Uteroplacental blood flow disorders is a symptom complex that develops during pregnancy due to a disorder of the functions of the placenta or morphological changes occurring in its structure. There may be no clinic on the mother’s side. Against the background of obstetric pathology, fetal hypoxia occurs, manifested by increased or slower heart rate, decreased activity. Diagnosis of disorders of uteroplacental blood flow is carried out by ultrasound, CTG, Dopplerometry. Treatment is carried out in a hospital in a conservative way using drugs that improve hemodynamics in the vessels of the placenta.
Uteroplacental blood flow disorders is an obstetric pathology that occurs due to a disorder of hemodynamic functions in the “woman-placenta-child” system. This anomaly is diagnosed in about 4% of pregnant women. In 25% of cases, the disease develops against the background of already existing extragenital diseases of the patient. Violation of uteroplacental blood flow poses a threat to the health and life of the fetus, as it can lead to insufficient intake of nutrients, which is complicated by intrauterine development delay, hypoxia and even possible death of the child.
The danger of violation of uteroplacental blood flow depends on the severity and duration of existence of this obstetric pathology. The less nutrients the child receives, the higher the probability of abnormalities. According to statistics, about 85% of newborns exposed to such pathology are born with signs of hypoxia or congenital anomalies of varying severity. Violation of uteroplacental blood flow can occur at different stages of pregnancy, most often it is diagnosed in the 2-3 trimester of gestation. Hemodynamic disorder, which has developed up to 16 weeks, often ends in spontaneous miscarriages.
Uteroplacental blood flow disorders develops due to improper formation of the villous layer of the fetal membranes during the placenta laying period or as a result of the influence of unfavorable factors on the mother’s body that cause hemodynamic disorders in the normal placenta. The pathogenesis of the disease consists in incomplete uteroplacental perfusion, leading to insufficient oxygen supply to the fetus. As a consequence, a violation of the uteroplacental blood flow triggers the mechanism of hypoxic changes that contribute to fetal development delay.
Endogenous and exogenous causes can provoke a violation of the uteroplacental blood flow. The first group includes factors that affect the future mother’s body from within. The risk of developing pathology is observed if a woman has diabetes mellitus, kidney, heart and vascular diseases, against the background of thyroid dysfunction. The formation of a violation of uteroplacental blood flow is facilitated by a burdened obstetric history – late gestosis, threats of termination, multiple abortions and miscarriages, benign uterine tumors. A high risk of hemodynamic disorder is observed against the background of pregnancy with Rh conflict, as well as if the patient suffered from infertility.
Violation of the utero-placental blood flow often develops against the background of genetic disorders in the fetus and in the presence of congenital defects of the mother’s reproductive system (with a two-horned or saddle-shaped uterus, partitions in the organ cavity). The probability of obstetric pathology also exists with sexual infections, as well as if the patient has suffered viral diseases, for example, influenza, ARVI. Exogenous factors contributing to the disruption of uteroplacental blood flow include work in hazardous industries, drug and alcohol use, smoking. Irrational nutrition also has an adverse effect. The risk group for the development of uteroplacental blood flow disorders includes women under the age of 18 and older than 35 years. The risk of abnormal hemodynamics is present with constant stress, intense physical exertion.
Depending on the localization of pathological changes in obstetrics, there are several degrees of severity of uteroplacental blood flow disorders:
- 1a – is characterized by a disorder of hemodynamics between the uterus and placenta, while a sufficient amount of nutrients gets to the child.
- 1b – circulatory disorders occur in the “fetus-placenta” circle.
- Grade 2 – violation of uteroplacental blood flow is observed in the circle “fetus-placenta-mother”, but hypoxia is expressed slightly.
- Grade 3 – accompanied by a critical disorder of hemodynamic parameters, can lead to the death of a child or spontaneous abortion.
Taking into account the gestation period, at which there is a violation of the uteroplacental blood flow, the following types of pathology can be distinguished:
- Primary – occurs in the first trimester, usually develops against the background of abnormal implantation, disorders in the formation or attachment of the placenta.
- Secondary – diagnosed after 16 weeks of embryogenesis, as a rule, provoked by negative external factors or the state of the mother’s health.
Clinical manifestations of uteroplacental blood flow disorders depend on the severity of obstetric abnormality. On the mother’s side, pathological signs are not always observed. The patient may develop gestosis, there is often a threat of miscarriage or premature birth, which is accompanied by abdominal and groin pain. The appearance of bloody mucus from the genital tract is possible. Against the background of a violation of the uteroplacental blood flow, the activity of conditionally pathogenic flora is activated, colpitis often occurs. This complication of the violation of uteroplacental blood flow can cause intrauterine infection of the fetus.
Violation of uteroplacental blood flow is more pronounced on the part of the child. In some cases, the patient herself may suspect signs of fetal hypoxia. The pathological condition is manifested by a decrease in the child’s motor activity. During the examination, the obstetrician-gynecologist reveals an increase or decrease in the heart rate of the baby, which is also a reliable sign of a violation of the uteroplacental blood flow. Lack of nutritional components can cause premature placental abruption. At the same time, the condition of the woman and the fetus is rapidly deteriorating, there may be a threat to life.
Diagnosis and treatment
It is possible to detect a violation of the uteroplacental blood flow during ultrasound. The presence of obstetric pathology is indicated by the pathology of the placenta and intrauterine fetal development delay, manifested by the discrepancy in the size of the anatomical parts to the gestation period. It is possible to assess the degree of violation of uteroplacental blood flow using Dopplerography. CTG is used to assess the functionality of the child’s cardiovascular system. A characteristic feature is tachycardia or bradycardia, which occurred against the background of hypoxia.
Treatment of uteroplacental blood flow disorders is carried out in a hospital setting. The patient is shown bed rest, exclusion of stress and intense physical exertion. Conservative therapy consists in the use of drugs to relieve disorders of uteroplacental blood flow and improve fetal oxygenation. Antiplatelet agents and agents that improve the nutrition of brain tissues are also used. In case of violation of uteroplacental blood flow, the use of vitamins, calcium channel blockers is indicated. The latter are used to eliminate hypertonicity of the uterus.
In case of violation of the uteroplacental blood flow, all the efforts of specialists are aimed at prolonging pregnancy up to 37-38 weeks. Provided that the drug therapy is sufficiently effective, the patient is transferred to outpatient treatment after 4 weeks. If it is not possible to cope with the signs of a violation of the uteroplacental blood flow and the condition of the fetus continues to deteriorate, premature delivery is performed by emergency caesarean section. If the pregnancy was carried to 38 weeks, childbirth can occur naturally. In the second period, the use of vacuum extraction of the fetus or the imposition of obstetric forceps is indicated. In the case of a violation of uteroplacental blood flow against the background of other diseases, the mother has a planned cesarean section at 38 weeks.
Prognosis and prevention
Timely treatment of uteroplacental blood flow disorders allows a woman to prolong pregnancy up to 37 weeks of gestation and give birth to an absolutely healthy baby. With the primary form of pathology, stillbirth or spontaneous miscarriage is possible. Prevention of uteroplacental blood flow disorders consists in the elimination of extragenital pathologies even before conception, early registration with an obstetrician-gynecologist and the implementation of all his recommendations. A pregnant woman should adhere to a rational diet, give up bad habits, stress and hard physical work. The exclusion of contacts with possible sources of infections also makes it possible to reduce the likelihood of developing a violation of the uteroplacental blood flow.