Therapy of placental insufficiency
Acute placental insufficiency develops especially in the last trimester of pregnancy and leads to serious consequences within minutes and hours. It is not a persistent clinical picture, but a highly acute event that requires immediate medical attention. In chronic placental insufficiency, however, the disturbed metabolic situation develops over days, weeks and even months. The goal is to quickly determine the cause and, if possible, to eliminate it in order to counteract this development. In an acute state of oxygen deficiency of the child (hypoxia), usually only an emergency caesarean section (emergency section) is left to control the situation.
Causes of placental insufficiency
Placental insufficiency can have various causes. Acute and chronic placental insufficiency can be distinguished. Different mechanisms and clinical pictures are responsible for the interruption of the metabolism.
Acute placental insufficiency leads to a life-threatening lack of oxygen supply to the child within minutes and hours. The cause is an acute event, such as a prolapsed umbilical cord or an umbilical cord wrap. In an umbilical cord prolapse, parts of the umbilical cord come between the preceding part of the child (usually the head) and the maternal pelvic wall.
There the umbilical cord can be squeezed and the blood flow between mother and child is interrupted. Similarly, when the umbilical cord is wrapped around itself or the infant’s body, the child is cut off. The risk of such an incident is particularly increased in multiple pregnancies, an abnormal position (positional anomaly) of the child or an excess of amniotic fluid (polyhydramnios).
Another cause of acute placental insufficiency is the so-called vena cava compression syndrome. This is an incarceration of the inferior vena cava, which transports oxygen-depleted blood from the body’s circulation back to the heart. It can be easily pinched off by the growing uterus, especially in the last trimester of pregnancy.
Pregnant women should therefore prefer to lie on their left side. Other possible causes of acute placental insufficiency are premature placental abruption, eclampsia, excessive contractions (toe of labour) or placenta-praevia bleeding. In the case of placenta previa, the placenta is located very low down at the cervix and can be a complication that causes heavy bleeding during pregnancy.
Chronic placental insufficiency is usually the result of general or pregnancy-related diseases of the mother, which gradually worsen the blood flow situation between mother and child. Examples of such general diseases are diabetes mellitus, high blood pressure, anaemia, uterine fibroids and smoking. Special pregnancy diseases can also lead to such chronic placental insufficiency.
These include pregnancy diseases associated with high blood pressure, such as pre-eclampsia or pregnancy-induced hypertension. Too long a pregnancy (transmission) is also a possible cause. or pregnancy poisoning (pre-eclampsia)Smoking is a risk factor for many different diseases, even within one pregnancy.
Smoking can also be a cause of placental insufficiency. The poorer blood flow situation that smokers experience due to tobacco consumption can lead to 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 inflammatory processes in the body, which also have an influence on placental function.
