Syndrome of placental insufficiency

May 30, 2018 06:45 | Baby Diseases
With the development of placental insufficiency syndrome, it is important how this deficiency affects the fetus and the newborn. This syndrome is accompanied by impaired placental exchange, permeability of the placenta and inadequate supply of fetus with oxygen, which creates the conditions for the development of primary metabolic acidosis. Tissue hypoxia on its part further strengthens acidosis( secondary metabolic acidosis), leading to a breakdown in the metabolic processes of the fetus. At the same time their activity decreases, glycogen deposition decreases( use exceeds synthesis) and oxygen consumption irrespective of fetal needs, glucose production and consumption, blood supply is disrupted, etc. The placenta in these cases is smaller, sometimes flat and 10-15% of its tissue can beis affected by heart attacks. Often there are calcification and thrombosis of the placenta veins, hemorrhages, anomalies in the development of the umbilical cord and tumor. In less severe cases, compensatory changes are found, characterized by an increase in the number of arteriovenous anastomoses and the formation of new villi, which is a reaction of adaptation in the exchange between the mother and fetus.

The aetiology of placental insufficiency is due to various factors:
1. Pre- and eclampsia of the mother. Toxicosis of pregnancy is often the cause of prenatal hypotrophy and dysmaturia.
2. Diabetes in the mother, which sometimes causes fetal hypotrophy, in connection with which children are born with low weight. The placental insufficiency syndrome in women with diabetes is caused by severe vascular changes that affect not only the renal arterioles, but also the uterine and placental vessels.
3. Intrauterine infection. Especially important are toxoplasmosis, listeriosis and viral infections.
4. Ovarian insufficiency.
5. Fetal distortion, which is associated with decreased excitability of the uterus musculature, neuro-humoral, enzymatic or constitutional features. Mental factors, nutrition and climate also matter.
6. The elderly mother.
7. Smoking.

Placental insufficiency can lead to fetopathy, premature birth, impaired fetal development, and sometimes fetal or newborn death. Very often, the cause of fetal hypotrophy, dysmaturia, skewness or overripe of the fetus is placental insufficiency. The born children are marked with dry, yellowish skin, the hand of the washerwoman, peeling, hyperemia of large pudendal lips and scrotum, the absence of a damp grease. Amount of amniotic fluid is much less than normal. The respiratory center is characterized by maturity and more pronounced sensitivity to hypoxemia, which creates an additional risk of aspiration. Such newborns are born with dehydration, their growth usually corresponds to the term of birth, in contrast to the weight that is more susceptible to fluctuations.

With pregnancy, pregnancy lasts more than 280 days, counting from the first day of the last menstruation. The criterion of maturity of the fetus is not so much the duration of pregnancy and the weight of the fetus at birth as the degree of biological maturity. Peremeasures have a negative effect on the fetus and the newborn, and therefore perinatal mortality among these children is higher. Perezzrelye children are characterized by almost the same signs as those who are born. In connection with fetal hypoxia in severe degrees of overripeness, amniotic fluid contains meconium. Legs and umbilical cord are colored brown. Weight at birth in some cases below normal, in others - higher.

Children with severe hypotrophy and dysmaturia often have increased excitability, and sometimes convulsions, increased muscle tone, sometimes hemigipertonia, but these children can not keep the head. In severe forms of hypotrophy, apathy is noted in children, which is why they slowly and sluggishly suck. Instead of seizures, they have attacks of apnea and cyanosis. For children with severe dysmaturia, a typical living facial expression is characteristic. Neurological symptoms may be due to prolonged and persistent hypoglycemia and hypocalcemia. The erythropoiesis system is also affected. Often there is a polyglobule with a hematocrit above 0.7( 70%) and erythroblastosis.

For early recognition of placental syndrome, an obstetrician should promptly conduct a cytological examination of cervical secretion, amnioscopy, a microanalysis of the Salang method for metabolic acidosis, fetal ECG.

Prevention is reduced primarily to the prevention of toxicosis of pregnancy( dietary and drug treatment of chronic nephritis), timely treatment with insulin of mothers suffering from diabetes, treatment of ovarian insufficiency. The question of the term of birth is decided by the obstetrician.

Treatment of newborns with placental insufficiency should be aimed at combating hypoxia, asphyxiation, dehydration, hypoglycemia and hypocalcemia. Newborns with placental dysfunction need immediate resuscitation, oxygen supply, auxiliary ventilation with the aid of the apparatus. In severe forms of oxygen deficiency, the newborn is placed in a kuvez with a pressure of 2 atmospheres and 40% oxygen content. In the presence of metabolic acidosis, buffer solutions or 8.4% sodium bicarbonate solution are prescribed. It is better to put these children in a carve. With any additional infection, antibiotics are prescribed. These children are thirsty, so they should be provided with mother's milk and a sufficient amount of fluids. With good care and proper treatment, the prognosis is good. In the first months of life, children develop normally. However, during the first year such children lag behind in growth and weight, and in the future also in neuropsychic development.

Women's magazine www. BlackPantera.en: Ivanka Ivanova