The placenta is an organ that grows in the womb during pregnancy. Placental insufficiency also called placental dysfunction or uteroplacental vascular insufficiency is an uncommon but serious complication of pregnancy. It occurs when the placenta does not develop properly, or is damaged. Without this vital support, the baby cannot grow and thrive. This can lead to low birth weight, premature birth, and birth defects.
When a mother has placental insufficiency, there is a lack of adequate blood flow to the baby, which can cause the baby to have intrauterine growth restriction IUGRoligohydramniosand nutrient and oxygen deprivation. Categories : Haemorrhagic and haematological disorders of fetus and newborn Health issues in pregnancy. Is that nausea you're feeling actually morning sickness? Serving Clients Nationwide. Info Share:. Complications of the placenta can be very serious, and can cause concerns for both mother and baby. Placental Insufficiency.
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Fetal growth restriction FGR is a condition in which an unborn baby fetus is smaller than expected for the number of weeks of pregnancy gestational age.
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- The placenta plays a crucial role during pregnancy.
- The placenta is an organ that grows in the womb during pregnancy.
- The placenta is the link between you and your baby.
Placental insufficiency or utero-placental insufficiency is the failure of the placenta to deliver sufficient nutrients to the fetus during pregnancy , and is often a result of insufficient blood flow to the placenta. Placental insufficiency can be induced experimentally by bilateral uterine artery ligation of the pregnant rat.
The following characteristics of placentas have been said to be associated with placental insufficiency, however all of them occur in normal healthy placentas and full term healthy births, so none of them can be used to accurately diagnose placental insufficiency:. Placental insufficiency should not be confused with complete placental abruption, in which the placenta separates off the uterine wall, which immediately results in no blood flow to the placenta, which leads to immediate fetal demise.
Several aspects of maternal adaptation to pregnancy are affected by dysfunction of placenta. Maternal arteries fail to transform into low-resistance vessels expected by 22—24 weeks of gestation. Placental insufficiency can affect the fetus, causing Fetal distress. Placental insufficiency may cause oligohydramnios , preeclampsia , miscarriage or stillbirth. Placental insufficiency is most frequent cause of asymmetric IUGR.
Metabolic changes occurring in uteroplacental insufficiency: . Decrease in overall thyroid function is correlated with fetal hypoxemia. Fetal hypoxemia triggers erythropoietin release. This stimulates RBC production from medullary and extramedullary sites and eventually results in polycythemia. Prolonged tissue hypoxemia may cause early release of erythrocytes from maturation sites and thus count of nucleated RBCs in blood increases.
There is decrease in immunoglobulin, absolute B-cell counts  and total WBC count. These conditions lead to higher infection susceptibility of infant after delivery. There is decrease in magnitude of umbilical venous volume flow. Blood flow is selectively redirected to myocardium, adrenal glands and, particularly, brain. The last phenomenon is called "brain-sparing effect"  or cerebral redistribution.
In late stage, the redistribution becomes ineffective, there is decrease in cardiac output , ineffective preload handling and elevation of central venous pressure. Chronic hypoxemia leads to delay in all aspects of CNS maturation. Gross body movements and tone decrease further. This leads to intrauterine fetal death. According to the theory of thrifty phenotype , placental insufficiency triggers epigenetic responses in the fetus that are otherwise activated in times of chronic food shortage.
If the offspring actually develops in an environment rich in food it may be more prone to metabolic disorders, such as obesity and type II diabetes. The following tests have been promoted as supposedly diagnosing placental insufficiency, but all have been unsuccessful at predicting stillbirth due to placental insufficiency:  .
From Wikipedia, the free encyclopedia. The core curriculum, ultrasound. British Journal of Obstetrics and Gynaecology. Elsevier Health Sciences.
American Journal of Obstetrics and Gynecology. Early Human Development. Obstetrics and Gynecology. Ultrasound in Obstetrics and Gynecology. Journal of Perinatal Medicine. Indian Pediatrics.
Fetal Diagnosis and Therapy. Albert Malden, MA: Blackwell Pub. Arterial, intracardiac, and venous blood flow velocity studies". Developmental Psychobiology.
Correlation with antepartum umbilical venous fetal pH". Fetal and infant origins of adult disease. London: British Medical Journal. BMC Pregnancy and Childbirth. ICD - 10 : P MedlinePlus : Placenta praevia Placental insufficiency Twin-to-twin transfusion syndrome. Umbilical cord prolapse Nuchal cord Single umbilical artery. Breech birth Asynclitism Shoulder presentation. Intrauterine hypoxia Infant respiratory distress syndrome Transient tachypnea of the newborn Meconium aspiration syndrome pleural disease Pneumothorax Pneumomediastinum Wilson—Mikity syndrome Bronchopulmonary dysplasia.
Pneumopericardium Persistent fetal circulation. Ileus Necrotizing enterocolitis Meconium peritonitis. Erythema toxicum Sclerema neonatorum. Perinatal asphyxia Periventricular leukomalacia. Gray baby syndrome muscle tone Congenital hypertonia Congenital hypotonia. Vertically transmitted infection Neonatal infection Congenital rubella syndrome Neonatal herpes simplex Mycoplasma hominis infection Ureaplasma urealyticum infection Omphalitis Neonatal sepsis Group B streptococcal infection Neonatal conjunctivitis.
Decrease in branched chain amino acids valine , leucine , isoleucine , serine and lysine. Increase in hydroxyproline Glycine :Valine ratio increases in amniotic fluid Increase in ammonia in amniotic fluid positive correlation with ponderal index. Decrease in long-chain polyunsaturated fatty acids Decrease in overall fatty acid transport via umbilical cord. Oxygen and Carbon dioxide. Degree of hypoxemia is proportional to villous damage Hypercapnia , acidemia , hypoxemia and hyperlacticemia in proportion to hypoxemia.
Respiratory Intrauterine hypoxia Infant respiratory distress syndrome Transient tachypnea of the newborn Meconium aspiration syndrome pleural disease Pneumothorax Pneumomediastinum Wilson—Mikity syndrome Bronchopulmonary dysplasia.
IUGR absent flow and not growing In: Preemie Support Community I'm 27 and 5 and they are talking about possibly delivering me on monday if baby hasn't grown since last growth assessment 2 weeks ago. Placenta not feeding baby?? I am just having the wiggins about having to leave her there all night and not getting the bonding time we need. Opinions on breast-feeding? He ask me to do another US again a week later. But do they really work?
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Placental Insufficiency, Medical Malpractice, and Birth Injury
When a mother has placental insufficiency, there is a lack of adequate blood flow to the baby, which can cause the baby to have intrauterine growth restriction IUGR , oligohydramnios , and nutrient and oxygen deprivation. Blood is brought to and returned from the unborn baby through the placenta. The placenta allows for nutrients to be transported to the baby, and it is also where gas exchange takes place. Oxygen-rich blood from the mother must travel through the placenta and umbilical cord in order to get to the baby.
Placental insufficiency is the most frequent cause of intrauterine growth restriction IUGR , a condition in which the unborn baby is failing to grow at a normal pace. It can also cause oligohydramnios low amniotic fluid and preeclampsia high maternal blood pressure.
The clinical course of placental insufficiency often includes an initial finding that the baby is small and has IUGR. Next, the mother is usually diagnosed with oligohydramnios. The baby may have fetal distress , which will show up on the fetal heart rate monitor as non-reassuring heart tones.
Placental insufficiency can cause severe injury to the baby. As blood flow perfusion becomes more and more deficient and the baby becomes increasingly oxygen deprived — or poor perfusion and oxygen deprivation continue for an extended period — the baby develops a high likelihood of having acidemia at birth. This means her blood is acidic due to prolonged anaerobic metabolism. Due to the severe consequences of placental insufficiency, it is critical for physicians to promptly diagnose and adequately manage this condition.
Mothers with placental insufficiency should be referred to maternal-fetal specialists. Very close monitoring, including frequent non-stress tests and biophysical profiles , should be performed.
Sometimes the physician will decide to deliver the baby early by C-section delivery in order to get the baby out of the oxygen-depriving conditions. In addition, babies who have IUGR do not tolerate labor and contractions very well. This is another reason the baby may be delivered early.
If babies who have IUGR are subjected to labor, they must be closely monitored and they should be emergently delivered at the first sign of distress.
Uteroplacental perfusion refers to blood flow from the uterus and placenta to the developing baby. If uteroplacental blood flow is normal, the baby gets enough oxygen and nutrients. If uteroplacental perfusion is compromised, the baby may not grow properly or receive adequate oxygen and nutrients. During routine prenatal screening, medical professionals often use color Doppler to detect any abnormalities in uteroplacental perfusion, allowing them to diagnose and treat the underlying cause of any perfusion issues, which can range from maternal hypertension high blood pressure to structural uterine abnormalities to issues with the umbilical cord.
Timely delivery when perfusion is compromised is critical. Placental resistance resistance in uteroplacental blood flow is a measure of how well blood is perfusing flowing through the placenta and uterus to get to the baby.
This is checked during routine prenatal testing using Doppler flow studies. One of the most common concerns with placental resistance is high resistance, which can result from preeclampsia and other factors.
When blood pressure increases, resistance increases, which can mean that overall blood flow to the baby decreases. This can cause fetal growth restriction FGR. Insufficient placental perfusion is called placental insufficiency and must be promptly addressed by medical professionals. A mother with placental insufficiency usually does not have any symptoms. Late decelerations are an indication of placental insufficiency, even when there are no other signs of reduced blood flow to the placenta.
Another way to diagnose placental insufficiency is through measurements and ultrasounds that indicate that the uterus womb is not growing as it should. If the measurements are less than what is normal for the gestational age of the baby, an ultrasound should be performed. Doppler ultrasounds give information about the blood flow in the placenta and baby. Doppler velocimetry can be performed at the beginning of the third trimester. When vessels in the placenta are developing abnormally, there are progressive changes in placental blood flow, as well as in fetal blood flow, blood pressure, and heart rate.
This causes circulation problems in the placenta and baby. Doppler measurements from certain vessels, such as the umbilical artery, can indicate severe compromise and dysfunction of the group of vessels in the placenta. When compromise to these vessels is present, the baby may become significantly oxygen-deprived, and eventually, certain vessels will constrict and others will dilate to direct blood flow to the most important organs in the baby, the brain and heart.
After this occurs, circulation through the umbilical artery may change even more in response to ongoing severe oxygen-deprivation.
Blood flow measurements that the Doppler picks up correlate with acidosis in the baby. Since placental insufficiency can cause the baby to be deprived of adequate oxygen and nutrients while in the womb, which can cause IUGR, the standard of care is to deliver the baby at 34 — 37 weeks. When the gestational age is less than 34 weeks, the physician will continue monitoring the mother very closely until 34 weeks or beyond.
If either of these becomes a concern, then immediate delivery should occur. When delivery is suggested prior to 34 weeks, the physician should perform an amniocentesis to help evaluate fetal lung maturity. If the decision is made to deliver the baby prior to 34 weeks, corticosteroids are usually given to the mother within 24 hours of the time the baby will be delivered.
Corticosteroids also help prevent brain bleeds in the baby. Failure to follow standards of care and deliver the baby early can cause her to be deprived of oxygen and nutrients for too long, which can result in permanent brain injury.
Due to the potential oxygen and nutrient deprivation in babies of mothers who have placental insufficiency, the standard of care requires more frequent prenatal testing and that physicians pay very close attention to signs of IUGR and decreased well-being of the baby. Failure to take appropriate action when a baby has IUGR and is receiving decreased blood flow can cause the baby to have brain damage and hypoxic-ischemic encephalopathy HIE , cerebral palsy and seizures.
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Email or call us at Serving Clients Nationwide. Placental Insufficiency When a mother has placental insufficiency, there is a lack of adequate blood flow to the baby, which can cause the baby to have intrauterine growth restriction IUGR , oligohydramnios , and nutrient and oxygen deprivation. What is Uteroplacental Perfusion? What is Placental Resistance? How is Placental Insufficiency Diagnosed? The Importance of Close Monitoring in IUGR Due to the severe consequences of placental insufficiency, it is critical for physicians to promptly diagnose and adequately manage this condition.
HIE often leads to a later diagnosis of cerebral palsy, seizure disorders, or developmental disabilities. Cerebral palsy. Cerebral palsy is a group of disorders that cause the child to have problems with movement, balance, coordination, and posture. Specifically, cerebral palsy causes problems in brain to nerve to muscle communication, which causes mild to severe problems with motor muscle function.
Fine motor function is also usually affected, which can make it hard for a child to hold a crayon or a small piece of cereal.
There may be problems with oral-facial muscles, thereby making eating and talking difficult for children. When a baby has brain damage such as HIE, she may have seizures very soon after birth. In fact, HIE is the most common cause of seizures in a baby. For this reason, it is critical that physicians recognized and treat seizures as soon as possible. Seizures occur when there is uncontrolled electrical activity in the brain. This causes brain disturbances, altered consciousness, and convulsions.
In many babies, outward signs of seizure activity may not be evident. Thus, if the medical team thinks that a baby may have brain damage, they should perform frequent EEGs on her to check for abnormal electrical activity in the brain. Several neonatal intensive care units throughout the country have continuous EEG monitoring. Babies with IUGR are at risk of having low blood sugar. This is because the baby has decreased stores of glycogen and lipids. Glucose is essential for brain function.
Meconium aspiration can also occur when the mother has placental insufficiency. Meconium aspiration is when a baby has a bowel movement in the womb which typically occurs when the baby experiences oxygen deprivation and distress and then inhales a mixture of stool and amniotic fluid.
This can cause major breathing problems after birth. A baby who inhales meconium may have respiratory distress and may develop pneumonia.
These conditions can cause even more oxygen deprivation in the baby, which increases the risk of brain damage and HIE.
In addition, babies who have meconium aspiration syndrome often have to be placed on a breathing machine ventilator for help breathing. Awards and Memberships. Do I Have A Case? This field is for validation purposes and should be left unchanged.