The placenta is a temporary, unique organ that nourishes and protects the fetus. The functioning efficiency and maturity of the placenta by week of pregnancy are two interdependent concepts. The extent to which the child's place corresponds to the current period determines the subsequent actions of the doctors.
Degree of placenta maturity by week of pregnancy
On the 10th day after conception, the baby's place begins to form. By the end of the first month, the fertilized egg envelops tissue with specific villi - the chorion, and by the end of the third trimester maturation occurs. All necessary substances are supplied to the baby through chorionic fibers and blood vessels.As they mature and grow, the membrane increases for more complete intrauterine development. The degree of maturity of the placenta by week of pregnancy indicates the thickness and functionality of the embryonic organ.
The closer labor is, the thinner the membrane becomes. It stops its growth and the aging process begins. At earlier stages, such a pathology may indicate the presence of inflammatory reactions in the woman’s body.
Through ultrasound examination and subsequent analysis, the formation of a membrane from grade 0 to grade 3 is determined. Thus, until week 30, the stage 0 membrane must be smooth, uniform and without peeling, in order to fully function and perform its duties.
The doctors’ decision on the subsequent prescription of therapeutic actions depends on the diagnosed degrees. So, if stage 2 is detected at the beginning of the third trimester, this indicates premature aging and an expected danger to the child’s life.
Degree of placenta maturity by week: table and norm
The vital activity of the fetus largely depends on the development of the embryonic membrane. As the baby grows, the area and number of vessels feeding the baby increases, and the walls become thicker. At a certain point, the formation ends and natural rejection begins.The process involves the following stages, which are presented in the table:
| Maturity | Norm/week. | Structure | Chorionic tissue | Calcium deposits |
| 0 tbsp. | until the 30th | smooth, no damage | Smooth surface | completely absent |
| 1 tbsp. | 27 – 36 | slight compactions are observed | becomes slightly wavy | present in minimal quantities |
| 2 tbsp. | 34 - 39 | visually marked seals | laughing echopositive inclusions with a wavy structure | are observed to a large extent |
| 3 tbsp. | From 36th | high likelihood of cystic formations | deep waves | large clusters |
In cases where the membrane increases the rate of development, there is a risk of premature labor and oxygen starvation of the child (hypoxia). Doctors can extend the period of intrauterine gestation with the help of medications aimed at improving blood circulation so that the fetus can receive the missing nutrients.
Early maturation during pregnancy
Early maturation of the placenta during pregnancy indicates:- premature aging of the embryonic organ;
- loss of many functional capabilities (protection, oxygen supply, nutrition).
Rapid placental formation is characterized by wall thickness on ultrasound, which can be caused by toxicosis and carry the threat of miscarriage or malnutrition. The presence of diabetes mellitus or Rh conflict is determined by a thicker membrane wall.
Additional examination methods are used to confirm the diagnosis. Only after absolute confirmation of the existing threat is appropriate therapy prescribed in a hospital setting.
During pregnancy, the expectant mother’s uterus contains not only the baby, but also the placenta. To ensure the life of the baby, women have to “grow” an entire internal organ! Like a baby, the placenta grows, develops, and then... grows old and ends its life cycle.
Ideally, the development of the placenta parallels the development of the baby. But what if she is “in a hurry” or “late”?
How the placenta grows
The placenta is a special organ that, like the unborn baby, grows from the embryonic membranes. As a matter of fact, most of it, the one that dies after childbirth, also belongs to the fetus (the maternal part of the placenta is that area on the wall of the uterus to which it is adjacent with special outgrowths - villi). Since initially the child is just a few cells embedded in the loosened, blood-saturated inner surface of the uterus, then, of course, no placenta exists at this moment. The placental structure is formed gradually, but very quickly; So, by the time the fetus has its own heartbeat (and this is only the third week of pregnancy!), nutrients reach the baby precisely through the modified outer shell - the chorion.
Zero degree of placenta maturity
The baby grows, and the outer shell changes: in the place where it adjoins the wall of the uterus, it thickens, “branches,” and at 12-16 weeks it forms a full-fledged placenta. This is the placenta of the so-called “zero” degree of maturity.
Its thickness changes all the time: at the 12th week it is 11-20 mm, at the 27th, when the placenta can reach the next degree of maturity - 21-36. As you can see, the placenta can be of different thickness, and this is not necessarily a sign of pathology. That is why, if the pregnancy proceeds normally, then ultrasound diagnostic specialists in the first trimester do not pay special attention to the size of the placenta. A thin, “cake-shaped” placenta, or, conversely, a thickened, “spherical” placenta can be an individual feature of the body.
” But the structure of the placenta, on the contrary, is of fundamental importance: it must be homogeneous, without echogenic inclusions (i.e., during an ultrasound examination it looks like a single whole), and the surface facing the uterine cavity must be even and smooth. Ideally, it remains this way until the 30th week of pregnancy.
First degree of placenta maturity
On the 30th, an ultrasound specialist can state the first degree of maturity of the placenta. What does it mean? The placenta begins to change! Its structure becomes heterogeneous - compactions appear in it, which are visible during ultrasound examination, and the surface becomes slightly wavy. The thickness of the placenta at this moment is from 24 to 40 mm.
” These changes do not occur overnight - the doctor can detect the first signs of aging of the placenta at 27 weeks - this is the lower limit of the norm.
If the specialist is not sure that he is precisely observing the beginning of the aging process, he can note in the examination report “the degree of placental maturity 0-1.”
Second degree of placenta maturity
The second stage of placental maturity normally occurs in the 34th week of pregnancy and lasts until the 37th. At this time, the placenta changes even more: light “waves” on its surface become noticeable tubercles, and the heterogeneity of the internal structure is manifested by clear echo-positive inclusions, which are visible during ultrasound examination. The thickness of the placenta increases slightly - now the norm is a size from 28 to 50 mm.
Third degree of placenta maturity
The third, final stage of placenta maturity indicates impending birth. It is no longer growing, moreover, the area of the placenta is even decreasing. Its structure changes seriously: the surface becomes tortuous, the placenta itself is divided into lobes, and areas of salt deposition appear between them. The placenta is not just maturing - it is old and close to ceasing to function. It's time for the baby to be born and develop independently!
Premature aging of the placenta
If the structure and size of the placenta correspond to the stage of pregnancy, then everything is going according to plan: each stage of maturity is designed to meet the needs of the child at a specific stage of development. The fact that the placenta begins to “age” does not make the baby worse.
” So if your doctor tells you about this, don't panic! As long as nothing terrible happens, the placenta of the first degree of maturity copes with its “duty” - life support for the baby - no worse than before. Doctors are worried about the prospects: if the aging of the placenta began earlier, it means it will end earlier.
The second, and then the third degree of maturity of the placenta will be achieved before the baby is ready to be born, and then the child’s blood supply will deteriorate, his needs will not be met, and the child experiences hypoxia - oxygen starvation, which has a detrimental effect on his development.
” The danger is also that the mother, as a rule, does not notice the premature aging of the placenta - she does not experience any unpleasant sensations. That is why it is important to undergo diagnostic examinations in a timely manner.
Causes of premature aging of the placenta
There are many reasons for premature aging of the placenta, and they are very diverse. First of all, these are diseases that a woman suffered from before pregnancy, or that developed after pregnancy. These are diseases of the cardiovascular system, diabetes, hypertension, and infectious diseases.
Secondly, conditions accompanying pregnancy itself: gestosis, Rh conflict or hormonal imbalance. Multiple pregnancies are also sometimes accompanied by premature aging of the placenta.
Third - poor location of the placenta, for example, its . Partial placental abruption can also accompany premature aging.
Fourthly, mother's bad habits - consumption of alcohol, nicotine, drugs. It must be said that premature aging of the placenta is not the worst possible consequence, so try to get rid of these dependencies as soon as possible!
Finally, premature aging of the placenta contributes excess calcium in a woman’s body, so before taking any medications, including vitamins and microelements, be sure to consult with the doctor monitoring your pregnancy!
” Premature aging of the placenta occurs in every third mother at risk.
Premature aging of the placenta does not always require special therapy, but such a pregnancy requires additional monitoring by doctors. This is why expectant mothers are offered prenatal hospitalization. If fetal hypoxia is diagnosed, the doctor will prescribe medications to maintain the required level of blood supply to the baby.
Late maturation of the placenta
This pathology is much less common than premature ripening of the placenta, and doctors have differing opinions regarding its danger to the fetus. The fact is that back in the 60-70s of the last century, there was a belief among obstetricians that the degree of maturity of the placental tissues clearly indicates the degree of maturity of the fetal tissues. It was assumed that if the placenta has not reached the third degree of maturity, then, obviously, the child’s lungs are not yet adapted to independent breathing. Today this point of view is considered outdated.
” Indeed, late maturation of the placenta is occasionally observed in pregnant women with diabetes mellitus, Rh conflict, syphilis, as well as in cases of severe fetal anomalies. However, this is more likely a concomitant pathology, and not the cause of “mental retardation and stillbirth” - such an interpretation should be considered incorrect.
If after the 30th week of pregnancy the ultrasound specialist does not see any changes in the placenta relative to the zero degree of maturity, then attention should be paid to additional examinations. Perhaps the underlying disease (usually diabetes) requires additional medication.
But if late maturation of the placenta is the only sign of an unfavorable pregnancy, then there is no need to worry in vain. The immaturity of the placenta in itself does not indicate that the baby is not ready to be born. As we have already mentioned, the results of an ultrasound examination largely depend on the doctor’s experience, the quality of the equipment, and finally, on his subjective perception.
It is impossible to “age” or “rejuvenate” the placenta, but careful monitoring of its changes during pregnancy and, if necessary, timely medical intervention will ensure adequate blood supply to the baby until the very moment of birth!
Today, many mothers know far more about pregnancy than our parents knew. Therefore, many women during pregnancy worry about the state of their health, and are very worried if the doctor talks about the condition of such an important organ during pregnancy as the placenta. This organ performs the most important functions, and without it it is impossible to carry a pregnancy to term.
Deviations in the structure or functioning of the placenta can lead to 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 the placenta?
The term “placenta” itself comes from the Greek language and is translated by the simple word “cake”. Indeed, in 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 carrying a baby; it is due to the existence of the placenta that it is possible to carry and give birth to a child normally.
In terms of structure, the placenta, or, as it may be called differently in the literature, “baby 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 does the placenta work?
The main part of the placenta is special villi that branch in it and form from the beginning of pregnancy, resembling the branches of centuries-old trees. The baby’s blood circulates inside the villi, and outside the villi are actively washed by the blood coming from the mother. That is, the placenta combines two circulatory systems at once - the maternal one from the uterus, and the fetal one from the amniotic membranes and the baby. According to this, the sides of the placenta are also different - smooth, covered with membranes, with an emerging umbilical cord - on the fetal side, and uneven lobulated - on the mother's side.
What is the placental barrier?
It is in the area of the villi that an active and constant exchange of substances occurs between the baby and his mother. From the mother's blood, the fetus receives oxygen and all the necessary nutrients for growth and development, 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 fetus does not mix in any part of the placenta. The two vascular systems - the fetus and the mother - are separated by a unique membrane that is capable of selectively allowing some substances to pass through and retaining 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 approximately twelve weeks of pregnancy. The placenta retains bacteria and viruses penetrating into the maternal blood, special maternal antibodies that can be produced in the presence of Rh conflict, but at the same time the placenta easily allows the nutrients and oxygen necessary for the child to pass through. 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. Thus, many minerals actively penetrate from the mother to the fetus, but practically do not penetrate from the fetus to the mother. And also, many toxic substances actively penetrate from the baby to the mother, but practically do not pass back from her.
Hormonal function of the placenta
In addition to the excretory function, 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 as a whole - hormonal. Once the placenta begins to fully function, it can produce up to 15 different hormones that perform various functions during pregnancy. The very first of these are sexual functions, which help in maintaining and prolonging pregnancy. Therefore, gynecologists, if there is a threat of early pregnancy termination, always wait 12-14 weeks, helping in the early weeks of pregnancy with external hormones (duphaston or utrozhestan). Then the placenta begins to actively work 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 not without reason, by the time of 12 weeks the fetus weighs about 5 grams, and the placenta is up to 30 grams, by the end of pregnancy, at the time of birth, the size of the placenta will be about 15-18 cm, and the thickness will be 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 there are two arteries and one vein. The umbilical cord can attach to the placenta in several ways. The first and most common is the central umbilical cord attachment, but lateral or marginal umbilical cord attachment may also occur. The umbilical cord functions are not affected in any way by 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 membrane.
Problems with the placenta
Most often, the placenta and umbilical cord system work harmoniously and supply the baby with oxygen and nutrition. But sometimes malfunctions may 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 abnormalities in the development and functioning of the placenta and how to identify and treat them.
Placental hypoplasia
Reducing the size or thinning of the placenta in medical language is called “placental hypoplasia.” You should not be afraid of this diagnosis, because... it occurs quite often. The fetus is affected only by a significant decrease in the diameter and thickness of the placenta.
A significantly reduced placenta, a small baby's place, is uncommon. This diagnosis is made if the reduction in size is significant compared to the lower limit of normal for the size of the placenta at a given stage of 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 based on a single ultrasound; it can only be made as a result of long-term observation of a pregnant woman. In addition, it is always worth remembering that there may be individual deviations in the size of the placenta from 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 woman. In addition, there is no absolute proof of the relationship between placental hypoplasia and the presence of genetic disorders in the fetus. But when a diagnosis of placental hypoplasia is made, parents will be advised to undergo medical genetic counseling.
During pregnancy, a secondary reduction in size of the placenta may occur, which may be associated with exposure to various unfavorable factors during pregnancy. This could be chronic stress or fasting, drinking alcohol or smoking, or 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 when the placenta is underdeveloped, there is gestosis with the development of severe edema, high blood pressure and the appearance of protein in the urine.
Changes in the thickness of the placenta occur. A placenta is considered thin if it has insufficient mass but is of a size that is quite normal for its age. Often, such thin placentas occur with congenital defects of the fetus, and children are born with manifestations, which causes serious problems with the health of the newborn. But unlike a primary hypoplastic placenta, such children are not associated with the risk of developing dementia.
Sometimes a membranous placenta is formed - it is very wide and very thin, measuring up to 40 cm in diameter, almost twice as large as normal. Typically, the cause of the development of such a problem is a chronic inflammatory process in the endometrium, which leads to dystrophy (depletion) of the endometrium.
Placental hyperplasia
In contrast, a very large, giant placenta occurs, which usually occurs in cases of severe gestational diabetes. Enlargement (hyperplasia) of the placenta also occurs in diseases of pregnant women such as toxoplasmosis or syphilis, but this is not common. 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 Rh protein begin to attack the mother's antibodies. The placenta can increase significantly in case of thrombosis of its vessels, if one of the vessels is blocked, as well as in case of pathological growth of small vessels inside the villi.
An increase in the thickness of the placenta more than normal may be associated with its premature aging. Thickening of the placenta is also caused by such pathologies as Rh-conflict, hydrops fetalis, diabetes mellitus in pregnancy, gestosis, viral or infectious diseases suffered during pregnancy, placental abruption. Thickening of the placenta is normal in multiple pregnancies.
In the first and second trimesters, an enlarged placenta usually indicates a previous viral disease (or latent carriage of the virus). In this case, the placenta grows to prevent disease in the fetus.
The rapid growth of the placenta leads to its premature maturation and, consequently, aging. The structure of the placenta becomes lobular, 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 for placental hyperplasia usually involves careful monitoring of the fetus.
What is dangerous about changing the size of the placenta?
Why are doctors so worried about significant changes in placenta size? Usually, if the size of the placenta changes, functional insufficiency in the functioning of the placenta may also develop, that is, so-called feto-placental insufficiency (FPI), problems with the supply of oxygen and nutrition to the fetus, will form. The presence of FPN may mean that the placenta cannot fully cope with the tasks assigned to it, and the child experiences a chronic lack of oxygen and the supply of nutrients for growth. In this case, problems can grow like a 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 (intrauterine growth retardation in the fetus) or fetal growth restriction syndrome (FGR) will form.
To prevent this from happening, it is best to engage in advance prevention of such conditions, treatment of chronic pathology even before pregnancy, so that exacerbations do not occur during pregnancy. During pregnancy, it is important to control blood pressure, blood glucose levels and protect the pregnant woman as much as possible from any infectious diseases. You also need a good diet with enough proteins and vitamins.
When diagnosing “placental hypoplasia” or “placental hyperplasia”, careful monitoring of the course of pregnancy and the condition of the fetus is first required. The placenta cannot be cured or corrected, but there are a number of medications prescribed by a doctor to help the placenta perform its functions.
In the treatment of emerging feto-placental insufficiency, special drugs are used - Trental, Actovegin or Curantil, which can improve blood circulation in the placental system on both the maternal and fetal sides. In addition to these medications, intravenous infusions of drugs can be prescribed - rheopolyglucin with glucose and ascorbic acid, saline solutions. The development of FPN can have varying degrees of severity and should not be self-medicated; this can lead to the loss of the child. Therefore, it is necessary to follow all the appointments of the 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 located between them, and the lobules themselves are separated from each other by partitions, however, not complete ones. If changes occur in the formation of the placenta, new variants of the structure of the lobules may arise. Thus, the placenta can be bilobed, consisting of two equal parts that are connected to each other by 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 may be formed in a normal placenta. Even less commonly, a so-called “fenestrated” placenta may occur, which has areas covered with a membrane and resembling windows.
There can be many reasons for such deviations in the structure of the placenta. Most often this is a genetically determined structure, or a consequence of problems with the uterine mucosa. Prevention of such problems with the placenta can be the 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 have such a strong effect on the child during pregnancy, and almost never affect its development. But during childbirth, such a placenta can cause a lot of trouble for doctors - such a placenta can be very difficult to separate from the wall of the uterus after the baby is born. In some cases, separation of the placenta requires manual control of the uterus under anesthesia. Treatment for the abnormal structure of the placenta during pregnancy is not required, but during childbirth you must remind the doctor about this so that all parts of the placenta are born and no pieces of the placenta remain in the uterus. This is dangerous due to bleeding and infection.
Degree of maturity of the placenta
During its existence, the placenta goes through four successive stages of maturation:
Degree of placenta maturity 0- normally lasts up to 27-30 weeks. Sometimes at these stages of pregnancy there is 1 degree of placental maturity, which can be caused by smoking or drinking alcohol during pregnancy, as well as by previous infection.
Degree of placenta maturity 1- from 30 to 34 weeks of pregnancy. During this period, the placenta stops growing and its tissues thicken. This is a crucial period when any deviations can pose a danger to the health of the fetus.
Degree of placenta maturity 2- lasts from 34 to 39 weeks of pregnancy. This is a stable period when some advance in the maturity of the placenta should not cause concern.
Degree of placenta maturity 3- can normally be diagnosed starting from the 37th week of pregnancy. This is a stage of natural aging of the placenta, but if it is combined with fetal hypoxia, the doctor may recommend a cesarean section.
Disturbances in placental maturation
For each stage of placenta formation, there are normal periods 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 can be uniform or uneven. Typically, expectant mothers with underweight experience uniform premature aging of the placenta. Therefore, it is important to remember that pregnancy is not the time to follow various diets, since their consequences can be premature birth and the birth of a weak baby. The placenta will mature unevenly if there are problems with blood circulation in some of its zones. Typically, such complications occur in overweight women with prolonged late toxicosis of pregnancy. Uneven maturation of the placenta occurs more often 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 of diabetes mellitus in the pregnant woman, alcohol consumption 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 stone; such areas are called petrificates or placental calcifications. Hardened areas 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 due to premature aging of the placenta or postterm pregnancy. In such cases, the doctor will closely monitor the pregnant woman to exclude the development of fetal hypoxia. But usually such a placenta functions quite normally.
Low attachment and placenta previa
Ideally, the placenta should be located in the upper part of the uterus. But there are a number of factors that prevent the normal location of the placenta in the uterine cavity. These could be uterine fibroids, tumors of the uterine wall, malformations, multiple pregnancies in the past, inflammatory processes in the uterus, or abortions.
Requires more careful observation. It usually tends to rise during pregnancy. In this case, there will be no obstacles to natural childbirth. But it happens that the edge of the placenta, part of it, or the entire placenta blocks the internal os of the uterus. If the placenta partially or completely covers the cervix of the uterus, natural childbirth is impossible. Typically, if the placenta is abnormally located, 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 and fetal hypoxia. The most dangerous is partial or complete placental abruption, which leads to the death of the fetus and a threat to the life of the mother. , including sexual, you cannot exercise, swim in the pool, walk a lot and work.
What is placental abruption?
What is premature placental abruption? This is a condition when the placenta (normally or abnormally located) leaves its place of attachment before its due date, that is. In case of placental abruption, an emergency cesarean section is necessary to save the life of the mother and fetus. If the placenta has separated in small areas, then doctors try to stop this process, maintaining 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 abdomen, 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, which affects all organs and systems of the mother and fetus. It is important to remember that premature 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 - amniotic sac
Dense attachment and placenta accreta
Sometimes anomalies occur not only in the location, but also in the method of attachment of the placenta to the wall of the uterus. A very dangerous and serious pathology is placenta accreta, in which the placental villi are attached not only to the endometrium (the inner layer of the uterus, which peels off during childbirth), but also grow deep into the tissues of the uterus, into its muscular layer.
There are three degrees of severity of placenta accreta, depending on the depth of villous germination. In the most severe, third degree, villi grow into the uterus to its full thickness 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, cesarean sections, fibroids, as well as intrauterine infections and uterine malformations. Low placentation may also play a certain role, since in the area of the lower segments the growth 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 the dense attachment of the placenta, from the accreta, differing in the depth of penetration of the villi. Tight attachment occurs when the placenta is low or previa. The main difficulty with such attachment of the placenta is the delay in its birth or the complete impossibility of spontaneous passage of the placenta in the third stage of labor. If the attachment is tight, they resort to manual separation of the placenta under anesthesia.
Diseases of the placenta
The placenta, like any organ, can hurt. It can become infected, infarctions (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, does not happen often.
Infectious damage to placental tissue (placentitis) is caused by various microbes that can penetrate the placenta in various ways. So, they can be brought with the bloodstream, penetrate from the fallopian tubes, ascending from the vagina, or from the uterine cavity. The inflammation process can be spread throughout the entire thickness of the placenta or occur in its individual areas. In this case, treatment must be specific, and it depends on the type of pathogen. Of all the possible drugs, the one that is acceptable for pregnant women at this stage will be selected. And for the purpose of prevention before pregnancy, it is necessary to carry out comprehensive therapy for chronic infections, especially in the genital tract.
Placental infarction usually develops, like any other, as a result of prolonged ischemia (spasm of placental vessels), and then the areas of the placenta that receive blood from these vessels die as a result of oxygen deficiency. Typically, infarctions in the placenta occur as a result of severe gestosis or the development of hypertension in the pregnant woman. Placentitis and placental infarction can cause FPN and problems with fetal development.
Sometimes, as a result of inflammation or damage to the vascular wall, when blood viscosity is disrupted, or due to sudden movements of the fetus, blood clots form inside the placenta. But small blood clots do not affect the course of pregnancy in any way.
The placenta is called an embryonic organ, which is very important for the protection and development of the fetus. Its formation begins immediately after fertilization. The placenta ages naturally, reaching maturity by 37 weeks of gestation. In some cases, early aging of the placenta is observed; this condition is dangerous and requires treatment.
General characteristics of the phenomenon
The placenta begins to form approximately 12 days after conception, when the egg attaches to the wall of the uterus. During this period it is called chorion.
The formation of the placenta continues for the first 3 months, then it grows until the 8th month, after which the process of aging begins. This order is natural.
Aging of an organ means that its functional abilities decrease. This condition is dangerous, since the placenta is necessary to protect the fetus from infection, external damage, and ensure the supply of oxygen and nutrients.
It is fair to note that the ripening of the placenta ahead of schedule is quite rare. In some cases, such a diagnosis is made erroneously due to the incompetence of the doctor or incorrect interpretation of the examination results.
The maturation of the organ occurs in stages. Each stage has specific deadlines:
- 0 degree. The beginning of this stage is timed to coincide with the formation of the placenta, and it continues until 27-30 weeks.
- I degree. At this stage there is active growth of the placenta. It lasts approximately between 30-35 weeks.
- II degree. This period is considered the maturity of the placenta and lasts at 35-39 weeks.
- III degree begins after 39 weeks. The completion of this stage is childbirth.
Pathological aging of an organ is when degree II is diagnosed before 35 weeks or degree III before 39 weeks.
Early maturation is also often observed, when the first degree of aging of the placenta began at 27-29 weeks. This phenomenon can be considered the norm, but the further process of maturation of the organ and the compliance of subsequent degrees of aging with the deadlines established for them should be monitored.
Week 21 is often called the equator. At this stage, the placenta should be well formed and strengthened. The thickness of its walls should be approximately 23 mm, but not more than 30 mm.
At week 22, the thickness of the placenta should increase to 24 mm. If it exceeds 30 mm, then there is a risk of premature aging.
Subsequently, the thickness of the placenta walls should increase by 1-1.5 mm per week, reaching 36.5 mm by week 36. The maximum permissible upper limit at this period is 46 mm. If the thickness of the placental walls increases more than normal, then there is a risk of premature aging of the organ.
Causes
Aging of an organ ahead of schedule is a deviation from the norm. This condition can be caused by many factors:
- endocrine disorders;
- placenta previa, its partial detachment;
- low or polyhydramnios;
- infection;
- multiple pregnancy;
- exposure to toxic substances;
- gestosis (complication during pregnancy);
- impaired blood clotting;
- Rhesus conflict;
- chronic kidney disease, cardiovascular system;
- bad habits.
Premature aging of the placenta can be caused by either one of these factors or a combination of them. For proper treatment, it is important to identify the exact cause of the pathology.
It is almost impossible to independently determine the pathology. This condition is asymptomatic.
The main measure for identifying aging of the placenta that does not correspond to the prescribed period is ultrasound scanning. Such an examination is normally carried out three times during pregnancy, but if there are any violations, it is resorted to more often. Ultrasound scanning is safe, so there is no need to worry about the consequences of its frequent use.
The scan reveals thickening of the walls of the organ and the presence of calcifications in it. These deposits interfere with the full functioning of the organ.
Another important sign of pathology during ultrasound scanning is the condition of the fetus. The baby may be delayed in development, and his heart rate may deviate from the norm. Ultrasound examination allows you to assess the size of the fetus and its individual parts. This is important for assessing the degree of development and identifying its compliance with the norm or deviation from it.
To confirm the diagnosis, a blood test (general and coagulogram) is also performed. To identify disturbances in uteroplacental blood flow, Doppler ultrasound is performed.
Additionally, fetal cardiotocography is often prescribed. This measure is necessary to control the condition of the fetus. The study allows you to determine whether it has enough oxygen and nutrients.
What are the dangers of premature aging of the placenta?
Maturation of the placenta ahead of schedule can provoke the development of fetoplacental insufficiency. In this case, the risk of miscarriage increases tenfold, since the most important functions of the placenta are disrupted. This is especially true for the blood supply, if it is disrupted, oxygen and nutrients reach the fetus in insufficient quantities. This leads to a delay in his development.
Hypoxia of the fetus against the background of early aging of the placenta can cause fetal asphyxia. In this case, due to lack of oxygen, antenatal death occurs.
With abnormal aging of the placenta, there is a risk of premature birth, as the body receives certain signals. This is dangerous because the fetus is not yet able to function normally, so the chances of a favorable outcome are significantly reduced. But true premature aging of the placenta is extremely rare.
Premature aging of the placenta does not necessarily mean a threat to the fetus. If the violations are minor and do not have a negative effect on the fetus, then there is no need to worry. In this case, treatment may not be required; it is enough to monitor further aging of the placenta and the condition of the fetus.
Ultrasound specialist Susidko E.N. talks about the stages of placental maturation, the causes and degree of danger of the pathology:
Treatment methods
If the placenta ages earlier than expected, treatment is necessary. It is carried out in a hospital setting.
The goal of treatment in this case is to normalize blood flow and support the vital functions of the fetus. To achieve the required result, an integrated approach is required, including the use of the following means:
- Droppers to prevent oxygen starvation of the fetus. Usually they resort to Curantil or Actovegin. These drugs are important not only for the prevention of oxygen starvation, but also for the normalization of umbilical cord blood flow.
- Eufillin. This drug is a vasodilator and helps normalize metabolism in the placenta and microcirculation.
- Aspirin. Necessary for thinning the blood and improving blood supply.
If premature aging of the placenta is caused by infection, then appropriate drug therapy is necessary. To prescribe it, the pathogen is first identified.
The list of necessary medications can only be determined by a specialist, focusing on the diagnostics performed and the individual characteristics of the woman’s body and her pregnancy.
Even drug therapy is not able to reverse the process. Treatment is necessary to slow down the aging of the placenta, maintain its necessary functions and maintain pregnancy until a safe date of delivery.
If a pathology is detected, a pregnant woman must give up bad habits if she has not done so before. It is also important to strictly monitor your diet and daily routine, and spend more time outdoors.
Proper nutrition means avoiding fried, salty and smoked foods. It is better to steam food. Flour products and sweets should be excluded.
Stabilization of the psycho-emotional background is necessary. Stress and emotional overload should be avoided. If necessary, you can take sedatives. It is better to choose herbal remedies such as Persen or motherwort tinctures. Taking any medications should be discussed with your doctor.
Forecast
With timely detection of pathology and proper treatment, the prognosis is favorable. An important condition for this is compliance with the regime, proper nutrition and all doctor’s instructions. If these rules are followed, the birth will take place on time, and the baby will be full-term and healthy.
In most cases, with diagnosed pathology, drug therapy is sufficient. Severe complications may require premature delivery. This option is only appropriate in critical situations, when the risk of negative consequences is high, so there will be more benefit from the development of the fetus outside the womb.
Premature delivery is usually resorted to when the third degree of aging of the organ has occurred ahead of schedule. Childbirth is carried out by caesarean section.
Aging of the placenta is an inevitable and natural process, but it must occur in accordance with certain deadlines. Premature aging of the placenta can pose a threat to the health of the fetus, its normal development and even life. It is important to start treatment in a timely manner to maintain pregnancy and avoid possible complications.
The placenta is a unique organ that helps the baby grow, develop, receive all the necessary nutrients and even oxygen. It develops from a thin membrane (chorion) to a dense layer lining the uterine cavity. Since the placenta is the most important for the development of the child, doctors pay close attention to its condition. There are several, which she goes through with increasing pregnancy.
Degree of placenta maturation
The placenta is formed around the 12th week and takes on the functions of feeding the baby and regulating the mother’s hormonal levels. At the same time, the placenta is in the process of changes, adapting to the needs of the child. During screening ultrasounds, which are performed at 20 and 32 weeks, or more often, according to indications, specialists carefully assess the degree of its maturity. The fact is that changes can be not only natural, physiological, but also pathological. In this case, a decision is made to use medications or even emergency delivery.
How is the stage of placenta maturity determined?
The placenta in pregnant women has a certain structure, which is assessed by ultrasound. Zero degree of maturity corresponds to the placenta, which has a homogeneous structure without any inclusions. As a rule, such a placenta is observed from the beginning of the second trimester and persists up to 30 weeks. However, already from 27 weeks, changes in the structure of the placenta can be observed, echogenic inclusions appear, and slight waviness is noted. This is stage 1 placenta. Gradually, increasingly strong changes are observed in the placenta, large and small inclusions increase. Closer to childbirth, around 37-38 weeks of pregnancy, the placenta acquires a lobular structure, there are areas of salt deposits, this is the third degree of maturity. If the degree of change in the structures does not correspond to the deadline, then it is diagnosed.
First degree of placenta maturity
Sometimes, when the situation looks dubious, a specialist can record in the ultrasound protocol the degree of placental maturity 0 1 or placental maturity 1 2. If in terms of timing you are at the junction of different degrees of maturation, then this situation is quite normal. If the term is too early, the obstetrician who is monitoring your pregnancy will take all measures to slow down the maturation of the placenta, as well as to carefully monitor the baby’s condition. In addition, it is imperative to assess the state of the uteroplacental blood flow, this will confirm or refute the diagnosis.
However, the maturity of the placenta 1 allows the baby to be well supplied with nutrients, and often at this stage, premature maturation requires only observation. At the next ultrasound, the mother will be sure to check the degree of maturity of the placenta and, if necessary, adjust the treatment regimen.
The opposite situation is also observed, late maturation of the placenta, it is much less common, but still if after 34-35 weeks the placenta still remains in the first stage, experts may suspect disturbances in the development of the baby, as well as problems in the health of the mother. This condition also requires additional examinations.
The timing of placental maturation varies widely, and ultrasound is a subjective assessment method. However, if you suspect early or late maturation of the placenta, you need to double-check the diagnosis, conduct additional research, and, if necessary, treatment. This is the key to the baby's health.
