Accelerated maturation of the placenta. True early puberty. What Causes Precocious Puberty

21.06.2019

Early puberty is its onset before 8 years. For European countries, this age is still relevant, but in the United States it is proposed to use a 7-year threshold for white girls and a 6.5-year threshold for African Americans.

Differences between Europe and the US in early puberty may be due to ethnicity, different prevalence of obesity, or methodological reasons. Puberty is now developing earlier than in the past, but there is little evidence that menarche occurs earlier in modern girls; it is believed that the rate of puberty at an early onset may be slower than in past generations. In boys, the boundaries of normal sexual development are still determined by the age of 9.

Types of early sexual development

It is necessary to separate "true" (or "central") and "false" early puberty. With true early puberty, all the signs of normal puberty develop earlier, while with false, only certain signs, depending on the production of androgens or estrogens. Excess production of estrogen in girls or testosterone in boys leads to isosexual development. Conversely, excess or early production of estrogen in boys or testosterone in girls leads to heterosexual development.

There are also two forms of partial development that are usually considered normal variants: premature adrenarche, or pubarche (early growth of pubic hair) and thelarche (breast development). (It should be noted that since the first sign of true precocious puberty in girls is breast enlargement, the differential diagnosis between precocious puberty and early thelarche cannot be made on the basis of a single physical examination alone: it is important to take into account height and bone age, which are in within the normal range in early thelarch and ahead of normal rates in precocious puberty.)

Symptoms

True (central) precocious puberty

True precocious puberty is characterized by:

harmonious development of all structures involved in puberty - breast enlargement, growth of pubic hair in girls, maturation of the uterus and ovaries after menarche; enlarged testicles and penis, growth of pubic hair in boys;
the simultaneous development of secondary changes, such as mood swings, acne, the appearance of a specific body odor;
teenage growth spurt;
rapidly progressive advance of bone age, which leads to premature closure of the epiphyseal growth zones and a decrease in final growth.

True precocious puberty can be idiopathic (by far the most common form in girls) or caused by CNS pathology (more often in boys). These may include congenital anomalies, hypothalamic hamartomas, increased intracranial pressure, and tumors that may occur after exposure, especially in girls. Intracerebral lesions may occur de novo or against the background of existing predisposing diseases, such as neurofibromatosis. Early puberty in rare cases can be observed in primary long-term hypothyroidism due to the homology of the protein sequence of TSH and human chorionic gonadotropin (hCG).

In girls adopted from developing countries to developed countries, puberty may begin slightly earlier, progressing rapidly to menarche at 11+ years of age (vs. 12+ years of age) and decreasing height into adulthood.

Subacute ovarian torsion causes pronounced and maturation of stromal cells; often there is estrogenization, development of the mammary glands and androgenization due to the production of testosterone by the ovaries. Clinically, it is very difficult to differentiate this condition from central precocious puberty; aid in the diagnosis is provided by a test with inhibition of the LH-FSH axis and typical ultrasound signs.

False precocious puberty

False sexual development is characterized by:

hypertrophy of affected tissues due to excessive production of hormones;
regression or suppression of structures that normally produce hormones during adolescence;
advancing bone age;
increase in growth rate.

Early puberty may be isosexual or less commonly heterosexual due to adrenal tumors producing either testosterone or estrogen; non-salt-wasting congenital virilization with adrenal hyperplasia, administration of exogenous gonadotropin or sex steroids, estrogen- or testosterone-producing gonadal tumors, gonadotropin or hCG-producing tumors, ovarian cysts that produce estrogen. Heterosexual precocious puberty in girls is often the result of severe clitoral hypertrophy, which can serve as a differential diagnostic difference from premature adrenarche.

In Albright-McCune-Sternberg syndrome, there is discordant puberty.

Patients are characterized by the presence of age spots such as coffee with milk, usually located on one side in the upper body. There are also foci of bone dysplasia and cysts in the long bones and bones of the skull. Signs of puberty are usually contradictory - the early onset of menstruation and the absence of gonadotropin cycling. The syndrome is more common in girls; in rare cases, thyrotoxicosis, gigantism and Cushing's syndrome can be detected. The syndrome is caused by a common mutation of a part of the G protein (secondary signal transmitter for receptor activation) in endocrine tissues, which leads to an increase in their activity.

Apart from the cases of abnormal secretion by tumors described above, there is an excess production of estrogens from testosterone by peripheral aromatase, which leads to overweight in boys, gynecomastia in adolescence. Breast development and lactorrhoea caused by prolactinoma are extremely rare.

Testotoxicosis is a familial male disease, accompanied by precocious puberty, general changes characteristic of male puberty, but small testicles that do not correspond to the degree of virilization are often observed. In this disease, there is no cyclic activation of gonadotropin, puberty is caused by constitutive activation of LH receptors, which leads to early testosterone production in the absence of circulating LH.

Premature adrenarche, or pubarche

Premature adrenarche, or pubarche, is characterized by:

hair growth in the armpits and on the pubis;
acne, body odor and other androgen-mediated effects;
slight advance of bone age;
usually normal growth rate.

Adrenarche is a normal aging process of maturation of the adrenal cortex, possibly under the influence of ACTH (or other "central adrenarche-stimulating hormones"), causing increased secretion of DHEA and other androgenic testosterone precursors. Their effects are usually limited to adolescence. With early maturation, signs of virilization become noticeable. Idiopathic displacement of adrenarche from adolescence is more common in girls than in boys. There is evidence of genetically determined hyperactivity of one of the pathological pathways for the synthesis of adrenal steroids 17,20 desmolase, which can lead to familial adrenarche and, in some cases, familial polycystic ovary syndrome. Most girls with precocious adrenarche develop an SCS-like phenotype, including "metabolic syndrome X". Premature adrenarche may also be secondary to non-progressive intracranial lesions, predominantly mediated by abnormal production of ACTH or adrenarche-stimulating central hormones. The most common intracranial causes are hydrocephalus and the consequences of meningitis (especially tuberculous meningitis). Since in some cases these manifestations can be severe or familial, it may be necessary to make a differential diagnosis with late manifestations of atypical or non-classical congenital adrenal hyperplasia (CAH).

hirsutism

Other causes of adrenal hyperactivity or androgen production that cause excessive hair growth in girls (with or without late male pattern baldness) include the following diseases.

Classic VGN.
Late onset CAH is common but poorly diagnosed. The non-classical subtype of the disease is associated with the human major histocompatibility complex antigens HLA B14 and B35.
Cushing's syndrome.
A secondary increase in the level of testosterone secreted in polycystic ovaries, which, in turn, may be due to increased activity of the adrenal glands and hyperinsulinemia, or be the primary manifestation of puberty.
Idiopathic hirsutism is also observed with an increase in the activity of 5a-reductase in the skin. Treatment consists of blocking the enzyme, such as finasteride.
Some girls or their parents have cosmetic problems due to the normal growth of dark hair.
It is noted that hirsutism, limited to the lower part of the body, testifies in favor of the adrenal origin of androgens. Along with the treatment of the causes of hirsutism, cosmetic correction is also carried out: lightening and destroying hair with electric current, depilation.

Premature thelarche

This benign condition is characterized by:

breast enlargement, usually at an early age (may occur in later childhood), accompanied by a cyclical pattern of clinical symptoms within a month;
the absence of any subsequent manifestations of puberty;
normal growth and maturation of the skeleton. In premature thelarche, periods of follicular development (more than 3-4 mm) occur during FSH-aromatase induction. Laboratory tests may reveal low estrogen levels.

Different variants of diseases with similar signs with central precocious puberty and thelarche are described, in which the level of FSH is increased (in contrast to true puberty, in which the level of LH>FSH).

Isolated premature menarche

This poorly explained condition occurs in prepubertal girls, often during the summer. There may be cyclic bleeding every 4-6 weeks for 3-4 days for several months in a row. There are no signs of an increase in the concentration of gonadotropin, but a small echopositive endometrial layer is detected during the bleeding phase. Differential diagnosis is carried out with sexual abuse, malignant neoplasms of the vagina and erosion of the cervix; with an unclear history and atypical findings, an examination under anesthesia may be necessary.

Examination at early puberty

History and physical examination

When taking a history of early puberty, it is important to find out the following points listed below.

The exact time of onset of symptoms of puberty; girls are asked if their breasts enlarged before or after the onset of pubic hair.
Vaginal discharge, which may be thick, mucus or bloody.
Height (has increased rapidly lately? - changes can be noted relative to the height of peers or by changing the size of clothes or shoes).
Any signs of hypothyroidism.
Any neurological or ophthalmic symptoms.
Family history of precocious puberty or suspected neurofibromatosis.
Past diseases with damage to the nervous system.
Reception of any medicinal substances (estrogens, androgens, cimetidine). Medicines may be prescribed or taken accidentally (eg, accidental use of contraceptives) or spontaneously. Precocious puberty has been reported in both boys and girls when taking traditional Chinese herbal preparations. Organochlorine pesticides of the DDT (dichlorodiphenyltrichloromethylmethane) group can cause steroid-like effects.
Eating poultry and meat that has been over-treated with veterinary drugs.

An objective examination in early puberty should include the following steps.

An accurate description of the stage of sexual development (for long-term observation, it is useful to measure the circumference of the chest).
Height, sitting height and body weight, their assessment relative to normative indicators and previous measurements (due to the fact that the growth of the spine is partly due to the influence of sex hormones, with early puberty, sitting height is relatively longer than the length of the limbs).
Inspection of the color of vaginal mucus, pale color indicates estrogenic activity.
Signs of hyperandrogenization (hirsutism, enlargement of the clitoris or penis, acne). Hirsutism can be assessed on a simple scale. Hirsutism in the lower body only is most often of adrenal origin.
Blood pressure (increased with 11 β-hydroxylase form of adrenal hyperplasia or with increased intracranial pressure).
Inspection of congenital pigmentation.
Thyroid size and signs of hypothyroidism. In boys with hypothyroidism, testicular volume may be larger than would be expected from other sex characteristics. In girls with hypothyroidism, menstruation may come earlier than the stage of development of the mammary glands suggests.
Hepatomegaly and tumor-like formations in the abdominal cavity.
Tumor-like masses in the pelvic cavity (for example, ovarian cysts or tumors) on transabdominal or rectal examination.
Neurological examination (including examination of the fundus).

Interpretation of the received data

True early puberty

In girls with no other symptoms or syndromes = idiopathic precocious puberty confirmed by CT or MRI.
In the presence of neurological symptoms or syndromes = CNS involvement.
With more than five café-au-lait spots or freckles in the armpit, with or without a family history = neurofibromatosis and optic glioma or other CNS tumors.
Thyroid enlargement and/or typical symptoms and syndromes = hypothyroidism.
Tall boys and girls with early pubic hair growth, sweating, and other signs of puberty may have a non-salt-wasting form of CAH, in which there is a pronounced advance in bone age, in contrast to false precocious puberty.

False early puberty

Positive family history = adrenarche or atypical 21-hydroxylase deficiency.

Hypertension in girls with signs of virilization or in a boy with false puberty = deficiency of 11β-hydroxylase.
Cliteromegaly, advance of bone age and growth acceleration = androgenization is not a consequence of adrenarche.
Random café-au-lait macules and/or evidence of lytic bone lesions on x-ray = Albright-McCune-Sternberg syndrome.
Tumor in the pelvis or palpable through the rectum = ovarian tumor.
Hepatomegaly = tumor of the liver (producing hCG).
Tumor in the abdomen = tumor of the adrenal gland.
Gynecomastia with unilateral testicular enlargement = germ cell tumor.
Gynecomastia without testicular enlargement = intra-abdominal tumor (often not palpable) or extraglandular aromatase conversion at puberty (most common, but not always + in obese adolescents).
Past diseases with damage to the nervous system = premature adrenarche.
Early enlargement and cycling = premature thelarche.
Positive family history in boys = familial testotoxicosis.

Additional Research

Growth assessment in determining the stage of puberty is a fundamental criterion for determining the tactics of further examination depending on the sex of the child.

In-depth examination in early puberty in girls

If a little girl has only a slight enlargement of the mammary glands without any other signs of estrogenic activity, and growth rates are within the normal range, then further research may be limited to radiography of the bones of the hand and wrist to determine bone age. If the bone age is not ahead of the calendar, the child may be examined after a few months, when the decrease or progression of symptoms, growth of pubic hair, growth rate is assessed. If there is no progression of symptoms of early puberty, and the growth rate is within the normal range, the most likely diagnosis is premature thelarche or temporary exposure to exogenous estrogens. Further research is needed and parents should be instructed to seek immediate medical attention if any other signs of puberty appear. The detection by ultrasound of one or two follicles in the ovary of a small volume in the absence of an increase in the uterus requires a second examination.

If signs of estrogenic activity are detected (active development of the mammary glands, thick mucous discharge, pale mucous membrane of the entrance to the vagina, psychological changes, an increase in the growth rate and an advance in bone age), the following studies are indicated.

Determination of the concentration of basal estradiol (E2), LH, FSH.
Analysis of thyroid function - T 4 s and TSH.
Ultrasound of the abdominal cavity to determine the size of the ovaries and uterus.
Determination of the concentration of inhibin B (a derivative of granulosa cell glycoprotein, which returns to the pituitary gland and inhibits the production of FSH), which increases with thelarch (the concentration of inhibin A produced in the corpus luteum does not increase); to differentiate from true puberty, in which the level of inhibin A and B increases. If there is doubt about the determination of estrogens, a cytological examination of the vaginal secretion (percentage of squamous cells) is performed.
A test with luliberin in a specialized department: - before the onset of puberty, the increase in LH and FSH is insignificant, while the level of FSH increases more than LH; - during puberty, the level of LH and FSH increases equally, LH is increased more than FSH in the middle of late puberty; - thus, the ratio of LH to FSH (>1) can be used as an indicator of "achievement" of puberty.

If there is evidence of true precocious puberty (E2 greater than 50 pmol/L, LH/FSH ratio >1, peak LH increase) in the absence of hypothyroidism, the cause should be established by CT or MRI of the brain.

If evidence of false precocious puberty (increased E2 concentration, decreased LH and FSH levels even after the administration of luliberin) is obtained, further targeted studies are needed to identify the cause. Most tumors are detected during ultrasound of the ovaries, liver and adrenal glands, in rare cases, tumors can be localized inside the chest cavity. Sometimes a CT scan is needed to detect small adrenal lesions.

If signs of a slight excess of androgens are noted with normal bone age and growth of the child, then benign premature adrenarche can be assumed, in which case further studies are not indicated. (This usually reveals a slight increase in serum DHEA sulfate, and a slight increase in the metabolites of adrenal cortex hormones in the steroid profile of the urine.) Confirmation of a non-classical deficiency of 21-hydroxylase, which can simulate premature adrenarche to determine the basal level and increase 17a-hydroxyprogesterone, it is necessary to conduct a test with short ACTH (synacthen).

In more severe virilization, accompanied by cliteromegaly, increased bone growth and maturation, a urinary steroid profile and measurement of 17a-hydroxyprogesterone, DHEA, DHEA sulfate, and androstenedione will detect most forms of CAH and androgen-secreting tumors. The localization of the tumor is specified during ultrasound or CT.

In the presence of abnormal pigmentation, a skeletal x-ray will confirm Albright-McCune-Sternberg syndrome, in which thyroid and adrenal function should also be assessed.

In-Depth Examination for Early Puberty in Boys

When identifying signs of early sexual development and in the form of testicular enlargement, the determination of the basal level of testosterone in the blood serum, LH, FSH and a test with luliberin in a specialized department are shown. If testosterone levels are elevated (>1.0 mmol/L) and the luliberin test corresponds to puberty (see above), true precocious puberty is diagnosed. Since boys with precocious puberty have a relatively high incidence of brain pathology, CT or MRI of the brain is mandatory.

If testosterone levels are elevated with small testicles during early puberty, a diagnosis of false precocious puberty is likely, as also evidenced by the inhibition of LH and FSH during the luliberin test. Additional determination of other steroids in urine and serum (androstenedione, DHEA, DHEA sulfate and 17a-hydroxyprogesterone) is indicated to determine the source of androgen increase. By relative magnitude, it is possible to differentiate premature adrenarche (relatively rare in boys), exogenous steroid use, various non-salt-wasting forms of CAH, and adrenal tumors.

When isolated gynecomastia is detected, the determination of testosterone, prolactin, E2, hCG and LH is indicated. HCG and/or E2 levels are elevated in some estrogen-secreting tumors, which may be of testicular origin (detected by ultrasound) or extragonadal origin (detected by ultrasound and CT). Gynecomastia in the absence of other signs of puberty can also be detected in primary testicular lesions (menopausal LH levels are increased), as well as in hypothalamic or pituitary hypogonadism (LH levels are not determined). Very rarely, in children with early sexual development, prolactinoma is detected, which usually manifests itself as symptoms of CNS damage and is the only cause of lactorrhea. If the level of estrogen is slightly elevated, and all other samples are normal, extragonadal conversion of testosterone by aromatase is most likely.

Treatment

True early puberty and leads to a decrease in final height, early puberty can create psychological problems in a child. For this reason, treatment is usually carried out in specialized departments. Currently, the treatment consists in the introduction (intramuscular or subcutaneous) of depot luliberin (depending on the drug with a slow release every 4-12 weeks).

To prevent initial hyperstimulation and enhance precocious puberty in the first 6 weeks of treatment, a competing administration of blockers of the synthesis of steroid sex hormones is carried out - cyproterone at a dose of 100 mg / m 2 of body surface per day for 2-3 doses. (Cyprotsterone can be used alone to treat precocious puberty, however, being effective against the progression of sexual development, it does not affect final growth. In addition, the drug may have side effects in the form of increased fatigue and leads to hypocortisolism, which necessitates the introduction of glucocorticoids into stressful situations). Treatment of early sexual development with gonadoliberin analogues continues until normal growth is achieved and signs of puberty appear in the child's peers. After this, puberty continues from the point at which it was suspended at the beginning of treatment; So far, no delayed side effects of this treatment regimen have been noted.

The most reasonable treatment option for testotoxicosis and Albright-McCune-Sternberg syndrome - gonadotropin-independent conditions that do not respond to therapy with luliberin analogues - is the use of cyproterone or ketoconazole (which blocks some steps in the synthesis of steroids, including testosterone). If the bone age in these conditions goes well beyond 12 years, true puberty develops (of central origin). In such cases, additional treatment with GnRH may be necessary.

With false early puberty caused by the secretion of sex steroids by the tumor, consultation and subsequent surgical intervention is necessary.

Treatment of any form of CAH with or without virilization, hypertension, or late onset non-classical 21-hydroxylase deficiency is steroid hormone replacement therapy. With true central early puberty, luliberin is additionally prescribed.

Adrenarche, like isolated hirsutism, is a benign condition that leads to cosmetic problems. Treatment may be required to restore the menstrual cycle in polycystic ovary syndrome. In older pediatric patients, it is possible to prescribe antiandrogenic drugs in combination with contraceptives under the strict supervision of a physician. The problem of excessive hair growth is solved by applying depilatory creams and electrolysis. Sanitation of acne is achieved by means for cleansing the skin and local.

Thelarche usually does not require any treatment. With a progressive form with an increase in FSH ("telarchic variant"), in some cases, analogues of luliberin are used with a limited effect.

The best way to treat idiopathic gynecomastia in early puberty is surgical treatment (due to the proven ineffectiveness of medical treatment).

The article was prepared and edited by: surgeon

The placenta is an organ that ensures the normal growth and development of the fetus. The maturation of the placenta has four stages. From the beginning of pregnancy until the thirtieth week, the formation process takes place. Until the thirty-second week, it grows. The maturation stage lasts from the thirty-fourth to the thirty-sixth week, and starting from the thirty-seventh week of pregnancy, the aging of the placenta occurs. After childbirth, this organ comes out as an afterbirth.

The degree of maturity of the placenta is determined by ultrasound examination.

What does premature maturation of the placenta mean?

The processes of maturation and aging that occur a little ahead of time may be associated with the individual characteristics of the body and do not pose any threat to the fetus and mother.

If the degree of maturity of the placenta overtakes the gestational age by a significant gap, this means that the woman has a chance of premature aging of the placenta. This diagnosis should be taken with responsibility, since the rapid maturation of the placenta worsens its functionality, and the baby will not be able to fully receive oxygen and nutrients from the mother's body. During aging, the area of the exchange surface decreases, and salt can be deposited in some of its areas.

What is dangerous about premature maturation of the placenta is hypoxia and fetal hypotrophy. Such a pathology can cause a violation of the blood supply to the baby. Premature aging of the placenta threatens placental abruption, untimely discharge of amniotic fluid and miscarriage. This pathology can cause abnormalities in the development of the brain, and in some cases even miscarriage. To avoid these pathologies, it is necessary to undergo a course of treatment on time and be constantly under the supervision of a doctor.

Causes of premature maturation of the placenta

This pathology can be provoked by several factors:

deviation from the norm of the body weight of a pregnant woman, it can be both overweight and thinness;
violation of the structure of the walls of the uterus and its nutrition - these changes may occur due to a history of abortions or difficult births;
damage to the uterus as a result of mechanical influences;
diseases of the endocrine system, liver, urinary system;
pathology of the circulatory system;
chronic diseases, infectious diseases;
smoking;
prolonged late gestosis;
toxicosis of high severity.

Usually, there are no signs of premature aging of the placenta. This process can only be determined with the help of ultrasound. During the study, the density of the placenta is measured and the data obtained are compared with the gestational age. Also study the data of its thickness and accumulation of calcium salts.

Treatment of premature maturation of the placenta

Treatment of such a pathology begins after receiving confirming results of a comprehensive examination. First of all, risk factors are eliminated and complex drug therapy is used. to improve placental function and prevent fetal hypoxia. With the help of medications, it is quite possible to restore the functioning of the circulatory system of the fetus and the supply of nutrients.

In some cases, hospitalization is necessary. After the course of treatment, repeat ultrasound, and CTG. For the birth of a healthy child, childbirth often begins early. In this case, the stimulation of labor is carried out with medication.

Knowing what premature maturation of the placenta means and what its consequences are, the expectant mother should be attentive to herself, follow the doctor's recommendations and not self-medicate.

The baby in the womb feels completely safe. The placenta, which is formed by the end of the third month, protects the fetus from harmful substances or negative influences like a barrier. Gradually, she goes through four stages of development and leaves the female body after delivery in the form of an afterbirth. But it happens that the normal mechanism of placental maturation fails, the organ ages too quickly. What are the features of the maturation of the placenta at 32 weeks of gestation? And what are the reasons for her premature aging?

The correct formation of a natural barrier occurs in four stages:

from 8–10 days of pregnancy, the laying of the placenta begins, its first cell is born, gradually growing to a whole organ. This whole process takes 28 weeks until the thirtieth week of pregnancy;
on average, from the thirtieth to the thirty-third week of gestation, an increase in the parameters of the placenta occurs;
the next four weeks, the organ matures, is finally formed. This stage lasts up to 37 weeks;
the final stage is the aging of the placenta. At this time, she is fully developed and is preparing to be born along with the baby.

Only an uzist can determine at what stage of maturation the organ is at after the 20th week of pregnancy. If premature maturation is detected, consultation of several doctors is necessary to clarify the diagnosis.

Normal indicators of the thickness of the placenta by week

Normally, at 32 weeks of gestation, the placenta reaches the second level of maturity. Its thickness is determined by the widest section. It is this parameter that shows what the state of the body is, and whether it performs well the functions assigned to it.

The thickness of the placenta in millimeters should approximately coincide with the gestational age in weeks. So, at the 32nd week of pregnancy, the thickness of the organ is 32 mm. But a slight fluctuation in this indicator does not give rise to panic. At week 20, the normal thickness of the placenta is from 16.7 mm to 28.6 mm. At the fortieth week - from 26.7 mm to 45 mm. If a woman has a deviation from the norm, but it fits into the acceptable range, then after additional tests, a conclusion is made about the individual development of this organ.

The parameters of the pregnant woman herself are also of great importance. A miniature young lady is much smaller in everything, including the thickness of the placenta, than an obese lady.

The placenta is the link between mother and baby in the womb. It is thanks to her that the fetus can breathe, eat. The placenta maintains normal blood flow in the small body. This continues until its organs and systems can perform vital functions.

Functions of the placenta:

№	Function	Description
1	Immunity protection	It is a natural barrier between two organisms: mother and child. Prevents immune conflict that can cause rejection of the fetus as a foreign body. Passes the mother's antibodies to the baby, triggering his defense system
2	barrier function	Protects the fetus from the negative effects of various substances. But still, toxins, alcohol-containing drinks, nicotine, and some drugs are not subject to the barrier.
3	Protection against viruses and bacteria	Provides fetal immunological protection
4	endocrine function	Ensures the supply of crumbs with mother's hormones, including sexual and adrenal endocrine products. As the placenta grows, it independently begins to secrete a number of hormones: prolactin for the respiratory organs of the fetus, progesterone for uterine growth, placental lactogen for the mammary glands, estrogen for the development of the baby, the stress hormone cortisol, chorionic gonadotropin (hCG), somatomammotropin, mineralocorticoids
5	Trophic function	Provides the fetus with useful trace elements, water, electrolytes, vitamin complex, useful proteins, enzymes, fats, sugar
6	Respiratory	Carries out the delivery of oxygen to the child and the removal of carbon dioxide from him

A strong discrepancy with natural timing can lead to serious complications for a woman and a child, or even death. At the 32nd week of pregnancy, without due attention to this condition, its consequences are quite noticeable.

What are the causes of premature aging of the placenta

After an ultrasound examination, a woman can be diagnosed with "premature maturation of the placenta." There may be several reasons for this:

alcohol addiction and smoking (due to nicotine addiction, some parts of the placenta die off without the possibility of recovery);
severe underweight or excess body weight;
toxicosis or preeclampsia in prolonged stages (vomiting and severe swelling);
Rhesus conflict between mother and fetus;
sexually transmitted diseases;
dysfunction of the circulatory system (poor clotting);
failure of the endocrine system (diabetes mellitus);
diseases of the liver and genitourinary system;
mechanical damage to the uterine cavity and genital organs;
termination of pregnancies and difficult childbirth in the history of the pregnant woman;
placenta previa;
multiple pregnancy;
placental abruption;
genetic predisposition.

What is the danger of premature maturation of the placenta

This pathology can cause as a complication:

Development of fetoplacental insufficiency or oxygen starvation.
Delayed physical development of the fetus.
Detachment of the placenta.
There is also a risk of failure in the blood flow system on individual parts of the placenta.
Too rapid aging of the placenta can provoke an early onset of labor or abortion at a short time.

How is premature maturation of the placenta diagnosed, what is done when it is detected

Diagnose the state of premature aging of the placenta can only be a doctor on ultrasound. This does not affect the woman's well-being, it does not appear outwardly. If the specialist suspected something was wrong with the ultrasound, then an urgent CTG procedure (cardiotocography) is prescribed, where the fetal heartbeat is heard, its tone and clarity are assessed, and the baby's activity is analyzed. According to these indicators, the specialist determines whether the fetus suffers from a lack of oxygen.

It makes sense to prescribe CTG in late pregnancy, when the child's heart muscle is fully formed. Both ultrasound and CTG are necessary and absolutely safe procedures for mother and baby.

If at the 32nd week of pregnancy a significant aging of the placenta is found in a pregnant woman, she is urgently hospitalized in the pathology department of the maternity hospital. There, a woman is examined, laboratory assistants take the necessary tests, specialists examine the fetus. The purpose of these events is to find out whether the maturation of the organ somehow affects the child, whether he feels a lack of nutrients and oxygen starvation.

To diagnose the functions of the placenta, the following are used:

laboratory tests on the level of placental hormones;
analysis of enzyme activity in plasma;
listening with a simple gynecological stethoscope or CTG procedure;
dopplerometry (control of blood supply in the vessels of the uterus and umbilical cord).

If the placenta has ceased to supply the fetus with useful trace elements from the mother, then the woman is prescribed drugs that stimulate the functioning of the placenta. But therapy must be prescribed by a doctor. Self-medication is simply unacceptable here. After a course of drugs, the pregnant woman is sent for repeated studies.

It is possible to prescribe drugs:

antibacterial agents;
vitamin complexes, minerals and iron-containing preparations;
drugs that stimulate the work of uteroplacental blood flow, namely Curantil, Actoverin.

If acute fetal hypoxia is detected, a decision is made on an urgent caesarean section. Childbirth is also artificially induced when a child has a severe developmental delay.

If at the 32nd week of pregnancy the deviation from the norm is insignificant, then no treatment is prescribed. But it is important to understand how fast the placenta will mature. To do this, the woman is more carefully monitored, additional examinations are carried out throughout the remaining gestation period.

Doctors advise a woman to eliminate all risk factors:

body weight stabilization, proper diet;
getting rid of cigarettes (according to studies, the vast majority of women who were found to have early placental maturity were smokers);
taking medications that reduce the impact of harmful toxins on the child;
treatment of late preeclampsia and edema;
therapy against infectious diseases and sexually transmitted diseases;
walks in the fresh air for three or four hours a day;
the introduction of a balanced diet, including dairy products, vegetables, fruits, cereals, wholemeal bread, dried fruits;
elimination of possible sources of infection;
elimination of physical stress;
protection from emotional and stressful situations;
timely and long rest, sleep for at least ten hours;
it is recommended for pregnant women to sleep on the left side.

The placenta is a rather complex mechanism that takes on a huge functionality in the body of a woman carrying a baby. Like any impressive system, it tends to fail for a variety of reasons. As a preventive measure, a pregnant woman should take care of herself and her baby and do everything possible to avoid premature aging of the placenta. To do this, the first step is to leave bad habits and take care of your health.

At the 12th week of pregnancy, the placenta begins to function in the woman's body - a vital organ, the state, location and work of which directly affects the well-being of the woman carrying the child and the developing fetus itself.

The word "placenta" came to us from the Latin language and is translated as "flat cake". This organ carries out the timely transfer of oxygen and nutrients to the child, removes the waste products of the fetus, protects it from possible infections, and promotes the production of hormones necessary during pregnancy.

In late pregnancy, the placenta has a diameter of 20 cm, its thickness is 3 cm, and its weight approaches 500 grams.

Premature aging of the placenta is a condition that is dangerous for the life and health of the child, which is detected during a routine ultrasound examination of a woman and additional medical manipulations - cardiotocography (CTG) and Dopplerography, which allows determining the blood flow velocity in a developing fetus.

If the placenta ages ahead of time, then the fetus in the womb experiences an acute shortage of nutrients and oxygen, as a result of which the physical and mental development of the child slows down, and his unexpected death may occur.

The rapid aging of the placenta prevents the supply of oxygen to the brain tissues of the child, causing irreversible changes in the activity of this organ.

As a result of a violation of the uteroplacental blood flow, the surface area of the placenta decreases, the number of blood vessels in it decreases, and it becomes saturated with calcifications, that is, salt deposits.

The considered embryonic organ has 4 stages of maturation. If a woman's pregnancy proceeds without complications, then the placenta reaches the first degree of maturity by 27–36 weeks, and the second degree by 35–39 weeks.

The zero stage of placental maturity is detected, in most cases, during a routine ultrasound examination at a gestational age not exceeding 30 weeks. The third stage of maturity occurs shortly before the onset of childbirth, after 36-37 weeks from the date of conception of the child.

Some expectant mothers are diagnosed with "premature aging of the placenta." In this case, pregnant women seek to find more information about such a terrifying diagnosis in order to fully prepare and protect their child from possible dangers.

Mothers of any age are interested in what premature aging of the placenta is, what are the reasons that contribute to the development of this disorder during pregnancy. Let's try to give detailed and detailed answers to such complex questions that haunt expectant mothers.

Why is the "children's place" starting to age rapidly?

We list the main reasons leading to the development of this violation.

Traumatic damage to the uterus. They are caused by difficult childbirth, miscarriages, abortions that a pregnant woman suffered some time ago. Such processes change the structure of the uterus, disrupt the blood supply in it.
The presence of diseases in the expectant mother in the acute or chronic stage. Premature aging of the embryonic organ can be provoked by diabetes mellitus, dysfunction of the thyroid gland, and inflammatory diseases of the genital organs.
Multiple pregnancy, in which there is an excessive overstretching of the uterus, increases the risk of early and late toxicosis.
Misplacement of the placenta. Sometimes this embryonic organ is too close to the internal os, that is, to the exit from the uterine cavity. Low attachment and detachment of the "children's place" are the main causes of premature aging of the placenta.
The intake of toxic substances and drugs in the body of a pregnant woman. Also, the harmful habits of the future mother can also cause intoxication. We are talking about smoking, drinking alcohol and dangerous drugs. Work in conditions of harmful production leaves its mark on the formation of a developing fetus, causes fetoplacental insufficiency.
Toxicosis in late pregnancy. The severity of toxicosis is a determining factor that directly affects the likelihood of placental aging.
Infection of the uterine cavity. It is provoked by inflammatory processes in the pelvic organs. Often, aging of the placenta occurs due to the fact that a pregnant woman becomes ill with endometritis, salpingo-oophoritis or metroendometritis.
Rhesus conflict. It can occur in a mother with a negative Rh blood factor when she carries a child with Rh-positive blood. The incompatibility of the blood of the mother and the baby she is carrying causes the aging of the placenta. Its causes are diagnosed by the gynecologist observing the woman.
Presence in the expectant mother of diseases of the cardiovascular and bronchopulmonary systems, disorders in the work of internal organs.

Small changes in the structure and location of the placenta are not a cause for panic. These phenomena are caused by the woman's heredity, therefore, they do not require maintaining the pregnancy on an outpatient basis or placing the mother in a medical institution where doctors and nurses will monitor her condition.

Significant changes in the placenta are clearly visible on ultrasound and require urgent action by specialists observing a woman's pregnancy. Usually, premature aging of the "children's place" is detected when the placenta has reached the third degree of maturity before the onset of 36 weeks of pregnancy or the second degree before 32 weeks.

How can early maturation of the placenta be detected?

The aging of the "children's place" is detected by a special apparatus - an optical heart monitor, which records changes in the fetal cardiac activity. By the way, the action of the heart monitor is based on the Doppler principle, and modern models of this equipment are equipped with a strain gauge.

With early aging of the placenta, the baby's heart begins to work in an accelerated mode to provide more blood to the tissues suffering from insufficient oxygen supply. Early maturation of the "children's place" proceeds without the appearance of symptoms, so a pregnant woman is not able to determine her pathology.

In the first months of bearing a child, untimely detected aging of the "children's place" leads to a missed pregnancy or the development of serious abnormalities in a child developing in the womb.

In the middle of pregnancy, the earlier maturation of the placenta leads to a delay in the mental and physical health of the baby. So we figured out why the placenta ages ahead of time and how this pathological condition is detected in expectant mothers.

It remains to be clarified what actions are taken by medical workers observing a pregnant woman in order to maintain her normal state of health and the health of the child she is carrying until the onset of childbirth.

What is the correct treatment for this pathology?

Treatment of premature aging of the placenta is carried out in a hospital under the close supervision of medical professionals. The standard treatment regimen includes the following medical manipulations and therapeutic and preventive measures:

Maintenance of fetal life and normalization of placental circulation. These actions require an integrated approach.
The appointment of special medications and injections for the expectant mother, in the case when a protozoal, viral or bacterial infection is detected in a pregnant woman.
The use of droppers that help improve uteroplacental blood flow and relax the uterine muscles. In Russian hospitals, to achieve these goals, a glucose-novocaine mixture, "Eufillin", as well as droppers with the drug "Ginipral" or "Magnesium sulfate" are used.
Improvement of microcirculation and activation of metabolic processes in tissues. Pregnant women are prescribed vitamin preparations, essential phospholipids, as well as Actovegin, Zufilin, Aspirin, Curantil.

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In severe pregnancy, if it is caused by premature maturation of the placenta, medical workers stimulate labor.

Timely observation by a gynecologist throughout pregnancy, implementation of his recommendations, maintaining a healthy lifestyle and a complete rejection of bad habits is a guarantee of the birth of a healthy baby and the preservation of his mother's well-being

The placenta (children's place) is an embryonic organ responsible for supplying the fetus with oxygen, nutrients, as well as immune protection and excretion of waste products. This organ is formed at the 12th week of pregnancy from the mucous membrane of the uterus - the endometrium - and the fibrin cells of the embryo. Many people confuse the placenta with the umbilical cord, but they are completely different organs.

The placenta looks like a flat vascular formation weighing 0.5-0.6 kg and up to 200 mm in size. The baby seat is usually attached to the upper or back wall of the uterus, connecting to the fetus through the umbilical cord. Maternal blood with oxygen and nutrients enters the placenta, and from it passes through the umbilical arteries and veins to the fetus.

What is placental aging

The embryonic organ ages naturally, which is due to the physiological processes of gestation. But with various adverse factors, this process begins prematurely, which in some cases negatively affects the child. Outwardly, early maturation does not manifest itself in any way, and aging can be diagnosed during ultrasound.

What does "aging placenta" mean? The process of aging of the embryonic organ is the exhaustion of the resource, when changes occur in the density, structure, thickness and area of its tissues and blood vessels. Any deviation in morphology is the basis for the diagnosis of "premature aging".

Stages of aging

In its natural state, the baby's place reaches maturity at 37 weeks, after which its blood supply function begins to decline.

Gynecologists diagnose four degrees of aging in a child's place:

0 - if the organ retains its normal structure and function up to 30 weeks;
1 - a slight modification of the structure, found from 27 to 34 weeks;
2 - exhaustion of the resource from 35 to 38 weeks;
3 - pronounced aging after 37 weeks.

The discrepancy between the structure and function of the child's place for the duration of pregnancy may be different. The more pronounced the changes in the structure in the early stages, the more dangerous this condition is for the child.

From 12 to 30 weeks, the baby's place develops along with the fetus, at which time an extensive network of blood vessels is formed to adequately supply the developing child with nutrients. Normally, it fully matures by 30-32 weeks, after which calcium deposits and other morphological signs of resource exhaustion appear on the walls of the vessels. During childbirth, the so-called "death of the placenta" occurs: it is separated from the wall of the uterus and comes out after the expulsion of the fetus. After the exit, the child's place is called the placenta.

Useful doctor's comments in this video:

Why does the placenta age?

Accelerated maturation occurs as a result of various factors on the part of the mother and child:

multiple pregnancy - carrying twins or triplets;
hormonal disorders - insufficiency of the chorionic hormone, deficiency of the progestin component;
oligohydramnios or polyhydramnios - insufficient or excessive amount of amniotic fluid;
damage to the walls of the uterus as a result of abortions, operations, injuries or pathological births in history;
late motherhood (after 35 years);
complicated pregnancy (gestosis);
Rhesus conflict - incompatibility of blood types of mother and child;
chronic sexually transmitted infections in the mother (herpes, toxoplasmosis, chlamydia);
reduced immunity, chronic respiratory infections in a pregnant woman;
other chronic diseases in a woman (renal failure, diabetes mellitus, hypothyroidism).

Theoretically, any pathological processes in the body of a pregnant woman can lead to premature exhaustion of the resource of the embryonic organ. Especially often this happens due to the pathology of the reproductive system. Postponed sexual infections, surgical abortions, curettage of the uterus for medical reasons, injuries and operations on the pelvic organs in a woman lead to scarring of the inner surface of the uterus. This disrupts the blood supply to the endometrium during placentation and limits the natural resource of the child's place.

What is the danger of early maturation of the placenta

Premature maturation of a child's place does not always mean a danger to the child. If the morphology of tissues and vessels corresponds to the gestational age, then doctors usually give a favorable prognosis. The exhaustion of the resource at 36-37 weeks, corresponding to 2-3 degrees of aging, is a normal physiological process.

If the expectant mother is healthy, then placental insufficiency is not diagnosed, because. compensatory mechanisms are activated in the woman's body. If there are no abnormalities in the intrauterine development of the fetus during ultrasound, then small changes in the structure do not require correction.

What threatens pathological placental insufficiency due to premature maturation? At week 20, the 2nd or 3rd degree of maturity is already dangerous for the unborn baby. Pathology is understood as a clear discrepancy between the size and morphology of the organ and the gestational age. Since it is responsible for supplying the child with oxygen and nutrients, the degenerative process is potentially dangerous.

Ripening ahead of time leads to different consequences:

chronic hypoxia (oxygen starvation) of the fetus;
premature detachment of the placenta;
earlier discharge of amniotic fluid;
deviations in the development of the newborn;
premature birth.

At stages 0-1, aging at 22-25 weeks is amenable to correction. By detecting early maturation in time, the doctor can reduce the negative consequences for the child. At stages 2-3, as a result of early aging of the embryonic organ, hypoxia occurs in the child, which is fraught with deviations in mental and / or physical development. In this case, labor induction is indicated, provided that the fetus is viable before the due date of delivery.

How to Diagnose a Problem

The problem of diagnosing premature maturation of the placenta is that it cannot be detected by any signs. Indirectly, it can be assumed by changes in the motor activity of the fetus. As a result of hypoxia, the child begins to move more actively or vice versa, practically freezes.

It is possible to confirm the diagnosis only on the basis of an ultrasound examination, in which a change in thickness and area or in its structure is detected. More informative is ultrasound dopplerography, cardiotocography (examination of the child's heartbeat), biochemistry of blood taken from the umbilical cord. The doctor can determine the accelerated aging of the child's place and the condition of the fetus. If there is chronic hypoxia and nutritional deficiency, then the fetus may have a smaller size that does not correspond to the gestational age.

Methods of treatment

It is impossible to restore the structure of a child's place or prevent its further degeneration. The treatment of precocious puberty is aimed at compensating for the lack of oxygen and nutrients in the child.

What can be done to improve the nutrition of the fetus and make up for the lack of nutrients and oxygen? The expectant mother is prescribed drugs that increase blood flow and improve oxygen supply. Vitamin and mineral complexes are also prescribed to improve the nutrition of the child's body.

In parallel with vitamins and minerals, the factors that caused the pathology are corrected. For example, a future mother in a hospital is prescribed antiviral and antimicrobial drugs if a genital tract infection was detected during the examination.

Features of pregnancy and childbirth with this diagnosis

The rapid depletion of the resource does not always negatively affect gestation and delivery. Premature aging after 33-25 weeks practically does not decide the outcome of pregnancy and childbirth. Even stages 2 and 3 of maturation give almost the same prognosis as in a healthy pregnancy.

In other cases, complications arise. If the embryonic organ begins to age before 27 weeks, then ultrasound can show fetal dropsy, underdevelopment of the limbs and internal organs, resulting from a nutritional deficiency. Severe deviations in intrauterine development are a provoking factor in miscarriage.

Sometimes premature maturation of a child's place indirectly affects the outcome of pregnancy and delivery. For example, as a result of hypoxia, the baby can move excessively in the womb, which leads to cord entanglement and complications during childbirth.

How to prevent premature aging of the placenta - prevention

It is possible to prevent the early maturation of a child's place during the planning of conception, as well as in its early stages. This condition is easier to prevent, because. there are no methods of "rejuvenation" of the placenta. Knowing about the existing risk, the expectant mother should be examined by a gynecologist for latent genital infections before conception. These are the most common causes of accelerated aging. Antiviral or antimicrobial therapy is acceptable in early pregnancy. Drugs for treatment should be prescribed by a doctor.

Six months before the intended conception, in the presence of chronic diseases, a woman must undergo a course of treatment. Particular attention should be paid to the condition of the kidneys, thyroid and pancreas, as well as the hypothalamic-pituitary complex, ovaries and adrenal glands. Women suffering from arterial hypertension are at risk of polyhydramnios, increased uterine tone, which leads to placental insufficiency. Therefore, it is advisable to start a course of antihypertensive therapy before conception in order to reduce the risk of preeclampsia in the middle of the term.

Practice shows that regular intake of perinatal vitamin and mineral complexes reduces the likelihood of early depletion of resources.

Conclusion

Aging of the placenta is a natural process that begins after 30-32 weeks. The organ that supplies the baby with oxygen and nutrients exhausts its resource by 39 weeks. This natural process ends with the "death" of the placenta, which comes out as an afterbirth during childbirth.

With a healthy pregnancy, the earlier maturation of the embryonic organ, doctors do not qualify as a pathological condition. But if the process begins before the 27th week, then with aging of 2-3 degrees, chronic fetal hypoxia occurs. It is fraught with the birth of a child with a lack of weight, mental and physical developmental disabilities. In pathological pregnancy, if the fetus is viable, labor is stimulated.