Fetoplatsentarny insufficiency – the complex of morfofunktsionalny violations from a fruit and a placenta developing owing to various ekstragenitalny and gynecologic pathology, and also pregnancy complications. Existence of fetoplatsentarny insufficiency can be followed by threat of termination of pregnancy, a hypoxia and an arrest of development of a fruit etc. Diagnostics of fetoplatsentarny insufficiency is based on data of ultrasonography, KTG, dopplerometriya of a uterine and placentary blood-groove. Treatment of fetoplatsentarny insufficiency demands therapy of the main disease; carrying out the medicamentous courses directed to improvement of a fruit and uterine blood-groove, correction of hypoxemic violations of a fruit; if necessary – an early rodorazresheniye.
Fetoplatsentarny insufficiency serves as a factor of perinatal death of a fruit more than in 20% of cases, considerably complicates course of pregnancy and childbirth. Manifestations and complications of fetoplatsentarny insufficiency, and also their consequence for mother and a fruit are caused by extent of change of functions of a placenta, gestation term, force and duration of violation, development of compensatory and adaptive mechanisms in the mother-placenta-fruit system.
In the conditions of fetoplatsentarny insufficiency the fruit hypoxia, a delay of its pre-natal growth and development develops; the probability of premature birth, various anomalies of patrimonial activity, patrimonial injuries of a fruit increases. At newborns subsequently adaptation processes proceed heavier, perinatal encephalopathy, congenital anomalies (a dysplasia of coxofemoral joints, a wryneck) comes to light more often; such children are more subject to respiratory and intestinal infections.
Reasons of fetoplatsentarny insufficiency
Nature of development of fetoplatsentarny insufficiency of a mnogofaktorn. Morfofunktsionalny violations of a placenta can develop owing to ekstragenitalny diseases of the pregnant woman: cardiovascular (heart diseases, an arterial hypertension or hypotension, insufficiency of blood circulation), kidney (pyelonephritis, a renal failure), pulmonary (bronchial asthma), neuroendocrine (diabetes, hypo - and a gipertireoza, pathologies of adrenal glands and a hypothalamus) etc.
At anemia of pregnant women fetoplatsentarny insufficiency is caused by deficiency of iron in a maternal and fruit blood-groove that leads to decrease in transport of oxygen to a fruit and a hypoxia. At violations of coagulability of blood (for example, an anti-phospholipidic syndrome) in vessels of a placenta the microblood clots breaking a fruit and placentary blood-groove are formed.
Fetoplatsentrany insufficiency quite often develops owing to various infections proceeding sharply or which are becoming aggravated in the course of pregnancy. In this case the placenta quite often is surprised viruses, protozoa, bacteria that it leads to its inflammatory changes. Various infectious defeats (flu, STD, etc.) arising in the I trimester often lead to spontaneous termination of pregnancy. In later terms of a gestation infection can be limited to local changes which weight will depend on the activator and ways of its distribution.
Genital pathology of the pregnant woman belongs to risk factors of formation of fetoplatsentarny insufficiency: anomalies of a uterus (a two-horned, saddle uterus), endometriosis, uterus fibroma, chronic endotservitsit also an endometritis, a hem on a uterus. Obstetric pathology can be the reasons of fetoplatsentarny insufficiency: Rhesus factor conflict, prelying of a placenta, pelvic prelying of a fruit, polycarpous pregnancy, early or late toxicosis of pregnancy (). In turn, can not only result in fetoplatsentarny insufficiency, but also aggravate its weight, creating a peculiar vicious circle.
Risks of fetoplatsentarny insufficiency increase in proportion to age of the pregnant woman; at the anamnesis burdened by abortions, addictions, ecological trouble, social and household disorder. The listed states in a varying degree cause violations at first of a uterine and placentary, and then and fetoplatsentarny blood-groove that brings to irreversible morphological changes and violation of the main functions of a placenta (gas exchange, trophic, secretory, protective and vnutrisekretorny, etc.). Usually several etiofaktor from which the leader is distinguished are involved in pathogenesis of fetoplatsentarny insufficiency.
Classification of fetoplatsentarny insufficiency
On development time fetoplatsentarny insufficiency happens primary and secondary. Primary insufficiency arises already on early terms of a gestation (16-18 weeks), at stages of formation of a placenta and an organogenesis under the influence of infectious, endocrine, yatrogenny factors. Secondary fetoplatsentarny insufficiency develops at initially normally created placenta, as a rule, under the influence of maternal factors or complications of pregnancy.
The clinical course of fetoplatsentarny insufficiency can be sharp or chronic. At sharp insufficiency which can develop both on any term of pregnancy, and in labor, first of all, gas exchange function of a placenta is broken that is followed by a sharp hypoxia and death of a fruit. The often sharpest fetoplatsentarny insufficiency is caused a premature otsloyky placenta, hemorrhages in regional sine, by a heart attack of a placenta and thrombosis of its vessels.
The obstetrics and gynecology face chronic fetoplatsentarny insufficiency more often. The current and the forecast are defined by protective and adaptive reactions in this connection allocate the compensated, subcompensated, dekompensirovanny and critical forms of fetoplatsentarny insufficiency.
The optimum compensated form is determined by data of a dopplerometriya; the fruit in this case does not suffer and continues to develop. At the compensated form of fetoplatsentarny insufficiency minor pathological changes are compensated thanks to the protective and adaptive mechanisms promoting pregnancy progressing. Adequate therapy and the correct conducting childbirth provide a possibility of the birth of a healthy fruit.
In case of the subcompensated form of fetoplatsentarny insufficiency protective and adaptive reactions are insufficient for ensuring normal course of pregnancy. At this form lag of a fruit in development is noted, risks of various complications are high.
The Dekompensirovanny form of fetoplatsentarny insufficiency is characterized by an overstrain and failure of compensatory mechanisms, impossibility of normal progressing of pregnancy. Sufferings of a fruit are shown by heavy violations of warm activity, an arrest of development, a heavy hypoxia; on pre-natal death of a fruit is excluded. At a critical form of insufficiency irreversible morfofunktsionalny changes of a fetoplatsentarny complex inevitably lead to death of a fruit.
Symptoms of fetoplatsentarny insufficiency
Fetoplatsentarny insufficiency can be shown in various clinical forms. The most often this state is followed by threat of termination of pregnancy, a hypoxia of a fruit and a delay of its pre-natal development. The risk of spontaneous termination of pregnancy usually arises on early terms of a gestation and can be expressed in development of the menacing, begun abortion or abortion in the course. In some cases at fetoplatsentarny insufficiency the stood pregnancy is observed.
In the II-III trimesters fetoplatsentarny insufficiency, as a rule is shown by a fruit arrest of development. At the same time reduction of a circle of a stomach of the pregnant woman, discrepancy of height of standing of a bottom of a uterus to gestation term is noted. By means of ultrasonography lag in development of a fruit comes to light. The fruit hypoxia at fetoplatsentarny insufficiency is connected with violations of transport and gas exchange function of a placenta. Weight of defeat of a fruit is caused by the size of the struck area of a placenta: so, at switching off from blood circulation of the site more than 1/3 placentae develop violations, critical for a fruit. Are signs of the hypoxia tested by a fruit the increased chaotic physical activity, and then reduction of number of stirs of a fruit up to their total absence in the beginning.
Disorder of vnutrisekretorny function at fetoplatsentarny insufficiency of a placenta can promote a perenashivaniye of pregnancy or premature birth. Owing to violation of secretory function of a placenta change of amount of amniotic waters – usually lack of water is noted, however at some accompanying pathology (diabetes, pre-natal infection, a hemolytic disease of a fruit) – abundance of water. Changes of a placenta at fetoplatsentarny insufficiency can be followed by adjournment of kaltsinat, expansion of interfleecy space, placenta cysts. Against the background of violation of hormonal function of a placenta and insufficient activity of a vaginal epithelium at the pregnant woman colpitises quite often develop.
Diagnostics of fetoplatsentarny insufficiency
Considering a mnogofaktornost of etiopatogenetichesky mechanisms, diagnostics of fetoplatsentarny insufficiency has to include comprehensive dynamic examination of the pregnant woman. When collecting the anamnesis the leading factor promoting development of fetoplatsentarny insufficiency (age, gynecologic and ekstragenitalny diseases, operations, habits, professional and vital conditions etc.) becomes clear. Complaints of the pregnant woman at fetoplatsentarny insufficiency I can be on belly-aches, the raised uterus tone, bleach from a genital tract, activization or oppression of stirs of a fruit, bloody allocations.
At a fizikalny research the gynecologist performs measurement of a circle of a stomach, assessment of standing of a bottom of a uterus, weighing of the pregnant woman that allows to assume a fruit arrest of development, much or lack of water. Carrying out gynecologic survey allows to estimate the nature of allocations, to reveal inflammation signs, to execute a material intake for a bacteriological and microscopic research.
Ultrasonography value in diagnostics of fetoplatsentarny insufficiency consists in a possibility of definition of fetometrichesky indicators (the sizes of a head, a trunk, fruit extremities) and their comparison to norm indicators for this term of a gestation. Besides, measurement of thickness of a placenta and definition of degree of its maturity is performed. At doppler sonography of a uterine and fruit blood-groove blood circulation in vessels of an umbilical cord, a uterus and a fruit part of a placenta is estimated. By means of a phonocardiography of a fruit and a kardiotokografiya the nature of warm activity of a fruit – the frequency and a rhythm of heartbeat is defined. Tachycardia, bradycardia, arrhythmia can be signs of a hypoxia.
Treatment of fetoplatsentarny insufficiency
Treatment of the compensated form of fetoplatsentarny insufficiency, on condition of positive dynamics of therapy and lack of threat for pregnancy development, can be carried out on an outpatient basis. In other cases immediate hospitalization with holding intensive therapeutic actions is shown. Considering a multifaktornost of development of pathology, the standard scheme of therapy of fetoplatsentarny insufficiency cannot be. The main place in treatment of fetoplatsentarny insufficiency is given to elimination of the leading etiologichesky factor and maintenance of compensatory mechanisms for continuation of a gestation.
At microcirculator frustration and violation of a vascular tone in a placenta medicines of the first row are antiagregant and anticoagulants (, a dextran, , heparin, etc.). For the purpose of correction of a hypotrophy and a growth inhibition of a fruit transfusion of plazmozameshchayushchy and proteinaceous solutions is applied. At the haemo dynamic violations accompanying fetoplatsentarny insufficiency the antagonists of calcium (nifedipine, verapamil) improving perfusion of bodies, normalizing sokratitelny function of a myocardium, possessing hypotensive action are appointed. Identification of a hyper tone the miometriya demands purpose of spazmolitichesky medicines (a drotaverin, glyukozonovokainovy mix, etc.)
Within normalization of antioxidant protection and transport function of a placenta vitamins E, C, gepatoprotektor are appointed. For metabolic therapy at fetoplatsentarny insufficiency B6 vitamin, , folic acid, glucose, polyvitamins, a haemo derivative of blood of calfs is used. In case of threat of early termination of pregnancy purpose of tokolitik is expedient (a fenoterola, a geksoprenalina).
The decision on term and way of a rodorazresheniye is accepted taking into account efficiency of therapy of fetoplatsentarny insufficiency. At the compensated form in the forecast natural childbirth is possible; at subcompensated the choice is made in favor of Cesarean section; at development of a decompensation the emergency surgical rodorazresheniye is shown.
Prevention of fetoplatsentarny insufficiency
At the heart of preventive measures – thorough training of the woman to pregnancy. Identification and correction of the available risk factors, early definition at pregnant women of probability of development of fetoplatsentarny insufficiency, conducting pregnancy at this group of patients with the increased control is necessary.
Prevention of development of fetoplatsentarny insufficiency can be promoted by carrying out preventive medicamentous courses in 14-16 weeks and 28-34 weeks of a gestation. Continuous monitoring of a state and development of a fruit by means of laboratory and ultrasonic screening is required from pregnant women with the compensated form of fetoplatsentarny insufficiency.