- a symptom complex that develops during pregnancy due to a disorder in the functions of the placenta or morphological changes occurring in its structure. On the mother's side, the clinic may be absent. Against the background of obstetric pathology, fetal hypoxia occurs, manifested by an increase or slowdown in heart rate, and a decrease in activity. Diagnosis of disorders of the uteroplacental blood flow is carried out by means of ultrasound, CTG, dopplerometry. Treatment is carried out in a hospital in a conservative way using drugs that improve hemodynamics in the vessels of the placenta.

Causes of impaired uteroplacental blood flow

Violation of the uteroplacental blood flow develops as a result of improper formation of the villous layer of the fetal membranes even during the laying of the placenta or as a result of the influence of adverse factors on the mother's body that cause hemodynamic disorders in the normal placenta. The pathogenesis of the disease consists in inadequate uteroplacental perfusion, leading to insufficient oxygen supply to the fetus. As a result, a violation of the uteroplacental blood flow triggers the mechanism of hypoxic changes that contribute to a delay in fetal development.

Endogenous and exogenous causes can provoke a violation of the uteroplacental blood flow. The first group includes factors that influence the future mother's body from within. The risk of developing pathology is observed if a woman has diabetes mellitus, diseases of the kidneys, heart and blood vessels, against the background of thyroid dysfunction. The formation of a violation of the uteroplacental blood flow contributes to a burdened obstetric history - late preeclampsia, threats of interruption, multiple abortions and miscarriages, benign tumors of the uterus. A high risk of hemodynamic disorders is observed against the background of pregnancy with Rhesus conflict, as well as if the patient suffered from infertility.

Violation of the uteroplacental blood flow often develops against the background of genetic disorders in the fetus and in the presence of congenital malformations of the mother's reproductive system (with a bicornuate or saddle uterus, partitions in the organ cavity). The likelihood of obstetric pathology also exists with sexual infections, as well as if the patient has had viral diseases, for example, influenza, SARS. Exogenous factors contributing to the violation of uteroplacental blood flow include work in hazardous industries, drug and alcohol use, and smoking. Poor nutrition also has an adverse effect. The risk group for the development of impaired uteroplacental blood flow includes women under the age of 18 and over 35 years. The risk of abnormal hemodynamics is present with constant stress, intense physical exertion.

Classification of disorders of uteroplacental blood flow

Depending on the localization of pathological changes in obstetrics, there are several degrees of severity of violations of the uteroplacental blood flow:

• 1a- is characterized by a disorder of hemodynamics between the uterus and the placenta, while a sufficient amount of nutrients enters the child.
• 1b- circulatory disorders occur in the "fetus-placenta" circle.
• 2 degree- violation of the uteroplacental blood flow is observed in the circle "fetus-placenta-mother", however, hypoxia is slightly expressed.
• 3 degree- accompanied by a critical disorder of hemodynamic parameters, can lead to the death of a child or spontaneous abortion.

Given the gestational age, at which there is a violation of the uteroplacental blood flow, the following types of pathology can be distinguished:

• Primary- occurs in the first trimester, usually develops against the background of abnormal implantation, disorders in the formation or attachment of the placenta.
• Secondary- is diagnosed after 16 weeks of embryogenesis, as a rule, provoked by negative external factors or the state of health of the mother.

Symptoms of impaired uteroplacental blood flow

Clinical manifestations of impaired uteroplacental blood flow depend on the severity of the obstetric anomaly. On the part of the mother, pathological signs are not always observed. The patient may develop preeclampsia, often there is a threat of miscarriage or premature birth, which is accompanied by pain in the abdomen and in the groin area. There may be bloody mucus from the genital tract. Against the background of a violation of the uteroplacental blood flow, the activity of the opportunistic flora is activated, and colpitis often occurs. This complication of impaired uteroplacental blood flow can cause intrauterine infection of the fetus.

Violation of the uteroplacental blood flow is more pronounced on the part of the child. In some cases, the patient herself may suspect signs of fetal hypoxia. The pathological condition is manifested by a decrease in the motor activity of the child. During the examination, the obstetrician-gynecologist reveals an increase or decrease in the heart rate in the baby, which is also a reliable sign of a violation of the uteroplacental blood flow. The lack of nutrients can cause premature placental abruption. At the same time, the condition of the woman and the fetus is rapidly deteriorating, and a threat to life may arise.

Diagnosis and treatment of disorders of the uteroplacental blood flow

It is possible to identify a violation of the uteroplacental blood flow during an ultrasound scan. The presence of obstetric pathology is evidenced by the pathology of the placenta and intrauterine growth retardation of the fetus, which is manifested by a discrepancy between the size of the anatomical parts and the gestational age. It is possible to assess the degree of violation of the uteroplacental blood flow using dopplerography. CTG is used to assess the functionality of the child's cardiovascular system. A characteristic sign is tachycardia or bradycardia, which arose against the background of hypoxia.

Treatment of disorders of the uteroplacental blood flow is carried out in a hospital. The patient is shown bed rest, the exclusion of stress and intense physical activity. Conservative therapy consists in the use of drugs to relieve uteroplacental blood flow disorders and improve fetal oxygenation. Antiplatelet agents and agents that improve the nutrition of brain tissues are also used. In case of violation of the uteroplacental blood flow, the use of vitamins, calcium channel blockers is indicated. The latter are used to eliminate uterine hypertonicity.

In case of violation of the uteroplacental blood flow, all the efforts of specialists are aimed at prolonging the management of pregnancy up to 37-38 weeks. Subject to sufficient effectiveness of drug therapy after 4 weeks, the patient is transferred to outpatient treatment. If it is not possible to cope with the signs of impaired uteroplacental blood flow and the condition of the fetus continues to deteriorate, premature delivery is carried out by emergency caesarean section. If the pregnancy has been carried to 38 weeks, childbirth can occur naturally. In the second period, the use of vacuum extraction of the fetus or the application of obstetric forceps is indicated. In the event of a violation of the uteroplacental blood flow against the background of other diseases, the mother undergoes a planned caesarean section in a period of 38 weeks.

Prediction and prevention of uteroplacental blood flow disorders

Timely treatment of impaired uteroplacental blood flow allows a woman to extend her pregnancy to 37 weeks of gestation and give birth to an absolutely healthy baby. In the primary form of pathology, intrauterine fetal death or spontaneous miscarriage is possible. Prevention of violations of the uteroplacental blood flow consists in the elimination of extragenital pathologies even before the moment of conception, early registration with an obstetrician-gynecologist and the implementation of all his recommendations. A pregnant woman should adhere to a balanced diet, give up bad habits, stress and hard physical work. The elimination of contacts with possible sources of infections also reduces the likelihood of developing a violation of the uteroplacental blood flow.

During pregnancy, a woman's body undergoes strong hormonal changes. A new circle of blood circulation appears, through which the fetus receives nutrition and oxygen, and also removes waste products. It is the placenta that protects the baby from infections and viruses, and connects the two most complex circulatory systems: mother and child. A special membrane between these systems does not allow the blood in them to mix with each other. Sometimes, for various reasons, this interaction is disrupted, placental insufficiency occurs, which can lead to negative consequences both for the body of the expectant mother and for the health of the child. That is why it is important to timely analyze the movement of blood in the umbilical cord and uterine arteries of a pregnant woman, check the blood circulation in the vessels and aorta of the baby, get treated in time and lead a healthy lifestyle. What are the consequences of impaired blood flow during pregnancy, what is its cause and how to avoid it?

Causes of inadequate blood flow in the uterus

There are several reasons why placental insufficiency occurs. They can both affect the formation of the placenta, and appear at later gestation periods:

• uterine tumors
• genetic defects
• hormonal disorders
• preeclampsia
• infectious diseases
• structural features
• consequences of abortion
• diabetes
• atherosclerosis
• hypertension
• adrenal and thyroid problems
• multiple pregnancy
• Rhesus conflict

Most often, one, the main risk factor is manifested. But there may be several reasons at the same time.

Types and degrees of uterine blood flow disorders
There are three levels of violation:

1 degree

Occurs with the smallest changes in placental blood flow that do not have a dangerous character for the child. Within a month, with early detection and proper treatment, there is a high probability of complete recovery without consequences. It is divided into two types:

• 1a - there is a failure only in uteroplacental hemodynamics
• 1b - there are problems in the fetal-placental. The uterus remains full

2 degree

In the second degree, both systems of blood movement fail. The percentage of fetal death is about 13%. In a short time, usually up to 10 days, it passes into the third stage.

3 degree

The blood supply to the fetus is critical. Premature birth is often artificially induced, since the probability of death of an unborn little man is almost 50%.

In the second and third degree, a caesarean section is most often prescribed. At the first childbirth occur naturally, under the close supervision of a doctor.

Treatment of disorders of the placental circulation

Since the main consequence of insufficient blood movement is hypoxia, doctors prescribe drugs that increase the resistance of the tissues and brain of the fetus to oxygen starvation. In the complex, agents that improve the functioning of the heart and blood microcirculation can be used. If necessary, antiviral and antibacterial drugs are prescribed, as well as agents that prevent the formation of blood clots. The appointment of medications is carried out by a doctor, based on the severity of the blood circulation disorder. Sometimes a pregnant woman is offered hospitalization in order to provide her with bed rest, and so that the treatment takes place under the close supervision of specialists.

Prevention of pathologies

For the timely detection of pathological changes in the blood flow between the uterus and the fetus, all future women in labor are prescribed a Doppler study three times during gestation. It is carried out together with a planned ultrasound and helps to assess the general condition and development of the child, and also gives a complete picture of the state of blood flow in the vessels of the umbilical cord, uterus and fetus. Early detection of disorders in the functioning of the placenta and blood flow will help prescribe the drugs necessary for treatment in time and avoid negative and dangerous consequences for the baby in the future. Dopplerography is a mandatory study for expectant mothers with bleeding disorders.

It must also be remembered that the health of the baby largely depends on the condition of the mother. Therefore, with food, the body should receive a maximum of macro- and microelements, a sufficient amount of fats, proteins, carbohydrates and liquids. In the absence of puffiness, you need to drink at least one and a half liters of water per day. It is necessary to completely eliminate bad habits, try to avoid unnecessary physical and emotional stress. It is important to monitor the increase in body weight, weigh yourself and measure the circumference of the abdomen. It is advisable to walk more often in the fresh air and not be in stuffy rooms for a long time. For pregnant women at risk, medication is carried out for prevention, which helps the mother and child to fully interact.

Summarize

Every woman who wants to become a mother should understand that in most cases, a successful pregnancy and the birth of a healthy toddler depends on herself, on attention to her condition and a positive attitude.

Placenta- one of the most important organs formed in the uterus of a pregnant woman. It is the main link between the blood circulation of the expectant mother and the baby. With the help of the placenta the child receives oxygen and nutrients, which take part in the laying and formation of its organs, as well as with its help, metabolic products are displayed.

Violation of placental blood flow (or violation of uterine blood flow) leads to the development of placental insufficiency and, as a result, to the death of the baby.

During pregnancy, mandatory screening is carried out three times, including ultrasound examination and allowing timely detection of violations, determining the plan for pregnancy and delivery, prescribing adequate treatment, and preventing death or abnormalities in the development of the child.

The fetal-mother circulatory system includes structures such as the umbilical arteries and veins, as well as the placenta.

The placenta receives blood through the uterine arteries. The structure of the walls of these vessels is such that their muscle fibers can contract, thereby blocking the lumen. Until the moment of pregnancy, this mechanism allows you to reduce blood loss during menstruation.

At the fourth or fifth week of attachment of a fertilized egg, the muscle layer in the vessels disappears and the blood flow to the placenta is no longer controlled by the contraction of the vessels. By the sixteenth week, the arteries are completely changed for continuous blood supply. This feature becomes dangerous with the development of bleeding, since it is not possible to stop them by reducing blood vessels.

In a normal pregnancy, the placenta is attached to the inner lining of the uterus with the help of villi that penetrate deep into the mucosa. The villi grow into the vascular walls and come into contact with the mother's blood, carrying out metabolism at the cellular level.

In addition, direct participation in the fetal circulation is also umbilical cord vessels(vein and two arteries). Blood flows to the baby through the umbilical arteries, and flows to the placenta through the umbilical vein.

Violations in the circulatory system between the placenta and the fetus can lead to abnormalities in the development of internal organs and cast doubt on the birth of a healthy child.

There are several groups of factors, one of which is associated with pregnancy, and the other with maternal diseases.

Problems during pregnancy

Pathologies of pregnancy that can lead to hemodynamic disorders in the uteroplacental blood flow are:

Mother's illnesses

• Acute maternal infections during pregnancy. Bacteria and viruses can cross the placental barrier and damage blood vessels.
• Anomalies in the development of the uterus. For example, a bicornuate uterus, which has a septum in the cavity, which divides it into two parts, while pregnancy can develop only in one of these parts, as a result of which there is no connection between the arteries, the vascular network is underdeveloped, which leads to placental hypoxia.
• Endometriosis is damage to the inner surface of the uterus that occurs as a result of numerous abortions, genital infections, alcohol and smoking.
• Neoplasms of the uterus. Pregnancy provokes the growth of tumors, as a result of which the neoplasm takes away part of the blood flow from the fetus.
• Diabetes mellitus, due to which the vascular walls are damaged.

Threat to the fetus

All violations of placental blood flow lead to hypoxia (that is, oxygen starvation of the fetus), as a result of which:

• the formation of fat depots is disrupted;
• internal organs are formed incorrectly and the baby does not gain weight (these phenomena are called intrauterine growth retardation);
• there is an imbalance of hormones, as the endocrine glands do not function properly;
• fetal heart rate increases (tachycardia) or slows down (bradycardia), arrhythmias are also possible;
• the most serious consequences are the threat of miscarriage and intrauterine death of the child.

Fetoplacental insufficiency

It is a violation in the circulatory system of the placenta - the fetus. There are the following types:

Chronic placental insufficiency proceeds in several stages:

1. Compensation stage: has a favorable course, since the protective mechanisms in the mother's body compensate for the lack of nutrition for the fetus. Treatment at this stage is effective. As a result, the child is healthy and appears on time.
2. subcompensation stage. In this case, the mother's body cannot fully compensate for the lack of blood supply, and therefore complex treatment is required. The fetus lags behind in development and may be born with abnormalities.
3. Stage of decompensation: compensatory mechanisms are not effective. The fetal heart is impaired. Possible intrauterine death.
4. Stage critical: severe dysfunction of the placenta, due to deep structural changes in it. The therapy is not effective. Fetal death occurs in one hundred percent of cases.

Degrees of blood flow disturbance

1 degree: violations are compensated and concern only the uteroplacental blood flow, there is no threat to the fetus. The development of the child is within the normal range. According to the level of change, there are:

• violation of utero-placental blood flow 1a degree: violations occur only in one of the arteries of the uterus, hemodynamics are stable, there are no deviations from the norm, that is blood flow disorder type 1a has a favorable course;
• impaired fetal placental blood flow 1b degree: damage is detected at the level of the vessels of the umbilical cord, the arteries of the uterus provide adequate blood supply, that is, impaired blood flow of the 1b degree during pregnancy has a favorable prognosis.

2nd degree: develops in the absence of first-stage therapy within three to four weeks. In this case, the blood flow in the umbilical and uterine arteries changes.

3rd degree: indicators are at a critical level, a reverse flow of blood may occur in the arteries.

Diagnostics

The most accurate and informative method of research in case of circulatory disorders is dopplerography. With its help, it is possible to detect even minor changes in the blood flow of veins and arteries, study the hemodynamics of the fetus and obtain a graphic color image. That is, thanks to this method, it is possible to determine the prognosis of a real pregnancy and prescribe adequate therapy.

Less accurate methods are ultrasound and CT, during which indirect signs of hypoxia are determined: pathology of the placenta and lack of fetal weight.

Treatment

Establishing the degree of placental circulation disorders is extremely important, since it determines the further tactics of pregnancy management:

• consider that the preservation of pregnancy is possible in case of violation of the IPC of degree 1a and degree 1b; at this stage, the treatment is quite effective;
• the second degree is considered as borderline, that is, the treatment in this case is ineffective, but possible;
• in the presence of the third degree, immediate delivery by operative methods is required.

Medical therapy:

• in order to improve microcirculation, actovegin and pentoxifylline are prescribed;
• to maintain adequate blood flow and pressure in the vessels, infucol, stabizol and venofundin are used;
• to eliminate arterial spasm, no-shpu and aminofillin are used;
• by reducing the tone of the uterus, it is possible to eliminate vasospasm, as well as reduce hypoxia; for these purposes are appointed: ginipral, magne-B6, magnesium sulfate;
• antioxidants (tocopherol, hofitol, and so on) fight the effects of hypoxia;
• Essentiale is prescribed to improve the functioning of the liver and increase blood phospholipids;
• in the case of a combination of uterine fibroids with pregnancy, chimes are used to prevent the formation of blood clots and improve microcirculation;
• cocarboxylase is used to improve tissue respiration.

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Symptoms of the disease - violations of fetal blood flow

Violations and their causes by category:

Violations and their causes in alphabetical order:

violation of fetal blood flow -

Doppler effect is based on the change in the frequency of the sound wave depending on the speed of the observed emitter. In our case, it is a change in the frequency of the reflected ultrasonic signal from an unevenly moving medium - blood in the vessels. Changes in the frequency of the reflected signal are recorded in the form of curves of blood flow velocities (BFR).

Hemodynamic disturbances in the functional system "mother-placenta-fetus" are the leading pathogenetic mechanism of violation of the state and development of the fetus in various complications of pregnancy. At the same time, in the vast majority of observations, hemodynamic disorders are characterized by the universality and uniformity of changes, regardless of the state of the fetus and the etiopathogenetic factor.

A change in the normal parameters of CSC is a non-specific manifestation of many pathological conditions of the fetus, and in many cases preceding the appearance of clinical symptoms, it is important that this also applies to the main pathological conditions during pregnancy - FGR, fetal hypoxia, preeclampsia, etc. With a period of 18-19 to 25-26 weeks. Doppler- selection method, because the biophysical profile of the fetus is informative from 26 weeks, and cardiotocography is not yet indicative.

The Doppler method involves obtaining curves of blood flow velocities in the vessels of the uterine-placental-fetal blood flow, calculation of vascular resistance indices (VR), and analysis of the results obtained.

What diseases cause violation of fetal blood flow:

Classification of fetal blood flow disorders

1st DEGREE - violation of fetal-placental blood flow, not reaching critical values ​​and a satisfactory state of fetal hemodynamics (impaired blood flow only in the umbilical artery). LMS in the thoracic aorta - 5.52 ± 0.14, in the internal carotid artery - 3.50 ± 1.3. There is a compensatory decrease in the diastolic function index of both ventricles of the fetal heart in 58.3% of cases, an increase in the maximum blood flow velocity through all heart valves in 33.3%.

2 DEGREE - compensated violation of fetal blood flow (violation of the hemodynamics of the fetus itself). Centralization of the fetal circulation. Reducing the maximum blood flow velocity through all valves of the fetal heart in 50% of cases, for the left sections - to a lesser extent. Further decrease in diastolic ventricular function (E/A). Prevalence of the right parts of the fetal heart remains. Pathological spectrum of blood flow in the aorta and / or internal carotid artery of the fetus. Aorta - a violation of blood circulation by the type of violations in the artery of the umbilical cord. In the internal carotid artery, an increase in the level of diastolic blood flow is a decrease in the resistance of the microvascular bed of the fetal cerebral hemispheres. In 100% of cases, circulatory disorders in these vessels are secondary to changes in the umbilical artery. The secondary nature of changes in the internal carotid artery to changes in the fetal aorta has not been established. The primary change in the blood circulation of the cerebral vessels is much less common (non-placental type of fetal hypoxia). 2 degree is not long, quickly passes into 3 degree.

3 DEGREE - a critical state of fetal blood flow. The functional predominance of the left parts of the heart over the right ones is a deeper restructuring of intracardiac hemodynamics associated with the centralization of blood circulation. Increased fetal hypoxia - a decrease in transvalvular blood flow by 10.3% for the valves of the left sections and by 23.3% for the right ones. Functional insufficiency of the tricuspid valve in 66.7% of cases (flows of regurgitation). Aorta - decrease in diastolic blood flow to its absence (69.6%). Decreased resistance of the internal carotid artery in 57.1% of cases. The combination of simultaneous violations in the aorta and in the internal carotid artery more often than in the 2nd degree of violation (14.3% and 42.3%, respectively).

Stages of fetal blood flow disorders

1 degree goes to the second after an average of 3 weeks; 2 to 3 in 1.3 weeks. It is possible to compensate for fetal blood flow disorders in various stages, more in the first stage, less in the second. In stage 3 - decompensation of fetal hemodynamics.

Perinatal losses: 1st degree of fetal hemodynamic disorders - 6.1% of cases, 2nd degree - 26.7%, 3rd degree - 39.3%.

Intensive care of newborns: 1st degree - 35.5%, 2nd degree - 45.5%, 3rd degree - 88.2%.

1. An increase in DLS (peripheral resistance) is a high risk factor for complications in the neonatal period.
2. The most common cause of an increase in LMS is intrauterine infection.
3. Prolonged spasm of cerebral vessels plays an important role in reducing compensatory capabilities, which leads to disruption of adaptation processes in the early neonatal period.

Mean value of uterine artery IR at 22-41 weeks of gestation.
1. Newborns born in normal condition - 0.482 ± 0.052.
2. Newborns born with initial signs of hypoxia in the early neonatal period - 0.623±0.042.
3. Newborns born in a state of moderate severity 0.662 ± 0.048.
4. Newborns born in serious and extremely serious condition; death in the early neonatal period - 0.750±0.072.

After 29 weeks, the threshold value of LMS (at least on one side) is 2.4, IR is 0.583.
With arterial hypotension, in 88% of cases, a decrease in BMD due to a small minute volume of blood.
A decrease in FPC and BMD with a high probability indicates the possibility of developing complications in newborns in the early neonatal period, while the absence of a decrease is not a reliable diagnostic criterion for placental circulatory insufficiency, which is the cause of chronic fetal suffering in 45-60% of cases.
The main cause of malnutrition is a violation of the uteroplacental blood flow.

Forecasting NWFP:

In case of impaired blood flow of degree 1A, the syndrome of sdfd develops in 93.2% of cases; on the one hand - in 66.7% of cases, on both sides - 95.7%. In case of circulatory disorders of the 1B degree, IUGR develops in 81.6% of cases. With a simultaneous decrease in the IPC and FPC - in 100% of cases.

Under the influence of therapy, it is possible to improve hemodynamics with a mild degree of preeclampsia. At the same time, circulatory disorders in the uterine-placental link are less susceptible to positive dynamics than in the fetal-placental link, which can be explained by the development of morphological changes in the vessels of the uterus due to preeclampsia. At the same time, normalization of blood flow in 40% of cases in the umbilical artery suggests a possible functional nature of changes in fetoplacental hemodynamics. However, in severe gestosis, fetoplacental hemodynamics did not change significantly after treatment. The appearance of "zero" or retrograde blood flow in the umbilical artery, indicating an extreme degree of fetal suffering, dictates the need to abandon therapy in favor of emergency delivery.
The diagnostic significance of dopplerometry of MA and AP is reliable only in violation of blood flow, with abnormal CSCs. However, dopplerometry of MA and AP, if the size of the fetus does not correspond to the gestational age (if a symmetrical form of malnutrition is suspected), can be used for differential diagnosis with a healthy, low-weight fetus. The presence of normal blood flow with a small-sized fetus in most cases will indicate the presence of a healthy, low-weight fetus.

More conclusions:

1. Dopplerometry is a fairly reliable method for diagnosing the condition of the fetus.
2. Normal parameters of FPC and BMD, cerebral blood flow are not reliable diagnostic criteria for the absence of fetal disorders.
3. The decrease in placental blood flow in most cases is accompanied by fetal hypotrophy.

There is a clear relationship between the nature of the blood flow in the uterine artery and the severity of the clinical picture of preeclampsia (violation of 59.5%).

With gestosis, circulatory disturbance occurs only in one artery in 80.9% of cases (19.1% in 2 uterine arteries). In this regard, the blood flow must be assessed in both uterine arteries.

With gestosis, the fetal-placental blood flow is disturbed in almost half of the pregnant women; with sdfd in 84.4% of cases.

There was no correlation between the frequency of blood flow disturbances in the umbilical artery and the clinical picture of preeclampsia.

Violation of blood flow in the fetal aorta is accompanied by severe FPI, clinically manifested by FGR 2 and 3 degrees.

With gestosis, the blood flow in the uterine artery is primarily disturbed, then, as the violations deepen, in the umbilical artery.

perinatal mortality

With normal indicators of the MPP of blood flow and 1st degree of disturbance, there are no cases of perinatal mortality, 2nd degree - in 13.3%, 3rd degree - in 46.7% of cases.

A Doppler study conducted in women with grade 3 hemodynamic impairment in the "mother-placenta-fetus" system made it possible to establish the ineffectiveness of the therapy for placental insufficiency. With conservative management of childbirth, perinatal mortality was 50%. There were no perinatal losses during delivery by caesarean section.

A comprehensive Doppler assessment of the blood flow of the uterine and umbilical arteries can be considered as an objective indicator of the severity of preeclampsia, regardless of its clinical manifestations.

Dopplerometry in the right uterine artery is a valuable diagnostic method that allows in the 2nd trimester to identify a group of pregnant women at high risk for the development of late preeclampsia (from 20-24 weeks, most accurately 24-28 weeks). The reliability is 98%. According to the theory of preferential blood supply to the right uterine artery of the uterus, the frequency of preeclampsia and FGR is higher when the placenta is located on the left wall of the uterus. In multiparous with the location of the placenta on the left, SGR develops significantly more often than in primiparas. With the placenta located on the right, there are no differences. Probably, this happens because the postpartum involution of the uterus leads to a significant reduction of the "inferior" channel of the left MA.
Measurement of ASC in the right MA should be considered an acceptable method for selecting a group of pregnant women for the development of late toxicosis. The prognosis should be determined mainly in the 2nd trimester of pregnancy.
Dopplerometry has a high diagnostic and prognostic value in pregnancy complications: OPG - preeclampsia, FGR, intrauterine fetal hypoxia.

This method makes it possible to predict the complicated course of the early neonatal period and the development of neurological disorders in the newborn.

The outcome of pregnancy and childbirth is determined not so much by the nosological affiliation as by the degree of hemodynamic disturbance in the mother-placenta-fetus system.

Timely correction of the tactics of pregnancy and childbirth, drug therapy, carried out taking into account Doppler indicators, can reduce perinatal morbidity and mortality, but do not exclude a high risk of developing severe neurological complications in the early neonatal period.
The high diagnostic value of the study of blood flow in the MA in IUGR is explained by the fact that the primary link in the development of this pathology in most cases are disorders of the uteroplacental blood flow. With a change in CSC in one uterine artery, IUGR develops in 63.6% of cases, in 2 - in 100% of cases.

With gestosis, pathological CSCs are detected in 75% of cases. In severe forms of preeclampsia, changes occur in parallel in the umbilical artery. In hypertension, the accuracy of predicting adverse perinatal outcomes during pregnancy significantly exceeds the accuracy of clinical tests (BP, creatinine clearance, urea, etc.).

With an increase in SDS in the uterine artery more than 2.6, prediction of adverse outcomes with a sensitivity of 81%, a specificity of 90%.

If we focus on the dicrotic notch, the sensitivity is 87%, the specificity is up to 95%.
To predict complications in the 3rd trimester, it is important to assess the CSC in the 2nd trimester of pregnancy. Pathological CSC at 15-26 weeks of pregnancy is a reliable prognostic sign of the development of preeclampsia and sdfd in the 3rd trimester. The detection of a pathological decrease in diastolic blood flow in the uterine artery for 4-16 weeks precedes the appearance of clinical symptoms of preeclampsia. The study of CSC in the uterine artery makes it possible to predict placental abruption with great accuracy. 4 weeks before placental abruption (in 4 out of 7 pregnant women), a pathological decrease in diastolic blood flow and the appearance of a dicrotic notch were noted. With detachment, LMS in the umbilical artery rises to 6.0.

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After a woman finds out about her pregnancy, she must realize that now the body belongs not only to her, but also to her unborn child. Hormonal surges and a complete restructuring of the pelvic organs quite often end with a violation in the blood supply to the fetus. In this article, we will talk about impaired blood flow during pregnancy, what it is fraught with, what symptoms are inherent, what therapy can be used, and how to bear a healthy child.

How blood flow changes during pregnancy

Initially, let's figure out how everything works in mothers' tummies. During pregnancy, the placenta is responsible for the transfer of beneficial trace elements and oxygen to the baby. It is the same unifier through which the vascular system of the pregnant woman is connected to the vascular system of the fetus, becoming common. Any disturbances in the work of the placenta affect the condition of the baby, so it is necessary to monitor the blood flow during pregnancy. Diagnosis is made through a study - dopplerometry. About it, below we will talk in more detail.

What is blood flow disorder during pregnancy

Violation of blood flow can appear at any gestation period. A pregnant woman is diagnosed with placental insufficiency. This is one of the most common complications during pregnancy associated with dysfunction of the placenta. This pathology occurs in two forms:

1. The acute form appears suddenly and is most often the result of placental abruption. It can provoke a violation of gas exchange in this organ and, as a result, oxygen starvation in the fetus.
2. Chronic, it is also called premature aging of the placenta. Most often detected in the third trimester of pregnancy. It is divided into the following types:

• compensated - is considered minimally dangerous, since with this form the child continues normal physiological development. In the mother's body, protective mechanisms are “turned on” that compensate for impaired blood flow;
• decompensated - the mother's body can not cope with the problem, pathological changes occur in the placenta. The first oxygen starvation of the fetus appears, entailing developmental delays, intrauterine death of the baby is possible;
• subcompensated - with this form, the condition of the fetus worsens, it lags far behind in development;
• critical - with this form of insufficiency, the death of the child is inevitable.

Diagnosis of pathology

It has already been said earlier that during pregnancy, a violation of blood flow can be diagnosed by means of dopplerometry. It is an ultrasound examination that can detect any pathological abnormalities in blood flow. During the diagnosis, a pregnant woman takes a horizontal position on her back or side. The specialist conducts a study by the transabdominal method. Usually dopplerometry is prescribed twice:

• at 20–22 weeks, in order to make sure that there are no deviations in the development of the fetus;
• at 32 weeks.

Degrees of blood flow disorders in pregnant women

Conventionally, the blood flow system during pregnancy can be divided into two subsystems:

• woman (womb) - placenta;
• placenta is a baby.

In medicine, there are norms for Doppler readings. They are applied from the second trimester. Doctors compare the obtained diagnostic data with the norms and identify the degree of blood flow disturbance during pregnancy.

I degree

When diagnosing, the presence of deviations in one of two forms is recorded:

• I-a degree - a violation of blood flow occurs in the area pregnant - placenta (utero-placental blood flow);
• I-b degree - pathological changes are observed in the placenta-child subsystem.

Violation of blood flow during pregnancy of the first degree does not affect the condition of the unborn baby and is easily amenable to medical correction.

II degree

In the second degree, both subsystems are affected. For 7-12 days, this condition threatens to develop into the III degree, which can end tragically.

III degree

The critical point at which the child's blood supply may be completely absent or reversed. If within 72 hours, with reverse blood flow, it is not possible to stabilize the condition, then a diagnosis is made for artificial birth, or premature termination of pregnancy.

What is the danger of impaired blood flow during pregnancy

Complications and dangers that can develop as a result of impaired blood flow include:

• placental abruption;
• hypoxia;
• fetal hypotrophy;
• pathology of development;
• intrauterine death.

At I degree, if the fetus does not suffer from hypoxia, then the woman is allowed to give birth on her own. In other cases, delivery is carried out through a caesarean section.

Why blood flow disorders occur during pregnancy

There are many reasons that contribute to impaired blood flow during pregnancy. Consider the most common factors that provoke a violation of blood flow.

1. Diseases of the uterus: bicornuate uterus, endometriosis, uterine hypoplasia, the presence of fibroids, etc.
2. Maternal health problems: kidney failure, diabetes mellitus, hypotension, pyelonephritis, endocrine system diseases, bronchial asthma, etc.
3. Unfavorable conditions for gestation: Rhesus conflict, multiple pregnancy, preeclampsia, abnormal presentation of the fetus, etc.
4. External factors: alcohol intake during pregnancy, smoking, constant being in a nervous environment, first birth (and a woman over 35), poor (limited) nutrition of the mother.

Symptoms of pathology

At the first degree of manifestation of the pathology, the symptoms do not manifest themselves in any way, so the expectant mother learns about the problem by visiting the next scheduled ultrasound. If the pathology proceeds in an acute or decompensated form, then changes in the activity (movement, stirring) of the fetus can be noticed. Such states are characterized by changes of too strong movements with fading.

In addition to behavioral changes in the baby's abdomen, there may be:

• slow growth of the mother's abdomen;
• late toxicosis;
• increased swelling;
• oligohydramnios or polyhydramnios are diagnosed.

Treatment Methods

If the disease is mild (first degree), then the doctor may prescribe drugs that improve blood circulation.

The dynamics of the state of the fetus is carried out, weekly, until the indicators normalize, the pregnant woman is given dopplerometry and the fetal heartbeat is checked. If the indicators stabilize, then the woman will continue to bear the child further. In case of deterioration, it is recommended to perform a caesarean section (for a period of more than 25–28 weeks).

In the second degree, the pregnant woman is hospitalized and treated under the strict supervision of the medical staff. If the condition worsens, an unscheduled operation is performed.

As for the third degree, it cannot be treated, since irreversible changes begin in the development of the fetus. Therefore, in order not to risk the life of the child, doctors insist on an urgent cesarean.

In conclusion about prevention

Prevention actions should be aimed at organizing conditions for healthy growth and intrauterine development of the child. To do this, a woman must:

• watch your diet;
• rest more often;
• regularly visit the fresh air;
• to refuse from bad habits;
• minimize emotional stress.

The main thing is to regularly visit a doctor and follow his recommendations.