Placental insufficiency
| Classification according to ICD-10 | |
|---|---|
| O43 | Pathological conditions of the placenta |
| O36.5 | Care of the mother because of identified or suspected fetal retardation - placental insufficiency |
| ICD-10 online (WHO version 2019) | |
As placental insufficiency in which is obstetric medicine , the lack of function of the placenta (placenta), respectively.
The placenta is normally used to nourish the unborn child: oxygen , nutrients and other substances (such as hormones or antibodies ) can pass from the maternal circulation to that of the child. The two cycles are basically separate from each other - there is no mixing of the mother's blood with that of the child. Blood cells spill only minimally.
In addition, the placenta is where numerous hormones are formed, the most important of which are estrogens and gestagens (pregnancy-promoting hormones), as well as human chorionic gonadotropin (hCG). If the placenta only insufficiently fulfills these functions, one speaks of placental insufficiency or disruption of the feto-maternal unit.
to form
A distinction is made between an acute and a chronic form.
An acute placental insufficiency is usually formed by a sudden reduction of blood flow in either the maternal or infant part of the placenta. Causes for this can be:
- on the part of the mother the vena cava compression syndrome, a drop in blood pressure z. B. in the context of an epidural anesthesia , the thunderstorm during childbirth , the premature placental detachment or a bleeding from a placenta previa .
- on the part of the child i. d. R. Umbilical cord problems such as entanglement, herniation, or knot formation.
Acute placental insufficiency is an emergency in which the child experiences an acute lack of oxygen and threatens to die quickly.
A chronic placental insufficiency manifested by slower growth of the child. Characteristics can be a belly of the pregnant woman that is too small for the pregnancy week (imprecise sign!). The safest way to make the diagnosis is through an ultrasound scan. This shows a fetus that is too small and that swims in too little amniotic fluid ( oligohydramnios ); Ultrasound of the maternal vessels (aa. uterinae) and that of the child (aa. umbilicales or aa. cerebri mediae) reveal pathological findings. The causes are usually found in the mother's underlying disease, such as anemia , diabetes mellitus , kidney failure , high blood pressure or infections . Pregnancy-specific conditions can also be the cause, e.g. B. Rhesus incompatibility or preeclampsia . Finally, the consumption of alcohol or nicotine during pregnancy can lead to poor performance of the placenta.
activities
In order to prevent a worsening of the child's condition in the chronic form of placental insufficiency, the pregnant woman is prescribed bed rest and physical rest, in case of doubt also admission to the hospital in order to detect complications early. If there are signs of a deterioration in the child's condition, delivery must be initiated. Often times, the acute form of the disorder requires immediate delivery.
literature
- Walter Siegenthaler, Hubert Erich Blum: Clinical Pathophysiology. Georg Thieme Verlag, 2013, ISBN 978-3-13-176089-0 , p. 424.
