Fetoplacental insufficiency
Contents:
Description:
Fetoplacental insufficiency (FPN) represents a symptom complex at which there are various disturbances both from a placenta, and from a fruit owing to various diseases and obstetric complications. A variety of options of manifestation of fetoplacental insufficiency, frequency and weight of complications for the pregnant woman and a fruit, the prevailing disturbance of this or that function of a placenta depend on duration of gestation, force, duration and the nature of influence of disturbing factors, and also on a stage of fetation and a placenta, degree of manifestation kompensatorno - adaptive opportunities of system a mother-placenta-fruit.
Symptoms of Fetoplacental insufficiency:
It is reasonable to classify fetoplacental insufficiency taking into account a condition of protective and adaptive reactions. The compensated form of fetoplacental insufficiency at which initial manifestations of pathological process in a fetoplacental complex take place. Protective and adaptive mechanisms become more active and test a certain tension that creates conditions for further fetation and progressing of pregnancy. At adequate therapy and conducting childbirth the birth of the healthy child is possible.
The subcompensated form of fetoplacental insufficiency is characterized by aggravation of weight of a complication. Protective and adaptive mechanisms test the extreme tension (opportunities of a fetoplacental complex at the same time are almost exhausted) that does not allow to provide their implementation sufficiently for the adequate course of pregnancy and fetation. The risk of emergence of complications for a fruit and the newborn increases.
The Dekompensirovanny form of fetoplacental insufficiency - takes place an overstrain and failure of compensatory and adaptive mechanisms which do not provide necessary conditions for further normal progressing of pregnancy any more. In fetoplacental system there are irreversible morfofunktsionalny disturbances. Significantly the risk of development of heavy complications for a fruit and the newborn increases (including their death). The clinical picture of fetoplacental insufficiency is shown in disturbances of the main functions of a placenta.
Delay of pre-natal fetation. Change of respiratory function of a placenta is demonstrated generally by fruit hypoxia symptoms. At the same time in the beginning the pregnant woman pays attention to the increased (chaotic) physical activity of a fruit, then to its reduction or total absence. The most characteristic sign of chronic fetoplacental insufficiency is the delay of pre-natal fetation. Clinical manifestation of a delay of pre-natal fetation is reduction of the sizes of a stomach of the pregnant woman (a stomach circle, height of standing of an uterine fundus) in comparison with the normative indicators characteristic of this duration of gestation.
At a symmetric form of a delay of pre-natal development which develops from early durations of gestation, proportional lag of length and body weight of a fruit is noted. At the same time quantitative indices of a fetometriya have lower values in comparison with the individual fluctuations characteristic of this duration of gestation.
The asymmetric form of a delay of pre-natal development is characterized by disproportionate fetation. This form most often arises in II or in the III trimester of pregnancy and is shown by lag of body weight of a fruit with its normal length. Preferential the sizes of a stomach and thorax of a fruit decrease that is connected with lag of development of parenchymatous bodies (first of all a liver) and a hypodermic fatty tissue. The sizes of the head and extremities of a fruit correspond to the indicators characteristic of this duration of gestation.
Disturbances of functions of a placenta. Reflection of disturbances of protective function of a placenta when weakening a placental barrier is pre-natal infection of a fruit under the influence of the pathogenic microorganisms getting through a placenta. Perhaps also penetration through a placental barrier of various toxics which also have the damaging effect on a fruit.
Change of synthetic function of a placenta is followed by an imbalance of level of the hormones produced by it and decrease in protein synthesis that is shown by a delay of pre-natal fetation, a hypoxia, pathology of a sokratitelny uterine activity at pregnancy and in labor (long threat of premature abortion, premature births, anomalies of patrimonial activity).
Long and frequent increase in a tone of a myometrium leads to decrease in arterial inflow of blood to a placenta and causes venous stagnation. Hemodynamic disturbances reduce gas exchange between an organism of mother and a fruit that complicates receipt to a fruit of oxygen, nutrients, removal of products of metabolism, promotes increase of a hypoxia of a fruit.
Disturbance of endocrine function of a placenta can lead also to a pregnancy perenashivaniye. Decrease in hormonal activity of a placenta causes dysfunction of a vulval epithelium, creating favorable conditions for development of an infection, an aggravation or developing of inflammatory diseases of an urogenital path. Against the background of disorder of secretory function of a placenta and amniotic covers the pathological amount of amniotic waters - most often an oligoamnios is noted, and at some morbid conditions (a diabetes mellitus, an edematous form of a hemolitic disease of a fruit, pre-natal infection, etc.) - a hydramnion.
Reasons of Fetoplacental insufficiency:
Fetoplacental insufficiency can develop under the influence of various reasons. Disturbances of formation and function of a placenta can be caused by heart diseases and vascular system of the pregnant woman (heart diseases, a circulatory unefficiency, arterial hypertension and hypotension), pathology of kidneys, a liver, lungs, blood, persistent infection, diseases of neuroendocrinal system (a diabetes mellitus, hypo - and hyperfunction of a thyroid gland, pathology of a hypothalamus and adrenal glands) and a number of other morbid conditions. Fetoplacental insufficiency at anemia is caused by decrease in level of iron, both in maternal blood, and in the placenta that leads to oppression of activity of respiratory enzymes and transport of iron to a fruit. At a diabetes mellitus metabolism is broken, hormonal frustration and changes of the immune status come to light. Sclerous defeat of vessels leads to reduction of receipt of an arterial blood to a placenta. An important role in development of fetoplacental insufficiency is played by various infectious diseases which are especially proceeding in an acute form or becoming aggravated during pregnancy. The placenta can be struck with bacteria, viruses, the elementary and other contagiums.
Important value in formation of fetoplacental insufficiency is played by uterus pathology: endometriosis, myometrium hypoplasia, uterus malformations (saddle, two-horned). Risk factor of fetoplacental insufficiency should be considered a hysteromyoma. However the risk of fetoplacental insufficiency at pregnant women with a hysteromyoma is various. With high risk carry to group primapara at the age of 35 years and is more senior with preferential intermuscular arrangement of myomatous nodes of the big sizes, especially at localization of a placenta in the field of a tumor arrangement. The group with low risk of fetoplacental insufficiency is made by young women up to 30 years without serious extragenital illness, with small myomatous nodes of preferential subperitoneal arrangement in day and a body of the womb.
Treatment of Fetoplacental insufficiency:
At detection of fetoplacental insufficiency it is reasonable to hospitalize the pregnant woman in a hospital for profound inspection and treatment. Pregnant women with the compensated form of fetoplacental insufficiency can make an exception provided that the begun treatment gives positive effect and there are necessary conditions for dynamic clinical and tool control of character of a course of pregnancy and efficiency of the carried-out therapy. The leading place in holding medical actions is taken by treatment of a basic disease or complication at which there was a fetoplacental insufficiency. Now, unfortunately, it is not possible to save completely the pregnant woman from fetoplacental insufficiency any medical influences. The applied means of therapy can promote only stabilization of the available pathological process and maintenance of compensatory and adaptive mechanisms at the level allowing to provide continuation of pregnancy to a possible optimum delivery time.
Treatment of fetoplacental insufficiency has to be directed to improvement of a matochnoplatsentarny and fetoplacental blood-groove; gas exchange intensification; correction of rheological and coagulative properties of blood; elimination of a hypovolemia and hypoproteinemia; normalization of a vascular tone and sokratitelny uterine activity; strengthening of antioxidant protection; optimization of metabolic and exchange processes. The standard scheme of treatment of fetoplacental insufficiency cannot exist owing to an individual combination of etiological factors and pathogenetic mechanisms of development of this complication. Selection of drugs should be carried out individually and differentially in each specific observation taking into account severity and duration of a complication, etiological factors and pathogenetic mechanisms which are the cornerstone of this pathology. Individual approach is demanded by a dosage of drugs and duration of their use. It is necessary to pay attention to correction of side effect of some medicines.
Treatment of fetoplacental insufficiency is begun and spend in a hospital not less than 4 weeks with the subsequent its continuation in clinic for women. The general duration of treatment makes not less than 6-8 weeks. For assessment of efficiency of the carried-out therapy exercise dynamic control by means of clinical, laboratory and tool methods of a research. An important condition of successful treatment of fetoplacental insufficiency is observance of the pregnant woman of the corresponding mode: good rest not less than 10-12 hours a day, elimination of exercise and emotional stresses, the balanced balanced diet.
One of the leading pathogenetic mechanisms of development of fetoplacental insufficiency are the disturbances of a matochnoplatsentarny blood-groove (MPK) and a fetoplacental blood-groove (FPK) which are followed by increase in viscosity of blood, hyper aggregation of erythrocytes and thrombocytes, disorder of microcirculation and a vascular tone, insufficiency of arterial circulation. Therefore the important place in treatment of fetoplacental insufficiency is taken by drugs of antiagregantny and anticoagulating action, and also the medicines normalizing a vascular tone.
It is necessary to take into account that periodic and long increase in a tone of a uterus promotes disturbance of blood circulation in intervillous space owing to decrease in venous outflow. In this regard it is aware of therapy of fetoplacental insufficiency at patients with the phenomena of threat of abortion reasonably purpose of drugs of tokolitichesky action (β-mimetika). Progressing of a hypoxia happens against the background of an intensification of peroxide oxidation of lipids, to education and accumulation of the products of a peroksidation damaging mitochondrial and cellular membranes. Activation of this process is caused by weakening of mechanisms of antioxidant protection. In therapy of fetoplacental insufficiency normalization of antioxidant protection is important that exerts positive impact on transport function of a placenta. Considering the most important disintoxication function of a liver, and also its defining role in products of proteins and pro-coagulants, in complex therapy of fetoplacental insufficiency it is reasonable to use gepatoprotektor.
Integral part of a complex of therapeutic actions is use of the medicines allocated for improvement of metabolic and biopower processes that also promotes improvement of a hemodynamics, gas exchange and other functions of a placenta. Existence of the adverse and aggravated signs of fetoplacental insufficiency which testify to a decompensation of a fetoplacental complex, followed by the expressed combined reduction of a matochnoplatsentarny and fetoplacental blood-groove, considerable disturbance of indicators KTG and low level of compensatory and adaptive opportunities of a fruit serve as indications for urgent delivery. In this situation the most preferably Cesarean section. If there are no signs of a decompensation of a fetoplacental complex, the carried-out therapy is effective and the put clinical situation allows, then delivery is possible in natural patrimonial ways at observance of the following conditions: head presentation; full proportionality of a head of a fruit and mother's basin; sufficient readiness of an organism for childbirth.
