Placental Insufficiency

Placental Insufficiency

Alternate Names

  • placental dysfunction
  • Fetal development

Definition

Placental insufficiency is the failure of the placenta to supply nutrients to the unborn child and remove toxic wastes.

What is going on in the body?

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).

Risks

What are the causes and risks of the condition?

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 membranes
  • defects of the umbilical cord
  • abnormal implantation of the placenta in the uterus
  • a break in the placental membrane that causes the baby's blood to mix with the mother's blood
  • Rh incompatibility, a condition in which the mother's blood is not compatible with the baby's blood
  • being pregnant with twins or triplets
  • previous low-birth-weight infant
  • long-term high blood pressure
  • diabetes
  • severe kidney disease
  • heavy smoking
  • insufficient weight gain by the mother during pregnancy, defined as less than 10 pounds
  • preeclampsia or eclampsia, conditions which raise the mother's blood pressure
  • high altitude
  • drug addiction, such as addiction to cocaine
  • blood thinners such as warfarin
  • immunosuppressive medications
  • human immunodeficiency virus (HIV) infection in the mother
  • alcohol abuse
  • infection with cytomegalovirus, toxoplasmosis, rubella, or syphilis, known collectively as TORCH infections
  • poor nutrition of the mother
  • unborn child with known birth defects or chromosome abnormalities
  • frequent vaginal bleeding due to placenta previa, a condition in which the placenta is attached to the uterus over or near the cervix
  • certain blood disorders in the mother, such as sickle cell anemia or thalassemia
  • premature placental separation, known as placental abruption

Prevention

What can be done to prevent the condition?

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 placenta
  • alpha-fetoprotein (AFP) levels in a sample of the mother's blood
  • amniocentesis 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 cats
  • avoid alcohol, smoking, and illicit drugs
  • get 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.

Diagnosed

How is the condition diagnosed?

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

What are the long-term effects of the condition?

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.

Other Risks

What are the risks to others?

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 delivery
  • 5-fold higher risk of poor oxygenation at birth that may lead to cerebral palsy and other complications
  • hypothermia, or low body temperature
  • hypoglycemia, or low blood sugar
  • 30 to 40% chance of learning disabilities
  • premature delivery
  • poor tolerance of labor
  • increased chance of cesarean birth
  • increased chance of having birth defects
  • increased chance of meconium aspiration, in which the baby inhales some of the amniotic fluid during labor
  • polycythemia, which is an excess of red blood cells
  • hypocalcemia, which is too little calcium in the blood

Treatments

What are the treatments for the condition?

To treat this condition, the healthcare provider may recommend that the pregnant woman:
  • stop smoking
  • stop taking illicit drugs, such as cocaine
  • stop drinking alcohol
  • eat a healthy diet that includes more than 2500 calories per day
  • rest in bed during the day, lying on the left side as much as possible
  • take low-dose aspirin to prevent tiny blood clots from forming in the placenta, as well as to dilate, or open, the blood vessels
  • pay attention to the movement of the baby, any contractions, or rupture of the membranes ("breaking water") earlier than expected
  • deliver in a hospital setting
  • have the baby monitored electronically during labor
  • use as little anesthesia as possible and no narcotics during labor
  • have a cesarean birth or forceps delivery if fetal distress is detected

Side Effects

What are the side effects of the treatments?

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.

After Treatment

What happens after treatment for the condition?

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.

Monitor

How is the condition monitored?

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 contractions
  • biophysical profile done weekly or biweekly
  • Doppler umbilical artery waveforms, a special test for baby's health
  • pregnancy ultrasound scans every 10 to 14 days

Sources

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

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