Placental insufficiency refers to a deficiency of the placenta, which is important for feeding the unborn baby. In this case, the placenta is not supplied with sufficient blood, so that the exchange of substances between the fetus and the placenta does not function properly.
What is placental insufficiency?
The placenta is of great importance to the unborn baby because nutrients and oxygen can pass through it from the mother’s circulation to that of the baby. In addition, hormones are produced in the placenta, including, for example, progestins, estrogens, and human chorionic gonadotropin (hCG), respectively. In addition, the placenta ensures the removal of waste products and keeps toxins away from the unborn child. The placental barrier is thus a kind of filter that can be used to protect the fetus. When the placenta cannot perform these functions, the condition is called placental insufficiency.
Causes
Acute placental insufficiency occurs when blood flow in the fetal or maternal portion of the placenta is decreased. Possible causes may include a drop in blood pressure or a labor storm during delivery. However, placental insufficiency can also be caused by the so-called vena cava compression syndrome (a circulatory disorder of the mother due to pressure exerted by the baby on the inferior vena cava when the mother is lying down) or premature detachment of the placenta. In some cases, umbilical cord problems such as knotting, prolapse or entanglement are also causative. In acute placental insufficiency, the baby does not receive enough oxygen, putting life at risk. A slowed growth of the unborn child is the cause of a chronic placental insufficiency. In this case, there is usually an underlying disease on the part of the mother such as high blood pressure, renal insufficiency, diabetes mellitus or anemia. However, circumstances specific to pregnancy can also cause acute placental insufficiency. These include, for example, preeclampsia (pregnancy intoxication) or rhesus incompatibility. Furthermore, nicotine or alcohol during pregnancy can also lead to acute placental insufficiency. Other factors that can promote chronic placental insufficiency include low maternal weight gain during pregnancy, especially if the mother already had a low body mass index before pregnancy. Low maternal height, as well as drug abuse during pregnancy and other genetic factors, also play a critical role.
Symptoms, complaints, and signs
In acute placental insufficiency, there are actually no direct symptoms that can be detected. It occurs abruptly during the birth process. As a result, the baby becomes undersupplied and the heartbeat slows. The mother may experience cramping and bleeding. Another warning sign can be very infrequent baby movements. In this case, it is best to consult a doctor. In chronic placental insufficiency, the baby grows very slowly and the amount of amniotic fluid is reduced. The still unborn child reacts to the deficiency in many ways. These include the following changes:
- Metabolic: insulin secretion, gluconeogenesis and lactate increase and the transport capacity for amino acids decreases.
- Endocrine: increase in glucagon and decrease in cholesterol.
- Vascular: fetal blood flow is redistributed, leading to an increase in blood flow in the adrenal gland, coronary vessels, as well as the liver.
- Biophysical: Maturation is delayed and heart rate changes. Physical activity decreases.
- Hematological: changes in the immune system occur, especially the number of B-lymphocytes un T-helper cells drops.
Diagnosis and course of the disease
For example, if the mother has diabetes mellitus, the reduced growth in size of the child can be detected by ultrasound examination. In addition, the physician can use Doppler sonography to measure blood flow velocity and obtain an indication of any placental insufficiency. Sometimes, in the case of chronic placental insufficiency, the mother is also admitted to the hospital so that the baby can be monitored and also treated immediately in case of any problems.The following criteria are also used for the diagnosis of chronic placental insufficiency, such as fetal locomotor activity and fetal heart rate, oxytocin stress test (OBT), and amnioscopy. Also amniotic fluid color, Clifford rating, and imaging techniques (sonography, MRI) to detect a brain lesion postportal.
Complications
Placental insufficiency can cause serious discomfort and complications during pregnancy or delivery. However, this condition is usually discovered by chance, so early diagnosis and treatment 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 affected person. Inner restlessness or anxiety can also occur due to placental insufficiency, significantly reducing the quality of life. The amount of amniotic fluid is reduced, so that the child suffers from a significant undersupply. This can lead to the development of various malformations or malformations in the worst case scenario. In the worst case, the affected person suffers a stillbirth or the child dies shortly after birth. For this reason, the patients and their relatives are not infrequently dependent on psychological treatment. As a rule, birth must be induced early in cases of placental insufficiency. This can lead to various complications. It is also possible that the mother’s life may be put at risk because of the premature birth.
When should you go to the doctor?
Acute placental insufficiency is manifested by bleeding and cramping. If these and other unusual symptoms occur, a gynecologist should be seen. The gynecologist can determine the condition by ultrasound examination and initiate further measures. If a premature birth is imminent, the patient must be hospitalized immediately. Close medical monitoring 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 further follow-up care. The child must also be examined in detail by the pediatrician and a neurologist. Chronic placental insufficiency does not cause clear symptoms. If the condition is detected during maternity care, regular visits to the doctor are recommended. If the treatment measures do not have the desired effect, the doctor must be informed. Depending on the suspected cause, a cardiologist or nutritionist may be involved in the treatment. Many female patients also require therapeutic support.
Treatment and therapy
If acute placental insufficiency occurs, immediate emergency measures are required. These may include forceps or suction-cup delivery or cesarean delivery. If the placenta detaches prematurely, delivery is also induced prematurely. In the case of chronic placental insufficiency, strict bed rest is required and the condition of the unborn child is regularly checked by CTG (cardiotocography) or ultrasound examinations. However, direct treatment of the impaired function of the placenta is not possible. However, the causes such as diabetes mellitus or high blood pressure can be treated. However, the child may suffer severe damage due to insufficient oxygen supply. In the case of extreme undersupply, it is therefore necessary to induce birth before the due date. If the unborn baby is not yet ready for birth, lung maturity can be accelerated with appropriate medication. If the baby is small but still developing, the causes of chronic placental insufficiency should be corrected, but otherwise there is no urgent need for action.
Prevention
If the mother has diabetes or hypertension, then impaired placental function can be detected and treated with intensive screening. In addition, pregnant women should also avoid cigarettes, as this can significantly reduce placental failure.
Follow-up care
In most cases, there are no special and direct measures of follow-up care available to those affected by placental insufficiency.First and foremost, a rapid and, above all, very early diagnosis and subsequent treatment of the disease is necessary to prevent further complications and discomfort. However, in many cases placental insufficiency cannot be completely cured, so that the child sometimes dies. Early diagnosis therefore usually has a very positive effect on the further course of this disease. In many cases, the child is delivered by cesarean section. In any case, the mother should rest and take it easy after the procedure. Efforts or physical and stressful activities should be refrained from. In many cases of placental insufficiency, the support and care of one’s family and friends is very important. This can prevent the development of depression and other psychological complaints. Intervention is not always necessary, so placental insufficiency does not always need to be treated if the child develops normally.
What you can do yourself
Placental insufficiency means that the baby cannot receive adequate care in the womb. Mothers who use nicotine during pregnancy risk that the placenta calcifies early during the 40 weeks of pregnancy so that the baby is no longer sufficiently supplied. Accordingly, in the field of self-help, it is strongly advised to stop smoking immediately during pregnancy. Mothers who smoke despite known risks should by no means conceal this from the doctor, but openly address their vice. With the help of special ultrasound examinations, the doctor can determine how the child is being cared for. It is therefore important in everyday life that mothers attend all check-up appointments and also talk about known risks such as nicotine, so that the gynecologist can pay particular attention to the supply via the placenta. Apart from risks such as smoking, placental insufficiency is often a surprising finding that is unrelated to the mother’s lifestyle or other known conditions. Accordingly, affected individuals cannot treat placental insufficiency themselves. Once placental insufficiency has been reliably diagnosed, it is important to carry out close monitoring. If it is determined that the baby in the abdomen is undersupplied, therapy can only consist of terminating the pregnancy and inducing birth.
