Stomach pain and impaired blood flow in pregnant women. Violation of uterine blood flow during pregnancy

A clearly functioning “mother-placenta-baby” system is the key to the health of a woman expecting a new addition to the family and her baby. A failure in this system, resulting in impaired blood flow, can lead to negative consequences for the child, the reversibility of which is often simply impossible. Violation is fraught with delayed development of the fetus in the womb. The consequences of this disorder also include hypoxia, malformations and even embryonic death.

What is Doppler?

An additional circle of blood circulation in a pregnant woman requires additional examination by a specialist. This examination is called Doppler ultrasound. Doppler is ultrasound diagnostics intensity of blood flow in different vessels. Diagnosis is carried out in the third trimester of pregnancy. It is at this time that Doppler shows almost 100% reliable results. In some cases, Doppler measurements are performed at twenty weeks.

By comparing the information received on the device and guided by blood flow standards, the diagnostician determines whether the child is experiencing oxygen starvation or not.

Doppler testing has its own approved standards, which include: index of vascular resistance of the uterus, umbilical cord, aorta and fetal cerebral artery. Independent decoding and comparison of data obtained after diagnosis and Doppler measurements is a thankless task. Only a doctor can calculate the vascular resistance index using the appropriate formula.

What should you do if the doctor, having deciphered the Doppler data and compared it with the norms, notes a violation of the blood flow of the pregnant woman? Well, definitely don’t panic and don’t get nervous. It won't be good for the child either. Timely treatment is quite effective in combating blood flow diseases.

Severity of blood flow disorders during pregnancy

Disturbances in the circulation of blood through the blood vessels during pregnancy vary in severity.

In the first degree, blood flow disturbance does not reach critical values. The fetal hemodynamics are positive.

The hemodynamics of the fetus in the second degree of the disease is impaired. In half of the cases, the maximum speed of blood movement through all heart valves is reduced. In this case, blood flow is disrupted both in the child and in the arteries of the uterus of the expectant mother. In a very short period, the second degree can develop into the third.

The third degree is destructive for the child. Its diagnosis states the critical state of the blood supply to the fetus. Intracardiac hemodynamics at this stage have profound changes. Fetal hypoxia is most likely in this case.

Symptoms of impaired blood flow

Can a pregnant woman experience blood flow problems? There are certain symptoms. But, for example, in the first stage, placental insufficiency does not manifest itself in any way. It can only be diagnosed by ultrasound. A second degree symptom is a change in the baby’s behavior. He is either too active or, conversely, inactive. Secondary signs of blood flow disease may include protein excretion in the urine, insufficient or excessive amounts of amniotic fluid, swelling, gestosis (late toxicosis), pressure surges, sudden weight gain.

Bloody discharge from the birth canal is the most dangerous sign of a disorder associated with placental abruption. In this situation, only ambulance specialists.

Consequences of impaired blood flow during pregnancy

The consequences of impaired blood flow are very sad if treatment is not prescribed in time. This is at least spicy or chronic hypoxia, as well as delay intrauterine development. More severe complications: premature birth; pregnancy fading; miscarriage; development of congenital pathologies, including those incompatible with life; intrauterine fetal death.

To prevent the disastrous consequences of impaired blood flow, we need, first of all, thorough prevention.

In order for the baby to be fully nourished, a woman must consume a balanced diet during pregnancy. These are products with the maximum possible amount of vitamins and microelements. High-quality proteins, carbohydrates and fats. Frequent consumption of water (more than one liter) is also required. Except in cases where the expectant mother is prone to swelling.

Prevention of pathology

Prevention of blood flow disorders involves monitoring weight changes during pregnancy. An increase of more than 10 kg by the end of pregnancy is considered excessive.

If a pregnant woman is at risk (under 17 years of age or over 36 years of age; with bad habits; with chronic diseases, etc.), then prevention should include taking medications that prevent blood flow diseases.

A woman who dreams of becoming the mother of a healthy baby in the future should, already during pregnancy planning, analyze her lifestyle and, if possible, eliminate potential risks.

Video on the topic of the article

Violations and their causes by category:

Violations and their causes in alphabetical order:

disturbance of fetal blood flow -

Doppler effect is based on a change in the frequency of a 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 blood flow velocity curves (BVR).

Hemodynamic disturbances in the functional system “mother-placenta-fetus” are the leading pathogenetic mechanism of disturbances in the condition and development of the fetus during various complications of pregnancy. Moreover, in the vast majority of observations, hemodynamic disorders are characterized by the universality and uniformity of changes, regardless of the condition of the fetus and the etiopathogenetic factor.

A change in the normal indicators of FSC is a nonspecific 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, gestosis, etc. For a period from 18-19 to 25-26 weeks. Doppler- selection method, because The biophysical profile of the fetus is informative from 26 weeks, but cardiotocography is not yet indicative.

The Doppler technique involves obtaining blood flow velocity curves in the vessels of the utero-placental-fetal blood flow, calculating vascular resistance indices (VRI), and analyzing the results obtained.

What diseases cause disruption of fetal blood flow:

Classification of fetal blood flow disorders

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

2nd DEGREE - compensated disturbance of fetal blood flow (disturbance of the actual hemodynamics of the fetus). Centralization of fetal circulation. A decrease in the maximum speed of blood flow through all valves of the fetal heart in 50% of cases, for the left sections - to a lesser extent. Further decrease in ventricular diastolic function (E/A). The predominance 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 is a circulatory disorder similar to that in the umbilical cord artery. In the internal carotid artery, an increase in the level of diastolic blood flow means 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 cord artery. The secondary nature of changes in the internal carotid artery to changes in the fetal aorta has not been established. Primary changes in the blood circulation of cerebral vessels are much less common (non-placental type of fetal hypoxia). 2nd degree does not last long, quickly progresses to 3rd degree.

GRADE 3 - critical state of fetal blood flow. The functional predominance of the left parts of the heart over the right 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 (regurgitation flows). Aorta - decrease in diastolic blood flow to its absence (69.6%). Reduced resistance of the internal carotid artery in 57.1% of cases. The combination of simultaneous disorders in the aorta and in the internal carotid artery is more common than in degree 2 disorders (14.3% and 42.3%, respectively).

Stages of fetal blood flow disorders

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

Perinatal losses: 1st degree of disturbance of fetal hemodynamics - 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 SDO (peripheral resistance) is a high risk factor for complications in the neonatal period.
2. The most common reason for increased SDO 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.

The average value of uterine artery IR at 22-41 weeks of pregnancy.
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 SDO (at least on one side) is 2.4, IR is 0.583.
With arterial hypotension, in 88% of cases there is a decrease in BMD due to low minute blood volume.
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 intrauterine suffering of the fetus in 45-60% of cases.
The main cause of malnutrition is a violation of the uteroplacental blood flow.

Forecasting of SGR:

In case of blood flow disturbance of 1A degree, FGRP syndrome develops in 93.2% of cases; on one side - in 66.7% of cases, on both sides - 95.7%. In case of circulatory disorders of 1B degree, FGRP develops in 81.6% of cases. With a simultaneous decrease in BMD and FPC - in 100% of cases.

Under the influence of therapy, it is possible to improve hemodynamics with mild gestosis. At the same time, circulatory disorders in the utero-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 gestosis. At the same time, normalization of blood flow in 40% of cases in the umbilical cord artery suggests a possible functional nature of changes in fetoplacental hemodynamics. However, in severe cases of gestosis, fetoplacental hemodynamics did not change significantly after treatment. The appearance of “zero” or retrograde blood flow in the umbilical cord artery, indicating an extreme degree of fetal suffering, dictates the need to abandon therapy in favor of emergency delivery.
The diagnostic significance of Doppler measurements of MA and AP is reliable only in cases of impaired blood flow, with abnormal CSCs. However, Doppler measurements 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 fetus in most cases will indicate the presence of a healthy low-weight fetus.

More conclusions:

1. Doppler ultrasound is a fairly reliable method for diagnosing the condition of the fetus.
2. Normal indicators of FPC and BMD, cerebral blood flow are not reliable diagnostic criteria for the absence of disturbances in the condition of the fetus.
3. A decrease in placental blood flow in most cases is accompanied by fetal malnutrition.

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

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

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

No relationship was found between the frequency of blood flow disturbances in the umbilical cord artery and the clinical picture of gestosis.

Impaired blood flow in the fetal aorta is accompanied by severe FPN, clinically manifested by grade 2 and 3 FGR.

With gestosis, blood flow in the uterine artery is initially disrupted, then, as the disturbances deepen, in the umbilical cord artery.

Perinatal mortality

With normal indicators of MPP blood flow and 1st degree impairment, 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 allowed us to establish the ineffectiveness of the therapy placental insufficiency. With conservative management of labor, perinatal mortality was 50%. During delivery by caesarean section there were no perinatal losses.

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

Doppler testing in the right uterine artery is a valuable diagnostic method that allows, in the 2nd trimester, to identify a group of high-risk pregnant women for the development of late gestosis (from 20-24 weeks, most accurately 24-28 weeks). Confidence is 98%. According to the theory of the predominant blood supply to the right uterine artery of the uterus, the incidence of gestosis and FGR is higher when the placenta is located on the left wall of the uterus. In multiparous women with the placenta located on the left, FGR is significantly more likely to develop than in primiparous women. There are no differences with the placenta located on the right. This probably happens because postpartum involution of the uterus leads to a significant reduction of the “defective” bed 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.
Doppler testing has a high diagnostic and prognostic value for complications of pregnancy: OPG - gestosis, 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 studying blood flow in the uterus in FGR is explained by the fact that the primary link in the development of this pathology in most cases is disturbances in the uteroplacental blood flow. When the CSC changes in one uterine artery, FGR develops in 63.6% of cases, in 2 - in 100% of cases.

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

When the SDO in the uterine artery increases by more than 2.6, the prediction of unfavorable outcomes with a sensitivity of 81% and 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, assessing the CSC in the 2nd trimester of pregnancy is important. Pathological SSCs in 15-26 weeks of pregnancy are a reliable prognostic sign of the development of preeclampsia and FGR in the 3rd trimester. Detection of a pathological decrease in diastolic blood flow in the uterine artery precedes the appearance of clinical symptoms of gestosis by 4-16 weeks. 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, the SDO in the umbilical cord artery increases to 6.0.

Which doctors should you contact if there is a violation of fetal blood flow:

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

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If you have previously performed any research, Be sure to take their results to a doctor for consultation. If the studies have not been performed, we will do everything necessary in our clinic or with our colleagues in other clinics.

Is your fetal blood flow disrupted? It is necessary to take a very careful approach to your overall health. People don't pay enough attention symptoms of diseases and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called symptoms of the disease. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to do it several times a year. be examined by a doctor, in order not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the organism as a whole.

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In medical practice, circulatory disturbances are very often observed in women expecting a new addition to the family. The appearance of an additional circle of blood circulation in the mother’s body requires frequent examination by a specialist. After all, if blood flow is impaired during pregnancy, then there is a risk of fetal death, and different dates its gestation.

Blood flow during pregnancy: normal

Many women, especially those who are carrying their first child, are not aware of the existence of such a study as Doppler. It consists of 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 testing 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. By 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 Doppler standards starting from the second trimester of pregnancy. These are the norms of the vascular resistance index of the uterus, umbilical cord, aorta and fetal cerebral artery. Doctors recommend not trying to decipher the results yourself. There is a certain formula for accurately calculating the vascular resistance index - this procedure should only be done by a doctor.

Impaired blood flow during pregnancy: degrees

For many expectant mothers, this diagnosis causes panic and confusion. Should you 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 disturbances in blood circulation through the blood vessels during pregnancy. The first is characterized by impaired blood flow, which does not reach critical values ​​(in the umbilical cord and artery). In this case, a positive state of fetal hemodynamics is observed. In both ventricles of his heart, there is a decrease in the index of diastolic function, as well as an increase in the maximum speed of blood flow through all the heart valves. The first degree of the disease is divided into 1-a, in which only uteroplacental blood flow is impaired, and 1-b degree, in which defective fetal-placental blood flow is observed.

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

The third degree signals a critical state of the blood supply to the fetus. At this stage, a deeper restructuring of intracardiac hemodynamics occurs. It is directly related to the centralization of blood circulation. Fetal hypoxia cannot be ruled out. A decrease in diastolic blood flow in the aorta is also possible, until it disappears. There is simultaneous inadequate blood movement in the aorta and carotid artery.

What are the consequences of impaired 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 gestation of the unborn baby, with the help of which its breathing and nutrition occurs, as well as the excretion of waste products. It is in the placenta that two systems of blood vessels converge, between which there is a membrane that acts as 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 disrupted, and the placenta itself is not fully matured. Due to these changes, the unborn child does not receive sufficient quantities of nutrients and oxygen. For this reason, its development and growth slows down, and existing pregnancy complications worsen.

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

Disturbance of uteroplacental blood flow

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

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

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

What are the dangers of poor blood flow in a child?

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

If this pathology is detected early, the doctor must determine the need for treatment in a hospital or at home. It all depends on the specific case and stage of pregnancy.

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

How to treat blood flow problems during pregnancy

To treat inadequate blood flow during pregnancy, various drugs are used to increase the resistance of the fetal brain to hypoxia, improve blood microcirculation and reduce blood clotting. If necessary, the doctor prescribes antibacterial and antiviral drugs, as well as immunomodulators.

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

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

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

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

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Consequences of blood flow disorders during pregnancy: symptoms, diagnosis, treatment

A clearly functioning “mother-placenta-baby” system is the key to the health of a woman expecting a new addition to the family and her baby. A failure in this system, resulting in impaired blood flow, can lead to negative consequences for the child, the reversibility of which is often simply impossible. Violation is fraught with delayed development of the fetus in the womb. The consequences of impaired blood flow during pregnancy also include hypoxia, malformations and even embryonic death.

An additional circle of blood circulation in a pregnant woman requires additional examination by a specialist. This examination is called Doppler ultrasound. Doppler is an ultrasound diagnosis of the intensity of blood flow in different vessels. Diagnosis is carried out in the third trimester of pregnancy. It is at this time that Doppler shows almost 100% reliable results. In some cases, Doppler measurements are performed at twenty weeks.

By comparing the information received on the device and guided by blood flow standards, the diagnostician determines whether the child is experiencing oxygen starvation or not.

Doppler testing has its own approved standards, which include: index of vascular resistance of the uterus, umbilical cord, aorta and fetal cerebral artery. Independent decoding and comparison of data obtained after diagnosis and Doppler measurements is a thankless task. Only a doctor can calculate the vascular resistance index using the appropriate formula.

What should you do if the doctor, having deciphered the Doppler data and compared it with the norms, notes a violation of the blood flow of the pregnant woman? Well, definitely don’t panic and don’t get nervous. It won't be good for the child either. Timely treatment is quite effective in combating blood flow diseases.

Disturbances in the circulation of blood through the blood vessels during pregnancy vary in severity.

In the first degree, blood flow disturbance does not reach critical values. The fetal hemodynamics are positive.

The hemodynamics of the fetus in the second degree of the disease is impaired. In half of the cases, the maximum speed of blood movement through all heart valves is reduced. In this case, blood flow is disrupted both in the child and in the arteries of the uterus of the expectant mother. In a very short period, the second degree can develop into the third.

The third degree is destructive for the child. Its diagnosis states the critical state of the blood supply to the fetus. Intracardiac hemodynamics at this stage have profound changes. Fetal hypoxia is most likely in this case.

Can a pregnant woman experience blood flow problems? There are certain symptoms. But, for example, in the first stage, placental insufficiency does not manifest itself in any way. It can only be diagnosed by ultrasound. A second degree symptom is a change in the baby’s behavior. He is either too active or, conversely, inactive. Secondary signs of blood flow disease may be the release of protein in the urine, insufficient or excessive amounts of amniotic fluid, edema, gestosis (late toxicosis), pressure surges, and sudden weight gain.

Bloody discharge from the birth canal is the most dangerous sign of a disorder associated with placental abruption. In this condition, only emergency medical help will help.

The consequences of impaired blood flow are very sad if treatment is not prescribed in time. This is, at a minimum, acute or chronic hypoxia, as well as intrauterine growth retardation. More severe complications: premature birth; pregnancy fading; miscarriage; development of congenital pathologies, including those incompatible with life; intrauterine fetal death.

To prevent the disastrous consequences of impaired blood flow, we need, first of all, thorough prevention.

In order for the baby to be fully nourished, a woman must consume a balanced diet during pregnancy. These are products with the maximum possible amount of vitamins and microelements. High-quality proteins, carbohydrates and fats. Frequent consumption of water (more than one liter) is also required. Except in cases where the expectant mother is prone to swelling.

Prevention of blood flow disorders involves monitoring weight changes during pregnancy. An increase of more than 10 kg by the end of pregnancy is considered excessive.

If a pregnant woman is at risk (under 17 years of age or over 36 years of age; with bad habits; with chronic diseases, etc.), then prevention should include taking medications that prevent blood flow diseases.

A woman who dreams of becoming the mother of a healthy baby in the future should, already during pregnancy planning, analyze her lifestyle and, if possible, eliminate potential risks.

Video on the topic of the article

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Disturbance of uteroplacental blood flow during pregnancy

Pregnant women and their families usually expect one answer from an ultrasound examination - what is the sex of the child. For an obstetrician-gynecologist, a research method is necessary to promptly identify impaired blood flow during pregnancy and abnormal fetal development.

The management plan and delivery tactics depend on this. To understand the mechanisms of the disorder, it is necessary to consider the capabilities of the circulatory system between mother and child.

Structure of the uteroplacental blood flow

Mother and child are connected not only by the placenta, but also by a complex system of blood vessels. Therefore, all joint blood circulation is usually divided into levels that cannot exist in isolation, but work only in combination.

• The central part of the system is the placenta. It ensures the “absorption” of products from the maternal blood through the villi that have grown deep into the wall of the uterus. At the same time, the blood of mother and child does not mix. Several rows of special cells form a hematoplacental barrier, which is a serious obstacle to substances unnecessary for the fetus. Through it, the waste blood returns to the mother's venous system.
• The second part of the blood flow consists of the branches of the uterine arteries. If before pregnancy in the female body they are in a collapsed state and are called spiral, then from the period of 1 month they lose the muscle layer that can cause spasm. And by four months, the arteries transform into full-fledged trunks, filled with blood and heading to the placenta area. It is this mechanism, useful for feeding the fetus, that can turn out to be fatal during uterine bleeding: the walls of the vessels can no longer contract.
• The vessels in the umbilical cord form the third pathway of blood flow. There are 2 arteries and a vein here. They connect the baby with the placenta and form the fetal-placental circle. Reduced blood flow at this level causes the most severe damage to the fetus.

How is placental circulation disrupted?

Poor blood flow associated with the placenta is called placental insufficiency. It can occur at any stage of pregnancy in two forms.

Acute appears suddenly, even during childbirth, and does not depend on the duration of pregnancy. The fetus falls into a state of hypoxia (oxygen deficiency), which threatens its death.

The main pathological mechanisms of this condition:

• premature placental abruption;
• heart attack due to thrombosis.

Chronic often complicates the course of pregnancy after 13 weeks. Symptoms appear in the third trimester. Formation mechanism - early aging placenta due to fibrin deposition on the villi.

As a result of changes in the structure of chorionic villi (placental tissue), the functioning of the hematoplacental barrier ceases, metabolic processes between the maternal body and the fetus are disrupted

Negative consequences in such conditions, depending on the degree of violation, can lead to inevitable death of the fetus.

Causes of blood flow disorders during pregnancy

Various reasons can cause disruption of uteroplacental blood flow. These include common maternal diseases:

• pathology of the neuroendocrine system (diabetes mellitus, diseases of the thyroid gland and adrenal glands, changes in the hypothalamus region of the brain stem);
• lung diseases (emphysema, bronchial asthma);
• disorders in the cardiovascular system caused by developmental defects, the consequences of hypertension, a tendency to hypotension;
• renal pathology (chronic nephritis, pyelonephritis, especially in the stage of renal failure;
• anemia (anemia) associated with deficiency of iron and vitamins;
• conditions accompanied by increased blood clotting contribute to increased thrombus formation in the vessels of the placenta;
• acute and exacerbation of chronic infectious processes cause corresponding inflammation in the placenta, vascular edema and reduction in blood flow; in the first trimester this can result in miscarriage.

Pathology of the uterus creates local conditions for poor blood flow:

• any changes in the layers of the uterus (myometrium, endometrium);
• malformations (for example, “bicornuate”, “saddle-shaped” uterus);
• underdevelopment (hypoplasia);
• tumor formations from muscle tissue (fibroids), especially in a primiparous woman over the age of 35; at a younger age, small fibroids help compensate for blood flow.

To the reasons insufficient blood flow include unfavorable conditions during pregnancy in the following cases:

The risk of impaired blood flow occurs when:

• previous abortions;
• maternal smoking, alcoholism and drug addiction;
• constant nervous environment associated with social or everyday unsettlement;
• violation proper nutrition women.

Types of chronic placental insufficiency

Depending on the development of consequences for the fetus and the ability of the mother’s body to adapt, 4 forms or stages of chronic placental insufficiency are distinguished:

• compensation - the mother’s body fully protects the fetus by improving blood flow through other pathways, and the child does not feel a lack of oxygen, develops normally, is born on time and develops well;
• subcompensation - the mother is not able to fully compensate for the lack of nutrition, and the fetus lags behind in development, there is a risk of complications and congenital defects;
• decompensation - accompanied by a complete disruption of adaptation mechanisms, normal pregnancy is impossible, the fetus develops serious defects incompatible with viability, death in utero is very likely;
• critical - due to severe changes in the structure of the placenta, further gestation of the fetus is impossible, inevitable death occurs, any treatment is ineffective.

What degrees of blood flow disturbance does placental insufficiency cause?

A comparison of clinical manifestations and ultrasound examination results made it possible to distinguish 3 degrees of blood flow disturbance between mother and fetus.

The first is characterized by minimal changes at the uteroplacental level, provides a “reserve” of time of about a month for treatment and full recovery without consequences, there are 2 varieties:

• Ia - only the uteroplacental blood flow is reduced, with the fetal-placental blood flow unchanged. It manifests itself as a delay in fetal development in 90% of cases.
• Ib - fetal-placental circulation suffers, but the uteroplacental circulation remains normal. Delayed formation and development of the fetus suffers somewhat less (in 80% of cases).

The conclusion is issued after examining all components of the fetal blood flow

The second is that the disorder occurs both at the level of the uterine and umbilical vessels; hypoxia can be fatal to the fetus.

Third - blood circulation indicators are at a critical level, it is even possible that the direction of blood flow is reversed (reverse).

For clinicians, such a classification provides an opportunity to accurately determine the level of disorders and choose the most appropriate treatment tactics.

Symptoms of impaired blood flow

If the impaired blood flow is compensated, then the woman does not feel any abnormalities, but learns about them only after the examination.

Pronounced manifestations occur when acute form and chronic decompensation:

• physical activity the fetus increases sharply or completely disappears (at 28 weeks, normal development is accompanied by ten movements per day), this symptom requires immediate contact with an obstetrician-gynecologist;
• a slow increase in abdominal circumference, detected during monthly examination and measurement in the antenatal clinic (associated with excessive formation or lack of amniotic fluid);
• late toxicosis;
• high blood pressure;
• large weight gain;
• swelling in the legs;
• the appearance of protein in the urine.

Diagnostics

The most complete picture of blood circulation between the uterus and the fetus is obtained through Doppler ultrasound, which is performed on all women three times during pregnancy.

• measure blood flow by the speed of movement of the formed elements;
• determine its direction in arteries and veins;
• record changes before clinical manifestations.

The effect is based on the properties of ultrasonic wave reflection and is completely safe for the child and mother.

All changes are recorded on the monitor, measured with special sensors, and can be photographed in the required format.

By comparison with normal indicators a conclusion is drawn about the degree of pathology. Violations can be detected at any level, in the vessels:

The doctor has time to prescribe treatment and check it at the next examination.

A type of Doppler ultrasound is Doppler ultrasound. It is prescribed for:

• maternal concomitant pathology;
• suspected premature aging and disruption of the placental barrier;
• signs of high or low water;
• preliminary data on intrauterine growth retardation, the formation of congenital malformations of the fetus;
• presence of genetic diseases in the family;
• clinical symptoms of fetal hypoxia.

The examination can reveal:

• thinning of the placenta;
• increase in growth area;
• intrauterine infection.

The method of long-term inpatient monitoring of the degree of fetal hypoxia allows you to see the results of using medications

Treatment of pathology

Treatment takes into account the pathogenesis of disorders. To achieve results it is necessary to influence all links:

• In case of mild disturbance of microcirculation, Chofitol (with a mineral-herbal composition) is prescribed, in more severe cases - Actovegin, Petoxifilin.
• If a mother’s tendency to form blood clots and disrupt the aggregation properties of blood is detected, then drugs such as Curantil, Trental are indicated. They can improve blood flow through the vessels.
• If low blood pressure is detected, Venofundin, Stabizol, ReoHES are used.
• Vasodilators - No-spa, Eufillin in injections - eliminate spastic contraction of blood vessels.
• It is recommended to reduce the tone of the uterus with the help of Magnesia, the drug Magne B6, this acts as an antihypoxic way to improve blood flow.
• A group of vitamins with antioxidant action eliminates negative consequences (vitamin E, ascorbic acid).

Medications are prescribed by a doctor. If necessary, the woman is offered hospitalization. This allows:

• provide bed rest;
• Constantly monitor the progress of pregnancy.

What to do to prevent blood flow disorders?

Gynecologists urge women at risk to prepare themselves for pregnancy in advance and prevent unplanned conception.

Choice correct position body during sleep helps fetal blood flow

• avoid emotional and physical overload;
• eliminate bad habits;
• organize nutritious meals for the pregnant woman;
• monitor daily walks and stay in a ventilated room;
• do special gymnastics for pregnant women, yoga exercises;
• control body weight, carry out monthly weighing and measurement of abdominal circumference;
• It is considered more beneficial to sleep on the left side; this position reduces pressure on the inferior vena cava, which runs to the right of the uterus, but in some cases, with stagnation in the kidneys, sleeping on the right side improves the outflow from these important organs.

Modern diagnostic methods and approaches to the management of pregnant women make it possible to prevent severe disorders. However, many possibilities depend on the woman herself and her desire to have a healthy heir.

The doctor said that the fetus may have poor circulation and lack of oxygen. He said we need to go to perinatal center. And the weight of the fetus is normal (term 35 weeks, weight 2 kg 300), the heartbeat is clear.

Doppler revealed a disturbance in placental blood flow and I was sent to the perinatal center. There, a repeat examination did not reveal anything and adequate treatment was not prescribed. What should I do now?

Impaired blood flow during pregnancy: consequences for the child

Pregnancy is accompanied by various changes in a woman’s body, which are aimed at the full development of the child. Many processes and systems adapt to new conditions of existence, and the woman notes the appearance of previously unknown sensations. Any expectant mother wants her baby to be born healthy, and naturally worries about his condition when any abnormalities are detected.

The main factor that supports intrauterine growth and development of the child is the uteroplacental-fetal blood flow (UPF). It is a comprehensive system that supports normal course pregnancy. If the blood flow in the uterus is disrupted, then they speak of placental insufficiency. It is dangerous primarily due to miscarriage, and there are also frequent other negative consequences of this pathology for the expectant mother and child.

The lack of blood flow through the placenta must be detected in time, and treatment measures cannot be delayed.

Causes

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

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

Most often, a woman has an underlying risk factor that can cause placental insufficiency. A combination of several similar conditions is often observed when carrying a child.

To identify the causes of placental blood flow disturbances, it is necessary to conduct periodic screenings at various stages of pregnancy.

Symptoms

Each pathology has its own clinical picture, which allows us to make a preliminary conclusion. Hemodynamic insufficiency is manifested by changes in all functions of the placenta, and as a result, mainly the fetus suffers. It receives all nutrients and oxygen in insufficient quantities, and the excretion of metabolic products may slow down. Signs of fetal hypoxia appear, which subsequently leads to intrauterine growth retardation. As a result, the following symptoms are noted:

• Increased heart rate.
• Increase in physical activity, and then its decrease.
• Abdominal volume does not correspond to the duration of pregnancy.

As a rule, such signs appear in the decompensated form of placental insufficiency. If the blood flow disorder has a 1a or 1b degree, identified during a timely examination, then these symptoms do not yet exist, since the hemodynamics are compensated.

Classification

Symptoms depend on the severity of changes in BMD, which are recorded during additional examination. Based on a clinical and gynecological examination, it is impossible to say for sure about this, but one can first judge hemodynamics based on indirect data. Thus, blood flow disorders during pregnancy are classified according to degree:

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

This classification is based on the relationship between the speed of uterine and umbilical blood flow. In addition, disorders are identified in individual branches of the afferent artery.

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

Consequences

Placental insufficiency poses a risk to fetal development. Therefore, the main obstetric complications concern the condition of the unborn child. The greatest danger comes from severe blood flow disorders, which can have both a chronic and acute course. In this context, degrees 1a and 1b of hemodynamic disorders are not mentioned, as they are the mildest.

Placental abruption

Sudden disturbances in blood flow can be provoked by injuries, thrombosis or embolism of the uterine artery. Then a situation arises when the placenta exfoliates in one of the areas. Depending on its location, the pathology occurs as a central or peripheral type. The following symptoms appear:

1. Pain in the area of ​​detachment.
2. Local protrusion of the uterine wall.
3. Bloody issues.
4. Worsening of the fetal condition.

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

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

Miscarriage

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

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

If the process is stopped at the threat stage, the child will be saved. But when the placenta has completely detached and an abortion is diagnosed, unfortunately, it is no longer possible to correct anything. In the future, the pathology may be complete or incomplete. When parts of the fetus or membranes are retained in the uterine cavity, there is a risk of infection and severe bleeding, which often ends in hemorrhagic shock or disseminated intravascular coagulation.

Frozen pregnancy

In addition, the fetus may die if left in the uterine cavity. Then a so-called frozen pregnancy is formed. The woman herself can note some symptoms that indicate what happened:

1. Fetal movements stop.
2. You can't feel his heartbeat.
3. The abdomen does not increase in volume.
4. Bloody discharge occurs periodically.
5. Abdominal pain bothers me.
6. Body temperature rises.
7. An infection sets in.

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

Diagnostics

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

• Blood test for hormones (estrogens, progesterone, human chorionic gonadotropin).
• Ultrasonography.
• Cardiotocogram.
• Doppler.

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

Treatment

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

Treatment of blood flow disorders during pregnancy is complex - etiotropic, pathogenetic and symptomatic.

Drug therapy

The main means of correcting placental blood flow is the use of medications. When only initial signs of disorders are identified, you can undergo treatment on an outpatient basis. If the deficiency is more pronounced, then hospitalization in a hospital is necessary. This need also exists for extragenital pathology in women. The following drugs are mainly used:

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

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

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

Operation

When placental insufficiency is severe, emergency delivery is necessary. If conservative measures are ineffective, even with mild violations, a decision should be made within 2 days. The most commonly used procedure is a caesarean section. If it is planned before 32 weeks of pregnancy, then it is necessary to proceed from the condition of the fetus and its viability.

When it is necessary to ascertain that a spontaneous abortion has occurred, it is necessary to carry out curettage of the uterine cavity or vacuum extraction of the fetus. In case of a frozen pregnancy, surgical intervention depends on the gestational age and the condition of the woman.

Prevention

To avoid many unpleasant situations during pregnancy, including placental insufficiency, it is necessary to follow preventive recommendations. They mainly relate to lifestyle and include the following principles:

1. Healthy eating.
2. Refusal bad habits.
3. Walking outdoors.
4. Elimination of stress factors.
5. Follow all doctor's recommendations.
6. Timely treatment of concomitant diseases.

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

A diagnosis such as “Impaired uteroplacental blood flow” is given to pregnant women quite often, but to explain to the expectant mother What it is, not every gynecologist finds the time. Let's figure out in this article why this conclusion is dangerous and why disturbances in the uteroplacental blood flow occur.

A pregnant woman’s body has an established system that allows the baby in the womb to receive all the necessary nutrients. An approximate diagram of this system consists of three components: “mother’s body - placenta - fetal body.” If any part of this relationship is disrupted, this leads to complications in the condition and development of the baby with simultaneous complications during pregnancy.

There are three levels of impairment:

The first degree, when the development of the fetus is satisfactory, and the disorders are not dangerous and relate exclusively to the uteroplacental blood flow. In the absence of a response from specialists and proper treatment, this stage can last 3-4 weeks on average and moves to the next 2nd level. Divided into 2 types:

1A) When the fetal-placental circulation is normal, and disturbances are noticed in the uteroplacental blood flow. Fetal growth restriction syndrome develops in approximately 90% of cases.

1B) Characterized by normal uteroplacental circulation, but complications in the fetal-placental circulation. Fetal growth restriction syndrome develops in approximately 80% of cases.

• The second degree is characterized by disturbances in the movement of blood through the vessels both in the fetus and in the uterine blood flow. This grade can very quickly (sometimes within 1 week) progress to grade 3.
• The third degree means that the blood supply to the fetus is at a critical level.

What complications and diseases lead to the risk of placental insufficiency?

• hypertension varying degrees heaviness;
• threat of interruption;
• pyelonephritis;
• previous birth of children with fetal growth retardation syndrome;
• previously suffered a severe form of gestosis.

Table. Course of pregnancy depending on the degree of disturbances of uteroplacental blood flow

Degrees of violation	Doppler ratio control	Direction of treatment	Method of delivery
1	Up to 30 weeks - once every three weeks; 30-34 weeks - once every two weeks; 35-40 weeks - 1 time per week. If the obstetrician-gynecologist suspects that the fetus’s condition has worsened, then Doplerometry is performed unscheduled	Elimination of complications from the pregnant woman that are associated with diabetes, gestosis and other pathologies. Mandatory treatment placental insufficiency.	There will be an antenatal hospitalization at 37 weeks. Childbirth takes place naturally with early artificial puncture of the membranes.
2	Every 3-4 days	The pregnant woman is immediately sent to the hospital. Treatment is aimed at maturing the child’s lungs, eliminating complications on the part of the woman, and intensively restoring placental insufficiency.	Caesarean section using epidural anesthesia.
3	In dynamics	Determining the cause and carrying out treatment	A caesarean section is performed immediately. If the pregnancy is premature, then the decision is made based on the wishes of the pregnant woman

Treatment of grade 1A uteroplacental blood flow disorders is carried out comprehensively, based on the reasons that caused it. Drugs: Actovegin, Ginipral, Curantil, Pentoxifylline and others.

Attention! This article contains general information only and is not intended to substitute for advice from a qualified professional.

The role of the transport system, which supplies nutrients with oxygen from the mother to her baby, is played by the placenta. It acts as a special link connecting two separate vascular systems - the uterine and umbilical cord blood flow - together. The well-being and safety of the baby depends on the quality of work of this unique organ. That is why during ultrasound examination not only the level of physical development of the fetus is checked, but also possible disturbances in uterine blood flow during pregnancy are determined. What indicators should normal blood flow in the placenta meet, by what symptoms can pathology be suspected and how should this disease be treated?

Impaired blood flow during pregnancy. The structure of the uteroplacental blood flow

Blood flow between a woman and the fetus is ensured not only through the placenta. In addition, the uteroplacental circulatory system involves a complex network of blood vessels that work in conjunction with the placenta, which help it fully supply the fetus with everything necessary and at the same time prevent oxygen starvation of the fetal tissues.

The circulatory system between mother and baby consists of three levels, which change with increasing gestational age and perform certain functions. Under the influence of many factors, “breakdowns” can occur on any of them. And depending on their location and severity, the entire subsequent treatment plan and labor management tactics depend.

• The central link of the system is the placenta. As it grows, the villi grow tightly into the uterine walls and “suck” from the mother’s blood a set of all the necessary elements for the development of the fetus. In this case, incest between mother and baby does not occur. The multilayer hematoplacental barrier plays the role of a strong “sponge” that allows only beneficial substances to pass through, while filtering out all dangerous compounds and viruses and sending them back into the mother’s venous bloodstream.
• The second level of blood flow is considered to be the branch of the spiral arteries of the uterus. They are intended solely to support pregnancy and remain dormant until conception. When the embryo is four weeks old, the arteries gradually begin to lose muscle tissue and the ability to contract. Closer to the fourth month of gestation, they fill with blood and connect to the placenta. Disruption of blood flow in the uterine artery during pregnancy leads to blockage of blood circulation at all other levels.

In addition to the benefits for the child, these arteries carry a certain risk for the life of the mother. Their rupture can cause severe bleeding during delivery as they lose their ability to contract.

• The third level of blood flow is formed by the umbilical vessels. A vein and two arteries connect the embryo and the placenta and therefore play the most important role in the development of the baby. Violation of the fetal-placental system most often causes congenital abnormalities in the development of a child.

Impaired blood flow during pregnancy: causes

Factors of primary failure are:

• Genetic predisposition.
• Infection with viral or bacterial microflora.
• Endocrine disorders (inferiority of the corpus luteum, ovarian dysfunction, hypothyroidism).
• Lack of tissue that serves as the basis for further development ovum and placenta.

All these factors lead to improper development and attachment of the placenta, and its subsequent inferiority.

The causes of secondary placental insufficiency include:

• Obstetric diseases (fibroids, endometriosis).
• Diseases of the endocrine system (diabetes, hyperthyroidism).
• Chronic diseases (hypertension, renal pathologies, thrombophlebitis).
• Complications of pregnancy (abnormal placenta previa, Rh conflict, multiple pregnancy).
• Factors of the external unfavorable environment.
• Bad habits.
• Social conditions.

Impaired blood flow during pregnancy. Classification of placental insufficiency

Impaired blood flow is a common pathology, which is caused by disturbances in the structure of the placenta and umbilical cord, and in 60% causes mental and mental retardation. physical development baby. The following classifications are generally accepted and most common.

Depending on the time of appearance, there are:

• Primary placental insufficiency - manifests itself before the 16th gestational week and is associated with a violation of the mechanism of implantation of the fertilized egg and subsequent improper formation of the placenta.
• Secondary placental insufficiency is diagnosed after the 16th week of pregnancy, when the placenta is already fully formed. The cause of the disorder is the influence of various negative factors of external origin.

In accordance with the clinical picture of the disease, placental insufficiency is divided into the following forms:

• Compensation - metabolic disturbances in the functioning of the placenta are recorded, but the blood flow between the uterus and placenta or between the placenta and the baby is not impaired. In this condition, partial blockage of blood flow may occur, for example, disruption of the umbilical cord blood flow through one of the vessels or disruption of the right blood flow of the uterus during pregnancy. Female body is able to completely compensate for the baby’s oxygen deficiency by increasing blood flow in other ways. This ensures optimal development of the child without the risk of hypoxia. The baby develops normally and is born on time without any congenital anomalies.
• Subcompensation - the mother’s body cannot restore the flow of oxygen to the baby, since all parts of the blood flow system are not fully functioning. This causes some difficulties due to oxygen deficiency, which causes deterioration in the condition of the fetus and can provoke congenital malformations.
• Decompensation - during Doppler diagnostics, a complete disturbance of blood flow is determined, which is difficult to eliminate with drug treatment. This condition often results in complex heart defects or death after birth.

Disruption of placental blood flow during pregnancy can be acute and occurs against the background of premature placental abruption or its incorrect location in the uterus. Chronic blood flow disorders can occur at any stage of gestation and are most common.

According to ultrasound data, three degrees of fetal hemodynamic disorders are distinguished.

Degree 1 - involves minor changes in blood circulation between a woman and her baby, which can be effectively treated with special medications. At this stage, only one part of the circulatory system is disrupted, for example, only in the uterine artery. Timely diagnosis of pathology and its subsequent treatment completely eliminates the risk of disorders in the child.

Depending on what part of the bloodstream is affected, there are two types of first degree:

• Stage 1a blood flow impairment during pregnancy indicates that the patency between the uterus and the placenta is reduced, while the connection between the placenta and the fetus is not disrupted. Incorrect treatment in 90% of cases may be accompanied by slight retardation in fetal development, which is characterized by insufficient body weight and general indicators growth.
• impaired blood flow of 1b degree during pregnancy indicates that the uteroplacental blood flow is normal, and the fetal-placental circulatory system is disrupted. In 80% of expectant mothers, pregnancy proceeds with signs of delayed normal fetal development.

Degree 2 - diagnosed if there is placental insufficiency at all levels. In this case, it is almost impossible to compensate for the oxygen deficiency, since the fetal aorta, uterine artery and umbilical cord artery are unable to fully pass blood flow. This degree is detrimental to the baby and often becomes the cause of his death.

Blood flow impairment of the 2nd degree during pregnancy is very unstable and in as soon as possible goes to the last most critical degree.

Degree 3 - characterized by centralization of blood flow. The baby's condition becomes critical because his intracardiac hemodynamics are completely disrupted. Doppler measurements often show reverse diastolic blood flow. This degree is often diagnosed with obvious signs of developmental delay and is practically not amenable to drug treatment.

Diagnosis of placental insufficiency

For preventative detection possible problems with blood flow, all pregnant women undergo diagnostics three times, which includes Doppler testing. Recommended periods for ultrasound examination: from 11 to 14 gestational weeks, from 20 to 24, and from 32 to 34 weeks.

Obstetric examination

Pregnant women who are at risk for the formation of placental insufficiency are subject to regular clinical monitoring. Special attention give the following indicators:

• Woman's weight. Exceeding this value often indicates hidden gestosis.
• Abdominal circumference and uterine fundus height. Deviation from the norm of these indicators in 50% of cases indicates a delay in fetal development.
• Uterine tone and bleeding.
• Fetal movement and heart rate. A decrease in these indicators indicates possible fetal hypoxia.

Laboratory research

This diagnosis is used to determine the condition of a pregnant woman in the third trimester with compensated blood flow impairment. For this purpose, monitoring of the woman’s hormonal status is carried out, provided that the fetus has no signs of malnutrition (intrauterine retardation).

Laboratory tests include the following:

• Calculation of the amount of alkaline phosphatase in venous blood.
• Determination of oxytocin levels.
• Study of estradiol concentration in urine.

Doppler examination

This complex name belongs to a painless diagnostic procedure that allows:

• measure the speed of blood flow in the veins and arteries connecting mother and child;
• determine the direction of blood flow;
• diagnose pathological changes before the appearance of external symptoms.

Additionally, you can evaluate the following indicators:

• The degree of aging of the placenta.
• Much or little water.
• Possible developmental defects.
• Fetal hypoxia.
• Genetic abnormalities.
• Signs of intrauterine infection.
• Refinement of the placenta.

Such an examination is carried out using additionally equipped ultrasound machines or special portable devices. Thanks to sensors that measure indicators, all data is reproduced on the monitor. During the diagnosis, a Dopplerogram is compiled, which shows the systolic-diastolic ratio of blood flow. In other words, it shows the difference between the blood flow sent and the blood flow received back, which helps determine the degree of patency of the vessels that connect the uterus, placenta and baby.

The most favorable position for Doppler testing is lying on your side. It is also possible to conduct the study on the back, but in this position, many women may experience uterine hypertonicity, which significantly distorts the results obtained.

What symptoms indicate blood flow problems during pregnancy?

It is very difficult to suspect problems with blood flow in the placenta without examination. But there are several symptoms, if they occur, it is better to consult a doctor:

1. Pathological motor activity of the baby. If it is overly active or, conversely, practically does not move, this signals hypoxia.
2. Severe toxicosis in the second half of pregnancy. Late gestosis often accompanies pathology of placental blood flow.
3. Too slow increase in abdominal circumference. It is difficult to notice this on your own, so the gynecologist usually pays attention to this during a routine visit to the patient.
4. Bloody vaginal discharge. This is the most dangerous symptom that indicates placental abruption.

Impaired blood flow during pregnancy: consequences

Even the most minor deviations in blood circulation between mother and fetus reduce the amount of incoming nutrients, vitamins and oxygen. If such “fasting” is prolonged, the following complications may occur:

• Pathological termination of pregnancy.
• Fetal hypoxia.
• Congenital heart defects.
• Increased risk of intrauterine and perinatal death.
• Placental abruption or premature aging.
• Preeclampsia.

When diagnosing the first degree of compensated blood flow disturbance during pregnancy, the consequences for the child are not critical and over time, a slight lag in growth or development is smoothed out, and the baby catches up with his peers.

If a woman is given a more severe diagnosis of decompensated placental insufficiency of the last degree, the prognosis is less optimistic and the pregnancy often ends in fetal death or the birth of a defective child.

Blood flow disorders during pregnancy: treatment

The most favorable period for conservative treatment considered the first degree of pathological blood flow. The second degree is extremely rarely correctable, but the third is a direct indicator for emergency delivery by cesarean section, if the gestational age allows.

Treatment tactics are based on the pathogenesis of the disease and provide for a complex effect on all links in the blood flow chain:

• To improve microcirculation in case of minor deviations, women are prescribed the homeopathic drug Hofitol, and if it does not have the desired effect, medications with more active ingredients are prescribed, for example, Pentoxipharm or Actovegin.
• If a woman has a history of thrombophlebitis, she is prescribed medications to restore the ability of blood to flow through the vessels. Such remedies include Curantil.
• Drotaverine or No-Shpa is used as a vasodilator.
• To reduce uterine tone and improve blood flow, magnesium in the form of droppers and oral Magnesium B6 are prescribed.
• To provide an antioxidant effect, taking vitamin C and tocopherol is mandatory.

If the woman’s condition does not improve and the results of control studies do not restore blood flow, the woman is offered hospitalization. This provides more careful monitoring of the fetal condition.

To avoid possible complications on the side of the uteroplacental blood flow, it is better to prevent this pathology. Walk more fresh air, eat right, give up bad habits and, most importantly, undergo all scheduled examinations in a timely manner. Then you will be able to prevent, and if they occur, begin to treat blood flow disorders in a timely manner.

Video “Blood circulation between mother and child”