The second degree of maturity of the placenta at 30 weeks. Premature aging of the placenta: causes, treatment, prognosis. When do you start monitoring placenta thickness?
The placenta is an important organ that provides the fetus with nutrients and protects against most harmful agents.
The formation of the placenta (children's place) begins from the moment of penetration of the chorionic villi into the endometrium (approximately 3-4 weeks of pregnancy).
Further, the active growth of tissues and the vascular bed begins, a full-fledged placenta is formed. And then the reverse process takes place: deformation and blockage of blood vessels, the death of tissue fragments, which is called "aging of the placenta."
If for some reason the placenta ages before the fetal maturation, the diagnosis is “premature aging of the placenta”.
Doctors make a decision depending on the duration of pregnancy and the readiness of the unborn baby: premature birth, or carrying out pregnancy on an outpatient basis or under round-the-clock supervision of doctors in a hospital.
During pregnancy, the placenta goes through several stages of development.
During the first trimester, the placenta grows and develops, and from 10-12 weeks it is already formed and begins to fulfill its protective functions.
It is with the activity of the placenta that the weakening at the end of the first trimester is associated.
By the end of pregnancy, tissue cells and blood vessels of the child's place are gradually deformed and die, this process is called "placental aging".
This usually happens by 37-38 weeks, when all the organs and systems of the fetus have matured. But it happens that the placenta begins to die for more early term. This is the reason for the hospitalization of a woman. Pregnancy can be saved with medication.
The most reliable method for diagnosing the maturity of the placenta is ultrasound and Dopplerography (blood flow measurement).
In accordance with the ultrasound data, the specialist’s conclusion will indicate the degree of maturity of the placenta, it is classified as follows:
- 0 degree.
Normally, the zero degree persists until about 30 weeks.
This is the period active work placenta, freshly formed tissues reliably protect the baby from harmful external toxins, metabolic products are effectively filtered (they are excreted by the mother's excretory system).
The blood supply to the vessels is good, the fetus receives the necessary nutrients.
- 1 degree
The first degree of placental maturity is observed from about 27 to 34 weeks. Continued active growth of the placenta, at this stage it reaches its final size.
- 2 degree.
It falls on 34-38 weeks. It is characterized by the normal functioning of the mature placenta. By the end of the term, some vascular changes are possible, but they do not have a significant effect on blood flow. The surface of the placenta becomes more dense and bumpy.
- 3 degree.
The placenta reaches its maximum maturity at recent weeks pregnancy (37-40).
This period is associated with the natural wear and tear of tissues and blood vessels. There are signs of salt deposition and changes in blood flow.
But if examinations show that the fetus has a normal heart rate, growth and physical activity correspond to the gestational age, then you should not worry.
If the changes are diagnosed at earlier stages (for example, maturation to stage 1 before 30 weeks or a sharp transition to stage 3 with fetal growth retardation), they speak of premature aging of the placenta.
If chronic diseases of the mother are a contraindication to taking any of these drugs, the obstetrician-gynecologist, together with a specialized specialist, will select an individual therapy that is safe for the expectant mother and baby;
- Taking vitamins.
Vitamins A, and C, they will provide antioxidant protection and normalize the transport function of the placenta;
- Decreased tone of the uterus.
The decrease also improves placental blood supply. For this purpose, Ginipral is usually used in obstetric practice (if the mother has no contraindications!)
In the case of placental aging at an early stage (for example, the transition to stage 1 before 30 weeks), as a result of a set of measures taken, compensatory restoration of blood vessels is possible.
And in the future, pregnancy will develop according to the timing. After the control examination ( and ), the woman is discharged under observation at home.
The frightening diagnosis of "premature aging of the placenta" may be the result of bad habits, an untreated infection, or chronic diseases of the mother. Most causes are treatable or correctable.
Supportive care in a hospital setting will help restore blood flow and provide the fetus with conditions for normal further development.
Seven days after fertilization, the human embryo, freely located in the uterus, begins to sink into its mucous membrane. Attached to the posterior (rarely to the anterior) wall of the uterus with its villous membrane, chorion and allantois, the embryo enters the so-called fetal period of its development. At this time, a temporary organ is formed - children's place or placenta.
What role does this structure play in the process of intrauterine development of the unborn child, what does the degree of maturity of the placenta mean - these and other issues will be considered by us in this article.
Why is a placenta needed?
Everything that grows and develops must eat and breathe. And the future baby is no exception. From maternal blood, glucose, amino acids and, of course, oxygen enter its cells. It turns out that the blood vessels of the fetus and mother are not anatomically interconnected. This fact is of cardinal importance, otherwise the ballast substances from the maternal bloodstream would clog the blood of the embryo. On the other hand, germ proteins alien to the mother's immune system would provoke serious homeostasis disturbances in her. So it is the placenta that creates the necessary barrier, while simultaneously providing through its special structures - cotyledons - a passive exchange of plastic compounds and gases between the organisms of the mother and her unborn child. In embryogenesis, complex metamorphoses occur not only in the development of the fetus, but the degree of maturity of the placenta also changes week by week. The table below will reveal to us the dynamics of these changes.
Fetal part of the children's place
As we have already found out, the placenta is formed as a temporary organ, starting from 3-6 weeks of pregnancy. The fertilized egg - the zygote - begins to split up and is covered with a villous layer called the chorion. At 10-12 weeks, an early afterbirth is formed, and the chorionic villi grow into the endometrium of the uterus.
At first, the structure of the placenta is amorphous, but from the 12th week, the placenta gradually takes the form of a flat disk. By the end of pregnancy, its diameter reaches 20 centimeters, and its weight is 0.5 kg. The surface of the child's place facing the embryo is called the fetal. The histological structure of the amniotic membrane and the chorion that form it indicates a direct connection with the body of the embryo, which is carried out through the umbilical cords and the ring, which are included in the epithelium (skin) of the developing child.
Functions of the placenta
Together with the maternal part, represented by the endometrium, the child's place performs a number of important functions: trophic, respiratory, barrier, excretory, endocrine. We considered the first three earlier, we recall that thanks to such processes, the embryo receives the necessary nutrients, vitamins, solutions of mineral elements in the form of compounds.
The respiratory function of the placenta is carried out by diffusion of oxygen and carbon dioxide molecules circulating in the blood vessels of the umbilical cord. The barrier property of the placenta prevents the penetration of antigens into the body of both the mother and the fetus. The ability of the child's place to produce hormones such as progesterone and prolactin leads to the idea of the placenta as an endocrine gland. The excretory function of the child's place is to evacuate toxic products from the blood of the embryo through the umbilical veins: creatine, urea and excess salts.
Parameters of a normally developing fetus
Regular ultrasound examination of the unborn child allows you to determine what degree of maturity of the placenta should be, based on the duration of the woman's pregnancy. The shorter the period, the more the processes of biosynthesis of carbohydrates, proteins and lipids are carried out by the cells of the embryo and the more intense the exchange processes between the blood of the mother and the fetus.
The structure of tissues and the metabolism of the child's place during this period corresponds to the 0 degree of maturity of the placenta by weeks. The table compiled on the basis of the results of diagnosing a normal pregnancy and presented below shows that the period up to 30 weeks is characterized by the following physiological norm of the state of the child's place: an almost smooth surface of its fetal part, the uniformity of the tissue structure and the absence of deposits of calcium salts in them. However, even with the full compliance of the ultrasound results obtained with the above parameters of the placental development norm, the decisive indicators will be the heart rate and the supply of organs and tissues of the fetus with oxygen.
Aging of the placenta: norm or pathology?
The child's place is a temporarily functioning organ, therefore its tissues gradually coarsen (their consistency thickens), which leads to a deterioration in the processes of diffusion and osmosis, as well as to a decrease in the rate of blood flow in the placental vessels. The most significant for elucidating the mechanisms of aging of the placenta is the 34th week. The degree of maturity of the placenta during this period increases greatly, and by the 39th week of pregnancy, the placenta becomes very dense, and its functioning decreases.
This is a genetically and physiologically normal phenomenon that occurs during pregnancy. The dependence of the state of the child's place on the trimester of pregnancy is determined as the degree of maturity of the placenta by weeks. The table below provides visual information showing the correlation between the period of fetal development and the histological picture of placental structures.
Why does a child's place get old?
In some cases, the rate of aging of the organ connecting the mother and child organisms may increase. For example, according to the result of ultrasound, the doctor puts the 2nd degree of maturity of the placenta, although the gestational age is less than 32 weeks. There may be several reasons: a viral infection, regular intoxication as a result of smoking, chronic diseases of the woman herself (hypertension, diabetes mellitus, thrombophlebitis), or Rh conflict.
How much this will affect the development of the fetus is determined by the attending physician, who will choose the right treatment strategy. Usually it includes both additional diagnostic procedures and examination in a hospital setting.
The relationship between gestational age and the state of the placenta
As you can see, quite a lot of different factors can affect the degree of maturity of the placenta. The rules in the table will help expectant mother compare them with your own ultrasound results.
Early aging of the placenta is not necessarily a symptom that threatens the life of the mother and fetus. For example, if the 3rd degree of placental maturity, detected at 34-36 weeks of gestation, is not associated with impaired blood circulation in the vessels of the uterus and the child's place, or with a diagnosable violation of embryogenesis, or with an Rhesus conflict, then there is no cause for concern. Otherwise, the pregnant woman will be offered a course of treatment in a hospital, and as an extreme option - an artificial birth.
How pregnancy pathologies affect the early maturation of the placenta
Let us recall once again that a child's place is the most important temporarily functioning structure that connects the organisms of the mother and the unborn baby. The afterbirth unites the circulatory systems of the pregnant woman and the embryo, thanks to which nutrients and oxygen from the mother's blood diffuse into the organs and tissues of the fetus. Thus, all disorders of the general blood flow will have multiple Negative consequences. For example, gestational hypertension (increased blood pressure in a woman) from the 20th week of pregnancy can lead to the formation of defective vessels in the placenta. This inevitably entails the processes of decompensation of the placenta arteries, which leads to its premature aging, not to mention the threat of hypoxia in the fetus.
In this article, we found out how the various stages of pregnancy and the degree of maturity of the placenta by weeks are interconnected. A table compiled according to the results of Doppler ultrasound diagnostics will help expectant mothers to obtain the information they need.
In the womb, active growth and development of the fetus takes place. The placenta, an embryonic organ formed from the embryonic membranes, supports the life of the future baby. These membranes are adjacent to the wall of the uterus, form villi that grow into the mucous membrane. Thus, a strong connection is established between the fetus and the mother's body, which is necessary for the implementation of gas exchange, trophic and excretory, hormonal, and protective functions. Thus, the hemoplacental barrier is formed. The embryo is connected to the placenta by the umbilical cord.
The degree of maturity of the placenta
The placenta is a unique organ. It is formed only during pregnancy, belongs to both the mother's body and the body of the fetus. It is a temporary formation that develops in stages, and leaves the body through the genital tract with the birth of a child, more precisely, within 10-50 minutes after birth (depending on the tactics of childbirth).
Maturity of the placenta
During intrauterine development, the placenta undergoes structural changes. The wording “placental aging” is not quite correct, it is desirable to say “maturation”.
The degree of maturity of the placenta is an ultrasonic parameter. An ultrasound study is underway. Localization is determined, surface area, mass and size are estimated. In addition to placentometry, the degree of maturity of the structure is also assessed. Echographically, it is customary to distinguish four degrees. The visualization of inclusions of increased acoustic density speaks of maturation. If it is acoustically homogeneous, there is no lobulation, the subepithelial membrane is not thickened, then they speak of 0 degree of maturity.
As pregnancy progresses, the degree of maturity increases, and before childbirth it can have both 0 and 3 degrees.
How does the placenta mature?
At the end of the sixth week of pregnancy, the opening of the lumen of the spiral arteries occurs as a result of the ingrowth of the cytotrophoblast into the wall of the vessels of the falling membrane. These events determine the occurrence of uteroplacental circulation.
By the 13th week of pregnancy, placentation ends. For this period, in the morphofunctional plan, the placenta is not mature - only the main elements are formed. The structural unit of the formed placenta is cotyledon. In a mature placenta, there are up to 50 such cup-shaped formations.
It reaches functional maturity at the 16th week - now it fully carries out gas exchange, trophic and excretory, hormonal, protective functions.
In the second trimester, fetalization of the placenta occurs. The development of the fetus during this period does not catch up with the growth of the placenta. From the 22nd week, on the contrary, the growth of the fetus outstrips the growth of the placenta, and by the 36th week the child's place normally manages to reach full maturity.
By the end of the prenatal period, the so-called. aging of the placenta, which indicates the occurrence of hormone-dependent processes in the body of the unborn baby, which induce the acquisition of the morphological and functional maturity of its lung tissue.
Maturity of the placenta by week
The placenta must go through stages of development that meet the needs of the growing fetus, otherwise it would not be able to effectively cope with the tasks assigned to it. As noted above, as maturation progresses, corresponding transformations are revealed - dimensional, structural, etc. Let's talk about this in more detail.
- Zero maturity. It is also called the formation stage, which lasts from the second to the thirtieth week. The tissue increases in volume, mass. Acoustically homogeneous, no lobulation, no inclusions.
- First degree of maturity. Growth stage up to 34 weeks. Echogenic inclusions are found. The tissues become denser, the chorionic plate becomes wavy.
- The second degree of maturity. Maturity period, up to 39 weeks. The tortuosity of the chorionic plate increases, the acoustic density is increased, multiple inclusions are found.
- The third degree of maturity. From 37 weeks The area and volume are reduced. The chorionic plate becomes tortuosity.
Premature maturation of the placenta
Premature maturation of the placenta does not manifest itself in any way, but diseases that provoked PSP may be disturbing. That is, the symptoms of the underlying disease prevail. It is possible to change the motor activity of the fetus - both an increase in movements, and their complete absence.
They are detected during a routine ultrasound examination, as a rule.
Provoking factors:
- Chronic diseases of the reproductive organs, infectious diseases (specific genital, general infectious).
- Extragenital pathologies. Somatic, in particular, endocrine disorders.
- Isoserological incompatibility.
- Gestosis.
Premature maturation of the placenta is always associated with increased functioning of the mother-fetus system, which is provoked by the factors listed above. One way or another, unfavorable conditions become triggers. No matter how trite it may sound, this is an underweight or overweight woman, an unbalanced diet, drinking alcohol, smoking, and not only during gestation.
If we talk about pathogenesis, premature maturation is a compensatory reaction in response to fetoplacental insufficiency. A child's place grows and forms more intensively due to adverse factors (disturbance of trophic function, for example). As a result, the functionality of the placenta decreases.
Regardless of the period at which fetoplacental insufficiency was detected, the obstetrician-gynecologist in tandem with the relevant specialist conducts active treatment of the underlying pathology. Medicines that improve the blood supply to the fetus are also connected.
late ripening
Late maturation of the placenta may be associated with the presence of diseases in the mother, especially chronic ones. In some cases, genetic diseases occur, which will eventually be reflected in various kinds of malformations. However, early maturation is a more frequent phenomenon.
Placental maturity table
For clarity, a table is presented illustrating the norms for the degree of maturity of the placenta by week:
| The degree of maturity of the placenta | weeks of pregnancy | ||||||||||||
| 0 | 28 | 29 | 30 | ||||||||||
| 0-I | 29 | 30 | |||||||||||
| I | 30 | 31 | 32 | ||||||||||
| I-II | 32 | 33 | 34 | ||||||||||
| II | 34 | 35 | 36 | 37 | 38 | 39 | 40 | ||||||
| II-III | 35 | 36 | 37 | 38 | 39 | 40 | |||||||
| III | 38 | 39 | 40 | ||||||||||
- this is a unique organ, the life expectancy of which is only 40 weeks - the gestational age. We can say that the placenta is a temporary organ, which is absolutely necessary exclusively for growth and development in the womb. After childbirth, the placenta becomes unnecessary, so it is also removed from the uterus. However, like any other organ, the placenta goes through all stages - from birth to death. The death of the placenta is the moment of separation from the walls of the uterus after the birth of the child. But the life stages of the placenta - birth, growth, maturity, aging and death - occur within 40 weeks.
The term "degree of maturity" of the placenta reflects a certain stage of development and physiological changes in this organ. In fact, the degree of maturity is the stage of aging of the placenta. Each degree of maturity corresponds to certain structural features of the placenta and thickness. There are currently four grades placental maturity, denoted by Arabic numerals 0, 1, 2 and 3. In this case, the youngest placenta corresponds to the degree of maturity 0, and the oldest - 3.
The aging of the placenta occurs gradually, with each of the four degrees of maturity corresponding to a certain gestational age. This can be compared with the fact that signs of aging of organs and systems are recorded in the body at a certain age. If such signs appear before the age for which they are characteristic, then they speak of premature aging. The same is true for the placenta, it's just that its age is calculated by weeks of pregnancy.
Thus, at each gestational age, the placenta must be a certain degree of maturity. Today, clear norms for the correspondence of the degrees of maturity of the placenta and the duration of pregnancy have been defined:
- Up to 30 weeks of pregnancy, the degree of maturity of the placenta should be 0;
- From the 27th to the 36th week of pregnancy, the degree of maturity of the placenta 1;
- From the 34th to the 39th week of pregnancy, the degree of maturity of the placenta is 2;
- From the 37th to the 40th week of pregnancy, the degree of maturity of the placenta is 3.
If the degree of maturity of the placenta at any gestational age is greater than it should be (for example, at the 26th week of pregnancy 1 or 2 degree of maturity), then doctors talk about premature aging (maturation) of the organ. Such premature aging of the placenta is a sign of fetoplacental insufficiency, which leads to a deficiency of nutrients and oxygen delivered to the fetus and, accordingly, to a delay in its development. In addition, fetoplacental insufficiency can cause the threat of premature birth, intrauterine death of the fetus and other terrible complications of pregnancy. Therefore, premature aging of the placenta requires treatment in the conditions of the pregnancy pathology department.
Today, many mothers know more about pregnancy than our parents did. Therefore, many women during pregnancy worry about the state of their health, and are very worried if the doctor talks about the state of such an important organ during pregnancy as the placenta. This body performs the most important functions, and without it it is impossible to carry a pregnancy in principle.
Deviations in the structure or functioning of the placenta can threaten complications for the mother or fetus, and certain measures must be taken in a timely manner to correct everything. But what can happen to the placenta, and how can it be dangerous? Let's figure it out together.
What is a placenta?
The term "placenta" itself comes from the Greek language and is translated in simple words"cake". Indeed, by appearance the placenta resembles a large and voluminous cake with a “tail” extending from it in the form of an umbilical cord. But this cake is extremely important for every woman who is carrying a baby, it is due to the existence of the placenta that it is possible to endure and give birth normally to a child.
By structure, the placenta, or, as it may be called in another way in the literature, "children's place", is a complex organ. The beginning of its formation occurs at the time of implantation of the embryo into the wall of the uterus (from the moment the embryo attaches to one of the walls of the uterus).
How is the placenta arranged?
The main part of the placenta are special villi that branch out in it and form from the beginning of pregnancy, resembling the branches of centuries-old trees. Inside the villi, the baby's blood circulates, and outside the villi are actively washed by the blood coming from the mother. That is, the placenta combines two circulatory systems at once - maternal from the side of the uterus, and fetal, from the side of the amniotic membranes and the baby. According to this, the sides of the placenta also differ - smooth, covered with membranes, with an outgoing umbilical cord - from the side of the fetus, and uneven lobed - from the side of the mother.
What is the placental barrier?
It is in the region of the villi that an active and constant exchange of substances takes place between the baby and his mother. Oxygen and all the necessary nutrients for growth and development are supplied from the mother's blood to the fetus, and the baby gives the mother metabolic products and carbon dioxide, which the mother removes from the body for two. And the most important thing is that the blood of the mother and the fetus does not mix in any part of the placenta. Two vascular systems- fetus and mother - are separated by a unique membrane, which is able to selectively pass some substances, and retain other, harmful substances. This membrane is called the placental barrier.
Gradually forming and developing along with the fetus, the placenta begins to fully function by about twelve weeks of pregnancy. The placenta retains bacteria and viruses penetrating into the mother's blood, special maternal antibodies that can be produced in the presence of an Rhesus conflict, but the placenta easily passes necessary for the child nutrients and oxygen. The placental barrier has the property of special selectivity, different substances coming from different sides of the placental barrier penetrate the membrane to varying degrees. So, many minerals from the mother actively penetrate to the fetus, but practically do not penetrate from the fetus to the mother. And also, many toxic substances from the baby actively penetrate to the mother, and practically do not pass from her back.
Hormonal function of the placenta
In addition to the excretory function, the implementation of fetal breathing (since the placenta temporarily replaces the baby's lungs), and many other functions, the placenta has another function that is important for pregnancy in general - hormonal. The placenta, with the beginning of its full functioning, can produce up to 15 different hormones that perform various functions during the bearing of the baby. The very first of these are sexual functions, which help in maintaining and prolonging pregnancy. Therefore, gynecologists, with the threat of early termination of pregnancy, always wait 12-14 weeks, helping in the early weeks of pregnancy with hormones from the outside (dufaston or utrozhestan). Then the placenta begins to work actively and the threat disappears.
The functions of the placenta are so great that in the initial stages the placenta grows and develops even faster than your baby grows. And this is no accident, the fetus weighs about 5 grams by 12 weeks, and the placenta is up to 30 grams, by the end of pregnancy, at the time of delivery, the size of the placenta will be about 15-18 cm, and its thickness is up to 3 cm, with a weight of about 500 -600 grams.
Umbilical cord
The placenta on the fetal side is connected to the baby by a special strong cord - the umbilical cord, inside which two arteries and one vein pass. The umbilical cord can attach to the placenta in several ways. The first and most common is the central attachment of the umbilical cord, but there may also be a lateral or marginal attachment of the umbilical cord. The function of the umbilical cord does not suffer from the method of attachment. A very rare option for attaching the umbilical cord may be attachment not to the placenta itself, but to its fetal membranes, and this type of attachment is called sheath.
Problems with the placenta
Most often, the placenta and umbilical cord system work together and supply the baby with oxygen and nutrition. But sometimes failures can occur in the placenta due to the influence of various factors - external or internal. There are various kinds of developmental disorders or problems with the functioning of the placenta. Such changes in the placenta do not go unnoticed for the mother and fetus, often problems with the placenta can have serious consequences. We will talk about the main deviations in the development and functioning of the placenta and how to detect and treat them.
Hypoplasia of the placenta
Reducing the size or thinning of the placenta in medical language is called "placental hypoplasia". This diagnosis should not be frightened, because. it occurs quite frequently. The fetus is affected only by a significant decrease in the diameter and thickness of the placenta.
Significantly reduced placenta, a small child's place, occurs infrequently. Such a diagnosis is made if the size reduction is significant compared to the lower limit of normal for the size of the placenta in this period pregnancy. The causes of this type of pathology have not yet been clarified, but according to statistics, usually a small placenta is associated with the development of severe genetic abnormalities in the fetus.
I would like to immediately make a reservation that the diagnosis of "placental hypoplasia" is not made according to the data of one ultrasound, it can only be made as a result of long-term observation of the pregnant woman. In addition, it is always worth remembering that there may be individual deviations in the size of the placenta from the standard, generally accepted normal values, which will not be considered a pathology for each specific pregnant woman in each of her pregnancies. So, for a small and slender woman, the placenta should be smaller in size than for a large and tall one. In addition, there is no absolute evidence of the dependence of placental hypoplasia and the presence of genetic disorders in the fetus. But when a diagnosis of "placental hypoplasia" is made, parents will be recommended to undergo medical genetic counseling.
During pregnancy, a secondary decrease in the size of the placenta may occur, which may be associated with the impact of various adverse factors during the bearing of the baby. It can be chronic stress or starvation, drinking alcohol or smoking, drug addiction. Also, the causes of underdevelopment of the placenta during pregnancy can be hypertension in the mother, a sharp exacerbation of chronic pathology, or the development of some acute infections during pregnancy. But in the first place with the underdevelopment of the placenta is preeclampsia with the development of severe edema, high blood pressure and the appearance of protein in the urine.
There are changes in the thickness of the placenta. The placenta is considered to be thinned, which has insufficient mass at quite normal sizes for its terms. Often such thin placentas are found with congenital malformations of the fetus, and children are born with manifestations, which gives serious problems with the health of the newborn. But unlike the initially hypoplastic placenta, such children are not associated with the risks of developing dementia.
Sometimes a membranous placenta is formed - it is very wide and very thin, up to 40 cm in diameter, almost twice as large as normal. Usually the cause of the development of such a problem is a chronic inflammatory process in the endometrium, which leads to dystrophy (exhaustion) of the endometrium.
Hyperplasia of the placenta
In contrast, there is a variant of the very large, gigantic placenta that usually occurs in cases of severe gestational diabetes. An increase (hyperplasia) of the placenta is also found in diseases of pregnant women such as toxoplasmosis or syphilis, but this happens infrequently. An increase in the size of the placenta may be the result of kidney pathology in the unborn baby, if present, when the fetal red blood cells with the Rh protein begin to attack the mother's antibodies. The placenta can significantly increase in case of thrombosis of its vessels, if one of the vessels is clogged, as well as with pathological growths of small vessels inside the villi.
An increase in the thickness of the placenta more than normal may be due to its premature aging. Thickening of the placenta is also caused by pathologies such as Rhesus conflict, fetal dropsy, diabetes mellitus in pregnancy, preeclampsia, viral or infectious diseases transferred during pregnancy, placental abruption. Thickening of the placenta is normal in multiple pregnancies.
In the first and second trimesters, an increase in the placenta usually indicates a past viral disease (or latent carriage of the virus). In this case, the placenta grows to prevent disease of the fetus.
The rapid growth of the placenta leads to its premature maturation, and therefore aging. The structure of the placenta becomes lobulated, calcifications form on its surface, and the placenta gradually ceases to provide the fetus with the necessary amount of oxygen and nutrients. The hormonal function of the placenta also suffers, which leads to premature birth.
Treatment of placental hyperplasia usually consists of careful monitoring of the fetus.
What is the danger of changing the size of the placenta?
Why are doctors so worried about a significant change in the size of the placenta? Usually, in the case of a change in the size of the placenta, functional insufficiency in the work of the placenta can also develop, that is, the so-called feto-placental insufficiency (FPN), problems with the supply of oxygen and nutrition to the fetus, will form. The presence of FPI may mean that the placenta cannot fully cope with the tasks assigned to it, and the child experiences a chronic lack of oxygen and nutrient supply for growth. At the same time, problems can snowball, the child’s body will suffer from a lack of nutrients, as a result, it will begin to lag behind in development and IUGR (fetal growth retardation in the fetus) or fetal growth retardation syndrome (FGR) will form.
To prevent this from happening, it is best to engage in the prevention of such conditions in advance, the treatment of chronic pathology even before the onset of pregnancy, so that exacerbations do not occur during gestation. During pregnancy, it is important to control blood pressure, blood glucose levels and protect the pregnant woman from any infectious diseases as much as possible. You also need a good diet with enough protein and vitamins.
When making a diagnosis of placental hypoplasia or placental hyperplasia, first of all, careful monitoring of the course of pregnancy and the condition of the fetus is required. It is impossible to cure or fix the placenta, but there are a number of drugs prescribed by a doctor to help the placenta carry out its functions.
In the treatment of emerging feto-placental insufficiency, special drugs are used - trental, actovegin or chimes, which can improve blood circulation in the placental system both from the mother and the fetus. In addition to these drugs, intravenous infusions of drugs can be prescribed - rheopolyglucin with glucose and ascorbic acid, saline solutions. The development of FPI can have varying degrees of severity and with it you cannot self-medicate, this can lead to the loss of a child. Therefore, it is necessary to comply with all the appointments of an obstetrician-gynecologist.
Changes in the structure of the placenta
The normal placenta has a lobular structure, it is divided into approximately 15-20 lobules of equal size and volume. Each of the lobules is formed from villi and a special tissue that is between them, and the lobules themselves are separated from each other by partitions, however, not complete. If changes occur in the formation of the placenta, new variants of the structure of the lobules may arise. So, the placenta can be bilobed, consisting of two equal parts, which are interconnected by a special placental tissue, a double or triple placenta can also be formed, the umbilical cord will be attached to one of the parts. Also, a small additional lobule can be formed in a normal placenta. Even less often, the so-called "fenestrated" placenta can occur, which has areas covered with a shell and resembling windows.
There can be many reasons for such deviations in the structure of the placenta. Most often, this is a genetically incorporated structure, or a consequence of problems with the uterine mucosa. Prevention of such problems with the placenta can be an active treatment of inflammatory processes in the uterine cavity even before pregnancy, during the planning period. Although deviations in the structure of the placenta do not affect the child so much during pregnancy, and almost never affect its development. But in childbirth, such a placenta can cause a lot of trouble for doctors - such a placenta can be very difficult to separate from the uterine wall after the birth of the baby. In some cases, separation of the placenta requires manual control of the uterus under anesthesia. Treatment of the abnormal structure of the placenta during pregnancy is not required, but in childbirth it is necessary to remind the doctor about this so that all parts of the placenta are born and there are no pieces of the placenta left in the uterus. It is dangerous by bleeding and infection.
The degree of maturity of the placenta
The placenta in the course of its existence goes through four successive stages of maturation:
The degree of maturity of the placenta 0- normally lasts up to 27-30 weeks. Sometimes at these stages of pregnancy, 1 degree of placental maturity is noted, which can be caused by smoking or drinking alcohol during pregnancy, as well as a past infection.
Degree of maturity of the placenta 1- from 30 to 34 weeks of pregnancy. During this period, the placenta stops growing, its tissues thicken. This is a crucial period when any deviations can pose a danger to the health of the fetus.
Degree of maturity of the placenta 2- lasts from 34 to 39 weeks of pregnancy. This is a stable period when some advance in placental maturity should not cause concern.
Degree of maturity of the placenta 3- normally can be diagnosed starting from the 37th week of pregnancy. This is the stage of natural aging of the placenta, but if it is combined with fetal hypoxia, the doctor may recommend a caesarean section.
Disorders in the maturation of the placenta
For each stage of the formation of the placenta, there are normal terms in weeks of pregnancy. Too fast or slow passage of certain stages by the placenta is a deviation. The process of premature (accelerated) maturation of the placenta is uniform and uneven. Usually expectant mothers with a weight deficit face uniform premature aging of the placenta. Therefore, it is important to remember that pregnancy is not the time to follow various diets, as their consequences can be premature birth and the birth of a weak baby. The placenta will ripen unevenly if there are problems with blood circulation in some of its areas. Typically, such complications occur in overweight women, with prolonged late toxicosis of pregnancy. Uneven maturation of the placenta often occurs with repeated pregnancies.
Treatment, as with feto-placental insufficiency, is aimed at improving blood circulation and metabolism in the placenta. To prevent premature aging of the placenta, it is necessary to take measures to prevent pathologies and gestosis.
But delays in the maturation of the placenta occur much less frequently, and the most common reasons for this may be the presence diabetes in pregnant women, drinking alcohol and smoking. Therefore, it is worth giving up bad habits while carrying a baby.
placental calcifications
The normal placenta has a spongy structure, but by the end of pregnancy, some of its areas may become stony, such areas are called petrificates or placental calcifications. Hardened parts of the placenta are not able to perform their functions, but usually the remaining parts of the placenta do an excellent job with the task assigned to them. As a rule, calcifications occur with premature aging of the placenta or prolonged pregnancy. In such cases, the doctor will closely monitor the pregnant woman in order to exclude the development of fetal hypoxia. But usually such a placenta functions quite normally.
Low insertion and placenta previa
Ideally, the placenta should be located at the top of the uterus. But there are a number of factors that prevent the normal location of the placenta in the uterine cavity. These can be uterine fibroids, tumors of the uterine wall, malformations of its development, many pregnancies in the past, inflammatory processes in the uterus or abortions.
Requires closer observation. Usually during pregnancy, it tends to rise. In this case, there will be no obstacles for natural childbirth. But it happens that the edge of the placenta, part of it or the entire placenta covers the internal os of the uterus. With partial or complete overlapping of the cervix by the placenta, natural childbirth is impossible. Usually, with an abnormal location of the placenta, a caesarean section is performed. Such abnormal positions of the placenta are called incomplete and complete placenta previa.
During pregnancy, a woman may experience bleeding from the genital tract, which leads to anemia, fetal hypoxia. The most dangerous is partial or complete abruption of the placenta, which leads to the death of the fetus and a threat to the life of the mother. , including sexual, you can not engage exercise, swim in the pool, walk a lot and work.
What is placental abruption?
What is placental abruption? This is a condition when the placenta (normally or abnormally located) leaves the place of its attachment earlier than its due date, that is. With placental abruption, an emergency caesarean section is necessary to save the life of the mother and fetus. If the placenta exfoliated in small areas, then doctors try to stop this process, keeping the pregnancy. But even with minor placental abruption and slight bleeding, the risk of repeated episodes of abruption remains until childbirth, and the woman is carefully monitored.
The causes of placental abruption can be injuries or blows to the stomach, the presence of chronic pathologies in a woman, which leads to problems with blood circulation, defects in the formation of the placenta. Premature placental abruption can be caused by complications during pregnancy - most often gestosis with increased pressure, protein in the urine and edema, in which all organs and systems of the mother and fetus suffer. It is important to remember that placental abruption is the most dangerous complication of pregnancy!
Placental abruption
Rice. 1 - complete placenta previa;
Rice. 2 - marginal placenta previa;
Rice. 3 - partial placenta previa
1 - cervical canal; 2 - placenta; 3 - umbilical cord; 4 - fetal bladder
Dense attachment and accreta of the placenta
Sometimes there are anomalies not only in the place, but also in the way the placenta is attached to the wall of the uterus. A very dangerous and serious pathology is placenta accreta, in which placental villi are attached not only to the endometrium (the inner layer of the uterus, which exfoliates during childbirth), but also grow deep into the tissues of the uterus, into its muscular layer.
There are three degrees of severity of placental accreta, depending on the depth of germination of the villi. In the most severe, third degree, the villi grow through the entire thickness of the uterus and can even lead to uterine rupture. The cause of placenta accreta is the inferiority of the endometrium due to congenital defects of the uterus or acquired problems.
The main risk factors for placenta accreta are frequent abortions, caesarean sections, fibroids, as well as intrauterine infections, malformations of the uterus. Low placentation can also play a certain role, since in the region of the lower segments, the germination of villi into the deeper layers of the uterus is more likely.
With true placenta accreta, in the vast majority of cases, removal of the uterus with placenta accreta is required.
An easier case is a dense attachment of the placenta, which differs from the increment in the depth of penetration of the villi. Dense attachment occurs with a low location of the placenta or its presentation. The main difficulty with such an attachment of the placenta is a delay in its birth or the complete impossibility of independent discharge of the placenta in the third stage of labor. With tight attachment, they resort to manual separation of the placenta under anesthesia.
Diseases of the placenta
The placenta, like any organ, can get sick. It can become infected, infarcts (areas deprived of blood circulation) can develop in it, blood clots can form inside the vessels of the placenta, and the placenta itself can even undergo tumor degeneration. But this, fortunately, happens infrequently.
Infectious lesions of the tissues of the placenta (placentitis), caused by various microbes that can penetrate the placenta different ways. So, they can be brought with a blood stream, penetrate from the fallopian tubes, ascending from the vagina, or from the uterine cavity. The process of inflammation can be extended to the entire thickness of the placenta or occur in its individual sections. In this case, the treatment should be specific, and it depends on the type of pathogen. Of all the possible drugs, the one that is acceptable for pregnant women at a given time will be selected. And for the purpose of prevention before pregnancy, it is necessary to carry out a full-fledged therapy of chronic infections, especially in the genital tract.
Placental infarction usually develops, like any other, as a result of prolonged ischemia (vasospasm of the placenta), and then the parts of the placenta that receive blood from these vessels die as a result of oxygen deficiency. Usually, heart attacks in the placenta occur as a result of a severe course of preeclampsia or with the development hypertension pregnant. Placentitis and placental infarction can cause FPI and problems with fetal development.
Sometimes, as a result of inflammation or damage to the vascular wall, with a violation of blood viscosity, or with sudden movements of the fetus, blood clots form inside the placenta. But small blood clots do not affect the course of pregnancy.