Brief overview
- Symptoms: Growth retardation of the unborn child, high blood pressure and protein excretion in the mother
- Causes and risk factors: Malposition of the placenta, diseases of the mother, infections, malnutrition, smoking
- Diagnostics: anamnesis interview, ultrasound, Doppler sonography, CTG
- Treatment: Bed rest, avoidance of nicotine, optimal adjustment of blood pressure and blood sugar
- Course and prognosis: Very variable. Acute placental insufficiency requires rapid intervention, chronic forms can often be treated with a wait-and-see approach.
- Prevention: Avoid risk factors such as smoking, malnutrition, high blood pressure or excessive blood sugar levels
What is placental insufficiency?
Doctors define placental insufficiency as an inadequate supply of nutrients and oxygen to the unborn child via the placenta.
The placenta is a disc-shaped organ that implants itself in the uterine wall. It is where the mother’s and baby’s blood vessels meet to enable an exchange of substances between mother and child. The child is connected to the placenta via the umbilical cord. The unrestricted function of the placenta plays a decisive role in the development of the child in the womb. If this function is restricted (insufficiency), this can have serious consequences for the child.
Forms of placental insufficiency
- Acute placental insufficiency: develops within minutes to hours
- Subacute placental insufficiency: develops within a few days
- Chronic placental insufficiency: develops over weeks to months
The different forms sometimes have different causes and symptoms. What they have in common is that in severe cases they can be life-threatening for the unborn child (fetus).
What symptoms and long-term consequences are possible?
Placental insufficiency becomes apparent during pregnancy check-ups through symptoms in the fetus. The unborn child is often too small for the corresponding week of pregnancy due to the persistent lack of supply. It is also often less active than unborn babies of the same age in which the placenta fulfills its full function. In addition, the amount of amniotic fluid in placental insufficiency is often less than expected (oligohydramnios).
In acute placental insufficiency, the fetus suffers from a sudden lack of oxygen. This situation is life-threatening for the fetus. Premature birth or stillbirth is a possible consequence.
Late effects of placental insufficiency
In some cases, a lack of oxygen supply in the womb has long-term consequences for the child.
Overall, the affected babies have a higher risk of dying or developing other diseases. For example, children who have been exposed to placental insufficiency in the womb often show symptoms later in life:
- Diabetes mellitus (diabetes)
- Obesity (adiposity)
- High blood pressure (arterial hypertension)
- Vascular calcification (arteriosclerosis)
Many parents also fear that their child will later be mentally impaired or even disabled as a result of placental insufficiency. Scientists have found that children who have not grown in line with their age due to a lack of oxygen in the uterus, for example, tend to perform worse in intelligence tests as children and adolescents than their peers.
In some cases, placental insufficiency leads to premature birth. Children who are born immature have an increased risk of mental retardation.
What is the cause of placental insufficiency?
There are many reasons for placental insufficiency. Possible causes and risk factors for chronic placental insufficiency are, for example
- Congenital and formation defects of the placenta
- Maternal diseases such as diabetes, high blood pressure or heart defects
- Pregnancy-specific diseases such as pre-eclampsia or eclampsia
- Chronic low blood pressure (hypotension)
- Chronic malnutrition or malnutrition
- Smoking
Acute placental insufficiency is caused by an acute circulatory disorder and usually occurs during childbirth. Possible causes are
- Complications in the area of the umbilical cord, such as a prolapsed umbilical cord
- Premature placental abruption
- Vena cava compression syndrome
- Labor storm (contractions that are too strong or too frequent)
In vena cava compression syndrome, the mother’s inferior vena cava is pinched by the enlarged uterus when the woman is lying on her back. This impairs the return flow of blood to the heart. The result: the woman collapses and the unborn child is inadequately supplied with blood.
How is placental insufficiency diagnosed?
It is important that pregnant women attend regular check-ups with their gynecologist. The doctor checks whether the mother and child are healthy and the pregnancy is progressing well. If the gynecologist suspects placental insufficiency, he or she will first ask the pregnant woman about her medical history in detail. Possible questions include, for example
- Do you suffer from high blood pressure or are you diabetic?
- Do you smoke?
- Is this your first pregnancy?
If acute placental insufficiency is suspected, a cardiotocography (CTG) is performed. This records the fetal heart rate and the contractions.
A special form of ultrasound, known as Doppler sonography, shows the blood flow in the umbilical cord. In acute placental insufficiency, this is greatly reduced.
How is placental insufficiency treated?
There is no treatment for placental insufficiency that eliminates the cause (causal therapy). The aim of treatment is therefore timely delivery. The aim is to carry the pregnancy to term for as long as possible without putting the mother or child at risk. In the case of severe symptoms such as short stature in the child or eclampsia in the mother (a life-threatening form of pre-eclampsia), the risk of premature birth is accepted.
The doctor advises pregnant women with chronic placental insufficiency to rest in bed and recommends avoiding all stress and physical activity. In order to prevent a premature birth before the 37th week of pregnancy, it is important to optimally control blood sugar and blood pressure with medication. This is particularly important if the pregnant woman suffers from diabetes mellitus or high blood pressure. In this way, it may be possible to prevent the placental insufficiency from deteriorating further.
After the 37th week of pregnancy or if the placental insufficiency worsens, doctors often decide to bring the baby into the world. For this purpose, the pregnant woman is either given medication to induce the birth or a caesarean section is performed.
Acute placental insufficiency requires rapid action. A change of position for the mother, for example in the case of vena cava compression syndrome, may alleviate the situation. Otherwise, immediate delivery is necessary.
Children who are born prematurely, for example due to placental insufficiency, have an increased risk of neurological damage. There is evidence that the administration of magnesium protects the baby’s nerve cells and possibly reduces the risk of damage to the nervous and muscular system.
How does placental insufficiency progress?
The course and prognosis of placental insufficiency varies greatly from patient to patient. This depends on the severity and type of placental insufficiency.
In acute placental insufficiency, there is a sudden and immediate lack of supply to the fetus. This threatens the child with an acute lack of oxygen, which in the worst case can be fatal. Quick action is then required.
If placental insufficiency has been diagnosed, the attending doctor will work out a birth plan together with the expectant mother. The aim is to clarify how to act in an acute situation.
If factors such as high blood pressure, diabetes or nicotine consumption are not eliminated, there is a risk of placental insufficiency recurring during a new pregnancy.
How can placental insufficiency be prevented?
To prevent placental insufficiency, it is important that pregnant women eliminate the risk factors as far as possible. This includes, for example, eating a balanced and healthy diet and not smoking.
Women who suffer from diabetes mellitus or blood pressure should pay particularly close attention to ensuring that their blood sugar and blood pressure levels are optimally adjusted.
