have high blood pressure outside of pregnancy. Proteinuria is the appearance of large amounts of protein in the urine. Preeclampsia is a serious disease, the origin of which is not yet fully understood. It has a negative effect on placental function and can result in placental insufficiency.

Read more on the topic:

• Poisoning during pregnancy
• Pregnancy Hypertension - Is It Dangerous?
• Lowering blood pressure during pregnancy

Therapy of placental insufficiency

The treatment of placental insufficiency differs depending on whether it is an acute or chronic event. Furthermore, the cause of the placental insufficiency is also decisive for the therapy.

Acute placental insufficiency must be controlled immediately, as it is life-threatening for the child. If the oxygen supply cannot be controlled by measures such as lying on the left side in the case of a vena cava compression syndrome or medication to prevent contractions in the event of a storm of contractions, an emergency caesarean section must be performed immediately.

In the case of chronic placental insufficiency, a cause should be determined as soon as possible in order to undertake a causal therapy. This can include, for example, strict blood sugar and blood pressure settings. Close monitoring and physical restraint for the pregnant woman until the birth is also very important. Here too, however, a life-threatening lack of oxygen can occur at any time. In this case, a caesarean section is performed.

Duration of placental insufficiency

Acute placental insufficiency develops especially in the last trimester of pregnancy and leads to serious consequences within a few minutes and hours. It is not a permanent clinical picture, but a highly acute event that requires immediate medical attention.

In the case of chronic placental insufficiency, on the other hand, the disturbed metabolic situation develops over days, weeks and even months. The aim is to quickly determine the cause and, if possible, to eliminate it in order to counteract this development.

In the case of an acute state of oxygen deficiency in the child (hypoxia), usually only the emergency caesarean section remains (Emergency section), left to master the situation.

Causes of placental insufficiency

Placental insufficiency can have various causes. A distinction is made between acute and chronic placental insufficiency. Different mechanisms and clinical pictures are responsible for the interruption of the metabolism.

Acute placental insufficiency leads to a life-threatening shortage of oxygen in the child within minutes and hours.

The cause is an acute event, such as an umbilical cord prolapse or an umbilical cord wrapping. In the case of an umbilical cord prolapse, parts of the umbilical cord get between the previous part of the child (usually the head) and the maternal pelvic wall. There the umbilical cord can be pinched off and the blood flow between mother and child is interrupted. It is similar when the umbilical cord is wrapped around yourself or the child's body. The risk of such an incident is particularly high in the case of multiple pregnancies, an abnormal situation (Situation anomaly) of the child or an excess of amniotic fluid (Polyhydramnios) elevated.

Another cause of acute placental insufficiency is the so-called vena cava compression syndrome. This is an entrapment of the inferior vena cava (Inferior vena cava), which carries deoxygenated blood from the body's circulation back to the heart. Especially in the last trimester of pregnancy, it can easily be pinched off by the growing uterus. Therefore, pregnant women should prefer lying on the left side. Other possible causes of acute placental insufficiency are premature placental detachment, Eclampsia, too much labor (labor storm) or placenta previa bleeding. In placenta previa, the placenta is very far down from the cervix and can, as a complication, cause profuse bleeding during pregnancy.

Chronic placental insufficiency usually arises from general or pregnancy illnesses of the mother, which gradually worsen the blood circulation situation between mother and child. Examples of such general illnesses are diabetes mellitus, high blood pressure, anemia (anemia), Fibroids of the uterus but also smoking.

Read more on the topic: Diseases during pregnancy or how dangerous is smoking during pregnancy?

Special pregnancy diseases can also result in such chronic placental insufficiency. These include pregnancy diseases that are associated with high blood pressure, such as preeclampsia or pregnancy-induced hypertension. A pregnancy that is too long (transmission) is also a possible cause.

Read more on the topic: Pregnancy Hypertension - Is It Dangerous? or pregnancy poisoning (pre-eclampsia)

Read more on the topic:

• Childbirth complications
• Breech position
• Umbilical cord around the neck

Smoking during pregnancy

Smoking is a risk factor for many different diseases, including during pregnancy. Smoking can also be the cause of placental insufficiency. The poorer circulation situation that is given to smokers as a result of tobacco consumption can result in chronic placental insufficiency. Not only the direct influence on the blood circulation situation seems to play a role in this context. Smoking causes the development of various metabolic products and inflammation processes in the body, which also have an influence on the function of the placenta.

Read more on the topic:

• How dangerous is smoking during pregnancy?
• How to quit smoking

Diagnosis of placental insufficiency

Acute placental insufficiency is particularly evident in the ultrasound examination and changes in the CTG. The CTG measures the mother's labor and the child's heart rate. In acute placental insufficiency, the child is bradycardic, so the heartbeat is slowed down. Such a slowing down of the heart rate in the CTG is also called deceleration. This is caused by the insufficient supply of oxygen (Hypoxia) with placental insufficiency.

Read more on the topic: Normal CTG values

For example, the ultrasound examination may reveal premature dissolution of the placenta. Doppler sonography shows unusual changes in the blood flow to the placenta.

Chronic placental insufficiency is manifested by various changes that can be seen on ultrasound. Calcification of the placenta and a small amount of amniotic fluid (Oligohydramnios) are also typical of chronic placental insufficiency. The physical development of the child (biometrics) judged. There is a development of deficiency as a result of poor blood circulation.

What can you see in the ultrasound?

The ultrasound examination (Sonography) plays a very important role in the diagnosis of placental insufficiency. Different things such as the amount of amniotic fluid, the physical development of the child and the appearance of the placenta itself are assessed.

In the case of chronic placental insufficiency, the child is developing deficiency, which can be determined using various parameters such as the crown and rump length, the length of the thigh bone (femur length), the chest circumference (thorax circumference) and the diameter of the cerebellum.

Read more on the topic: Development of the embryo

The ultrasound is also used to determine the amount of amniotic fluid, which can be reduced in the case of placental insufficiency. This is known as Oligodydramnios.

When assessing the placenta itself, various abnormalities can be identified. Calcifications as well as a reduced placental size and thickness suggest placental insufficiency. An upstream placenta (Placenta previa) or an early placenta detachment are recognized.

Can placental insufficiency be prevented?

Placental insufficiency can arise due to various causes. Some causes can be actively prevented, but unfortunately not others.

The abstinence (renunciation) of drugs, alcohol and tobacco are important measures to prevent placental insufficiency. By avoiding these harmful substances, the expectant mother has a great influence on her own health and that of her child.

Read more on the topic: Alcohol during pregnancy

A low-protein diet or malnutrition in general can also impair the function of the placenta. Pregnant women should therefore not follow a diet and should value a healthy and balanced diet.

Read more on the topic: Prohibited foods during pregnancy

Furthermore, heavily pregnant women should be careful not to lie on their back for long periods of time, as this can lead to vena cava compression syndrome. Lying on the left should be preferred when lying down.

In addition, it is very important to attend the regular check-ups during pregnancy. If general illnesses such as diabetes, kidney disease or anemia are present, it is important to regularly review the treatment and to discuss the condition of the illness with the attending physician.

Read more on the topic: Pregnancy check-up

How high is the risk of repetition if I have already had an enrollment license?

The prognosis and the risk of recurrence of placental insufficiency can vary greatly from case to case. It is therefore not so easy to specify a general risk of repetition. It depends on the cause of the placental insufficiency.

Chronic maternal illnesses, smoking or pregnancy-related illnesses are associated with a generally increased risk of placental insufficiency.Women who have already suffered from placental insufficiency under such circumstances have an increased risk of developing another placental insufficiency compared to women without these risk factors.

However, acute placental insufficiency does not necessarily have to go hand in hand with an increased risk in future pregnancies.

What are the consequences of placental insufficiency for my child?

Placental insufficiency is a condition in which the child can be exposed to sudden deficiency. Such a sudden lack of oxygen (Hypoxia) can quickly be fatal and must therefore be controlled. If the oxygen supply cannot be restored quickly, a caesarean section is performed.

Chronic placental insufficiency leads to a creeping deficiency in the supply of important nutrients to the child. As a result, the fetus develops poorly. However, as long as it continues to develop and is still in the age-appropriate framework, there is no acute danger to life. However, the cause of the placental insufficiency should be eliminated as soon as possible. However, if the growth has stopped, childbirth must be initiated.

Read more on the topic: Development of the embryo

If there are signs of hypoxia, a caesarean section must also be performed here. However, it appears that children who were exposed to placental insufficiency in the womb are prone to developing certain diseases as they age. These include diabetes, obesity, vascular calcification, and high blood pressure. However, this does not necessarily have to be the case.