Pathogenesis (development of disease)
The placenta, as a connecting link between the maternal and the child’s organism, has the task of supplying the child with the necessary nutrients on the one hand, and on the other hand it serves as a disposer of excretory products from the child. This occurs through diffusion (transfer of a substance from one distribution space to another), metabolization (metabolization) and inactivation (inactivation). In the interaction between mother and child, the hormone production and the immunological barrier function (effective barrier against cells or substances in the sense of self and foreign recognition) of the placenta has an important additional function. However, a central task is also to provide for its own development, maturation and functionality. This entire system is therefore also referred to as the feto-maternal-placental (child-maternal-placental), feto-placental or uteroplacental unit. Disorders of this complex system are multifaceted and only partially pathogenetic (disease-causing). In acute placental insufficiency, the primary cause of fetal hypoxia is a disturbance in gas exchange, e.g., due to vena cava compression syndrome (synonym: hypotensive syndrome; pregnancy complication caused by a circulatory disturbance of the mother due to pressure of the child in utero on the inferior vena cava with obstruction of blood flow to the heart) or umbilical cord compression. In chronic placental insufficiency, the focus is on a deficient supply of nutrients to the child, followed by intrauterine growth retardation (abnormal fetal growth retardation), which leads to oxygen deficiency secondary to stress such as labor. Pathogenetic factors include maternal diseases such as hypertension (high blood pressure), placental disorders, and disorders of maturation and growth of the placenta.
Etiology (Causes)
Behavioral causes
- Diet
- Malnutrition
- Micronutrient deficiency (vital substances) – see micronutrient therapy.
- Pleasure food consumption
- Alcohol
- Tobacco (smoking)
- Drug use
- Drugs, unspecified
- Overweight (BMI ≥ 25; obesity).
Disease-related causes
- Anemia (anemia)
- Diabetes mellitus
- Fetal causes:
- Chromosomal disorders and syndromal conditions.
- Intrauterine infections (especially cytomegaly, toxoplasmosis, rubella, varicella).
- Multiple pregnancy
- Heart disease
- Hypertension (high blood pressure), preeclampsia (disease occurring during pregnancy and characterized by increased blood pressure (hypertension), increased protein excretion in the urine (proteinuria) and water retention (edema)), eclampsia (sudden onset, HELLP syndrome (H = hemolysis (dissolution of erythrocytes (red blood cells) in the blood), EL = elevated liver enzymes, LP = low platelets); Special form of preeclampsia associated with blood count changes).
- Kidney disease
- Systemic lupus erythematosus (SLE) – group of autoimmune diseases in which the formation of autoantibodies occurs. It belongs to the collagenoses.
X-rays
- Radiation exposure
Other causes
- Causes of acute placental insufficiency:
- Umbilical cord complications (umbilical cord nodules, umbilical cord entanglement, umbilical cord too short, umbilical cord compression).
- Placenta praevia hemorrhage (placenta praevia: malposition of the placenta (placenta); it is nested near the cervix and covers all or part of the birth canal)
- Uterine rupture
- Vena cava compression syndrome (synonym: hypotensive syndrome) – pregnancy complication caused by circulatory disturbance of the mother due to pressure of the child in the uterus on the inferior vena cava (vena cava inferior) with obstruction of blood flow to the heart).
- Premature placental abruption
- Labor abnormalities (hypertonic, uncoordinated, prolonged uterine contractions/labor)
- Causes of chronic placental insufficiency.
- Exceeding the term of delivery (e.g., diabetes mellitus).
- Transfer
