Placental insufficiency is the failure of the placenta to supply nutrients to the unborn child and remove toxic wastes.
When the placenta fails to develop or function properly, the baby cannot grow and develop normally. The earlier in the pregnancy that this occurs, the more severe the problems.
If placental insufficiency occurs for a long time during the pregnancy, it may lead to intrauterine growth restriction (IUGR).
There are usually no symptoms with placental insufficiency. However, a mother may notice that the size of her uterus is smaller than in previous pregnancies. The babu may also be moving less than expected.
Between 3 to 7% of all pregnancies are complicated by IUGR due to placental insufficiency. A low birth weight may be suspected if the size of the woman's uterus is smaller than what is expected for each week of pregnancy. The woman has a higher risk of having a child with IUGR if the following are present: defects of the placental membranesdefects of the umbilical cordabnormal implantation of the placenta in the uterusa break in the placental membrane that causes the baby's blood to mix with the mother's bloodRh incompatibility, a condition in which the mother's blood is not compatible with the baby's bloodbeing pregnant with twins or tripletsprevious low-birth-weight infantlong-term high blood pressurediabetessevere kidney diseaseheavy smokinginsufficient weight gain by the mother during pregnancy, defined as less than 10 poundspreeclampsia or eclampsia, conditions which raise the mother's blood pressurehigh altitudedrug addiction, such as addiction to cocaineblood thinners such as warfarinimmunosuppressive medicationshuman immunodeficiency virus (HIV) infection in the motheralcohol abuseinfection with cytomegalovirus, toxoplasmosis, rubella, or syphilis, known collectively as TORCH infectionspoor nutrition of the motherunborn child with known birth defects or chromosome abnormalitiesfrequent vaginal bleeding due to placenta previa, a condition in which the placenta is attached to the uterus over or near the cervixcertain blood disorders in the mother, such as sickle cell anemia or thalassemiapremature placental separation, known as placental abruption
Most cases of placental insufficiency and IUGR cannot be prevented.
However, there are several tests that can be done early in pregnancy to help detect problems. These include: pregnancy ultrasound scans to check the condition and size of the placentaalpha-fetoprotein (AFP) levels in a sample of the mother's bloodamniocentesis to check for problems with the baby's chromosomes
Pregnant women can also do the following to help prevent these conditions: avoid close contact with persons carrying the rubella virus or cytomegalovirus avoid toxoplasmosis, by not coming in contact with uncooked meat and animal excrement, especially from catsavoid alcohol, smoking, and illicit drugsget treatment for high blood pressure and diabetes
Before becoming pregnant, women should follow a healthy diet that contains folate. This can help to decrease the rate of certain anomalies in the baby.
Pregnancy ultrasounds can be used to check on the growth of the baby and placenta. It is important that this condition be diagnosed early in the pregnancy. This is to prevent the serious complications that may arise for the baby during labor as well as in later life.
Long-term effects of placental insufficiency depend on the underlying cause. During the pregnancy a mother may be restricted to bed and have to take several precautions.
The long-term effects for a baby born following placenta insufficiency can be serious. After birth, he or she will tend to remain physically small. There is a higher risk for neurological and intellectual impairments. Major disabilities include severe mental retardation, cerebral palsy, and seizures.
With placental insufficiency, there are many risks to the fetus during the pregnancy, at delivery, and after delivery. These risks include: 8-fold higher risk of death during delivery5-fold higher risk of poor oxygenation at birth that may lead to cerebral palsy and other complicationshypothermia, or low body temperaturehypoglycemia, or low blood sugar30 to 40% chance of learning disabilitiespremature deliverypoor tolerance of laborincreased chance of cesarean birthincreased chance of having birth defectsincreased chance of meconium aspiration, in which the baby inhales some of the amniotic fluid during laborpolycythemia, which is an excess of red blood cellshypocalcemia, which is too little calcium in the blood
To treat this condition, the healthcare provider may recommend that the pregnant woman: stop smokingstop taking illicit drugs, such as cocainestop drinking alcoholeat a healthy diet that includes more than 2500 calories per dayrest in bed during the day, lying on the left side as much as possibletake low-dose aspirin to prevent tiny blood clots from forming in the placenta, as well as to dilate, or open, the blood vesselspay attention to the movement of the baby, any contractions, or rupture of the membranes ("breaking water") earlier than expecteddeliver in a hospital settinghave the baby monitored electronically during laboruse as little anesthesia as possible and no narcotics during laborhave a cesarean birth or forceps delivery if fetal distress is detected
The side effects of surgery include bleeding, infection, and allergic reaction to the anesthesia . Medications have various side effects, including stomach upset, rash, and allergic reaction.
Placental insufficiency is not considered life-threatening to the mother. However, she may be at risk for significant illness or even death if she has an underlying condition such as high blood pressure or diabetes.
Placental insufficiency may cause serious conditions in the newborn, such as pneumonia, cerebral palsy, or other respiratory problems. A newborn who is born prematurely or with serious medical conditions may need an incubator, a special enclosed bed that can control temperature and oxygen levels.
If a child is born with cerebral palsy, there may be disabilities that require therapy, use of appliances such as crutches or canes, and a daily struggle with medical problems. As the child gets older, there may be a need for special education programs for learning disabilities caused by oxygen and nutritional deprivation while in the uterus.
If testing later in pregnancy shows that the baby's lungs are mature, then labor should be induced and the baby delivered. The following tests should be done when the baby is very premature or the lungs haven't matured fully: nonstress testing performed weekly or biweekly, to monitor uterine contractionsbiophysical profile done weekly or biweeklyDoppler umbilical artery waveforms, a special test for baby's healthpregnancy ultrasound scans every 10 to 14 days
Understanding Your Body, Felicia Stewart, Felicia Guest, Gary Stewart, and Robert Hatcher, 1987
Maternity and Gynecological Care, The Nurse and the Family, Irene Bobak, Margaret Jensen, Marianne Zalar, Mosby Co., 1989
