Pathologies of the placenta during pregnancy: pathogenesis, types, diagnosis, complications

This article describes the pathologies of the placenta during pregnancy, their types, methods of diagnosis and possible complications.

Content

Pathologies of the placenta during pregnancy often cause premature birth, impaired fetal development and other states of the mother and an unborn child. Read below useful information about the pathogenesis of placenta pathologies, types of classification, diagnosis and symptoms of different states of the mother and fetus.

Pathology of attachment of placenta and umbilical cord during pregnancy: Pathogenesis

The placenta is formed inside the endometrium. This functional layer during pregnancy is called decidual. Such a shell at the 40th week Making the fetus is located under the "children's place". During childbirth, it is separated, the vessels of the endometrium are reduced, and this process helps to avoid uterine bleeding.

If the expectant mother develops inflammation in the uterus, dystrophy or cicatricial changes in the mucous membrane occur, then the spongy layer of the placenta is replaced by connective tissue.
It is overgrown with villi and during childbirth will not be able to spontaneously separate from the uterus.

In obstetrics, several pathologies of attachment of the placenta and umbilical cord during pregnancy are distinguished. Such anomalies are different in the depth of the placenta in the deeper layers of the uterus, as well as the prevalence of the increment of placental fabric:

Tight diligence of the placenta:

This is the most popular type of pathological attachment of the placenta to the uterus.
It was described above that the chorion villi can reach the basal layer and attach well to the walls of the uterus along with the placenta.

Low placental attachment:

Frequent pathology, found in 15-20% of cases.
If it appears after 28 weeks pregnancy, the doctor is already diagnosed "Presentation of the placenta", since in this case, the children's place partially blocks the uterine pharynx.
But it is very good that only 5% pregnant women, the low location of the placenta is preserved up to 32 weeks. And only at 1/3 Of these, it is 5%, the placenta will remain in this position and by 37 weeks.

Placent presentation:

It comes to the inner pharynx or blocks it.
It occurs in pregnant women second or more times.
It occurs more often if there were abortions or gynecological operations after childbirth.
In addition, different tumors and abnormalities of the uterine development contribute to the development of such a pathology.
This disease can lead to severe bleeding and complexity with childbirth.

Placenta increment (true increment):

The chorion villi pass through the decidual shell in the myometrium.
The prevalence of increment in depth can be both insignificant and quite pronounced.
The penetration of villi occurs through all layers of the uterus, up to the serous membrane.
The most severe consequences in the form of pathological attachment of the placenta most often occur with pathological changes from the uterus.

The abnormal and pathological attachment of the umbilical cord is primarily associated with defective implantation of umbilical cord. As a result, the umbilical cord is located outside the trophoblast section. So the result of such a pathology is:

Shell -based umbilical attachment - The umbilical cord is attached to the shells of the fetus.
Regional attachment - The umbilical cord is attached to the edge of the placenta, and not to its center.
The only artery of the umbilical cordin half the cases, the fetal development defects can be combined: heart, kidneys, urinary tract, genital organs, musculoskeletal system. Such a pathology is found in 3-4 times More often with deviations such as multiple pregnancy and diabetes in the mother.

It is worth noting that with tight diligence of the placenta, there is no active uterine postpartum bleeding, since the “children's place” is not separated from the walls of the uterus. If the attachment is incomplete, then blood loss can be intense.

Pathology of the placenta during pregnancy: classification, types of violations, review

According to the international classification of diseases, the following pathologies of the placenta during pregnancy are distinguished:

Primary placenta hypoplasia

It can be primary when the development of tissues determines the genetic inclinations of the body of a pregnant woman.

Secondary placenta hypoplasia

Such a pathology develops if the expectant mother has chronic diseases of other organs that burden the course of a normally developing pregnancy.
This is mainly due to diseases of the cardiovascular system with atherosclerosis, hypertension.
If during late toxicosis the velocity of blood flow in the vascular system of the placenta begins to sharply decrease, then the proper development of the placental barrier is disturbed, signs of primary or secondary (more complex form) hypoplasia occur, which affects the intrauterine development of the fetus.

If the placenta has a normal structure, and the signs of a violation of the development of the fetus are increasingly manifested, then a deeper violation occurs, at the cell level and their organelles. These may be the following types of violations:

The vessels of the intermediate and stem villi are inflamed and the narrowing of their lumen occurs.
Metamorphosis of syntiotrophoblasts develops.
Skleros are sclerous.
Necrotic areas appear in the villi chorion.

Here are another review of several pathologies of the placenta and umbilical cords that can occur in a pregnant woman at different stages:

Underwestern - The secretion and exchange of amniotic fluid are violated. The diagnosis is made if the volume of water is less than 500 ml. It can develop with congenital diseases of a pregnant woman (polycystic kidneys, uraopathy), postponed pregnancy, premature rupture of the shell.
Multi -guide - excess accumulation of amniotic fluid (more than 1.5 liters). It develops due to infection, malformations of the fetus, vast placenta hemangioma, heart disease and diabetes in the mother.
Amniotic plugging. They can be introduced into the body of the fetus and cause various damage: amputation of the extremities, cranial-loud deformations.
Horioamnionite - infection inside the fetal membranes and amniotic fluid. Pathology develops with a premature rupture of the placenta or during an incorrect diagnosis: biopsy, amnioscopy. The pathogens are streptococci, staphylococci, enterococci and other bacteria.

All these changes at the cellular level of the components of the placenta cause violations of oxygen and nutrients to the fetus. There is a delay in the development of the fetus relative to normal pregnancy.

Pathology of the placenta during pregnancy: symptoms, diagnosis

Pathology of the placenta during pregnancy: Diagnosis

It is important, with any deviations in the pathologies of the placenta during pregnancy, consult a doctor in a timely manner. Therefore, it is worth knowing the symptoms:

The occurrence of internal or external bleeding.
The appearance of retro -placental hematoma In case of internal bleeding.
Development of uterine-placental apoplexy In the form of a "uterus of a cuveler."
Significant reduction in contractile ability, which can reach the atonic stage.
Development of DIC-syndrome Due to the penetration of the masses of thromboplastin into a vascular direction. Violation of coagulation leads to increased bleeding, both internal and external.

Diagnostics:

Ultrasound procedure. At the same time, differential diagnosis of pathological changes in the placenta with cervical pregnancy, rupture of the uterus or premature detachment of the placenta is carried out.
Finger vaginal research Through the arches to assess the density of the uterus.
Laboratory research coagulating system for identifying signs of DIC-syndrome.

Coagulogram is necessarily investigated - Bird, Achtv, RFMK, fibrinogen, thrombin time and thromboelastogram.

Pathology of the placenta: clinical protocol, treatment

Concept "Pathology of the placenta" It includes the processes of uterine-placentary failure. According to the federal standard, a clinical protocol for the diagnosis and treatment of pathological conditions of the placenta in pregnant women has been developed.

Clinical treatment protocol is an algorithm for strict rules that minimize the side effects of drugs and diagnostic manipulations on the health of a pregnant woman. In particular, with pathology, the placenta begins after making a diagnosis "Uterine-placental failure". The complex of therapeutic measures includes:

Restoring microcirculation in the vessels and capillaries of the placenta. Thus, the main violation in the placenta is normalized-uterine-placental blood flow.
The tone of the vessels of the placenta and the smooth muscles of the uterus With intravenous introduction of beta-mimetics.
Infusion technique of drugs - dosed through the infusomat. Therapy is carried out until it is registered for Ultrasound The uterus is a clinically significant effect. After such an infusion course, the patient with pathology of the placenta is transferred to the intake of tablet forms of similar drugs.
Conducting antihypertensive measures. Depending on what the values \u200b\u200bof blood pressure before the start of therapy are prescribed either comprehensive hypotensive therapy or a gentle treatment regimen is used.

Any treatment should be carried out only under the supervision of a doctor. Self -medication is unacceptable. Also, at the first signs of ailment, you should urgently turn for help, and upon planned examination, inform the obstetrician-gynecologist all the unpleasant symptoms that have appeared recently.

Mother and fetus diseases - placenta pathology: complications

Below are possible complications of the pathology of the placenta, diseases of the mother and fetus:

Bleeding

Sometimes childbirth can be so severe that during the process or after it, severe vaginal bleeding may begin.
Bleeding is usually not accompanied by pain, although some women may have uterine cramps during bleeding.
Bleeding from the placenta can increase the risk of premature rupture of the fetal membranes, which leads to premature birth.

Placental increment

It occurs when the placental fabric grows too deep into the uterus, attaching to the muscle layer.
This leads to the difficulty of separating the placenta from the uterine wall during childbirth.
This complication can cause a life -threatening bleeding.

Dystration of the fetus

Such a complication indicates an atypical size or position of the fetus, which leads to severe childbirth.
Treatment is carried out by physical activity to change the position of the fetus or with the help of cesarean section.

VASA Praevia

It occurs when the fetal membranes connecting the umbilical cord and the placenta are overlapped or are within the limits 2 cm From the inner neck of the uterus.
Bleeding accompanying VASA Praevia, puts in jeopardy, first of all, the life of a child, and not a mother.

Fetal anemia

Fetal anemia occurs when the amount of circulating red blood cells and hemoglobin in the fetus falls below the normal level.
The detachment of the placenta. This is a condition in which the placenta is separated from the uterus, violating the supply of the child with blood and nutrients, and can jeopardize the life of an unborn child.

Infarcts in the placenta

These are areas of inanimate tissues in the placenta that cause a decrease in blood flow.
They can appear with hypertension, which is caused by pregnancy.

In addition, the pathology of the placenta can have a significant emotional effect on a pregnant woman and even cause depression.

Pathology of the placenta: prevention

Prevention has a huge role in any conditions, and even more so during pregnancy. The main preventive measures to combat placenta pathologies should be listed:

Reducing the number of abortions - curettage, curettage, by preventing unwanted pregnancies: the use of contraceptives.
Treatment of inflammatory, hormonal and infectious diseasesfemale reproductive system.
Limiting the use of drugs To preserve pregnancy, as well as operational delivery without reasonable reasons.
Rubber's failure on the uterus After previous genera, it is necessary to adjust outside pregnancy with the help of reconstructive transvaginal plastic.
Reduced frequency the use of auxiliary reproductive technologies ( ECO).
Conducting conversations and consultations with women on the risk of the danger of pregnancy after 35 years.
Treatment of extragenital pathology in a woman.

You should also know that when diagnosing uterine fibroids in a woman who wants to become pregnant, it is necessary to remove it.

Milovanov "Pathology of the Mother Placenta-School"

Such a useful book as "Pathology of the Mother Placenta-School" A.P. Milovanova, serves as an excellent guide for doctors. Pathological processes are revealed and described in it. The issues of histogenesis, functional morphology of the placenta are considered.

All situations are revealed in detail and explained by professionals.
Thanks to the study of the book, mothers will significantly reduce the number of miscarriages, will teach to behave correctly during childbirth.
Such a book has a large number of recommendations that help to study the situation in detail, find the right solution.
Information is presented with an understandable and accessible language.

When you need to expand the horizons and find the answer in difficult cases, the leadership of this publication will become an ideal assistant. The book is intended for pathologists, obstetricians and doctors of other specialties. Such a manual that protects from spontaneous miscarriages, and with real examples will show how to properly monitor the women in labor and their children. Each case is individual, so the directory is very extensive and overflowed with various useful information.