Violation of fetal placental blood flow 1b degree of cause. What to do if blood circulation between the expectant mother and child is disturbed - treatment and preventive measures

During pregnancy, it is very important to constantly monitor the state of the organisms of the mother and fetus and their performance of vital functions. One of the most significant studies is the analysis of blood flow in the arteries of the uterus, the umbilical cord of a woman, as well as in the aorta and cerebral vessels of a child.

Among the main causes of perinatal mortality and morbidity, it is the violation of uterine blood flow (uteroplacental and fetal-placental) that occupies not the last place.

Blood flow in the placenta

The placenta, in which the fetus is located, supplies it with nutrition and oxygen from the mother's blood and removes metabolic products. child's body. It is this organ that unites two complex vascular systems - the maternal, which connects the vessels of the uterus and the placenta, and the fetal, passing into the umbilical arteries and leading to the fetus.

The aforementioned circulatory systems are separated by a membrane that does not allow the blood of the mother and child to mix. The placenta acts as a kind of barrier that is resistant to many viruses and harmful substances.

In some cases, completely different reasons placental insufficiency may develop, which inevitably affects the performance of trophic, metabolic, transport, endocrine and other vital functions of the placenta. In this condition, the metabolism between the body of the mother and the child deteriorates significantly, which is fraught with consequences.

Causes of impaired uterine blood flow

Violation of blood circulation in the uterus can be caused by increased pressure, pneumonia, intrauterine infection and insufficient supply of oxygen to the fetus ().

For diagnosing the circulatory system in obstetric practice applied three-dimensional ultrasonography(Doppler), with which the vessels are visible in the so-called 3D (three-dimensional) image. With the help of this modern diagnostic method, the prospect of diagnosing retroplacental bleeding, assessing malformations of the heart by monitoring the blood flow has appeared. This method is indispensable, since it can be used to see defects even in the smallest vessels that form the microvasculature, to monitor the development and formation of intraplacental hemodynamics, and also to control the amount of oxygen and nutrients that must enter the fetal body. New opportunities have opened up for the early detection of obstetric complications, and if correction or treatment is started without loss of time, then circulatory disorders and further pathologies associated with it can be practically avoided.

Hemodynamic disorders during pregnancy

Hemodynamic disorders are divided into three degrees of severity:

First degree includes two subtypes:

• 1A - violation of the uterine placental blood flow, which is the easiest. The fetal-placental circulation is preserved with it. In most cases, intrauterine infection leads to this problem;
• 1B - uteroplacental blood flow is preserved, while pathologies occur in the fetal-placental one.

Second degree It is characterized by violations of both blood flow systems, while it does not carry cardinal changes.

Third degree is that a violation of the uteroplacental circulation leads to defects in the blood circulation at the uterine-fetal level.

At the first degree of violations due to the timely detection and adequate treatment fetal death is avoided. Perinatal mortality in the second degree is 13.3%, in the third - 46.7%. At the time it was found that the correction placental insufficiency in patients with hemodynamic impairment of the third degree was ineffective. IN this case perinatal mortality in conservative childbirth was 50%, while it helps to avoid losses. 35.5% of newborns get into the intensive care unit with the first degree, 45.5% with the second and 88.2% with the third.

Prevention of blood flow disorders during pregnancy

Every woman who wants to give birth to a child must remember that the state of the mother is completely transmitted to the unborn baby. Therefore, in order for the fetus to develop without complications, she needs to make up her diet from food containing a maximum of vitamins, micro- and macroelements, as well as rich necessary quantity carbohydrates, proteins and fats. If the pregnant woman is not concerned about swelling, then fluid intake should be at least 1-1.5 liters.

It is important to control changes in body weight, since by the end of pregnancy, weight gain should not exceed 10 kg.

There are risk groups that need to be applied drug prevention, which promotes the interaction of the body systems of the fetus and mother and prevents dysfunction of the uteroplacental circulation.

Significantly reduce perinatal morbidity and mortality will help timely corrected methods of childbirth and drug therapy. But a high risk of severe neurological complications is still not excluded.

Especially for Elena Zhirko

After a woman finds out about her pregnancy, she must realize that now the body belongs not only to her, but also to her unborn child. Hormonal surges and a complete restructuring of the pelvic organs quite often end with a violation in the blood supply to the fetus. In this article, we will talk about the violation of blood flow during pregnancy, what it is fraught with, what symptoms are inherent, what therapy can be used and how to bear a healthy child.

How blood flow changes during pregnancy

Initially, let's figure out how everything works in mothers' tummies. During pregnancy, the placenta is responsible for the transfer of beneficial trace elements and oxygen to the baby. It is the same unifier through which the vascular system of the pregnant woman is connected to vascular system fruit, becoming common. Any disturbances in the work of the placenta affect the condition of the baby, so it is necessary to monitor the blood flow during pregnancy. Diagnosis is made through a study - dopplerometry. About it, below we will talk in more detail.

What is blood flow disorder during pregnancy

Violation of blood flow can appear at any gestation period. A pregnant woman is diagnosed with placental insufficiency. This is one of the most common complications during pregnancy associated with dysfunction of the placenta. This pathology occurs in two forms:

1. The acute form appears suddenly and is most often the result of placental abruption. It can provoke a violation of gas exchange in this organ and, as a result, oxygen starvation at the fetus.
2. Chronic, it is also called premature aging of the placenta. Most often detected in the third trimester of pregnancy. It is divided into the following types:

• compensated - is considered minimally dangerous, since with this form the child continues normal physiological development. In the mother's body "turn on" defense mechanisms that compensate for impaired blood flow;
• decompensated - the mother's body can not cope with the problem, pathological changes occur in the placenta. The first oxygen starvation of the fetus appears, entailing developmental delays, intrauterine death of the baby is possible;
• subcompensated - with this form, the condition of the fetus worsens, it lags far behind in development;
• critical - with this form of insufficiency, the death of the child is inevitable.

Diagnosis of pathology

It has already been said earlier that during pregnancy, a violation of blood flow can be diagnosed by means of dopplerometry. It is an ultrasound examination that can detect any pathological abnormalities in blood flow. During the diagnosis, a pregnant woman takes a horizontal position on her back or side. The specialist conducts a study by the transabdominal method. Usually dopplerometry is prescribed twice:

• at 20–22 weeks, in order to make sure that there are no deviations in the development of the fetus;
• at 32 weeks.

Degrees of blood flow disorders in pregnant women

Conventionally, the blood flow system during pregnancy can be divided into two subsystems:

• woman (womb) - placenta;
• placenta is a baby.

In medicine, there are norms for Doppler readings. They are applied from the second trimester. Doctors compare the obtained diagnostic data with the norms and identify the degree of blood flow disturbance during pregnancy.

I degree

When diagnosing, the presence of deviations in one of two forms is recorded:

• I-a degree - violation of blood flow occurs in the area pregnant - placenta (utero-placental blood flow);
• I-b degree - pathological changes are observed in the placenta-child subsystem.

Violation of blood flow during pregnancy of the first degree does not affect the condition of the unborn baby and is easily amenable to medical correction.

II degree

In the second degree, both subsystems are affected. For 7-12 days, this condition threatens to develop into the III degree, which can end tragically.

III degree

The critical point at which the child's blood supply may be completely absent or reversed. If within 72 hours, with reverse blood flow, it is not possible to stabilize the condition, then a diagnosis is made to artificial childbirth or premature termination of pregnancy.

What is the danger of impaired blood flow during pregnancy

Complications and dangers that can develop as a result of impaired blood flow include:

• placental abruption;
• hypoxia;
• fetal hypotrophy;
• pathology of development;
• intrauterine death.

At I degree, if the fetus does not suffer from hypoxia, then the woman is allowed to give birth on her own. In other cases, delivery is carried out through a caesarean section.

Why blood flow disorders occur during pregnancy

There are many reasons that contribute to impaired blood flow during pregnancy. Consider the most common factors that provoke a violation of blood flow.

1. Diseases of the uterus: bicornuate uterus, endometriosis, uterine hypoplasia, the presence of fibroids, etc.
2. Maternal health problems: kidney failure, diabetes, hypotension, pyelonephritis, diseases endocrine system, bronchial asthma and etc.
3. Unfavorable conditions for gestation: Rhesus conflict, multiple pregnancy, preeclampsia, malpresentation fetus, etc.
4. External factors: alcohol intake during pregnancy, smoking, constant being in a nervous environment, first birth (and a woman over 35), poor (limited) nutrition of the mother.

Symptoms of pathology

At the first degree of manifestation of the pathology, the symptoms do not manifest themselves in any way, so the expectant mother learns about the problem by visiting the next scheduled ultrasound. If the pathology proceeds in an acute or decompensated form, then changes in the activity (movement, stirring) of the fetus can be noticed. Such states are characterized by changes of too strong movements with fading.

In addition to behavioral changes in the baby's abdomen, there may be:

• slow growth of the mother's abdomen;
• late toxicosis;
• increased swelling;
• oligohydramnios or polyhydramnios are diagnosed.

Treatment Methods

If the disease is mild (first degree), then the doctor may prescribe drugs that improve blood circulation.

The dynamics of the state of the fetus is carried out, weekly, until the indicators normalize, the pregnant woman is given dopplerometry and the fetal heartbeat is checked. If the indicators stabilize, then the woman will continue to bear the child further. In case of deterioration, it is recommended to perform a caesarean section (for a period of more than 25–28 weeks).

In the second degree, the pregnant woman is hospitalized and treated under the strict supervision of the medical staff. If the condition worsens, an unscheduled operation is performed.

As for the third degree, it cannot be treated, since irreversible changes begin in the development of the fetus. Therefore, in order not to risk the life of the child, doctors insist on an urgent cesarean.

In conclusion about prevention

Prevention actions should be aimed at creating conditions for healthy growth and prenatal development child. To do this, a woman must:

• watch your diet;
• rest more often;
• visit regularly fresh air;
• to refuse from bad habits;
• minimize emotional stress.

The main thing is to regularly visit a doctor and follow his recommendations.

Pregnant women and their relatives usually expect one answer from an ultrasound examination - what is the sex of the child. For an obstetrician-gynecologist, a research method is necessary in order to identify a violation of blood flow during pregnancy, abnormal development of the fetus in time.

The management plan and tactics of delivery depend on this. To understand the mechanisms of the disorder, it is necessary to consider the possibilities of the circulatory system between mother and child.

The structure of the uteroplacental blood flow

Mother and child are connected not only by the placenta, but also by a complex system of blood vessels. Therefore, all joint blood circulation is usually divided into levels that cannot exist in isolation, but work only in combination.

• The central part of the system is the placenta. It provides "absorption" of maternal blood products through the villi that have grown deep into the wall of the uterus. It does not mix the blood of mother and child. Several rows of special cells form a hematoplacental barrier, which is a serious obstacle to substances unnecessary for the fetus. Through it, the spent blood returns to the venous system of the mother.
• The second part of the blood flow is made up of branches of the uterine arteries. If before pregnancy female body they are in a collapsed state and are called spiral, then from a period of 1 month they lose the muscle layer that can cause spasm. And by four months, the arteries are transformed into full-fledged trunks filled with blood and heading to the placenta zone. It is this mechanism, useful for feeding the fetus, that can be fatal in uterine bleeding: the walls of the vessels can no longer contract.
• Vessels in the umbilical cord form a third pathway for blood flow. There are 2 arteries and a vein. They connect the child with the placenta and form the fetal-placental circle. A decrease in blood flow at this level causes the most severe damage to the fetus.

How placental circulation is disturbed

Poor blood flow associated with the placenta is called placental insufficiency. It can occur at any stage of pregnancy in two forms.

Acute appears suddenly, even in childbirth, does not depend on the gestational age. The fetus falls into a state of hypoxia (oxygen deficiency), which threatens him with death.

The main pathological mechanisms of this condition:

• premature detachment of the placenta;
• myocardial infarction due to thrombus formation.

Chronic more often complicates the course of pregnancy after a 13-week period. Symptoms appear in the third trimester. Formation mechanism - early aging placenta due to the deposition of fibrin on the villi.

As a result of changes in the structure of the chorionic villi (placental tissues), the functioning of the hematoplacental barrier stops, metabolic processes between the mother's body and the fetus are disrupted

Negative consequences in such conditions, depending on the degree of violation, can lead to the inevitable death of the fetus.

Causes of impaired blood flow during pregnancy

Various reasons can cause a violation of the uteroplacental blood flow. These include common maternal illnesses:

• pathology neuroendocrine system(diabetes mellitus, diseases of the thyroid gland and adrenal glands, changes in the hypothalamus of the brain stem);
• lung diseases (emphysema, bronchial asthma);
• violations in cardiovascular system caused by malformations, the consequences of hypertension, a tendency to hypotension;
• renal pathology (chronic nephritis, pyelonephritis, especially in the stage of renal failure;
• anemia (anemia) associated with deficiency of iron, vitamins;
• conditions associated with increased clotting blood, contribute to increased thrombus formation in the vessels of the placenta;
• acute and exacerbation of chronic infectious processes - cause corresponding inflammation in the placenta, vascular edema and reduced blood flow, in the first trimester this can result in a miscarriage.

The pathology of the uterus creates local conditions for inadequate blood flow:

• any changes in the layers of the uterus (myometrium, endometrium);
• malformations (for example, according to the type of "bicornuate", "saddle-shaped" uterus);
• underdevelopment (hypoplasia);
• tumor formations from muscle tissue (fibroids), especially in a nulliparous woman over the age of 35, in more young age small fibroids allow you to compensate for blood flow.

The causes of insufficient blood flow include unfavorable conditions of the ongoing pregnancy in the following cases:

• multiple pregnancy;
• Rh conflict;
• preeclampsia;
• pelvic presentation of the fetus;
• pathological placenta previa.

The risk of impaired blood flow occurs when:

• previous abortions;
• smoking, alcoholism and drug addiction of the mother;
• constant nervous situation associated with social or domestic disorder;
• violation proper nutrition women.

Types of chronic placental insufficiency

Depending on the development of the consequences for the fetus and the ability of the mother's body to adapt, there are 4 forms or stages of chronic placental insufficiency:

• compensation - the mother's body completely protects the fetus by improving blood flow in other ways, and the child does not feel a lack of oxygen, develops normally, is born on time and develops well;
• subcompensation - the mother is not able to fully compensate for the lack of nutrition, and the fetus lags behind in development, there is a risk of complications, birth defects;
• decompensation - accompanied by a complete violation of the mechanisms of adaptation, normal pregnancy impossible, the fetus has serious defects that are incompatible with viability, death in utero is very likely;
• critical - due to severe changes in the structure of the placenta, further gestation is impossible, inevitable death occurs, any treatment is ineffective.

What degree of blood flow disturbance causes placental insufficiency?

Mapping clinical manifestations and the results of an ultrasound examination made it possible to distinguish 3 degrees of blood flow disturbance between the mother and the fetus.

The first is characterized by minimal changes at the uteroplacental level, provides a “reserve” of time for about a month for treatment and complete recovery without consequences, there are 2 varieties:

• Ia - only uteroplacental blood flow is reduced, with unchanged fetal-placental blood flow. Manifested by a lag in the development of the fetus in 90% of cases.
• Ib - the fetal-placental circulation suffers, and the uteroplacental circulation remains normal. The delay in the formation and development of the fetus suffers somewhat less (in 80% of cases).

The conclusion is issued after the study of all components of the fetal blood flow

The second - the violation occurs both at the level of the uterine and umbilical vessels, hypoxia can be fatal to the fetus.

The third - blood circulation indicators are at a critical level, even the reverse direction of blood flow (reverse) is possible.

For clinicians, such a classification provides an opportunity to accurately determine the level of disorders, to choose the most appropriate treatment tactics.

Symptoms of impaired blood flow

If the disturbed blood flow is compensated, then the woman does not feel any deviations, but finds out about them only after the examination.

Severe manifestations occur in acute form and chronic decompensation:

• fetal motor activity increases sharply or completely disappears (with a period of 28 weeks normal development accompanied by ten movements per day), this symptom requires immediate appeal to an obstetrician-gynecologist;
• slow increase in abdominal circumference, detected during monthly examination and measurement in antenatal clinic(associated with excessive formation or lack of amniotic fluid);
• late toxicosis;
• high blood pressure;
• large weight gain;
• swelling on the legs;
• the appearance of protein in the urine.

The most dangerous is the discharge of blood from the vagina. This sign can be regarded as a starting abruption of the placenta. You can not delay in providing medical care.

Diagnostics

The most complete picture of blood circulation between the uterus and the fetus is obtained with a Doppler study, which is performed for all women three times during pregnancy.

The technique allows:

• measure blood flow by the speed of movement of uniform elements;
• determine its direction in the arteries and veins;
• fix changes before clinical manifestations.

The effect is based on the reflection properties of the ultrasonic wave, completely safe for the baby and mother

All changes are recorded on the monitor, measured by special sensors, and can be photographed in the required format.

By comparison with normal indicators a conclusion is made about the degree of pathology. Violations can be detected at any level, in the vessels:

• umbilical cord,
• uterus,
• fetus.

The doctor has time to prescribe the treatment and check it at the next examination.

Doppler sonography is a type of Doppler sonography. It is assigned for:

• concomitant pathology of the mother;
• suspicion of premature aging and violation of the placental barrier;
• signs of a lot or oligohydramnios;
• preliminary data on intrauterine growth retardation, the formation of congenital malformations of the fetus;
• availability genetic diseases in family;
• clinical symptoms of fetal hypoxia.

The examination can reveal:

• thinning of the placenta;
• increase in growth area;
• intrauterine infection.

The method of long-term inpatient monitoring of the degree of fetal hypoxia allows you to see the results of the use of drugs

Treatment of pathology

Treatment takes into account the pathogenesis of disorders. To achieve results, it is necessary to influence all links:

• With a slight violation of microcirculation, Hofitol is prescribed (with a mineral and plant composition), in more expressed cases- Actovegin, Petoxifylline.
• If the mother's tendency to thrombosis and a violation of the aggregation properties of the blood is revealed, then drugs such as Curantil, Trental are indicated. They are able to improve the permeability of blood through the vessels.
• Upon detection of a low blood pressure use Venofundin, Stabizol, ReoHES.
• Vasodilators - No-shpa, Eufillin in injections - eliminate spastic contraction of blood vessels.
• It is recommended to reduce the tone of the uterus with Magnesia, the drug Magne B6, this acts as an antihypoxic way to improve blood flow.
• A group of vitamins with antioxidant action eliminates Negative consequences(vitamin E, ascorbic acid).

Medications are prescribed by a doctor. If necessary, the woman is offered hospitalization. This allows:

• provide bed rest;
• constantly monitor the course of pregnancy.

If there is an effect of conservative treatment, the woman bears herself to the end and gives birth to a child. In the absence of results, doctors may decide on an early caesarean section. In the third stage, only operative delivery is shown.

What can be done to prevent blood flow disorders?

Gynecologists urge women from risk groups to prepare themselves for pregnancy in advance, to prevent unplanned conception.

Choice right position body during sleep helps blood flow to the fetus

Against the background of an already occurring pregnancy, it is recommended:

• avoid emotional and physical overload;
• eliminate bad habits;
• organize good nutrition for a pregnant woman;
• monitor daily walks, stay in a ventilated room;
• study special gymnastics for pregnant women, yoga exercises;
• control body weight, conduct monthly weighing and measurement of abdominal circumference;
• sleep on the left side is considered more beneficial, this position allows you to reduce pressure on the inferior vena cava, which runs to the right of the uterus, but in some cases, with stagnation in the kidneys, sleeping on the right side improves the outflow from these important organs.

Modern methods of diagnostics and approach to the management of pregnant women can prevent severe disorders. However, many opportunities depend on the woman herself and her desire to have a healthy heir.

During the period of bearing a baby, a woman may face such a problem as a violation of the utero-placental blood flow of the 1a degree. In this case, the function of the placenta is preserved and the pathological changes are insignificant. However, without treatment, hemodynamic disorders can be dangerous to the health of the mother and child.

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Etiology of placental insufficiency

The causes of hemodynamic disorders can be divided into two groups. Endogenous factors are associated with improper villi maturation and impaired placentation. This leads to the development of an enzymatic-vascular type of insufficiency. Exogenous causes include many factors that lead to placental and uterine forms of circulatory disorders.

Violation of blood flow during pregnancy can be caused by:

• genetic factors;
• defective work of the ovaries;
• viral or bacterial infection.

These factors lead to anatomical pathologies of the placenta, namely, to pathologies of its structure, location and attachment. In this case, primary placental insufficiency develops. It is mainly observed in women diagnosed with infertility. Secondary insufficiency is caused by complications during pregnancy or the presence of gynecological diseases.

Social conditions can provoke the development of uteroplacental insufficiency, for example, malnutrition, physical and psycho-emotional stress during the period of bearing a baby, smoking, drinking alcohol, early or, conversely, late pregnancy.

At risk are pregnant women with extragenital and obstetric diseases. The reason for the development of fruit placental disorder blood flow, diseases such as preeclampsia, uterine fibroids, alloimmune cytopenia can act. External provoking factors include the intake of certain medicines, ionizing radiation and exposure caused by chemicals or poisons.

During pregnancy, hemodynamic disorders can be caused by anemia. In this case, the level of hemoglobin decreases and blood circulation accelerates in all vessels and arteries, including in the uterine cavity. placental system.

Infections are especially dangerous during pregnancy. Pathogenic microbes are capable of destroying placental tissue. The rate and volume of blood flow in the uteroplacental system can be adversely affected by a woman's unstable heart pressure. One of possible causes development of failure is one artery in the umbilical cord.



In some cases, a violation of the uteroplacental blood flow of the 1a degree can be caused by multiple abortions, surgical operations or diagnostic curettage.



Severity of PN

Violation of the uteroplacental circulation has three degrees of development. With a primary placental disorder, the condition of the fetus is assessed as satisfactory. Without appropriate treatment after a month this stage turns into a more severe form.

The first stage is subdivided into 1a and 1b degrees. 1a degree is the most mild form. In this case, the fetal-placental circulation is practically not disturbed. The causative factor of such a violation is mainly intrauterine infections. According to medical statistics, in 85-90% of cases, the fetus lags behind in development. At grade 1b, uteroplacental blood flow is preserved, but functional changes in the placental system are observed. The probability of fetal growth retardation in this case is 80%.



Secondary placental insufficiency is characterized by a violation of both circulatory systems. If at this stage it is not provided health care, then in a week hemodynamic disturbances will become severe. Cardinal changes and defects in the uteroplacental blood flow are observed at the third stage of development. In this case, the child is in critical condition.

This classification is used by doctors to display the level of placental disorders. In accordance with the severity of the development of hemodynamic disorders, the tactics of managing the patient changes.

If the first degree of blood flow disturbance was diagnosed in a timely manner and appropriate treatment was prescribed, then the consequences are minimal. In this case, the pregnancy persists. With the help of conservative treatment, it is possible to avoid the death of the child. Drug therapy in the second or third stage is considered ineffective. The mortality rate is 50%. In order to avoid the death of the baby, doctors perform a "caesarean section".





Types and symptoms

Clinical symptoms of PN depend on the nature of the pathology. An acute form of insufficiency can develop in any trimester of pregnancy. There is a violation of the gas exchange function of the placenta, which can lead to fetal hypoxia. The acute form develops due to premature detachment placenta or vascular thrombosis.

Often, women with a chronic form of insufficiency enter the clinic. She makes herself felt in the 2nd trimester. Fibrinoid is formed on the surface of the placenta, which disrupts the transplacental exchange.

In a chronic course, placental insufficiency can occur in a compensated, decompensated, subcompensated and critical form. In the first case, pathological changes are insignificant. With proper therapy, there is a high probability of having a healthy baby.



In the decompensated form, there is a violation of the heart and a delay in the development of the fetus. In this case, there is a risk intrauterine death child. With subcompensated insufficiency, pregnancy is quite difficult. Placental insufficiency does not pass without a trace. The risk of developing various complications is very high. The critical form is irreversible. This form is characterized by morphofunctional pathological changes. For a child, a critical form is fatal.

The chronic form is often asymptomatic. Many mothers may not be aware of its presence. Placental insufficiency can be detected by ultrasound.

The decompensated form can be determined by the activity of the fetus. The baby begins to move actively already at 28 weeks of pregnancy. Mommy can feel up to 10 movements a day. If the fetal activity indicators are significantly lower, then you should immediately consult a doctor.

Placental insufficiency can affect the slow growth of the abdomen. This symptom is due to a delay in the development of the crumbs. This symptom is almost impossible to identify on your own. Doctors observe changes in the growth of the tummy, so a woman must undergo a routine examination.



If a woman has spotting during pregnancy, it can be life-threatening for the baby. Bloody issues are a symptom of placental abruption.



Diagnostic measures

Diagnosis of uteroplacental circulatory disorders is carried out on the basis of the patient's complaints and the results of physical, laboratory and instrumental studies.

The physical examination includes assessment of such parameters as abdominal circumference, height and weight, the number of active fetal movements, uterine tone, and the presence of vaginal discharge. To determine the hormonal functioning of the placenta, laboratory research. The assessment of placental function is determined on the basis of blood and urine tests.



As instrumental examination ultrasound and CT scan. Ultrasound examination and CT can determine the thickness, structure and location of the placenta, as well as the presence of edema and extragenital diseases.

Instrumental studies during pregnancy are carried out three times. The first - from 11 to 14 weeks, the second - from 20 to 24, the third - from 32 to 34.

In the presence of obstetric or extragenital pathologies, it may be necessary to consult other doctors.



With timely diagnosis and treatment, the consequences are minimized.

Pathology therapy

The treatment regimen is determined by the attending physician based on the results obtained, the form and degree of insufficiency, individual features woman's health. To relax the muscles of the uterus, doctors prescribe tocolytics. This group of drugs includes Ginipral and Partusisten. These drugs reduce pressure in the vessels and arteries, normalize uteroplacental circulation. Trocolytics can cause side effects such as low heart pressure, tremors, nausea, and chills. When such symptoms appear, doctors prescribe Isoptin or Verapamil.



Vasodilating effect has No-shpa, Trental and Eufillin. In addition, they improve blood flow. Among side effects migraine, nausea, vomiting and heartburn are possible. Taking these drugs is contraindicated in diseases of the heart, thyroid gland, and also in epilepsy.

To avoid thrombosis, doctors prescribe antiplatelet agents. This category of drugs includes Curantyl and Aspirin. These drugs are taken until the 34th week of pregnancy, otherwise there is a risk of bleeding during childbirth.

In case of violation of the uteroplacental circulation, conservative treatment includes taking Actovegin. This drug develops resistance to hypoxia in the fetus. In addition, it stimulates cell regeneration. This drug is also prescribed for prophylactic purposes. The course of treatment is carried out during the entire pregnancy.

With the diagnosis of "placental insufficiency", a pregnant woman is prescribed Instenon. This tool helps to improve cerebral circulation and the heart. When prescribing Instenon, doctors recommend giving up strong coffee and tea, as these drinks weaken its therapeutic effect.

The doctor determines the course of treatment and dosage of drugs purely individually.



Depending on the effectiveness of drug treatment, the doctor determines the method of delivery. In the first degree or chronic compensated form, childbirth is carried out naturally. In all other cases, doctors perform a "caesarean section".

Necessary Prevention

As a preventive measure for the development of uteroplacental circulation disorders, doctors recommend eliminating physical and psycho-emotional stress. This will help relieve pressure in blood vessels. Otherwise, changes in the volume and speed of blood flow are possible. Non-drug prevention includes bed rest and treatment folk remedies. Medicinal decoctions and herbal infusions that have a calming effect are considered useful. These herbs include valerian, lemon balm, motherwort, chamomile and immortelle. It is considered useful herbal collection from these herbs. Mix all the ingredients in equal amounts and pour 1-1.5 tablespoons of 200 ml of boiling water. Take the infusion throughout the day in small sips.

Besides, Special attention should be given to nutrition during pregnancy. It should be balanced and useful. Nutritional supplements that stimulate bowel function are considered beneficial.



During the period of bearing a baby, it is necessary to exclude harmful factors that can provoke the development of placental insufficiency, for example, smoking or drinking alcohol.

From the 14th week of pregnancy, medication courses can be prescribed as a preventive measure. For this purpose, the pregnant woman is prescribed antispasmodic and detoxifying drugs. Timely prevention and drug therapy reduce the risk and severity of complications of pregnancy and childbirth.

Article publication date: 06/19/2017

Article last updated: 12/21/2018

In this article we will talk about such a concern for many pregnant girls as a violation of the uteroplacental blood flow. Causes of circulatory disorders in the mother-fetus system, their symptoms, dangers such violations and opportunities for treatment.

Violations of the uteroplacental blood flow are much more correctly called the term "violation of the uterine-fetal blood flow", since the blood circulation in the "mother-fetus" system can be conditionally divided into two components:

1. Uteroplacental circulation.
2. Feto-placental blood flow.

Violations of blood flow in any of these systems or in both at once is called in obstetrics disorders of the uterine-fetal blood flow.

The conditional boundary between these two systems can be called the placenta - a temporary organ of pregnancy, formed by the growth of the chorionic villi of the embryo into the mucous membrane of the uterine wall. The placenta is a filter consisting of numerous weaves of different levels of vessels in which maternal blood, without mixing with fetal blood, gives oxygen and nutrients to the fetal bloodstream, and takes it back harmful substances and exchange products.

The placenta is the most important organ for the fetus, which ensures its normal functioning.

Let's try to understand this most complex blood flow system:

• From the side of the uterus, the placenta is fed by the maternal arteries - uterine arteries and spiral arteries. They are the constituent component of the first level of blood supply to the pregnant uterus and fetus.
• The spiral arteries feed the placenta, forming directly the placental blood flow.
• The placenta forms the umbilical cord or umbilical cord - a complex of three vessels - two arteries and one vein, surrounded by a special jelly-like substance. Through the umbilical vein, blood rich in oxygen and nutrients moves to the umbilical ring of the fetus, further supplying the liver and other vital organs of the fetus. The blood flow in the umbilical vessels forms the second component of the blood circulation in the "mother-fetus" system.
• Large fetal arteries in vital organs - the aorta, the cerebral artery form the third component of blood circulation.

Fetal circulation. Click on photo to enlarge

If blood flow is disturbed at any level, the fetus receives less nutrients and oxygen - intrauterine hypoxia of the fetus or its oxygen starvation is formed. Intrauterine hypoxia can be both acute and quickly leading to fetal death, and chronic - long and sluggish, the main symptom of which is fetal growth retardation (abbreviated as FGR).

Depending on the severity and degree of blood flow disorders, the condition can be observed and treated conservatively (when it is not very dangerous) or urgent delivery of a woman at any stage of pregnancy to save the life of the child.

The problem of blood flow disorders in the "mother-fetus" system is dealt with by obstetrician-gynecologists in close contact with perinatal ultrasound diagnostics, since the main function for determining direct violations and their degrees belongs precisely to ultrasound doctors.

Causes of circulatory disorders in the "mother-fetus" system

• Placentation disorders - the formation and functioning of the placenta. Such violations can be primary - at the stage of pregnancy formation - placental abruption, lack of progesterone, defective uterine mucosa. An already formed placenta may also suffer. This is caused by disturbances in the coagulation system, infections, trauma to the placenta.
• Coagulation system disorders - spontaneous and induced thrombosis. Thrombi block large and small branches of the vessels of the uterus and placenta.
• Intrauterine infections damage the placenta and trigger the formation of blood clots.
• Complications of pregnancy - Rh conflict, preeclampsia, twin steal syndrome, placental abruption, premature birth.
• Lack of nutrients and vitamins - in particular iron deficiency - anemia.
• Maternal diseases - diabetes mellitus, hypertension, thrombophilia, vascular and vascular wall defects, heart and lung diseases.
• Impact of harmful factors external environment – harmful conditions at work, the effect of drugs, smoking, alcoholism, drug addiction.
• Stress and nervous strain.

Glucometer for measuring blood sugar levels. The presence of diabetes in the mother can lead to circulatory disorders in the system "mother-fetus"

The main symptoms of the disease

These symptoms are called external, because the main method for diagnosing disorders of placental and fetal blood flow is the Doppler ultrasound method, which will be discussed below in a separate section.

How can one suspect the suffering of the fetus before an ultrasound examination?

• Insufficient growth or complete absence of growth of the main indicators of measurements of the abdomen of a pregnant woman at the next admission - the height of the fundus of the uterus and the circumference of the abdomen. It is these two sizes that the doctor measures with a centimeter tape at each appointment of a pregnant woman.
• Unsatisfactory results of listening to the fetal heart by a doctor during examination. Every inspection future mother accompanied by listening to the heart sounds of the fetus using a special tube - an obstetric stethoscope. If the doctor notes a change in the fetal heart rate, muffled tones, lack of heart rate response to movements, then this should alert the physician.
• Unfavorable fetal movement profile. This symptom is clearly noted by the woman herself. A pregnant woman may complain of a weakening of movements, long periods of “silence” of the fetus, or excessively violent movement. The simplest test for motor activity fetus will test "Count to ten". In this case, a pregnant woman should count at least 10 separate fetal movements within 12 hours.
• Unfavorable or disturbing types of CTG - cardiotocography. This procedure for recording the electrical activity of the fetal heart is carried out every appointment in the antenatal clinic, starting from 28–30 weeks. CTG is a very sensitive method for assessing the condition of the fetus, therefore, in case of violations of the cardiotocogram, an obligatory ultrasound examination of the fetus and its blood flow is necessary.

These are the four main points under which there are objective reasons suspect a violation of the blood supply to the uterus and fetus. There are also relative indications for additional diagnostic measures regarding uterine-fetal blood flow:

1. Multiple pregnancy, especially in the presence of monochorionic twins. Such twins have one placenta for two, so the latter often cannot cope with such a load, especially in late pregnancy.
2. Anomalies in the structure of the placenta - hypoplasia of the placenta, rolled placenta, as well as its premature aging.
3. Anomalies in the structure of the umbilical cord or the presence of its true nodes - such nodes are formed when active stirring fetus.
4. Availability intrauterine infection- viral, bacterial or other.
5. Rh-conflict of the mother and fetus according to the Rh factor or blood type. Such a conflict is primarily diagnosed by the presence of antibodies in the mother's blood.
6. Maternal gestational diabetes mellitus during an existing pregnancy or pre-existing diabetes mellitus.
7. Gestosis is a complication late dates pregnancy, characterized by increased blood pressure, edema and the appearance of protein in the urine.
8. Maternal hypertension.
9. Any cardiac or vascular pathologies mother.
10. Blood clotting disorders - especially the tendency to thrombosis. Such disorders include hereditary thrombophilia and antiphospholipid syndrome.

All these factors significantly increase the risk of developing blood flow disorders in the mother-fetus system, and therefore are subject to close monitoring.

With the help of cardiotocography, it is possible to assess the fetal heartbeat at rest, movement and during uterine contractions.

Diagnosis of blood flow disorders

The gold standard for diagnosing disorders of perinatal blood flow is ultrasound examination of the fetus with obligatory dopplerometry. The Doppler method is based on the measurement of velocities, resistance indices and other indicators of blood flow in the vessels. The world medical community has developed a huge number of tables and diagrams of dopplerometry for each vessel.

In obstetrics, the assessment of fetal circulation is carried out in the following vessels:

• Uterine arteries - assessment of the first link of the "mother-fetus" system. Close attention indicators of the uterine arteries are given in pregnant women with diseases of the heart and blood vessels, anemia, arterial hypertension, preeclampsia and gestational diabetes mellitus.
• Vessels of the umbilical cord - assessment of the "mother-fetus" system - indicators of blood flow from the placenta to the child. The most commonly assessed indicators of blood flow in the umbilical artery.
• The middle or median cerebral artery is a powerful vessel in the fetal brain. The indicators of blood flow in this vessel are extremely important and significant in the presence of a conflict in the Rh system or blood groups, fetal anemia, and also in case of suspected fetal malformations.

The doctor measures blood flow indicators several times and correlates the obtained values ​​\u200b\u200bwith the tables. These are extremely variable indicators, they can fluctuate significantly depending on external and internal factors:

1. The gestation period is up to one week.
2. The number of fetuses and placentas - for twins and triplets, their Doppler indicators.
3. Maternal blood pressure - an ultrasound doctor is always interested in a pregnant woman with her pressure figures.
4. Maternal hemoglobin levels - with anemia, blood flow indicators can change significantly.
5. Smoking and other bad habits of the mother.
6. Medicinal preparations.
7. The tone of the uterus - both the usual hypertonicity, and regular contractions, for example, in childbirth.

Uterine tone (hypertonicity) - contraction of the muscular layer of the uterus

In addition to dopplerometry, the doctor performs the so-called fetometry - measuring the size of the fetus and calculating its estimated weight. If the fetus is significantly behind in development from the average, the doctor has the right to make a diagnosis of "fetal growth retardation", or FGR. A similar lag in fetal growth is observed with chronic hypoxia- that is, the fetus does not receive enough oxygen and nutrients for a long time several weeks and even months.

Based on the obtained indicators, the doctor of ultrasound diagnostics forms the diagnosis: “Violation of the utero-fetal blood flow” and indicates the degree. In the presence of fetal growth retardation, the diagnosis is supplemented by the wording "GRP".

Now we will talk in detail about the classification of the degrees of blood flow disorders.

Three degrees of pathology

There are three main degrees of utero-fetal blood flow disorders:

1. I degree - minor violations of one of the conditional circulatory systems. The first degree has two sub-degrees:

• I A - violations of the utero-placental blood flow with preserved feto-placental blood flow. This means a violation of blood circulation in the system of uterine arteries.
• I B - violation of the feto-placental blood flow with preserved utero-placental blood flow. In this case, the uterine arteries fully perform their function, but there are violations at the post-placental level.

II degree - a simultaneous violation in both conditional circulatory systems, not reaching critical changes. This means that on this moment blood flow is weakly disturbed and in the next day and even several days will not harm the fetus. The danger of this degree is that no one can predict how it will behave further and how quickly it will move to the next degree.

III degree - critical disorders of the feto-placental blood flow with preserved or impaired utero-placental. Such a violation speaks of the critical suffering of the fetus, which, without quick measures on the part of physicians, in a matter of hours will lead to severe intrauterine hypoxia fetus and death.

Treatment of fetal and uterine blood flow disorders

Mandatory treatment requires almost all degrees of blood flow disorders. The question is what degree of blood flow disturbances is detected, and whether it is accompanied by fetal growth retardation.

The most "harmless" are violations of the uteroplacental blood flow at 1a degree. It is important to understand that this type of violation is sometimes an accidental finding at the next ultrasound. This condition can occur against the background of an increase in the mother's blood pressure, her excitement, fatigue, and a decrease in hemoglobin levels. This degree does not always indicate the suffering of the fetus and often disappears on its own within a few hours after rest or a walk in the fresh air. However, this does not mean that you need to “give up” on the diagnosis. A pregnant woman must definitely undergo a control ultrasound in 5-7 days, and record CTG several times during the week.

The main methods of treatment of fetal blood flow disorders:

• Normalization of the lifestyle and nutrition of a pregnant woman. It is important to walk a lot in the fresh air, sleep at least 8 hours at night and try to rest at least an hour during the day, avoid long sitting in an uncomfortable position, move a lot, eat normally and fully.
• Blood pressure control is one of the most important parameters, causing uterine blood flow. In the presence of arterial hypertension, you must constantly take the drugs prescribed by the doctor and independently monitor the pressure indicators.
• Treatment of intrauterine infection antiviral drugs and antibiotics.
• Treatment extragenital pathology– normalization of sugar levels, normalization of hemoglobin levels, control of body weight, correction of the blood coagulation system. The latter includes taking drugs of low molecular weight heparins - Fragmin, Fraxiparin and others.
• The use of antispasmodics - No-shpy, Drotaverine, Papaverine. These drugs relax the wall of the uterus and spiral arteries, increasing blood flow.
• Taking magnesium preparations - magnesium has a relaxing effect on the uterine wall and a powerful protective effect on the central nervous system of the fetus. The last factor is important in the development of hypoxia.
• The use of "vascular" drugs - a large group of antiplatelet agents, angioprotectors and drugs that improve microcirculation and tissue trophism. The most common drugs in obstetrics are Pentoxifylline, Dipyridamole, Actovegin and their derivatives.
• In case of Rhesus conflict, plasmapheresis is prescribed - purification of the mother's blood on a special apparatus to reduce the amount of antibodies damaging the erythrocytes of the fetus.
• In the case of acute fetal hypoxia against the background of II and III degree blood flow disturbances, ineffectiveness of conservative therapy, as well as severe fetal growth retardation, early delivery is advisable, regardless of the gestational age. Most often, they resort to caesarean section, since the stimulation of childbirth is an additional burden on an already suffering fetus. The principle of “outside is better than inside” is the best fit for these situations.

Prognosis for the disease

The prognosis depends entirely on the degree of blood flow disorders, the duration of their course and the duration of pregnancy. The longer the duration of hypoxia and the higher the degree of blood flow, and less term pregnancy, the worse prognosis. Children born after prolonged intrauterine suffering are characterized by growth retardation and mental development especially after an emergency delivery before 37 weeks of gestation.

With untimely diagnosis and inadequate response to circulatory disorders, the situation can sharply worsen - acute hypoxia of the fetus occurs, fraught with its death or severe damage to the central nervous system.

Circulatory disorders are much worse against the background of extragenital pathology or preeclampsia. About 40% of preeclampsia are complicated by circulatory disorders in the "mother-fetus" system.

With adequate and timely treatment the condition can be, if not completely cured, then at least stabilized. This allows you to "grow" the baby to the maximum possible dates, after which his birth will be safe.