Violation of blood flow in a pregnant woman. Violation of blood flow during pregnancy - causes and consequences

The placenta in the body of a future mother plays not only the well-known role of a transport channel for supplying the fetus with nutrients. Its functionality extends much more widely - up to ensuring the complete protection of the child from the effects of negative substances and that may be present in the feeding maternal environment. Violation of blood flow during pregnancy is a direct threat of intrauterine death of the fetus due to poor blood circulation in the complex communicating apparatus of two closed vascular systems.

The blood of the fetus and mother should not mix at any stage of the complex multi-level movement. The first mechanism of blood circulation of the mother-fetus provides barrier functions - the hematoplacental barrier, which is a kind of unique filter that works in only one direction: by removing waste substances from the fetus along with the blood flow.

The movement of blood in the reverse order, from mother to child, is carried out through the arteries, which are fully formed by the 16th week of pregnancy. This is the second mechanism of the system. Due to the high tone of the arteries, starting from this period, the risk of fetal loss also increases.

The vessels of the uteroplacental circle, isolated by the umbilical trunk, are the third important mechanism of blood circulation between two organisms - feeding and feeding. Violation of blood flow during pregnancy at this stage, has the most serious and irreversible consequences for the fetus.

Causes

The causes of impaired blood flow during pregnancy can be found in the following pathological conditions:

• Anemia (anemia) of the expectant mother. cause high blood flow. This occurs due to compensation for the lack of oxygen and cannot but affect the processes in the development of the fetus and the quality of blood exchange;
• The position of the placenta. If presentation is diagnosed, which can be justified by a cesarean section, then the blood supply will be clearly reduced due to the thinning of the uterus at the site of the scar;
• Late toxicosis causing pathological changes in the work of small vessels. This is one of the most common signs of blood flow disorders during pregnancy;
• Viruses and infections present in the mother's body during the period of gestation. Some of them can cause damage to the placental tissue and contribute to the development of placental insufficiency;
• - may be complicated by the anemic condition of the fetus;
• Defects of the uterus. The most significant of them, capable of changing the course of fetal development for the worse, is the two-cavity structure of the uterine sac. The uterine space, divided into two parts, in itself is not an obstacle to the normal growth and formation of the child. However, the blood supply system does not adequately supply such a two-chamber cavity;
• Serious quantitative or configurational umbilical cord;
• Damage to the inner wall of the uterus obtained as a result of surgical interventions, or as a result of bad habits;
• Tumors such as fibroids, especially dangerous in women who have not given birth before after thirty-five years. This also applies to uterine fibroids, which are abundantly saturated with blood during perinatation. Against the background of an increase in size and the formation of a myomatous node, a persistent lack of blood flow to the placenta is formed;
• , which do not allow maintaining the uniformity of the blood flow rate;
• Pregnancy complicated by multiple pregnancy. Since the placenta is forced to adapt to the maintenance of several feeding organisms in proper conditions at once, such errors in the blood supply as the donor position of one of the fetuses are not excluded. Often at the same time, there is an underdevelopment of the feeding fetus, a significant lack of weight and physiological normal signs. A child who unwittingly acts as a recipient also suffers seriously from, on the contrary, too abundant blood supply;
• Mother's disease, sometimes developing precisely against the background of pregnancy, loosens the walls of blood vessels, which affects blood circulation in a bad way.

The degrees of violation of the uteroplacental circulation during pregnancy, in which significant changes in the development of the fetus are likely, formed the basis of the following classification list:

• Violation of blood flow during pregnancy 1A - all diagnostic indicators of the uteroplacental apparatus are normal, except for an insignificant change in blood flow in any of the uterine arteries;
• Violation of blood flow during pregnancy 1B - there are violations of blood circulation in the vessels of the umbilical cord, despite the fact that the state of the vessels of the uterus is unchanged;
• 2 - a comprehensive violation of both the uterine and umbilical vessels;
• 3 - changes at the global level, characterized by the most extreme rates of deviation.

Degrees of blood circulation 1 (A and B) allow you to keep the pregnancy and give birth to a healthy baby, subject to the prescribed treatment and all the doctor's recommendations. Grade 2 allows for fetal preservation, but this will require hospitalization. Grade 3 requires immediate surgical removal of the fetus to save the life and health of the mother.

The main diagnosis of blood flow disorders during pregnancy, at the moment, is. The most insignificant, at first glance, changes at one of the early stages of disorders are clearly visible on the screen, since Doppler provides a picture in color and has a high degree of resolution in terms of the clarity of the picture.

The very analysis of the frequency of ultrasonic waves reflected from objects in motion makes it possible to determine the speed of blood flow through the arteries, in the umbilical vessels, as well as the blood circulation inside the placenta. Then the indicators taken during the survey are compared with the table of normative data and the result is recorded.

The biggest plus of Dopplerography, in addition to the safety of the study, is the accurate prediction of any form of abnormality, detecting them at the stage when it is still possible to save the fetus and not harm the mother's body.

In addition, classical measures to confirm or refute the pathology are mandatory used:

• Analysis of the activity of the fetus, based on the words of the mother;
• Stethoscopic listening to the baby's heartbeat in the womb;

Treatment

It is impossible to treat disorders of the uteroplacental blood flow, acting only in one direction, or eliminating problems as they arise.

A complete cure necessarily includes a set of measures aimed at:

• Increased blood microcirculation;
• Achievement of optimal blood pressure;
• Vasodilation with spasmodic manifestations in the arteries;
• Reduction of uterine tone due to the relaxation of blood vessels;
• Prevention of the consequences of oxygen starvation (hypoxia);
• Saturation of the placental tissue with the phospholipids it needs.

Effects

Depending on the degree and nature of circulatory disorders during pregnancy, there are also difficulties in the development of the fetus, in rare cases leading to the death of the child.

The consequences of impaired blood flow during pregnancy are characterized by such nuances as:

• Inhibition of fetal development at some of the stages, or significant delays in its intrauterine formation;
• Critical indicators of weight and size;
• Rapid, slow, or intermittent heartbeat;
• Floating blood pH;
• Improper course of hormonal processes;
• Risk of miscarriage.

It must be remembered that only a cumulative assessment of the development of the baby, and not the results of one study, can provide complete information about compliance with standard indicators, or lagging behind them. At the moment, the Doppler procedure, which is the basis of examinations of the perinatal period, in no way detracts from the need for tried and tested methods of the old school of medicine.

Currently, the assessment of uteroplacental blood flow is a mandatory study in the generally accepted standards for the management of pregnant women. Thanks to triple ultrasound screening, which is performed on expert-class devices, obstetrician-gynecologists are able to recognize the degree of uteroplacental blood flow disorder (UTPC) in time, 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 uteroplacental blood flow system is an anatomically complex complex of the placenta, as well as the blood vessels of the mother and 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? 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, a full blood flow to the placenta is maintained. It has been proven that already by the 16th week of pregnancy, the spiral arteries are completely transformed. However, it is precisely 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 it 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 the so-called villi. These “outgrowths” of placental tissue are, as it were, immersed in the thickness of the uterine mucosa. Placental villi penetrate into the walls of the uterine vessels and are practically “washed” by maternal blood. It is here, at the cellular level, that complex processes of diffusion of maternal and fetal blood take place, separated from each other by only a few layers of cells. This is called the "blood-placental 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 cause admiration!
3. The umbilical cord vessels are the third layer in the complex system of blood flow 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 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 speed of circulating blood. This is a compensatory response. The same thing happens in the utero-placental system.
• Pathology of placental attachment(low placentation, presentation) is characterized by reduced blood flow, since in 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 to the scar on the uterus (usually after a previous caesarean section). The thinned area of ​​the scar cannot fully provide blood flow, so the amount of blood that enters the fetus may not be enough for the normal functioning of the developing organism.
• (late toxicosis) is one of the most common causes of impaired blood supply to the uterine-placental system, since with this obstetric complication, small vessels are damaged.
• 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. Decreased weight and size (syndrome of intrauterine growth retardation);
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 the acid-base balance in the body of the fetus (change);
4. Pathological functioning of the hormonal system of the child;
5. A pronounced decrease in fat depots, which is also manifested by a low body weight of the fetus;
6. The threat of termination of pregnancy;
7. A critical violation of blood flow can cause intrauterine death of the fetus.

Degrees of violation of 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 rest of the parameters of the system are normal.
• 1 B - blood circulation is disturbed at the fetal-placental level (vessels of the umbilical cord), while the indicators in the uterine arteries are within the normal range.
• 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 physicians, as it accurately reflects the level at which changes have occurred. In addition, the degree of violation of the uteroplacental circulation also affects the tactics of managing the patient.

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

Diagnostic methods

The "gold standard" of blood flow disorders in the mother-placenta-fetus system at the moment in obstetrics 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 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 cells, in particular, erythrocytes, as the most numerous cells. Registration of the received data and their comparison with the norm is called dopplerography.

What are the benefits of doppler sonography?

1. Modern ultrasound machines make it possible to examine the direction, speed of blood flow in the uterine arteries, and even intraplacental blood flow.
2. Thanks to color mapping, it is possible to study the blood flow in vessels with different blood flow (arteries and veins) separately. 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 feature of the method is the prediction of the development of pregnancy. What does this mean? Many studies have shown that disturbances in the blood flow of the uterine-placental system appear a little earlier than any clinical manifestations of fetal suffering appear (weight loss, changes in heart rhythm, etc.). And this means that with the timely diagnosis of fetal circulatory 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 preeclampsia (edema, increased blood pressure, the appearance of protein in the urine). Dopplerography is widely used in obstetric practice, as it opens up the opportunity for doctors not only to recognize blood flow disorders in time, but even to prevent the development of certain pregnancy complications.

Recently, the results of the use of Doppler ultrasound are being published more and more often, not only during pregnancy, but during childbirth. The conducted studies prove that the effectiveness of contractions can be assessed by measuring the diastolic blood flow velocity in the uterine arteries. Thus, this research method can even predict weakness or incoordination of labor activity already at the beginning of the first stage of labor.

case from practice

The non-standard situation that occurred in the maternity ward made obstetrician-gynecologists think about the use of Doppler ultrasound during childbirth.

A 25-year-old woman without any concomitant pathology was admitted to the genus. house with regular contractions every 3-5 minutes. Childbirth the first, urgent.

According to the anamnesis: the pregnancy proceeded without complications, no pathology was found on the part of the fetus, all ultrasound protocols with Doppler ultrasound were within the normal range.

The first stage of labor proceeded physiologically, 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 the 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 with a study of blood flow in the vessels during childbirth. The result of the study surprised everyone: in the intervals between contractions, the fetus clamped the umbilical cord with a pen, as a result of which the blood flow was significantly disturbed. As hypoxia increased in the child's body, his arms weakened, and he let go of the umbilical cord, meanwhile the blood flow was restored. Given the picture obtained, it was decided to force the management of the second stage of labor with the use of auxiliary aids. So, thanks to dopplerometry, doctors managed to avoid serious complications.

Secondary diagnostic methods

In addition to dopplerography, there are other research methods that indirectly indicate a violation of blood flow:

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

Important! A slight decrease in the estimated fetal body weight on ultrasound does not necessarily indicate a 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 during Doppler sonography gives grounds for making a diagnosis of intrauterine growth retardation syndrome.

Treatment of uteroplacental blood flow disorders

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

1. Improvement of 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", "Infucol", "Voluven", "ReoHES", "Venofundin". These drugs are an osmotic solution of starches that are able to retain fluid in the lumen of blood vessels. Their appointment is especially effective for preeclampsia, when it is necessary to transfer fluid from the intercellular to the lumen of the vessel. Thus, two goals are achieved at once: normalization of blood flow and a decrease in the severity of edema.
3. Vasodilator drugs help to eliminate spasm of arteries and arterioles (smaller vessels). Particularly effective use "Eufillina", "No-shpy", "Magnesia" in the form of injections.
4. A decrease in uterine tone also helps eliminate vasospasm, hypoxia, and also maintain pregnancy in the event of a 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. Useful intravenous administration 5% glucose solution which has detoxifying properties.
7. The drug has a protective effect on the placenta “Essentiale”, which saturates placental tissue with phospholipids. This medicine is especially useful in placental insufficiency.
8. When blood flow is disturbed, it is very effective to prescribe drugs that lead to the processes of activation of cellular respiration, for example "Cocarboxylases".
9. With a combination of uterine fibroids and blood flow disorders, the drug showed a good result. "Curantil", it is able to improve blood circulation in the vessels, and also prevents the formation of microclots. Many studies have shown that taking "Kurantil" with a large myoma prevents the development of secondary, inflammatory changes in the myoma nodes, due to the improvement of blood flow in them and the uteroplacental system.

Conclusion

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

Video: about fetal hypoxia - a consequence of NMPK

During the period of bearing a child, the body of the expectant mother undergoes strong hormonal changes. In this regard, it is very important to constantly monitor the health of the woman and the condition of the fetus. In medical practice, very often there is a violation of blood circulation in women who are waiting for an addition to the family. The appearance of an additional circle of blood circulation in the body of the mother requires frequent examination by a specialist. After all, if the blood flow during pregnancy is disturbed, then there is a risk of fetal death, and at different periods of gestation.

Blood flow during pregnancy: normal

Many women, especially those who are carrying their first child, are unaware of the existence of such a study as dopplerometry. It consists in ultrasound diagnostics, which is able to assess the intensity of blood flow in different vessels. This study is mainly carried out in the third trimester of pregnancy. But in some cases, they resort to it even after the twentieth week of bearing a child. Doppler is considered a serious study that allows you to diagnose vascular pathology in the uterus and placenta, in the cerebral and carotid arteries and the fetal aorta. Comparing the obtained figures and the norms of blood flow during pregnancy, the specialist determines whether the child in the mother's womb suffers from a lack of oxygen or not.

There are approved norms of dopplerometry, starting from the second trimester of pregnancy. These are the norms of the resistance index of the vessels of the uterus, umbilical cord, aorta and cerebral artery of the fetus. Doctors recommend not to try to decipher the results on your own. There is a formula for accurately calculating the vascular resistance index - only a doctor should do this procedure.

Violation of blood flow during pregnancy: degrees

For many expectant mothers, such a diagnosis leads to panic and confusion. Should I be nervous? Can this pathology have any consequences for the child? What are the degrees of this disease? Let's try to find answers to these questions.

There are three degrees of violations of blood circulation through the blood vessels during gestation. The first is characterized by impaired blood flow, which does not reach critical values ​​(in the umbilical cord and artery). At the same time, a positive state of fetal hemodynamics is observed. In both ventricles of his heart, there is a decrease in the diastolic function index, as well as an increase in the maximum blood flow velocity through all heart valves. The first degree of the disease is divided into 1-a, in which only the uteroplacental blood flow is disturbed, and 1-b degree, in which there is an inferior fetal-placental blood flow.

In the second degree, there is a violation of the hemodynamics of the fetus. In 50% of cases, the maximum rate of blood flow through all heart valves decreases. It should be noted that this phenomenon is less pronounced in the left sections. Violations of the movement of blood are observed both in the fetus and in the uterine arteries. The second degree often passes into the third, and in a very short period.

The third degree signals a critical state of the fetal blood supply. At this stage, a deeper restructuring of intracardiac hemodynamics occurs. It is directly related to the centralization of blood circulation. Fetal hypoxia is not excluded. It is also possible to reduce diastolic blood flow in the aorta, up to its disappearance. There is a simultaneous defective movement of blood in the aorta and carotid artery.

What threatens blood flow during pregnancy: consequences

This pathology leads to placental insufficiency, which is observed in 25% of pregnant women.

It is known that the placenta is the main organ during the bearing of the unborn baby, with the help of which it breathes and feeds, as well as excretes its waste products. It is in the placenta that two systems of blood vessels converge, between which there is a membrane that provides a kind of barrier between the body of the child and the mother. Thanks to the membrane, the blood of the mother and the unborn child does not mix. The placenta is also a protective shield against viruses and bacteria. It performs an immune function, providing protection to the fetus.

With placental insufficiency, the uteroplacental and fetal-placental blood flow is disturbed, and the placenta itself does not mature properly. In connection with these changes, the unborn child does not receive enough nutrients and oxygen. For this reason, its development and growth slows down, and the existing complications of pregnancy are exacerbated.

Naturally, due to the fact that the blood flow during pregnancy is low, such serious changes can even lead to the death of the fetus. But this happens on rare occasions. Often, this pathology is detected at an early stage and can be successfully treated.

Violation of the uteroplacental blood flow

In medical terminology, a violation of the uteroplacental blood circulation is indicated by degree 1a. The occurrence of this pathology indicates a dangerous complication of pregnancy. It usually occurs at a later date.

Inadequate blood flow occurs between the uterus and the placenta. This condition contributes to a significant deterioration in the metabolism between the body of a woman and the fetus. Naturally, such a state leads to certain consequences.

There are reasons that provoke the development of this condition. These include increased maternal blood pressure, diabetes mellitus, pneumonia and kidney disease in pregnant women, and infection in the fetus itself. It should be noted that timely identification of possible risk groups is a serious preventive measure. Therefore, it is important for a pregnant woman to monitor her health and seek medical help even with minor ailments.

What is the danger of impaired blood flow in a child

In a single functional system mother-placenta-fetus, defective fetal-placental blood flow leads to placental insufficiency. After all, the placenta supplies the unborn baby with food and oxygen. It is she who is the link that unites two complex systems - maternal and fetal. When such a pathology occurs, a violation of the blood flow in the child is observed. It should be noted that inadequate movement of blood in the vessels of any degree leads to malnutrition of the fetus. His condition also depends on the stage of blood flow disturbance. Naturally, the third degree signals the critical condition of the child.

In the case of early detection of this pathology, the doctor should determine the need for treatment in a hospital or at home. It all depends on the specific case and the duration of pregnancy.

In medical terminology, a violation of the fetal-placental blood flow is indicated by degree 1b.

How to treat blood flow disorders during pregnancy

For the treatment of inadequate blood flow during the period of bearing a child, various drugs are used to increase the resistance of the fetal brain to hypoxia, improve blood microcirculation and reduce its coagulability. If necessary, the doctor prescribes antibacterial and antiviral drugs, as well as immunomodulators.

A good remedy that improves cerebral circulation, heart function and metabolism in a child during hypoxia is Instenon. It is used in combination with other drugs.

The expectant mother is also credited with the use of Actovegin, a drug that helps to increase the resistance of tissues and the brain of the fetus to hypoxia. It also improves metabolism, stimulates the renewal of the cells of the unborn baby, improves blood circulation in the complex system - mother-placenta-fetus. As a result of treatment with Actovegin, blood flow indicators improve, and an active growth of the child in the mother's womb is observed.

It is known that with placental insufficiency, as a rule, there is a chronic violation of blood coagulation. In this regard, experts recommend the use of drugs that prevent the formation of blood clots in the vessels (for example, Curantila).

In the case of the 3rd (most difficult) degree of blood flow disturbance, specialists cause premature birth.

Especially for - Ksenia Manevich

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.

The body of a woman and a child during pregnancy is connected by the placenta, it is she who performs all vital functions during this time. The normal growth and development of the fetus depends on the placenta. It provides it with oxygen, nutrients, removes metabolic products and synthesizes hormones that are necessary for the normal course of pregnancy.

In the system of communication between the mother and the fetus (fetoplacental system), there are two types of blood circulation - placental and fetal. In the event that the uteroplacental blood supply is disturbed, then placental insufficiency develops and the fragile relationship fails. This can manifest itself in the form of pathological conditions and severe complications of pregnancy.

Classification of blood flow disorders in the placenta

Placental insufficiency negatively affects the functioning of the placenta. It can be acute and chronic.

Acute placental insufficiency may occur throughout pregnancy or during labor. Violation of gas exchange in the placenta, and as a result, acute fetal hypoxia, can cause the death of the child. Often this happens after premature from the walls of the uterus, the formation of blood clots in its vessels, placental infarction and hemorrhage.

Chronic placental insufficiency (FPI) is much more common than acute. As a rule, it develops in the second trimester, but is detected only at the beginning of the third. Premature aging of the placenta is due to the deposition of fibrin on the surface of the villi. This substance interferes with normal metabolic processes.

Chronic FPI is divided into types:

• Compensated - this is the most favorable form of placental insufficiency, the fetus does not suffer and continues normal development. The protective and adaptive mechanisms of the female body are able to compensate for these changes. With adequate therapy, the child will be born healthy and on time.
• Decompensated - compensatory mechanisms are no longer able to effectively resist pathological changes in the placenta, which interferes with the normal development of pregnancy. The fetus has oxygen deficiency, developmental delay and heart failure. With the decompensated form of FPI, intrauterine death of the child is likely.
• Subcompensated - the woman's body can not cope with placental insufficiency, and the fetus lags behind in development. The risk of serious complications is significant.
• Critical - serious morphological and functional changes occur in the placenta, which cannot be influenced, and the death of the unborn child is inevitable.

There are 3 degrees of blood flow disorders:

1. The fetus is in good condition.. Violations are not dangerous and develop at the level of uteroplacental blood flow. In the event that such changes were not detected or the woman did not receive proper treatment, then pathological changes become more complicated within 3-4 weeks and move to the second level.

   The first degree of blood flow disturbance has two varieties:
   1A. Uteroplacental circulation is disturbed, but fetal-placental circulation is normal. In 90% of cases, the fetus has a developmental delay.
   1B. Uteroplacental blood flow is normal. There are changes in fetal-placental blood flow. Fetal growth retardation occurs in 80% of women with this pathology.

2. Violation of the movement of blood in the uterine circulation and in the vessels of the fetus. This condition tends to move quickly into the third stage, this can happen within one week.
3. Critical level of fetal blood supply, its complete absence or reverse (reverse) blood flow.

Only stage 1B can be treated; more severe blood flow disorders are irreversible. This leads to disruption of the development of the fetus or even its death in the case of reversed blood flow, which lasts more than 72 hours. Such severe conditions are indications for premature delivery.

Symptoms of impaired blood flow

The manifestations of FPI depend on their type. With compensated chronic placental insufficiency, there are no symptoms. A woman learns about abnormalities during an ultrasound examination.

Acute and chronic decompensated forms of pathology are characterized by severe symptoms. A woman can note periods of rapid motor activity of the unborn child, which are replaced by periods of complete rest. There are certain norms, in accordance with them, a pregnant woman for a period of more than 28 weeks should feel at least 10 fetal movements per day. At lower rates, a woman should seek the advice of a gynecologist.

Additional signs of impaired blood flow may be a slowdown in the increase in abdominal circumference. It is difficult to identify this on your own, therefore it is necessary to visit the antenatal clinic, where such measurements are regularly carried out.

The most dangerous symptom of FPI is bleeding from the vagina. This may be a sign of placental abruption. This condition requires urgent medical attention.

Causes of impaired blood flow during pregnancy

The occurrence of fetoplacental insufficiency can occur for various reasons. Violation of blood flow is the result of the following pathologies:

• neuroendocrine diseases (, hyperthyroidism, diseases of the adrenal glands and hypothalamus);
• lung disease ();
• cardiovascular diseases (heart defects, hypotension and others);
• kidney disease (and kidney failure).

Maternal iron deficiency, or anemia, can cause placental insufficiency. Problems with blood clotting lead to the formation of microthrombi in the vessels of the placenta, which interfere with normal blood flow.

Exacerbation of various infectious diseases or their acute course during pregnancy often causes changes in the placenta. Pathogens provoke an inflammatory process, which in the first trimester often ends in a miscarriage. The consequences of infection in the later stages depend on the severity of the lesions of the placenta and the disease.

A significant risk factor for the development of FPI are uterine pathologies:

• pathological changes in the myometrium;
• malformations of the uterus (bicornuate and saddle uterus);
• hypoplasia;
• uterine myoma.

The high-risk group includes women over 35 years old with large myomatous nodes, who will be mothers for the first time. Women under 30 with small nodules are much less likely to develop placental blood flow disorders.

In addition, the causes of placental insufficiency may be the following:

• preeclampsia;
• Rh-conflict of mother and child;
• pelvic presentation of the fetus;

Bad habits, anamnesis aggravated by abortions, social and domestic disorder of a woman significantly increase the risk of changes in the placenta at various stages of pregnancy.

Diagnosis of blood flow disorders

Identification of pathological disorders of the placental blood flow is carried out through a comprehensive examination, but an enormous role in the diagnosis is played by ultrasound, which is combined with doplerometry. This method allows you to identify not only blood flow disorders, but also the complications caused by them.

Doppler is prescribed in such cases:

• maternal diseases that can provoke blood flow disorders in the placenta;
• premature aging of the placenta;
• intrauterine growth retardation syndrome;
• or ;
• signs;
• congenital malformations and genetic diseases in the fetus.

Depending on the complexity of the pathological process, disorders can be observed in the umbilical, uterine or fetal vessels. According to the results of the examination, a diagnosis is made of the uteroplacental, placental or fetoplacental form of blood flow disorders.

Atypical blood circulation in the placenta can be indicated by such an indirect sign as its thinning or increase in area, symptoms of intrauterine infection, and changes in amniotic fluid.

Prevention of blood flow disorders

Preventive measures are aimed at timely identification of risk groups among pregnant women. Currently, there is no single method for treating this condition. As a rule, therapy is complex and is aimed at stabilizing the condition in order to avoid premature birth.

For women at risk, rest, elimination of any physical and emotional overload, regular walks in the fresh air and good nutrition, and control over weight gain are recommended. Doctors recommend sleeping on the left side, drugs containing amino acids, ATP, glucose are often prescribed to stabilize metabolic processes. Medicines that reduce the tone of the uterus, normalize blood circulation, vasodilators and drugs that reduce blood clotting can also be recommended.

Only a doctor can prescribe treatment, sometimes hospitalization is required for a full examination, control and therapy. With a significant deterioration in placental blood flow, an emergency caesarean section is prescribed.

In order not to face placental insufficiency during the period of bearing a child, it is necessary to reconsider your lifestyle during pregnancy planning and eliminate all possible risks.