The placenta is responsible for the transfer of nutrition and oxygen from the mother to the fetus. Thanks to her, two complex vascular systems are united. One of them connects the placenta with the uterine arteries, and the other with the umbilical cord. In this case, the placenta serves as a barrier that protects the baby from viruses and harmful substances. It happens that during ultrasound, there is a violation of blood flow during pregnancy, which can affect the development of the baby.

Doppler

Such an unusual name has a diagnostic procedure that detects any pathology of blood flow in the arteries and veins. As a result, a dopplerogram is built on specialized equipment, which displays the frequency difference between the sent and reflected signal. The study is carried out in a standard mode or with color mapping, that is, the movement of blood through the arteries is displayed in color. The latter option allows you to quickly and accurately detect even a slight violation of the uteroplacental blood flow.

Doppler is performed while lying on your back or side. At the same time, a more truthful result can be obtained on the side, since on the back of many pregnant women a tone begins, provoking various pathologies. The specialist covers the area under study with gel and begins to drive the sensor over it.

This study is prescribed for all pregnant women together with the first (18-22 weeks) and second (32-34 weeks) screening. It can also be carried out in the interim, if there is evidence.

Causes of impaired blood flow

To identify a malfunction in the blood flow system, experts conduct an ultrasound scan with dopplerometry for women. This allows you to see defects in blood vessels, to track the amount of oxygen and nutrients entering the fetus.

Very often, expectant mothers are interested in why there is a violation of blood flow during pregnancy. The main reasons for this condition:

• Woman's age (too early or, conversely, late).
• Small gap between births.
• Gestosis (late toxicosis during pregnancy).
• Neoplasms in the uterus (for example, fibroids), myometrial pathology, endometriosis.
• Diabetes.
• Hypertension
• Kidney problems.
• Intrauterine infection due to viral diseases of a woman.
• Multiple abortions or miscarriages.
• Anemia (lack of iron).
• Placenta previa.
• Rhesus conflict.
• Blood clotting problems leading to blood clots.

The degree of blood flow disturbance

At the moment, there are three degrees of pathology. The first degree is divided into two subspecies: 1A (violation of uteroplacental blood flow) and 1B (problems with blood circulation between the fetus and the placenta). In the second degree, there are problems with both systems ("uterus - placenta" and "placenta - fetus"). The third degree is given to those women who have serious circulatory complications.

The first stage of the disease can be adjusted with drugs, and as a result, a healthy child is born. In other cases, there is a risk of his perinatal death.

Types of placental insufficiency

If, when carrying a baby, a violation of blood flow is detected, then doctors usually make a diagnosis. During pregnancy, such a pathology occurs quite often and can be acute or chronic. The acute form can appear suddenly, at any time, as a result, the fetus experiences hypoxia and may die. This is possible with premature placental abruption, placental infarction, blood clots.

The chronic form is much more common in the acute form. It usually occurs after 13 weeks and appears in the third trimester. As a result, premature aging of the placenta occurs. Depending on the severity, the disease is compensated, decompensated, subcompensated, critical.

In the compensated stage, the baby continues to develop normally, since these changes are eliminated by the protective mechanisms of the female body. With decompensated pathology, he ceases to cope with problems, as a result of which the fetus has a growth retardation and the subcompensated stage of the disease leads to a delay in the development of the baby, as well as to his possible death. The most difficult form is considered to be critical placental insufficiency. It does not occur very often, but its onset leads to the inevitable death of the child.

The main symptoms of the disease

Depending on the type of blood flow disorder, different symptoms may appear. The compensated placental does not manifest itself in any way, therefore, they will only find out about it during an ultrasound scan. With an acute and decompensated form, changes appear in the baby's movements: he moves either too much or very little. In this case, it is important to monitor this indicator (the fetus must move at least 10 times per day).

Additional signs may include slow abdominal growth, lack or excess of amniotic fluid. It will not be possible to monitor this on your own, so you need to visit a doctor so that he monitors changes in measurements. It happens that a violation of blood flow accompanies preeclampsia - late toxicosis during pregnancy. To the existing symptoms, an increase in pressure, a sharp weight gain, edema, and protein excretion in the urine may be added.

The most dangerous sign of placental insufficiency is the appearance of blood from the birth canal associated with placental abruption. In this condition, only an ambulance of specialists will help.

Pathology treatment

If a woman has an increased or tendency to thrombosis, most often she has a violation of blood flow. During pregnancy, treatment is prescribed only by a doctor, because you will have to take serious medications. The most commonly prescribed drugs are Curantil, Trental and Hofitol. They thin the blood and improve its movement through the arteries.

Most often, pregnant women are prescribed "Curantil", which has been used in obstetrics for more than 15 years. The drug does an excellent job with its tasks - it normalizes blood circulation due to its thinning, prevents blood clots from forming, helps to form new vessels, and increases immunity.

Also in demand is "Trental" - a drug that is similar in action to "Curantil". However, it has serious advantages: the drug does not dilate the blood vessels of the heart and continuously releases the active ingredient for 12 hours.

It happens that a woman has a slight disturbance of blood flow during pregnancy. In this case, treatment is carried out with "Hofitol" - a preparation with mineral and plant components (for example, the juice of the leaves of a field artichoke). It has a mild diuretic effect and does not harm the liver.

Treatment methods for different degrees of pathology

The first degree of the disease involves taking drugs that improve blood circulation. Also, doctors will conduct Doppler and cardiotocography in dynamics. Research should be carried out 1-2 times every 7 days. With positive dynamics, the woman will continue to carry the baby until he is born. If the indicators deteriorate, it is necessary to carry out daily tests to prevent irreversible changes and to carry out an emergency caesarean section in time. With the normal development of the fetus, childbirth can take place naturally.

Grade 2 blood flow impairment during pregnancy is also treatable. Usually, the same drugs are used as in the first case, but the woman will be offered hospitalization. Doctors will monitor changes in the body and, if necessary, perform an early delivery.

The third degree is not treated in any way, since irreversible consequences begin to appear. In this case, specialists do not risk the child's life and prescribe an emergency operation.

Prevention

Any woman can do so that the baby develops and grows without complications. To do this, she will have to monitor her diet: it should contain a lot of vitamins, minerals, proteins and other important substances. If a pregnant woman does not suffer from edema, then she must drink at least 1 liter of liquid daily (better than water).

It is very important to control your weight - the increase in carrying a baby can be a maximum of 10 kg. Some women need prophylaxis with medication to improve blood flow between mother and fetus. It will prevent impaired blood flow during pregnancy. It should be remembered that the correct method of childbirth and the timely connection of drugs will help to preserve the child's life.

Most women do not know about such a study as Doppler before the onset of the third trimester, and from that moment on, Doppler for pregnant women becomes a completely common procedure.

Doppler- This is one of the methods of ultrasound diagnostics, which makes it possible to assess the intensity of blood flow in various vessels, for example, in the vessels of the uterus and umbilical cord. It is most informative after 30 weeks, but in case of deviations during pregnancy (for example, when the fetus lags behind in development), an ultrasound Doppler can be prescribed earlier - starting from 20 weeks.

Indications for Doppler

Adequate placental blood flow ensures the normal course of pregnancy. Violation of blood flow can lead to a delay in intrauterine fetal development (IGRP), therefore, the main reason for prescribing Dopplerometry during pregnancy is precisely the discrepancy between the size of the body and / or the baby's organs to the norms.

It is not necessary that with impaired blood flow, the child will lag behind in development, it is just that the risk of an unfavorable course of pregnancy increases significantly. Well, on the contrary, if there is a suspicion of a fetal developmental delay, but the blood flow is not disturbed, then in most cases this indicates a woman carrying a small, but healthy child.

Also, dopplerometry is prescribed for:

• premature maturation of the placenta;
• severe lack of water or polyhydramnios;
• anomalies of the umbilical cord;
• Rh-conflict;
• preeclampsia (late toxicosis, complicated by vomiting, severe swelling and increased pressure in a pregnant woman);
• if the expectant mother has kidney disease, hypertension, diabetes mellitus;
• suspicion of chromosomal abnormality;
• non-immune dropsy of the fetus;
• uneven development of babies with multiple pregnancies (when there is a difference in their body weights by more than 10%).

If the fetus has heart problems, doppler is performed together with CTG, the so-called Doppler echocardiography.

In fetoplacental insufficiency, Doppler is performed systematically every 2-3 weeks.

Also, with the development of complications during the previous gestation of the fetus, a Doppler ultrasound scan may be prescribed during subsequent pregnancy.

Preparation for the study and how it is carried out

Doppler examination in pregnant women is carried out according to indications, and it is not a mandatory examination in the normal course of pregnancy. But more and more often, in antenatal clinics, all women, without exception, at 30-34 weeks undergo a Doppler ultrasound scan as an assessment of the condition of the fetus.

This procedure is painless and harmless to both the mother and the fetus. The principle of Doppler analysis is the same as for conventional ultrasound during pregnancy: a special Doppler sensor is used in the abdomen, which is equipped with every modern ultrasound diagnostic apparatus. Therefore, this type of research does not require special preparation.

Doppler- this is a visual assessment of blood flow (when a color and graphical representation of curves of blood flow velocities is observed from the monitor screen by an ultrasound device).

Doppler ultrasonography- this is the same dopplerometry, only in addition, the readings are recorded on the tape in order to track the change (improvement / deterioration) of blood flow after the treatment.

Decoding of indicators of dopplerometry

Uterine arteries (a. Uterina dextra - right and a. Uterina sinistra - left uterine arteries, respectively). The Uzist must determine the nature of the blood flow both in the left and in the right uterine artery, because with gestosis it can be disturbed only in one artery. Thus, assessing the blood flow in only one artery, it is possible to give a false conclusion, which will negatively affect the health of the baby and the expectant mother.

There is such a scientific theory that if blood flow is disturbed in only one (mainly in the right) uterine artery, a woman has a high risk of developing late toxicosis (gestosis) with all the negative consequences.

With gestosis, the blood flow in the uterine artery is first disturbed, and when the situation aggravates, the blood flow in the umbilical cord arteries deteriorates. Therefore, if the blood flow in the uterine arteries is disturbed, it is necessary to periodically repeat the Doppler to control the situation.

To assess blood flow in the uterine arteries, the resistance index (IR or RI) is calculated.

Pregnancy-induced hypertension often develops due to impaired uterine blood flow. The body of the expectant mother independently increases blood pressure to increase blood flow into the intervillous space. So mommy, without realizing it, helps the baby. Thus, it is necessary to improve blood flow and hypertension will disappear on its own.

Violation of blood flow in the uterine arteries is when the value of IR, PI or LMS is more than normal.

The pulsation index (PI) of the uterine arteries should be within the following limits.

Indicators in the right and left uterine artery may differ slightly from each other. If both indicators are within the normal range, then such a picture is not considered a negative phenomenon.

Deviation of blood flow indicators from the norms in two uterine arteries at once indicates a violation of the uteroplacental circulation. This situation requires specific treatment - to move more (regularly go swimming or gymnastics for pregnant women).

Violation of blood flow in only one uterine artery indicates the asymmetry of the uteroplacental blood flow. If the pregnancy is proceeding normally, and the baby develops in accordance with the term, then the placenta is performing its functions.

You should be aware that at 18-21 weeks there may be a temporary disturbance of blood flow in the uterine arteries. This phenomenon is explained by the fact that the adaptive physiological process of cytotrophoblast invasion has not yet been finally completed. Therefore, if abnormalities in the uterine arteries are detected, repeated Doppler ultrasound should be performed in 2-3 weeks, i.e. observe blood flow in dynamics.

The systole-diastolic ratio (SDR) in the uterine arteries should be:

Arteries of the umbilical cord (a. Umbilicalis). To obtain true results, the study should be carried out only at a time when the baby is at rest, and only when his heart rate is in the range of 120-160 beats per minute. After all, physiologically it is so laid down that with an increase in heart rate, there is a decrease in IR in the umbilical artery, and vice versa, with a decrease in heart rate, an increase in IR occurs.

Measurement of blood flow in the arteries of the umbilical cord should be performed while the pregnant woman is lying on her back! Assessment of the severity of umbilical cord blood flow disorders cannot be objective when the future mother is located “on her left side”.

The umbilical cord must have two arteries and one vein. If there is an abnormality (the only artery of the umbilical cord), then the fetus may suffer from a lack of oxygen and nutrients, which is why it lags behind in mass and growth. But it happens that the fetus adapts to such an existence and does not experience a deficiency of the necessary substances. Such babies are born with low weight, but absolutely viable. Therefore, if there is one artery of the umbilical cord and the blood flow in it is not disturbed, then there is no cause for concern. But, if the blood flow in a single artery is impaired, inpatient treatment should be carried out to improve blood flow and, if necessary, early delivery (if the fetus will greatly lag behind in development).

The most common in assessing the nature of blood flow in the arteries of the umbilical cord was the resistance index. The indicators in both arteries of the umbilical cord should be practically the same.

Violation of blood flow in the umbilical cord is when the value of IR, PI or LMS in the arteries of the umbilical cord is higher than normal.

The pulsation index (PI or PI) of the umbilical arteries must comply with the following standards:

Registration of zero and reverse values ​​of diastolic blood flow is pathological. This means that the fetus is in critical condition.

From the moment of the appearance of constant reverse values ​​to the death of the fetus, only 2-3 days remain, therefore, in the shortest possible time, it is necessary to carry out a cesarean section in order to save the baby's life. This is possible only starting from the 28th week, when the baby is viable.

Systole-diastolic ratio (SDR) in the arteries of the umbilical cord:

If the blood flow in the umbilical cord is impaired, then, as a rule, fetal growth retardation is also observed. If now there is no delay in development, and the blood flow in the umbilical cord is impaired, then without treatment, there may be a delay in the development of the fetus.

Middle cerebral artery of the fetus (a. Cerebri media). When the fetus is suffering, increase in the values ​​of PI, LMS and speed in the CMA.

Maximum speed (also known as V max) in the fetal middle cerebral artery:

Systole-diastolic ratio (SDR) for the middle cerebral artery:

Fetal aorta. It leaves the left ventricle of the heart, goes along the spine and ends in the lower abdomen, where the aorta is divided into two iliac arteries, which provide blood supply to the human legs.

Abnormalities in the blood flow of the aorta can only be detected after 22-24 weeks of pregnancy.

Violation of blood flow is increase in the values ​​of IR, PI and LMS... Critical (talking about the death of the fetus) is considered registration of extremely low values up to their complete disappearance.

Changes in the aorta characterize the severity of intrauterine fetal hypoxia.

Systole-diastolic ratio (SDR) for the fetal aorta:

Venous duct (VP). It is studied in extended Doppler blood flow assessment.

During the study, it is necessary to ignore the episodes of the child's hiccups-like respiratory movements and active movement.

Indices are not used to assess the ductus venosus.

The diagnostic criterion for the pathological state of the fetus is the presence negative or zero blood flow values in the phase of atrial contraction. Zero or reversible values ​​are recorded with fetal malnutrition, congenital malformations of the right heart, non-immune dropsy of the fetus.

Even with critical blood flow in the arteries of the umbilical cord, but with preserved blood flow in the ductus venosus in the phase of atrial contraction, it is possible to prolong gestation until the optimal time for childbirth.

Description of blood flow disorders and their treatment

1st degree

1 A degree- violation of blood flow in the uterine arteries, while in the umbilical cord blood flow remains normal.

This degree of blood flow disturbance is not dangerous to the fetus.

Medical treatment of such a condition is ineffective. Doctors still prescribe therapy with Actovegin and Curantil. Do not see each other on the occasion!
In fact, if the blood flow in the uterine arteries is disturbed, it is more advisable to simply walk more often in the fresh air (breathing deeply) + eat right + move more (walking, special exercises for pregnant women, morning exercises, yoga, swimming). And do not sit for hours at the computer! That's all the treatment.

1 B degree- violation of blood flow in the arteries of the umbilical cord, and in the uterine arteries hemodynamics are normal.

This degree of impaired blood flow requires taking blood-thinning drugs in order to avoid developmental delay and fetal hypoxia.

In this case, treatment is prescribed to improve blood circulation (the drug Placenta compositum, Curantil or Trental). Actovegin is prescribed as an antihypoxant that improves oxygen supply to the fetus.
A blood clotting test (coagulogram) is also prescribed. With increased blood clotting, it is necessary to take stronger blood thinning drugs than Curantil (for example, heparin or a drug that contains acetylsalicylic acid).

I degree of violation does not lead to fetal death. Systematic monitoring of the nature of blood flow (every 2 weeks) "plus" control of CTG of the fetus (after 28 weeks of pregnancy) is carried out. In addition, be sure to monitor the blood pressure of the pregnant woman.

2nd degree- simultaneous disturbance of blood flow in the uterine arteries and in the umbilical cord, which does not reach critical values ​​(when blood flow is preserved in the venous duct).

In such a condition, medical treatment in a hospital is mandatory, where round-the-clock monitoring of the condition of the fetus is provided. It is also necessary to monitor the state of blood flow by performing a Doppler + CTG every 2 days.

With II degree hemodynamic disturbances are rare, but cases of intrauterine mortality can be observed.

Grade 3- critical disturbances of blood flow in the umbilical cord with preserved or disturbed blood flow in the uterine arteries. Critical violation is understood as registration of reverse diastolic blood flow or its absence at all.

III degree of violation carries a danger to the health of the child, because in half of the cases, intrauterine death of the baby occurs. Therefore, if 3 degrees of blood flow disturbance are detected, it is necessary to urgently carry out a cesarean section in order to save the baby's life, because at this stage of the violation, the treatment is not effective.

Conservative (natural) childbirth at grade 3 can lead to perinatal death of the child.

The cost of a Doppler ultrasound scan in a private clinic is about 1,200 rubles.

Violations and their causes in alphabetical order:

violation of fetal placental blood flow -

Violation of fetal placental blood flow in a single functional system, the mother-placenta-fetus plays a major role in the pathogenesis of placental insufficiency, which is one of the leading causes of perinatal morbidity and mortality. Numerous works have shown the fundamental role of hemodynamic placental insufficiency syndrome in the clinic of miscarriage.

The bloodstream of the placenta includes two closely interconnected, but not communicating with each other, blood flow systems - the fetal and placental. Three-dimensional ultrasound makes it possible to get an idea of ​​the three-dimensional organization of the vascular system in the placenta. When evaluating the results of a 3D study of the selected area of ​​the placenta, it is necessary to pay attention to the nature of the distribution of the vascular component and the organization of blood vessels in the area under study, which allows obtaining the necessary data to understand the features of its physiology. Three-dimensional Doppler study allows you to obtain the spatial relationships of the fetal-placental and uteroplacental blood flow systems, as well as to diagnose the violation of placental blood flow.

For what diseases there is a violation of the fetal placental blood flow:

Placental insufficiency is expressed in a violation of the transport, trophic, endocrine, metabolic and other important functions of the placenta, which leads to a decrease in its ability to maintain adequate exchange between the organisms of the mother and the fetus. The basic sign of fetal placental dysfunction (41.9% of all cases of chronic placental insufficiency) is the predominant disturbance of blood flow in the arteries of the umbilical cord, chorionic plate and supporting villi, confirmed by Doppler results.

The outcome of decompensated placental insufficiency is intrauterine fetal growth retardation due to inhibition of the respiratory, hormonal and trophic functions of the placenta. The severity of intrauterine growth retardation of the fetus, as a rule, correlates with the severity of placental insufficiency.

The method of ultrasound dopplerometry, with the help of which direct measurements of blood flow in various vascular zones of the mother-placenta-fetus system are carried out in dynamics, makes it possible to assess the state of the fetal placental blood flow and therefore has an important diagnostic and prognostic value in the group of pregnant women of high perinatal risk. Numerous studies carried out prove that a comprehensive assessment of blood circulation in the mother-placenta-fetus system can improve the diagnosis and choice of optimal obstetric tactics for placental disorders.

A classification of disorders of the uteroplacental and fetal-placental blood flow was developed, based on the assessment of the curves of blood flow rates in the uterine arteries and umbilical cord arteries. According to this classification, there are three degrees of severity of hemodynamic disorders of the uteroplacental blood flow:
I degree:
A - violation of uteroplacental blood flow with preserved fetal-placental blood flow.
B - violation of fetal-placental blood flow with preserved uteroplacental blood flow.
II degree: simultaneous disturbance of the uteroplacental and fetal-placental blood flow, which does not reach critical changes (end-diastolic blood flow is preserved).
III degree: critical disturbances of fetal-placental blood flow (lack of blood flow or reverse diastolic blood flow) with preserved or impaired uteroplacental blood flow.

There was a direct proportional relationship with a high correlation coefficient between the degree of hemodynamic disturbances of the fetal placental blood flow in the mother-placenta-fetus system and the frequency of fetal growth retardation, intrauterine hypoxia, operative delivery by cesarean section, severe condition of the newborn and perinatal losses. It should be noted that during dynamic observation there was no normalization or improvement in hemodynamic parameters in IА, II and III degrees of impairment of uteroplacental-fetal blood flow. Normalization of fetal-placental blood flow was noted only in grade I B, usually in pregnant women with the threat of termination of pregnancy.

Which doctor should i contact if there is a violation of the fetal-placental blood flow

Have you noticed a violation of the fetal-placental blood flow? Do you want to know more detailed information or do you need an inspection? You can make an appointment with the doctor- clinic Eurolab always at your service! The best doctors will examine you, study the external signs and help determine the disease by symptoms, advise you and provide the necessary assistance. you also can call a doctor at home... Clinic Eurolab open for you around the clock.

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Disorders of blood flow in the uterine arteries, umbilical cord, placenta during pregnancy (NMPK)

Currently, the assessment of uteroplacental blood flow is a mandatory study in the generally accepted standards for the management of pregnant women. Thanks to three-fold ultrasound screening, which is performed on expert-class devices, obstetricians-gynecologists manage to recognize in time the degree of uteroplacental blood flow (UMPC) impairment, and, most importantly, choose the necessary tactics for managing the patient.

How is the circulatory system between mother and fetus arranged?

Many people mistakenly think that only the placenta is responsible for blood flow in the mother-fetus system. In fact, this is too superficial a judgment, because everything is much more complicated.

The system of uteroplacental blood flow is an anatomically complex complex of the placenta, as well as the blood vessels of the mother and the fetus.

Levels of the uteroplacental system:

1. The main vessels that bring blood to the placental complex are the terminal branches of the uterine arteries. An interesting fact is that before pregnancy, these arteries are called "spiral", since they contain muscle cells that can contract and close the lumen of the vessel. This is necessary during menstruation in order to quickly stop uterine bleeding. But what happens during pregnancy? Already starting from 4-5 weeks of gestation, the walls of the spiral arteries undergo changes, namely, the muscle layer disappears in them. Thanks to these processes, full blood flow to the placenta is maintained. It has been proven that by the 16th week of pregnancy, the spiral arteries are completely transformed. However, it is for this reason that obstetric bleeding is so massive, and it is so difficult to stop them, because the terminal branches of the uterine arteries no longer spasm.
2. The placenta is the central link in the uteroplacental system. It is here that the most complex processes of blood transfer from mother to child take place. Everyone has long known the postulate that maternal and fetal blood do not mix. But how does this happen? All this is achieved due to the complex anatomical structure. The placenta is very firmly attached to the inner wall of the uterus with the help of so-called villi. These "outgrowths" of the placental tissue are, as it were, immersed in the thickness of the uterine mucosa. Placental villi are embedded in the walls of the uterine vessels and are practically "washed" by the maternal blood. It is here, at the cellular level, that complex diffusion processes of maternal and fetal blood take place, separated from each other by just a few layers of cells. This is called the "hematoplacental barrier", which literally means "the barrier between the mother's blood and the placenta." In addition, it is in the placenta that two blood flows "meet": from mother to child and vice versa. Such a complex and fragile system cannot but arouse admiration!
3. The vessels of the umbilical cord are the third level in the complex blood flow system between mother and child. The umbilical cord contains three vessels: two arteries and one vein. The hemodynamics (blood circulation) of the fetus is arranged in such a way that the arteries bring blood to the organs and tissues of the baby, and the vein, on the contrary, performs the function of returning blood to the placenta. Violation of blood flow at this level is called "fetal-placental", it is the most severe option for the fetus in terms of prognosis.

Video: Fetal Circulation Lecture Series

Causes that can lead to impaired blood flow in the mother-placenta-fetus system

• in a pregnant woman. The decrease leads to an acceleration of blood flow in all vessels, including in the uterine arteries. This happens for one simple reason: with anemia, the body tries to increase the delivery of oxygen to the tissues by increasing the rate of circulating blood. This is a compensatory response. The same thing happens in the uteroplacental system.
• Placental attachment pathology(low placentation, presentation) is characterized by reduced blood flow, since in the region of the lower segment of the uterus the muscle layer is much thinner than in other areas. A similar situation develops when the placenta is attached in the area of ​​the scar on the uterus (usually after a previous cesarean section). The thinned area of ​​the scar cannot fully provide blood flow, so the amount of blood that flows to the fetus may not be enough for the normal functioning of the developing organism.
• (late toxicosis) is one of the most common causes of a violation of the blood supply to the uterine-placental system, since this obstetric complication causes damage to small vessels.
• Various infectious diseases transferred during pregnancy. Some microorganisms infect the placenta and cause pathological changes in its tissue, which can cause placental insufficiency.

Why is NMPK dangerous for the fetus?

- one of the main consequences of NMPK

Reduced blood supply to the fetus can cause the following obstetric complications:

1. Decrease in weight and size (intrauterine growth retardation syndrome);
2. Violation, in addition to tachycardia (rapid rhythm) and bradycardia (slow rhythm), arrhythmia can also develop as a result of a violation of the electrolyte composition of the blood;
3. Violation of acid-base balance in the fetus (change);
4. Pathological functioning of the child's hormonal system;
5. A pronounced decrease in fat depots, which is also manifested by a low fetal body weight;
6. The threat of termination of pregnancy;
7. Critical impairment of blood flow can lead to intrauterine fetal death.

The degree of impairment of the uteroplacental circulation

Changes can occur at each of the levels of the system, which is the basis of the classification:

• 1 A - characterized by changes in blood flow in one of the uterine arteries, while the other indicators of the system are normal.
• 1 B - blood circulation is impaired at the fetal-placental level (umbilical cord vessels), while the indicators in the uterine arteries are within normal limits.
• 2 - violation at the level of the uterine and umbilical vessels.
• 3 - characterized by critical indicators, up to reverse (reverse) blood flow in the arteries.

This classification is extremely convenient for doctors, as it accurately reflects the level at which changes have occurred. In addition, the degree of impairment of the uteroplacental circulation affects the tactics of patient management.

At grade 1 (A and B), pregnancy can be maintained and treated with conservative methods, grade 2 is borderline, and grade 3 may require urgent surgical delivery.

Diagnostic methods

Today in obstetrics, the "gold standard" of blood flow disorders in the mother-placenta-fetus system is. This method opens up opportunities for recognizing even the smallest changes, as it has high sensitivity and information content.

Doppler is a type of ultrasound examination that uses the Doppler effect. The essence of the study is to measure the frequency of an ultrasonic wave reflected from moving objects. In the study of blood vessels, the moving particles are blood corpuscles, in particular, erythrocytes, as the most numerous cells. Registration of the received data and their comparison with the norm is called Doppler ultrasonography.

What are the benefits of Doppler sonography?

1. Modern ultrasound machines make it possible to investigate the direction, velocity of blood flow in the uterine arteries, and even intraplacental blood flow.
2. Thanks to color mapping, it is possible to separately examine the blood flow in vessels with different blood directions (arteries and veins). The direction of arterial blood on the device is reflected in red, and venous - in blue.
3. It has been proven that the use of this method during pregnancy does not adversely affect the development of the fetus.
4. A unique opportunity of the method is to predict the development of pregnancy. What does this mean? Many studies have shown that disturbances in the blood flow of the uteroplacental system appear a little earlier than any clinical manifestations of fetal suffering appear (decrease in body weight, change in heart rhythm, etc.). This means that with the timely diagnosis of fetal blood supply disorders, the doctor has a small amount of time to make the right decision. An example of this is the detection of a change in blood flow, which is called "dicrotic notch" in 90% of cases before the development of clinical manifestations of gestosis (edema, increased blood pressure, the appearance of protein in the urine). Doppler ultrasonography is widespread in obstetric practice, as it opens up doctors not only the opportunity to recognize blood flow disorders in time, but even to prevent the development of certain complications of pregnancy.

Recently, the results of the use of Doppler ultrasonography, not only during pregnancy, but in childbirth, have been published more and more often. Studies have shown that the effectiveness of contractions can be assessed by measuring the diastolic blood flow velocity in the uterine arteries. Thus, this research method can predict even weakness or impaired coordination of labor as early as the beginning of the first stage of labor.

Case from practice

An unusual situation in the maternity ward made obstetricians and gynecologists think about the use of Doppler ultrasonography during childbirth.

A 25-year-old woman was delivered without any concomitant pathology. home with regular contractions every 3-5 minutes. First childbirth, urgent.

According to the anamnesis: pregnancy proceeded without complications, fetal pathology was not detected, all ultrasound protocols with Doppler measurements were within normal limits.

The first stage of labor was physiological, with the full opening of the cervix, the woman in labor was transferred to the delivery room.

However, during the attempts, at first glance, inexplicable phenomena began to occur: the fetal heartbeat during the attempts was restored, and in the intervals between attempts it slowed down significantly. Although, as a rule, everything happens the other way around. In this regard, it was decided to perform an ultrasound scan with a study of blood flow in the vessels during childbirth. The result of the study surprised everyone: in between contractions, the fetus clamped the umbilical cord with a handle, as a result of which the blood flow was significantly impaired. As hypoxia increased in the child's body, his arms weakened, and he released the umbilical cord, meanwhile, blood flow was restored. Given the picture obtained, it was decided to speed up the management of the second stage of labor using auxiliary aids. So, thanks to dopplerometry, doctors managed to avoid serious complications.

Secondary diagnostic methods

In addition to Doppler sonography, there are other research methods that indirectly indicate impaired blood flow:

• Collection of complaints. In case of impaired blood circulation, the fetus experiences hypoxia, which is manifested by an increase in the baby's motor activity. Usually pregnant women complain of active fetal movement.
• Listening to the heartbeat with a stethoscope can also help diagnose. Deceleration or acceleration of the rhythm, which goes beyond the physiological norm, may also indicate hypoxia.
• ... CTG registration within 40-60 minutes may be enough to diagnose signs of intrauterine fetal hypoxia.
• Some ultrasound indicators (premature aging of the placenta, study of the biophysical profile) can record the unfavorable condition of the fetus.

Important! A slight decrease in the estimated fetal body weight on ultrasound does not necessarily indicate developmental delay and impaired blood flow. An isolated measurement of fetal weight is not very informative, since this indicator is also largely influenced by genetic factors. Therefore, it is necessary to take into account the anthropometric indicators of the parents (height, weight) and their weight at birth. Only a combination of a decrease in fetal weight and impaired blood flow with Doppler ultrasound provides a basis for the diagnosis of intrauterine growth retardation syndrome.

Treatment of disorders of uteroplacental blood flow

In order to improve the blood supply to the fetus, it is necessary to act on several links of pathogenesis at once:

1. Improving microcirculation. The following drugs have this property: Pentoxifylline, Actovegin.
2. Maintaining normal blood flow in the vessels, eliminating low blood pressure is achieved through the use of drugs based on hydroxyethyl starch: Stabizol, Infukol, Voluven, ReoHES, Venofundin. These drugs are an osmotic solution of starches, which are able to retain fluid in the lumen of blood vessels. Their appointment is especially effective in gestosis, when it is necessary to transfer fluid from the intercellular to the lumen of the vessel. Thus, two goals are achieved at once: normalizing blood flow and reducing the severity of edema.
3. Vasodilator drugs help to eliminate spasm of arteries and arterioles (smaller vessels). Especially effective application "Euphyllina", "No-shpy", "Magnesia" in the form of injections.
4. Reducing the tone of the uterus also helps to eliminate vasospasm, hypoxia, as well as to maintain pregnancy with the threat of premature birth. In this situation, appoint "Magnesia", "Ginipral", "Magne B6".
5. Antioxidant drugs help to cope with the undesirable effects of hypoxia. Usually prescribed "Tocopherol", "Ascorbic acid", "Hofitol".
6. Intravenous administration is helpful 5% glucose solution which has detoxifying properties.
7. The drug has a protective effect on the placenta Essentiale, which saturates the tissue of the placenta with phospholipids. The use of this medication is especially useful in placental insufficiency.
8. In case of impaired blood flow, the administration of drugs is very effective, which lead to the processes of activation of cellular respiration, for example "Cocarboxylases".
9. With a combination of uterine fibroids and impaired blood flow, the drug showed a good result "Courantil", it is able to improve blood circulation in the vessels, and also prevents the formation of microthrombi. Many studies have shown that taking "Curantil" with a large myoma prevents the development of secondary, inflammatory changes in the myomatous nodes, due to the improvement of blood flow in them and the uteroplacental system.

Output

The study of uteroplacental blood flow using Doppler ultrasonography is a mandatory study during pregnancy. Practice shows that the use of this method has a positive impact on the prevention and treatment of many obstetric complications. However, one should not forget that in order to obtain reliable and informative results, the study of blood flow should be carried out on expert-class devices by highly qualified specialists.

Video: about fetal hypoxia - a consequence of NMPK

Pregnancy is accompanied by various changes in the woman's body, which are aimed at the full development of the child. There is an adaptation of many processes and systems to new conditions of existence, the woman notes the appearance of previously unknown sensations. Any expectant mother wants the baby to be born healthy, and naturally worries about his condition if any violations are detected.

The main factor that supports intrauterine growth and development of a child is uteroplacental-fetal blood flow (MPPF). It is a complex system that supports the normal course of pregnancy. If the blood flow in the uterus is disturbed, then they speak of placental insufficiency. It is dangerous, first of all, by miscarriage, as well as other negative consequences of this pathology for the expectant mother and child.

The lack of blood flow through the placenta should be detected in time, and treatment measures should not be postponed.

Causes

Violation of hemodynamics between the fetus and the woman's body is provoked by many factors. They affect the placenta both during its formation and later in pregnancy. Accordingly, there are primary and secondary circulatory failure. As a result, there is a violation of all functions of the placenta, as a separate organ: transport, metabolic, protective, immune and endocrine. This is provoked by the following conditions:

• Tumors of the uterus.
• Structural anomalies.
• Genetic defects.
• Hormonal dysfunctions.
• The consequences of abortion.
• Late toxicosis.
• Infectious diseases.
• Atherosclerosis, thrombosis.
• Hypertonic disease.
• Diabetes.
• Diseases of the thyroid and adrenal glands.

Most often, a woman has a major risk factor that can cause placental insufficiency. Often there is a combination of several similar conditions when carrying a child.

To identify the causes of impaired placental blood flow, it is necessary to carry out periodic screenings at different stages of pregnancy.

Symptoms

Each pathology has its own clinical picture, which allows us to make a preliminary conclusion. Lack of hemodynamics is manifested by changes in all functions of the placenta, and as a result, the fetus suffers mainly. He receives all nutrients and oxygen in insufficient quantities, and the excretion of metabolic products can slow down. There are signs of fetal hypoxia, which further leads to intrauterine growth retardation. As a result, the following symptoms are noted:

• The acceleration of the heartbeat.
• Increased physical activity, and then its decrease.
• The discrepancy between the volume of the abdomen and the gestational age.

As a rule, similar signs appear with a decompensated form of placental insufficiency. If the impairment of blood flow has a 1a or 1b degree, revealed during a timely examination, then these symptoms are not yet present, since the hemodynamics is compensated.

Classification

Symptoms depend on the severity of changes in the MPPK, which are recorded during additional examination. On the basis of a clinical and gynecological examination, it is impossible to say for sure about this, however, preliminary one can judge about hemodynamics from indirect data. So, impaired blood flow during pregnancy is classified according to the degree:

• Grade 1a - changes concern only the uteroplacental part of the blood flow.
• 1b degree - only the fetal-placental blood flow is weakened.
• Grade 2 - violations concern all hemodynamic processes, but diastolic blood flow is still preserved.
• Grade 3 - a situation when the fetal-placental blood flow has critical disturbances while maintaining or changing the uteroplacental hemodynamics.

This classification is based on the relationship between the velocity of uterine and umbilical cord blood flow. In addition, disturbances are distinguished in individual branches of the afferent artery.

Signs of impaired blood flow from the fetus may not be noticeable to a woman, but the doctor must pay attention to them.

Effects

Placental insufficiency is dangerous for the development of the fetus. Therefore, the main obstetric complications just relate to the condition of the unborn child. The greatest danger is expressed by violations of blood flow, which can be both chronic and acute. In this context, 1a and 1b degrees of hemodynamic disorders are not mentioned as the most mild ones.

Placental abruption

Sudden disturbances in blood flow can be triggered by trauma, thrombosis, or uterine artery embolism. Then a situation arises when the placenta exfoliates in one of the areas. Depending on its location, the pathology proceeds according to the central or peripheral type. In this case, the following symptoms appear:

1. Pain in the area of ​​detachment.
2. Local protrusion of the uterine wall.
3. Bloody issues.
4. Aggravation of the fetus.

If the detachment is of the central type, then there may be no external discharge at all, but blood seeps into the wall of the uterus, because of which it loses its contractility. It is fraught with atonic bleeding and disseminated blood clotting (DIC).

When placental complications are mild, they can be eliminated with adequate therapy.

Miscarriage

In turn, placental abruption causes spontaneous abortion or premature birth, which is included in the concept of miscarriage. This is a situation that, obviously, all women are afraid of, because losing a child is the worst thing that can happen during this period. Then the following signs come to light:

1. Pain in the lower abdomen, in the region of the sacrum, rectum.
2. Bloody discharge of varying intensity.
3. Increased urination.
4. Hypertonicity of the uterus.
5. Gradual dilatation of the cervix.

If the process is stopped at the stage of threat, then the child will be saved. But when the placenta has completely exfoliated, and an abortion is diagnosed in progress, something can no longer be corrected, unfortunately. In the future, the pathology can be complete or incomplete. When parts of the fetus or membranes linger in the uterine cavity, there is a risk of infection and severe bleeding, which often ends in hemorrhagic shock or disseminated intravascular coagulation.

Frozen pregnancy

In addition, the fetus may die if it remains in the uterine cavity. Then the so-called frozen pregnancy is formed. A woman herself may note some symptoms that speak of what happened:

1. The fetal movement stops.
2. His heartbeat is not felt.
3. The abdomen does not increase in volume.
4. Bloody discharge occurs periodically.
5. Disturbed by abdominal pain.
6. The body temperature rises.
7. The infection joins.

A frozen pregnancy must be removed. If this is not done in time, then there is a danger to the life of the woman herself.

Diagnostics

To determine violations of placental blood flow during pregnancy, it is necessary to use additional diagnostic methods. They allow you to establish the type and degree of changes, as well as determine the condition of the fetus. To do this, use the following procedures:

• Blood test for hormones (estrogens, progesterone, chorionic gonadotropin).
• Ultrasound procedure.
• Cardiotocogram.
• Doppler sonography.

Some data can also be obtained after a doctor's examination - the child's condition can be judged by the heart rate calculated during auscultation. But the most reliable results are obtained after instrumental and laboratory research.

Treatment

In case of violation of the uteroplacental blood flow of any severity, therapeutic measures are indicated. This is mainly aimed at preventing the progression of the pathology, while the normalization of hemodynamics, according to observations, is possible only at stage 1b. At the same time, they try to use all possible means to improve the condition of the fetus. Of course, conservative measures come first. Surgical treatment is used only for complications and for health reasons. In addition, great importance is attached to the prevention of placental insufficiency.

Treatment of blood flow disorders when carrying a child is complex - etiotropic, pathogenetic and symptomatic.

Drug therapy

The main means of correcting placental blood flow is the use of medications. When only the initial signs of abnormalities are identified, treatment can be done on an outpatient basis. If the insufficiency is more pronounced, then hospitalization is necessary. Such a need also exists for extragenital pathology in a woman. The following drugs are mainly used:

• Antispasmodics (No-shpa, Euphyllin).
• Tocolytics (Ginipral, Partusisten).
• Vascular (Actovegin).
• Improving microcirculation (Trental).
• Antiplatelet agents (Curantil).
• Antihypoxants (Instenon).
• Vitamins and trace elements (Magne B6, ascorbic acid).
• Metabolic (ATP).
• Hepatoprotectors (Essentiale, Hofitol).

As a rule, it is recommended to undergo two courses of therapy - immediately after diagnosis and within 32–34 weeks. After that, the question of delivery is decided. This is especially important in severe circulatory disorders. If violations are recorded at stage 1a or 1b, then childbirth takes place naturally.

During pregnancy, only proven medicines are used that have proven their safety and effectiveness.

Operation

When placental insufficiency is pronounced, emergency delivery is necessary. In case of ineffectiveness of conservative measures, even with mild violations, the decision should be made within 2 days. Basically, a cesarean section is used. If it is planned up to 32 weeks of pregnancy, then you need to proceed from the state of the fetus and its viability.

When it is necessary to ascertain that a spontaneous abortion has occurred, it is necessary to perform curettage of the uterine cavity or vacuum extraction of the fetus. With a frozen pregnancy, surgery depends on the gestational age and the woman's condition.

Prevention

To avoid many unpleasant situations during pregnancy, including placental insufficiency, preventive recommendations must be followed. They are mainly related to lifestyle and include the following principles:

1. Healthy eating.
2. Rejection of bad habits.
3. Outdoor walks.
4. Elimination of stress factors.
5. Compliance with all doctor's recommendations.
6. Timely treatment of concomitant diseases.

If you take good care of your own health during pregnancy, then you can prevent impaired blood flow in the mother-placenta-fetus system. And if this pathology is detected, it is necessary to carry out timely treatment, which will save the child.