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Violation of placental blood flow 1a degree. How placental circulation is disturbed. How to normalize the blood supply in the uterus

In the process of gestation, the mother's body is closely connected with the fetus through placental structures that provide full-fledged fetal development, as well as deliver nutrition and oxygen, produce hormonal components and remove metabolic products. In general, the placenta is responsible for all the most important processes during the gestation period. Sometimes, for various reasons, a woman develops a violation of blood flow during pregnancy. Such conditions are incredibly dangerous for gestation, they can provoke fetal pathologies and complications of gestation.

Scheduled ultrasound allows you to recognize any deviations in time

During gestation, a close relationship is established between the child and the mother, which is also called the fetoplacental system. It consists of several departments.

  • The central role is given to the placenta, which grows into the uterine wall with villi and through them nourishes the fetus in the uterus with the necessary substances. Moreover, maternal blood does not mix with fetal blood, since there is a hematoplacental barrier through which the blood is filtered, returning back to the woman.
  • Part of the fetoplacental system is the arterial network of the uterine body. Before conception, these arteries are spasmodic and twisted in the form of a spiral, but already from the first month of pregnancy, the muscle layer, which provides a spasmodic state, resolves, and by the fourth month of gestation, the arteries are transformed into special trunks that carry blood to the placental structures, fully participating in the blood supply. A similar phenomenon was specially provided by nature for the best intrauterine nutrition of the child. If uterine bleeding begins, then the vascular walls will no longer be able to contract, which is fraught with profuse blood loss, up to death.
  • Another part of the blood supply system between the mother and the fetus is the umbilical vessels, which form another blood supply pathway. A vein and two arterial channels pass through the umbilical cord, which connect the fetus to the placenta. If blood flow disturbances occur in this part, then the fetus is subjected to severe lesions.

Causes of violation of the blood flow of the uterus

Fetoplacental insufficiency can be provoked by various reasons. The main thing is that such a state pathologically affects such placental functions as metabolic and trophic, endocrine, transport, etc. In such states, the material exchange processes between the fetal and maternal organisms are seriously disrupted, which leads to serious consequences.

If you have diabetes, check your blood sugar levels regularly

Intrauterine infectious lesions, pneumonia or fetal hypoxia, hypertensive disorders, etc. can provoke a violation of the blood supply. Also, normal blood supply is disturbed in pathologies such as asthma, cardiac pathological conditions such as low blood pressure, malformations, etc. Often, the causes of pathological circulatory disorders are due to neuroendocrine ailments such as hyperthyroidism or diabetes, hypothyroidism, and hypothalamic or adrenal pathologies. Provoke circulatory disorders, kidney failure or pyelonephritis.

Also, problems with blood supply can be caused by anemia or thrombosis, which is actually the norm for such pathologies. Quite often, women suffer from exacerbations of various infectious pathologies, which also lead to placental changes. A variety of infectious agents cause inflammatory lesions, which in the first weeks of gestation can cause spontaneous interruption, and in the later stages, various deviations in fetal intrauterine development. No less dangerous are various uterine pathologies such as fibroids, endometriosis, hypoplasia or malformations, as well as pathological changes in the myometrial layer.

At risk of encountering blood flow disorders, moms after 35, pregnant women for the first time and having large fibroids. Also, placental or pelvic presentation, gestosis and multiple gestation, the presence of a Rh conflict, abortions in the past and a tendency to unhealthy habits, social and domestic dissatisfaction and other factors can also provoke fetoplacental blood flow disorders.

Varieties of fetoplacental insufficiency

First of all, placental insufficiency is classified into chronic and acute form. An acute pathology can occur at any time and even during delivery. In the placental tissues, meanwhile, there is a violation of gas exchange, leading to acute fetal hypoxia or the death of the baby. Often a similar phenomenon occurs against the background of premature placental infarction or detachment, bleeding or thrombus formation of blood vessels.

Chronic forms of placental insufficiency are diagnosed much more often and occur mainly during the second trimester of gestation, although they are found only in the third trimester. On the surface of the villi that grow into the uterine wall, fibrin begins to be deposited, which interferes with the normal course of material exchange processes. As a result, premature placental aging begins.

Chronic insufficiency of fetoplacental blood supply is divided into the following varieties:

  1. Critical. With this form, serious functional and morphological changes develop in the structures of the placenta, which cannot be influenced in any way, so fetal death becomes inevitable.
  2. Subcompensated insufficiency. With such a violation, the female body cannot cope with violations of placental activity, therefore, fetal development is delayed, which leads to complications during gestation and fetal development.
  3. Decompensated - when compensation mechanisms lose their ability to deal with pathological placental changes, therefore, the norm of indicators during the development of pregnancy is violated, the fetus begins to suffer from hypoxia, cardiac disorders, developmental delays, etc. There is a high probability of intrauterine fetal death.
  4. Compensated insufficiency is considered the most favorable of all of the above, since the fetus continues to develop without suffering from various abnormalities. The female body with such a deficiency is able to adapt and compensate for the deviations that have occurred to the child. If a woman receives the right treatment, then such deviations will not affect the health of the baby and the timing of delivery.

Degrees of hemodynamic abnormalities

Breathing exercises are useful for the expectant mother and baby

In addition to the types of disorders described above, there are various fetoplacental degrees during pregnancy. With the initial degrees of pathological abnormalities, the fetus is in a normal state, blood flow abnormalities are not dangerous and affect only the uteroplacental sphere. It is important to detect such violations in a timely manner, but if the patient does not receive the necessary assistance, then within a month the pathological deviations are aggravated, moving to a more serious degree.

Blood flow disorders of the 1st degree are conditionally divided into two types: deviations of the 1A degree and 1B. In the latter case, the blood flow between the placenta and uterine tissues is normal, but there are deviations in the placental-fetal circulation. In about 80% of cases, the fetus with such disorders develops developmental delay. Deviations of the blood flow of the 1A degree are characterized by disturbances between the placental and uterine circulation, while in the placental-fetal blood flow the norm of indicators is observed. About 90% of cases of such disorders are accompanied by a developmental delay in the child.

In the second degree of pathology, there are serious disturbances in the blood flow of the fetal vessels and the uterine body. This stage is usually short-lived, takes about a week and quickly moves on to the next stage of disorders. The third degree of hemodynamic disturbances is characterized by critical disturbances in the fetal blood supply or its complete absence. You can try to cure only the pathology of stage 1B, in other cases, the deviations are irreversible and often involve premature birth.

Signs of pathology

The clinical picture of blood flow disorders is determined by their severity. Compensated disorders usually proceed latently and are detected only with ultrasound diagnostics. Decompensated and acute forms of placental insufficiency are usually accompanied by changes in the motor activity of the fetus, which is either minimized or becomes excessively pronounced. Normally, the fetus should move at least ten times a day.

Sometimes such deviations are accompanied by insufficient growth of the tummy of a pregnant woman, polyhydramnios or oligohydramnios, severe preeclampsia or hyperedema, a sharp weight gain or pressure surges, and the appearance of protein compounds in urine. The most dangerous manifestation of insufficiency of placental circulation is uterine bleeding, which usually occurs against the background of placental abruption. In such a situation, a woman can only receive significant help from specialists, so you need to call an ambulance.

What is the danger of a blood flow disorder

During gestation, problems with blood flow are dangerous, because even a slight violation of blood circulation reduces the amount of nutrition and oxygen supplied to the fetus. With prolonged fasting of this kind, complications are likely to develop, such as:

When the initial stage of violations for the baby is identified, there are no particularly dangerous risks; with age, the child will catch up with the development of his peers. If more severe degrees of violation are detected, the prognosis is unfavorable, such pregnancies usually end in a frozen fetus or the appearance of a child with various anomalies, inferiority and other ailments.

Diagnosis of violations

If the development of placental blood flow disorders is suspected, the patient undergoes a comprehensive examination. The leading role in the diagnosis is given to dopplerometry in combination with ultrasound examination. Such techniques allow timely detection of pathological blood flow disorders and determine the degree of complications caused by them. Dopplerometry is usually prescribed for premature placental aging, lack or excess of amniotic fluid, congenital genetic pathologies or fetal malformations, with hypoxic manifestations or intrauterine fetal growth retardation.

How to normalize the blood supply in the uterus

The first stage of blood flow fetoplacental abnormalities responds most positively to treatment. In the second degree, therapy is practically ineffective, and in the third degree, emergency childbirth is necessary through surgical intervention. In the process of therapy, it is necessary to influence all parts of the blood flow structures. With minor microcirculation disorders, to improve blood flow, patients are shown taking Hofitol, which belongs to the category of homeopathic remedies. If the treatment does not provide the desired effect, then they resort to medications such as Actovegin or Pentoxipharm.

To expand the vascular passages, No-Shpa or Drotaverine is used, and for thrombophlebitis, Curantyl is indicated. Improves blood flow and reduces the tone of the uterine muscles Magnesium B6 and magnesium infusion. And with an antioxidant purpose, the intake of ascorbic acid and vitamin E is indicated.

In order not to treat blood flow disorders or their consequences, it is necessary to take preventive measures in advance to prevent these conditions. Mom should eliminate all risk factors that provoke the development of placental insufficiency. Mommy needs to control body weight, spend more time in the fresh air and undergo all planned procedures, diagnostic tests, laboratory tests and gynecological examinations on time. This is the only way to detect deviations in time and prevent their further development.

Violation of the uteroplacental blood flow of the 1a degree is a phenomenon in which the fetus receives an insufficient amount of oxygen. If this problem is ignored, the child may experience hypoxia, which leads to impaired development of internal organs or the death of part of the cerebral cortex. To prevent the formation of negative consequences, it is necessary to start treatment on time.

Normal uteroplacental blood flow

Pregnant women are often unaware of their existence. dopplerometry. Such a study helps to determine the volume and strength of blood flow using ultrasound radiation. Dopplerometry is usually performed in the third semester of pregnancy, but in some cases this study can be performed earlier.

With the help of dopplemetry, it is possible in the early stages to determine any pathology of the blood vessels in the uterus or placenta. It also helps to identify disorders in the carotid and cerebral arteries of the fetus. Based on the results, the doctor will be able to determine whether the child is experiencing a lack of blood flow or not.

If a woman has impaired uteroplacental blood flow, her fetus is in a constant deficit of oxygen and nutrients.

Doppler - ultrasound, which helps to determine the blood flow in the pelvis. Also, with its help, it is possible to determine the resistance index, the observance of which is necessary for the normal functioning of the fetus. Having received accurate data from such an analysis, doctors use special mathematical formulas to calculate the speed and volume of blood flow. Based on the results, it can be concluded whether the woman suffers from BMD disorders or not.

Causes of blood flow disorders in the pelvis

A huge number of factors can provoke circulatory failure in the pelvis. Separately, those that provoke violations during the formation of the placenta, and those that occur at a later date, are distinguished. Thus, it is customary to distinguish between primary and secondary forms of pathology. If the problem is ignored for a long time, the woman's risk of miscarriage increases, and the endocrine glands, metabolism, and immune functions cannot develop normally in the fetus. This phenomenon can be provoked by:


The risk of developing uteroplacental insufficiency increases even in the presence of one of the above factors. If there are several reasons, a woman needs to visit the attending specialist more often in order to establish deviations in time. Your doctor will send you for periodic screenings and other tests.

Symptoms of uteroplacental disorder

Like any other pathology, violation of the IPC has a number of features in the manifestation. If you know exactly the signs of this deviation, a woman will be able to identify her illness in the early stages, which will allow her to see a doctor in time. The main danger of impaired uteroplacental blood flow of the 1a degree is that the fetus experiences oxygen starvation. Such hypoxia interferes with the normal development of its internal organs, can cause miscarriage or fading of pregnancy. Pathology can be recognized by the following changes:

  • the child's heart rate is significantly accelerated;
  • the fetus periodically becomes either active or sluggish;
  • the volume of the abdomen does not correspond to normal indications - it is ahead of them.

Signs of violation of the IPC 1a degree usually appear in the decompensated form. However, in some cases, the manifestations of this pathology are completely absent. It is possible to find out about its presence only after the next examination.

Identification of blood flow disorders

Determining uteroplacental circulatory disorders is quite simple. To do this, the doctor uses modern diagnostic methods that allow you to identify the pathology without harm to the child. Before the specialist sends you for examination, he will collect a detailed history and assess the degree of manifestation of the violation of the BMD. In general, the diagnosis of this problem is as follows:


An experienced specialist can easily determine this pathology based on the patient's complaints alone. To do this, he needs to collect information about her obstetric background to assess the general condition of the body. According to the results of functional tests, the doctor will be able to identify the most optimal and effective treatment that will help to quickly rid the fetus of oxygen starvation.

How to help the body?

Treatment of uteroplacental disorders should be started in a timely manner to avoid negative consequences. If a woman is at an increased risk for the formation of this pathology, then she should visit the gynecologist more often. The method of treatment depends on the reasons that provoked such a phenomenon. In most cases, drugs that relieve the tone of the uterus or improve blood clotting help to improve blood circulation.

When the first signs of a change in blood circulation in the pelvis appear, a pregnant woman should immediately consult a doctor.

If a woman is diagnosed with a violation of the fetal-placental blood flow, she should immediately hospitalized at 36 weeks. She will have to stay in the hospital until the birth. It should be noted that labor activity in such a pathology requires special care. If a woman did not take any drugs during gestation, she is prescribed a caesarean section, which means the impossibility of natural childbirth.

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 the metabolic products of the 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, for 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 ().

To diagnose the blood flow system in obstetric practice, three-dimensional ultrasound (Doppler) is used, with the help of 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 uteroplacental 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.

With the first degree of violations, due to the timely detection and adequate treatment of cases of fetal death, it is possible to avoid. Perinatal mortality in the second degree is 13.3%, in the third - 46.7%. At the time, it was found that the correction of 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 in the necessary amount of 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 the use of drug prophylaxis, 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

Placenta - formed in the uterus after pregnancy. It is necessary for binding the body of mother and child with one blood circulation. With the help of the placenta, the fetus is supplied with oxygen, nutrients necessary for the development and formation of organs. In the opposite direction, unnecessary substances formed as a result of biochemical processes are removed.

Impaired uteroplacental blood flow causes a condition called placental insufficiency. This leads to the death of the fetus, miscarriage.

For 36 weeks, three mandatory ultrasound examinations are performed. It allows you to timely identify the violation, develop a plan for the management of pregnancy and childbirth, prescribe treatment, prevent the death and abnormal development of the child.

Modern requirements of obstetrician-gynecologists are aimed at examining pregnant women using safe methods in order to assess uteroplacental blood flow by volume.

How does blood flow between mother and fetus work?

The mother-fetus circulatory system is based on such anatomical formations as the placenta, umbilical arteries, and veins.

Blood flows to the placenta through the uterine arteries. The structure of their walls is characterized by the presence of a muscle layer that can contract and block the lumen. Before pregnancy, this mechanism helps to reduce blood loss during menstruation.

At 4–5 weeks of fixation of a fertilized egg (gestation process), the muscle layer disappears. Blood flow to the placenta is no longer dependent on vascular contraction. And by the sixteenth week, the arteries are transformed for constant blood supply. This is dangerous when bleeding occurs, since it is impossible to stop it by reducing the lumen of the vessels.

Under normal conditions, the placenta is fixed on the inner surface of the uterus with the help of villi that penetrate deep into the thickness of the mucosa. They grow into the walls of blood vessels and directly contact with maternal blood.

Here at the cellular level is happening:

  • exchange between the maternal organism and the fetal blood flow;
  • two oppositely directed streams meet;
  • necessary substances are transferred (diffusion).

Another part of the general blood circulation is provided by the vessels of the umbilical cord (normally there are 2 arteries and a vein). The main volume of blood flows to the fetus through the arteries, flows through the vein towards the placenta.


With the growth of the uterus, the arteries expand, form anastomoses

Violation of the fetal-placental blood flow is most difficult for a developing child. It creates conditions for an unsatisfactory forecast of the construction of internal organs and systems, the birth of a healthy baby.

What causes can break the flow of blood between the mother, placenta and fetus?

Causes of violations of the circulatory system between the mother's body and the fetus (fetoplacental insufficiency) are well understood. Some of the factors are formed only against the background of pregnancy. Another - depends on the general health of the woman.

Pathologies of pregnancy include:

  • Low attachment of the placenta (obstetricians say - presentation, "placentation") - the lower sections of the uterus are distinguished by a thinner muscle layer. Not enough blood flows through it to the fetus. A similar situation develops in the case of presentation in the area of ​​the postoperative scar (for example, from a caesarean section).
  • Late toxicosis - accompanied by damage to the small vessels of the uterus, a complication is the most common violation of blood flow.
  • Anemia - a low level of hemoglobin causes a compensatory acceleration of the heartbeat, blood flow through the uterine arteries increases in order to compensate for the lack of oxygen. The circulation in the utero-placental circle also changes.
  • Incompatibility between the blood of the mother and the fetus according to Rhesus - an immune conflict arises with the development of a hemolytic disease of the child, anemia. The same situation is possible when transfusing blood of different groups from a donor.
  • The burden on the kidneys due to toxicosis can cause an increase in blood pressure. This contributes to the change in blood flow.
  • Rarely, pathology of the umbilical arteries is detected. If there is only one umbilical artery, then the blood flow is insufficient for the fetus.
  • Multiple pregnancy - the placenta is enlarged and requires enhanced nutrition. Sometimes blood flow passes from one fetus to another.


It turns out that the first child is a constant donor for the twin, develops worse, because he transfers blood to his brother, and he himself is “malnourished”

Such changes are called fetotransfusion syndrome. The donor has a smaller body weight. And the recipient has an increased load on the developing heart. Both babies have problems.

Of the diseases of women, the most dangerous are:

  • Acute infections during pregnancy - pathogens can penetrate the placental barrier and destroy the vasculature.
  • Malformations of the uterus - the most significant is the "two-horned" uterus. Inside the cavity there is a partition dividing it into 2 parts. Pregnancy is possible only in one of them. The main violation is not the compression factor (the cavity has the ability to stretch enough), but the lack of communication between the uterine arteries, insufficient development of the vascular network, placental hypoxia.
  • Endometriosis - changes in the inner lining of the uterus, occur after inflammatory diseases (including genital infections), frequent abortions, diagnostic curettage. One reason is smoking and alcohol.
  • Tumor of the uterus - if a woman has even a small fibroid (benign tumor), then pregnancy stimulates the growth of nodes. They take over part of the blood supply, and the blood flow of the fetus is “robbed”. Deficiency directly depends on the size of the tumor.
  • Diabetes mellitus - affects the walls of blood vessels, often occurs in women with risk factors during pregnancy.

What threatens the fetus with insufficient placental blood supply?

All disorders of both uteroplacental and fetal-placental nature lead to fetal oxygen deficiency (hypoxia). Complications are caused precisely by this mechanism:

  • the formation of the internal organs of the fetus is disrupted, there is a lack of mass, this is called "intrauterine growth retardation";
  • the heart reacts with rapid contractions (tachycardia) or arrhythmias, bradycardia;
  • the composition of electrolytes and acid-base balance are disturbed;
  • the functioning of the endocrine system is disrupted, the fetus has a hormonal imbalance;
  • fat depots are not formed.

The most severe complications are fetal death, the threat of abortion.


Myomatous nodes take part of the vascular network in the fetus for its growth

Types of blood flow disorders in the placenta

There are fetoplacental (between the fetus and the placenta) insufficiency and uteroplacental insufficiency.

Fetoplacental hypoxia can proceed as:

  1. Acute deficiency- occurs in any period of pregnancy and during labor pains. Causes premature detachment of the placenta, vascular thrombosis, heart attack in the area of ​​the placenta, hemorrhage. Can cause the death of a child.
  2. Chronic - occurs more often, develops from the second trimester, but manifests itself only in the third. Changes in the placenta are in the nature of premature aging, fibrin is deposited on the surface of the villi. Permeability is sharply reduced, which provokes fetal hypoxia.

Against the background of the development of chronic placental insufficiency, stages can be distinguished:

  • compensation - a favorable course, since the protective mechanisms of the mother's body work and compensate for the missing nutrition for the baby, the treatment is effective, the child is born on time, healthy;
  • subcompensation - the mother's body is not able to fully compensate for the "unprofitable" blood supply to the fetus, full treatment is necessary, the child can be born with complications, lags behind in development;
  • decompensation - the pathology develops rapidly, compensatory mechanisms are not enough, the activity of the heart is disturbed in the fetus, intrauterine death is possible;
  • critical stage- characterized by pronounced structural changes in the placenta, which violates its functions, therapy cannot change the state of the fetus, death is inevitable.

Degrees of impaired blood flow

In a joint violation of the fetoplacental and uteroplacental blood flow, 3 degrees are distinguished.

I - changes are compensated, do not threaten the fetus, they capture only the uteroplacental blood flow, the child develops normally. Depending on the level of change, there are:

  • degree Ia - violation of uteroplacental blood flow is limited to one of the arteries of the uterus, all hemodynamic parameters are stable, within normal limits;
  • degree Ib - the blood flow is disturbed at the level of communication between the fetus and the placenta due to the vessels of the umbilical cord, enough blood flows through the uterine arteries.

If small changes in the first stage were not detected and the woman did not receive treatment, then after 3-4 weeks, violations of the second degree occur.

II - the blood flow in the uterine and umbilical arteries changes.

III - indicators are critical, reverse blood flow in the arteries is possible.

How is the diagnosis carried out?

The Doppler ultrasound method helps to make the correct diagnosis and identify the level of impaired blood flow most accurately. The method is highly sensitive and very informative. Shows even small changes in the first stage to clinical manifestations. An important advantage is safety for the fetus and the expectant mother.

With the help of dopplerography, it is possible to examine the blood flow through the arteries and veins, obtain a color graphic image, and measure the hemodynamic parameters of the fetus.

This plays a significant role in predicting the course of pregnancy, creates conditions for making decisions on therapeutic measures.

Indirect diagnostic methods include:

  • computed tomography,

Methods allow you to identify the lack of fetal weight, the placenta is not well. These signs may be evidence of the development of hypoxia.

What does the mother feel and the doctor determines during the examination?

Hypoxia stimulates the motor activity of the fetus.

At an appointment with an obstetrician-gynecologist, the doctor listens, draws attention to a high frequency, arrhythmia or bradycardia. This necessitates referral for Doppler examination.


A pregnant woman pays attention to the increase in movements, tremors

Treatment of disorders

Establishing the degree of impaired uteroplacental blood flow is necessary for choosing the tactics of pregnancy management.

  • It is believed that it is possible to maintain pregnancy in the first degree (a and b), treatment will still help.
  • The second degree is considered as borderline, requiring constant monitoring, the effectiveness of treatment is unlikely.
  • In the third degree, urgent delivery by surgical methods is required.

The possibilities of therapy are aimed at all parts of the pathology:

  • to improve microcirculation, Pentoxifylline, Actovegin are used;
  • Stabizol, Venofundin, Infucol are used as support for low blood flow velocity and pressure in the vessels (synthesized on the basis of a starch solution, capable of retaining fluid in the vessels);
  • vasodilating drugs such as Eufillin, No-shpy eliminate spasm of medium and small arteries;
  • by reducing the tone of the uterus, it is possible to influence vasospasm, reduce the degree of hypoxia, use magnesium sulfate, Magne B6, Ginipral;
  • antioxidants eliminate the effects of hypoxia, destroy decay products, prescribe Tocopherol, combinations of vitamin E and ascorbic acid, Hofitol;
  • Essentiale has a protective effect by increasing the level of useful phospholipids in the blood, improving liver function;
  • Curantyl is prescribed during pregnancy against the background of uterine fibroids, a positive effect on microcirculation and prevention of thrombosis has been established.

In the practice of obstetricians continue to use Cocarboxylase, which was abandoned by cardiologists. But gynecologists consider the drug effective for restoring tissue respiration.


For the treatment of newborns and care for them, according to indications, incubators are used

Forecast and consequences

For statistical studies, such an indicator as "perinatal mortality" is used. It includes all deaths in the fetus from the 22nd week of pregnancy and among newborns in the first week of life. It is believed that it fully reflects the influence of the factor of pregnancy and childbirth. The calculation is based on 1000 born children.

Currently, 13.3% of children die from the second degree of violation of the uteroplacental circulation, in the third - up to 47%. Timely caesarean section can reduce mortality.

Need intensive care for:

  • 35.5% of newborns with the first degree;
  • 45.5% - from the second;
  • 88.2% - from the third.

The consequences of preserving and treating children born under conditions of pathological hypoxia are unclear. Pediatricians and psychiatrists point to its unconditional influence on physical and mental development.

Only experienced specialists can diagnose and treat conditions associated with a violation of the uteroplacental barrier. You can not take medications on your own or use the advice of poorly educated people. The situation can become critical not only for the fetus, but also for the woman.

During pregnancy, the female body begins to rebuild. Therefore, during this period it is so important to keep under control the condition of both the woman and the fetus. According to medical statistics, a fairly large number of pregnant women have impaired blood flow. An additional one that has arisen in the body requires constant monitoring by specialists. Its violation can lead to the death of the fetus, and this can happen at any stage of pregnancy. Let's try to figure out why blood flow is disturbed during pregnancy.

A bit of theory

Everyone knows that the placenta acts as a link between the woman's body and the fetus. In this complex system, two types of blood circulation are distinguished - placental and fetal. Any violation of one of them can lead to rather sad consequences, including the development of various diseases. The severity of the problem is assessed only by the doctor.

In this case, a woman who is at the 30th week of pregnancy must necessarily undergo a special ultrasound diagnosis, on which the vessels of the placenta are clearly visible in a three-dimensional image. If there is any violation, the doctor will definitely see it, as there is a change in the spatial ratio of the uterine and fetal-placental circulation. This is a very dangerous condition of the body, as respiratory function is inhibited, and the development of the fetus is suspended.

Degrees of violation

Medicine distinguishes three degrees of severity of this pathology. The first degree is considered the easiest, when insufficient blood circulation has not yet reached its critical values. In this case, the hemodynamics of the fetus is in a satisfactory condition. There is a violation of the uteroplacental blood flow of 1 A degree and insufficient fetal-placental blood circulation of 1 B degree.

The second degree is characterized by a deterioration in the blood supply to the fetus. In 50% of cases, there is a decrease in the maximum velocity of blood moving through all the valves of the heart, and such a violation is observed both in the fetus and in the uterine arteries.

Quite often, in a short period of time, the second degree passes into the third. In this case, the blood flow practically ceases to flow to the fetus, which can cause its hypoxia. There is a high probability of a decrease in diastolic blood flow in the aorta, and in some cases it may disappear completely.

Causes

If there is a violation of the blood flow of the 1st degree during pregnancy, the reasons leading to this may be different. Numerous adverse factors can affect the placenta not only during its formation, but also at a later date. Medical practice distinguishes between primary and secondary, which disrupts the functioning of the placenta, which acts as a transport, protective, immune, metabolic and endocrine organ.

Thus, impaired blood flow of 1 A degree during pregnancy can occur for the following reasons:

  • tumor of the uterus;
  • genetic defects;
  • consequences of abortion;
  • infectious diseases;
  • hypertonic disease;
  • diseases of the adrenal glands and thyroid gland;
  • structural anomalies;
  • hormonal dysfunctions;
  • thrombosis, atherosclerosis;
  • diabetes.

If this pathology is not eliminated in a timely manner, then after 6 weeks a slight violation of blood flow can go into the third stage. If a problem is detected at the 30th week, the doctor still has enough time to take appropriate measures to restore normal blood circulation.

Symptoms

Any pathology is characterized by its clinical picture, so that the doctor can make an appropriate conclusion. The lack of hemodynamics leads to a change in the functioning of the placenta, because of which the fetus begins to suffer. The necessary nutrients and oxygen begin to flow to it in a limited amount, and the excretion of metabolic products slows down. Signs begin to appear, as a result of which its intrauterine development stops.

Thus, if there is a violation of blood flow during pregnancy, the symptoms of this condition are manifested as follows:

  • cardiopalmus;
  • decrease or increase in fetal motor activity;
  • discrepancy between the volume of the abdomen for a specific gestational age.

Such signs usually occur with a decompensated form. If the violation of uterine blood flow during pregnancy is grade 1 A or 1 B, then these symptoms do not yet appear, since hemodynamics is compensated. It is usually detected during diagnostic studies.

Diagnostics

In order to identify a violation of blood flow of 1 A degree during pregnancy, it is necessary to undergo a series of examinations, with the help of which the type and degree of the changes that have occurred are established, and the condition of the fetus is also determined. In this case, the doctor prescribes the following procedures:

  • a blood test for hormones such as estrogen, human chorionic gonadotropin, progesterone;
  • cardiotocography;
  • ultrasonography;
  • dopplerometry.

In some cases, the doctor, already during the examination, is able to determine the violation that has arisen, focusing on the heart rate of the child, which are counted during auscultation. But the most reliable results are usually obtained after laboratory and instrumental studies.

Treatment

Disturbed of any degree must be treated. Basically, therapeutic measures are aimed at ensuring that the pathology does not progress further. Hemodynamics normalizes only if a violation of blood flow of 1 B degree is detected.

During a pregnancy that occurs with deviations, various means are used that improve the condition of the fetus. Mostly conservative methods of treatment are used. Surgical intervention is possible only in case of complications and for vital indications. When normalizing blood flow disorders, a set of measures is used - pathogenetic, etiotropic and symptomatic treatment.

Medical treatment

Most often, impaired blood flow of 1 A degree during pregnancy is corrected with the help of medications. When identifying the initial signs of a violation, treatment is carried out on an outpatient basis. More severe circulatory failure requires hospitalization.

The following drugs are used for treatment:

  • antispasmodics - "Eufillin", "No-shpa";
  • vascular - "Actovegin";
  • antiplatelet agents - "Kurantil";
  • vitamins and microelements - "Ascorbic acid", "Magne B6";
  • hepatoprotectors - "Hofitol", "Essentiale";
  • tocolytics - "Partusisten", "Ginipral";
  • improving blood microcirculation - "Trental";
  • antihypoxants - "Instenon";
  • metabolic - "ATP".

Usually, to improve the condition, two courses of therapy are carried out - immediately after the diagnosis was made and at a period of 32-34 weeks. After that, the doctor decides on the method of delivery. This is especially important if the circulatory disorder is severe. In case of violation of the blood flow of the 1st degree, childbirth is carried out naturally.

Surgery

If the violation of blood flow is pronounced, an emergency delivery is performed. In case of failure of conservative treatment, even in the case of a slight violation, the decision is made within two days. Usually a caesarean section is performed. If it is planned for a gestational age of less than 32 weeks, then the condition of the fetus and its viability are assessed.

Preventive measures

To avoid such a pathological condition as impaired blood flow of 1 A degree during pregnancy, preventive measures should be taken. A woman who is expecting a baby should eat foods that contain the necessary vitamins, micro and macro elements, fats, carbohydrates and proteins. Every day, at least 1.5 liters of fluid should be consumed, but only if swelling does not torment.

It is also important to keep your weight under control. During pregnancy, the recommended weight gain should not exceed 10 kg. Women at risk are given prophylaxis with drugs to interact with the systems of the mother and fetus and prevent extremely dangerous dysfunction of the uteroplacental circulation. An important role is played by the timely corrected method of conducting childbirth. But it should be remembered that even compliance with these measures does not exclude the occurrence of severe neurological complications.

Conclusion

Thus, it is important to control blood flow during pregnancy. The reasons may be different. The main thing is to monitor your health, and timely detection of pathology will help prevent serious consequences for the unborn child.