Premature maturation of the placenta is the appearance of echographic signs of maturity of placental tissue before the gestational period, for which such changes are physiological. It does not manifest itself clinically in any way, it is diagnosed only with routine screening. When making a diagnosis, ultrasound data is used. The study is supplemented with placental blood flow dopplerography, CTG, fetometry, fetal phonocardiography. Treatment involves the therapy of the underlying disease and the appointment of drugs that improve blood circulation between a pregnant woman and a child — antiplatelet agents, vasodilators, essential phospholipids, amino acid complexes.
Normally, a child’s place goes through several stages (stages) of development corresponding to the peculiarities of growth and maturation of the fetus at certain gestation periods. Physiological changes occurring in the tissues of the placenta allow it to effectively cope with the performance of nutritional, respiratory, excretory and barrier functions. In the presence of some provoking factors that cause overstrain of compensatory processes, the child’s place grows and matures at an accelerated pace. In such cases, they talk about PMP — premature maturation (aging) of the placenta. The urgency of timely diagnosis of the disorder is due to the high probability of its complication by fetoplacental insufficiency, which poses a threat to the physiological development of the child.
The early onset of the aging processes of placental tissue is provoked by any factor leading to the enhanced functioning of the mother-fetus system. The starting point in the development of the disorder can serve as changes in the maternal body, adverse environmental factors, the pathological course of pregnancy. According to experts in the field of obstetrics and gynecology, the most common reasons for the premature onset of the aging process of a child’s place are:
- Extragenital pathology. Accelerated development of placental tissue is more often observed in pregnant women suffering from somatic and endocrine diseases (kidney diseases, arterial hypertension, diabetes mellitus, hypothyroidism, hyperthyroidism). This is due to increased stress on functionally incompetent organs and systems, as well as changes in microcirculation during pregnancy.
- Chronic diseases of the reproductive organs. Structural changes in the uterine wall that occurred after abortions, due to chronic endometritis, adenomyosis, and submucosal fibroids, lead to a violation of the processes of placentation, and then the functioning of the placenta. Premature onset of maturation is possible with dishormonal disorders against the background of ovarian diseases (oophoritis, adnexitis, sclerocystic syndrome).
- Gestosis. Characteristic changes in blood circulation in the uterine wall and the utero-placental complex, which occur during prolonged gestosis, increase the functional load on the baby’s place. At the initial stages, compensatory mechanisms allow maintaining normal fetal blood supply. However, in the subsequent breakdown of compensation accelerates the growth of the placenta, stimulates its premature development, maturation and aging.
- Infectious diseases. A significant load on the placental tissue, which performs a protective function, appears when the fetus is threatened with infectious agents. Causative agents of specific genital infections (herpes simplex, mycoplasmosis, ureaplasmosis, chlamydia), other infectious diseases (ARVI, rubella, toxoplasmosis, cytomegalovirus infection) become provoking factors.
- Isoserological incompatibility of mother and fetus. A child who has a hemolytic disease due to an AB0- or Rh-conflict needs a more intensive supply of nutrients and oxygen, which increases the load on the placental tissue. Enhanced functioning in combination with typical dyscirculatory disorders potentiates accelerated growth and early aging of elements of the fetoplacental complex.
Prerequisites for the development of pathology are also the influence of damaging environmental factors (chemical and vibrational industrial hazards, radiation effects), the presence of harmful habits in a pregnant woman (smoking, the use of psychoactive substances). The disorder is more often diagnosed in women with overweight or underweight, low motor activity and irrational nutrition.
Premature maturation of the placenta is part of the compensatory mechanisms that occur in fetoplacental insufficiency and subsequently aggravate its course. With an increase in the needs of the fetus in nutrients, the threat of infection with infectious agents, microcirculation disorders in the utero-placental or feto-placental complex, the formation and growth of the baby’s place occur more intensively, as a result, its tissues reach the stage earlier when their maturation begins, and then aging with the formation of cysts, calcifications, thrombosis, heart attacks. As a result, the functional capabilities of the placenta decrease, fetoplacental insufficiency increases.
The systematization of the stages of maturity of the placenta is based on the peculiarities of its physiological development, takes into account changes in the structure of the organ characteristic of certain stages of pregnancy. Premature maturation is spoken of when ultrasound signs of the next stage of maturity are determined earlier than the existing gestational period. Obstetricians and gynecologists distinguish 4 degrees of maturation of the child’s place:
- 0 — zero (formation). Lasts from the 2nd to the 30th week of gestation. Placental tissue gradually increases in mass and volume as the villous tree grows, and on ultrasound it has a homogeneous echonegative parenchyma without any inclusions.
- I is the first (growth). At 30-34 weeks of pregnancy, a small number of echogenic inclusions appear in the placenta due to collagenization of the stroma, there is a slight undulation of the chorial plate, the tissues begin to condense.
- II — the second (maturity). By the 35-39 weeks of gestational age, the waviness of the chorial membrane increases, the acoustic density is increased, and many small echopositive inclusions are detected in the tissues. The organ is functioning normally.
- III — the third (aging). From the 37th week of pregnancy, the chorial plate becomes sinuous, the structure of the placenta is represented by rounded dense lobules with a rarefaction in the center. The exchange area and volume of the organ are reduced.
Maturation is considered premature if signs of the first degree of maturity appear before the 27th week of gestation, the second degree — up to 32 weeks, the third — up to 36 weeks. Such dynamics of development indicates a high probability of functional organ failure and decompensation of adaptive capabilities of the “mother-fetus” complex.
Changes occurring during early aging in placental tissue are not clinically determined and can only be detected instrumentally. In the absence of acute diseases, a clear exacerbation of chronic diseases or signs of pregnancy complications, the patient usually does not make any complaints. In other cases, the symptoms of the underlying pathology prevail. With significant placental insufficiency caused by premature maturation of placental tissues, it is possible to change the motor activity of the fetus — an increase in the frequency of movements and an increase in their intensity. More serious disorders are indicated by rare movements of the child up to their complete cessation.
Since the aging of a child’s place is associated with a decrease in its functional capabilities, pathology is usually accompanied by the appearance or intensification of signs of placental insufficiency. According to observations, decompensation of disorders in the placenta-fetus system in 64% of cases is caused by premature maturation of the organ. Retrospective studies show that the appearance of signs of premature maturation of the placenta at 22-26 weeks of pregnancy is almost always associated with severe fetal development delay and intrauterine hypoxia at the beginning of the third trimester. In extreme cases, pathology leads to the antenatal death of the child. With the early onset of dystrophic and sclerotic processes, premature placental abruption, early discharge of amniotic fluid and premature birth are more often observed.
The detection of changes typical of premature placental maturation during ultrasound screening is the basis for performing a comprehensive assessment of the fetoplacental system with subsequent careful monitoring of pregnancy. The main activities are aimed at identifying structural changes and assessing the functional capabilities of the body. The most valuable in diagnostic terms are:
- Ultrasound of the uterus, placenta and fetus. The method is recognized as the “gold standard” of diagnostics, allows you to determine the thickness of placental tissue, detect characteristic structural changes indicating the compaction of the baby’s place, its structuring into lobules, the appearance of cysts, salt deposits, areas with impaired blood supply.
- Dopplerometry of uteroplacental blood flow. The reflection of ultrasound by the blood that moves in the vessels of the placenta depends on the speed of blood flow in the system. With the help of a Dopplerogram, it is easy to evaluate both quantitative indicators of blood supply and qualitative characteristics that indirectly indicate the condition of blood vessels.
Taking into account the high risk of fetoplacental insufficiency, it is necessary to monitor the growth of the child using fetometry, CTG, phonocardiography of the fetus. Since premature dystrophic changes of the placenta are usually secondary and provoked by other disorders, it is important to determine the underlying pathology. For this purpose, laboratory diagnostics of infectious processes is recommended — smear examination, microbiological analysis of culture media, ELISA, PCR, TORCH complex, consultations of related specialists – urologist, endocrinologist, therapist, cardiologist, infectious disease specialist, dermatologist, rheumatologist, immunologist, hematologist, etc. Differential diagnosis is carried out with infarcts of the child’s place, calcifications, its hyperplasia and neoplasms (chorioangioma, cystic drift).
The main medical tasks in the management of a pregnant woman with PMP are the correction of disorders that caused pathology, normalization of blood circulation in the utero-placental system, the choice of the optimal method and time of delivery. The tactics of the patient’s management at the prenatal stage is determined by the period at which premature aging was diagnosed:
- Early detection of PMP. Detection of metabolic and dystrophic changes in placental tissue at 20-24 weeks is an indication for examination in a specialized department of pregnancy pathology. In such cases, starting from the 26th week of gestation, dopplometric blood flow monitoring is performed at least once a week, fetal movements are counted daily. Urgent delivery with critical violations of the blood flow in the umbilical cord, CTG-signs of fetal hypoxia, stopping its growth, a sharp decrease in the volume of amniotic fluid, the appearance of other signs of a threat to the child can be performed even at 31-33 weeks.
- Detection of PMP in the third trimester. According to the research results, when the process of premature aging of the placenta is detected at 32-34 and, moreover, 35-37 weeks of gestational age, the probability of a pathological course of pregnancy is significantly reduced. However, in order to detect complications in a timely manner, it is necessary to ensure regular ultrasound and specialist supervision. The preferred method of delivery is natural childbirth. Only in cases where PMP is combined with a significant delay in fetal development, caesarean section is indicated for the prevention of acute distress syndrome in a child.
Regardless of the timing of detection of premature maturation of placental tissue, an obstetrician-gynecologist or a specialized specialist actively treats the main genital or extragenital disease using antibiotics, hormone therapy, immune correctors, cardiovascular and other medications. In parallel with the correction of the leading disorder, drugs are prescribed to improve fetal blood supply — vasodilators, antiplatelet agents, amino acid complexes, essential phospholipids. Drug therapy is supplemented by non—drug methods – rational motor activity, diet correction, normalization of sleep and rest.
Prognosis and prevention
Timely screening and proper medical tactics can reduce the risks of fetoplacental insufficiency with aging of the placenta, slow down this process and prolong pregnancy to safe terms for the birth of a child. Primary prevention involves pregnancy planning by patients with genital and extragenital diseases, protected sex to protect against specific infections, reasoned appointment of invasive gynecological procedures, smoking cessation, alcohol and drug use. During gestation, for the normal development of the placenta, it is important to take care of protection from possible infection with SARS and other infectious diseases, maintaining hemoglobin levels, sufficient motor activity and a rational diet. Secondary prevention is aimed at early diagnosis of the disorder, includes timely registration in a women’s clinic, regular scheduled examinations and ultrasound.