The key to a successful pregnancy and normal development of the fetus in the womb is the normal functioning of internal organs the expectant mother and the absence of any pathologies. The same applies to the placenta, the organ responsible for supplying oxygen and nutrients to the fetus. People also call this organ a “children’s place.” If for certain reasons the placenta does not cope with its functions, then doctors talk about its insufficiency or early maturation. What threat could this pose to the baby?

Reasons for early maturation of a child's place at 31-36 weeks

Normally, the placenta has 3 degrees of maturity and the fourth - zero. Until the 30th week of pregnancy, zero maturity of the organ is optimal, which means that the placenta copes with its functions and the pregnancy develops normally. As a rule, during a screening study of a pregnant woman at 31-36 weeks, she is diagnosed with placental maturity 1, which is also the norm. If at this stage the “baby place” has a second or even third degree of maturity, then this indicates that the organ is not coping with its functions and there are a number of reasons for this. These reasons most often include:

• leading an unhealthy lifestyle - smoking, drinking alcohol, drinking too much coffee;
• frequent stress;
• lack of sleep and significant physical or emotional stress;
• self-administration of medications, in particular antibiotics or analgesics;
• past viral infections and other diseases during pregnancy.

Dangerous consequences of early aging of a child's place at 31-36 weeks

It is the placenta that is a kind of “intermediary” between the mother’s body and the body of the unborn baby, therefore it is extremely important that this organ copes with its responsibilities before the birth itself - this will ensure the birth of a healthy baby. At a period of 31-36 weeks, the fetal cerebral convolutions improve, and with early maturation of the “children’s place” at this period the child receives an insufficient amount oxygen, which can lead to negative consequences:

• premature birth;
• , which may result in death;
• mental retardation and physical development against the background of insufficient blood supply to the placenta and the transfer of oxygen and beneficial nutrients to the fetus;
• infection of the fetus, since the placenta can no longer fully protect the child and “filter” substances entering the uterus.

Aging of the placenta: treatment at 31, 32, 33, 34, 35, 36 weeks

If early maturation of a child's place is detected by ultrasound, a woman should be under the constant supervision of doctors. Now antenatal clinic you will have to visit much more often, and, perhaps, even go to the hospital for a while. You should not refuse hospitalization if the gynecologist insists so, because every future mom interested in having a healthy baby on time.

Doctors cannot restore the original functions of the placenta during its early maturation, but their actions are aimed at restoring optimal blood flow in the vessels of the organ and maintaining the condition of the fetus in the uterus. For this, the patient is prescribed:

• intravenous administration of a glucose solution with vitamins for feeding the fetus;
• antispasmodics - to relax blood vessels and provide better access of nutrients and oxygen to the fetus;
• if necessary, medications used for respiratory failure are prescribed.

In addition to drug maintenance therapy, a woman should eliminate nervous stress, try to rest more and breathe fresh air.

Childbirth during aging of the baby at 31, 32, 33, 34, 35, 36 weeks

To assess the degree of risk to the fetus during early maturation of the placenta at 31, 32, 33, 34, 35, 36 weeks of pregnancy, in addition to ultrasound, a woman undergoes special studies - and. If the development of the fetus does not correspond to its gestational age and is delayed by 2 or more weeks, then the woman is required to be sent to a hospital for treatment. With the progression of pathology from the child's place and obvious signs If fetal hypoxia occurs, doctors can offer the patient a cesarean section earlier than expected - this will save the baby’s life and allow him to be delivered in an intensive care ward.

Irina Levchenko, obstetrician-gynecologist, especially for the site website

Diagnosis of the condition of the placenta during pregnancy is given special attention because it is the center life support future child. From the condition of the placenta directly The health status of the fetus also depends. In this light, the diagnosis “aging of the placenta” sounds like a death sentence for a pregnant woman.

placenta

The placenta is a unique organ that is developing and functioning exclusively during pregnancy. During a woman's pregnancy, the placenta goes through all stages of its evolution: formation, growth, aging, self-destruction.

The placenta is formed approximately 10-12 days after conception, immediately after implantation fertilized eggs into the wall of the uterus. Over the next 1.5 -2 months, there is an active process of placentation - that is, the gradual maturation of the placenta. By the end of the first trimester, the placenta already has a characteristic disc-shaped shape and fully performs the functions assigned to it by nature to protect and nourish the unborn baby.

Important: before the formation of the placenta begins, which means during the first 14 days after conception, fertilized the egg does not experience direct the influence of all those “harmful things” that the expectant mother allows herself. After the placenta has appeared, all toxic substances consumed by the pregnant woman (nicotine, alcohol) directly affect the health of the unborn child.

Finally having formed during the first three months of pregnancy, the placenta subsequently only increases in size proportionally fetal growth. By the end of pregnancy, its weight is approximately 17-18% of the weight of the fetus, and its size reaches 20 cm in diameter.

In the second half of the 3rd trimester of pregnancy, the placenta begins to “age”, which is due to the approaching delivery. Normally, the placenta performs its functions until the moment the baby is born, after which its mission is to life support the baby is considered complete and the placenta “dies” - ceases function and is expelled from the body of the woman in labor.

Aging of the placenta: how it happens

There are 2 types of placental aging:

Physiological- a normal stage in the evolution of the placenta, which begins no earlier than 36-37 obstetric weeks. The placenta gradually loses its functions due to the appearance of calcifications (salt deposits), reduction in area, and thinning.

Pathological or premature(early) - threatens the well-being of the unborn child and requires the earliest possible diagnosis and medical intervention. The diagnosis of “early aging of the placenta” is made only on the basis of ultrasound diagnostics. At the same time, doctors assess the degree of maturity of the placenta, which normally should correspond the following indicators:

Important: We can talk about pathologically early maturation of the placenta only if the gestational age clearly does not correspond to the identified degree of placental maturity: for example, before 26 weeks, 1 degree of maturity was detected.

How is the condition of the placenta diagnosed?

Only a doctor can give a qualitative assessment of the condition of the placenta based on an ultrasound examination, during which the following parameters are studied:

• location in the uterus;
• structure or degree of maturity;
• dimensions ;
• The thickness of the placenta - up to 36 weeks of pregnancy is approximately equal to the gestational age in weeks (fluctuations of 2 mm in both directions are acceptable).

Premature maturation of the placenta diagnosed, If :

• the placenta is more mature than it should be at this stage of pregnancy;
• a secondary reduction in the size of the placenta and its thinning was revealed.

But any of these conditions of the placenta can be classified as physiologically normal if it does not in any way affect the health of the fetus and does not cause discomfort to it. After all, it is the unborn child who is the “target” in case of pathology functioning placenta Therefore, any suspicion of early aging of the placenta is a reason to conduct additional studies using Doppler ultrasound and cardiotocography(CTG), with the help of which you can reliably assess the baby’s condition and the degree of its intrauterine suffering.

Important: A pregnant woman cannot independently determine the early aging of her placenta, because most often this condition is completely asymptomatic.

What is the danger untimely aging placenta

Fine evolution the placenta should correspond fruit ripening. The closer the moment of birth, the more ready the baby is to be born and the “older” the placenta becomes. If the placenta matures faster than the pregnancy develops, this means that soon it will not be able to fully meet the fetal needs for nutrition and oxygen. First of all, this will have the most deplorable effect on the health of the unborn child. The most common consequences of early aging of the placenta:

1. The child is born with insufficient body weight.
2. Diagnosed fetoplacental failure, due to which the fetus experiences a lack of oxygen and nutrients. Because of this, the health of the unborn child can be seriously affected. First of all, the baby’s nervous system and brain suffer from a lack of oxygen - in this case, we can talk about a delay intrauterine child development.
3. Labor may begin prematurely.
4. In severe cases, intrauterine fetal death may occur.

Important: For a pregnant woman, the best insurance against all unfavorable consequences pathological Maturation of the placenta is the timely completion of all ultrasound screenings and strict adherence to the recommendations of the attending physician.

Reasons for untimely aging of the placenta

The placenta is a formation rich in blood vessels; blood flow, exchange of nutrients and oxygen between the organisms of the fetus and mother continuously occur in it. Gradually, some of its parts seem to die off and cease to perform their functions. As a result, neighboring functioning areas of the placenta lie down and they, in turn, wear out faster. This is how progressive aging of the placenta normally occurs.

TO premature Aging of the placenta is caused, first of all, by those factors that negatively affect the condition of blood vessels, blood circulation and metabolism in general:

• endocrine diseases - diabetes, thyroid diseases;
• chronic heart or kidney disease;
• placenta previa - that is, its attachment near the internal uterine os;
• placental abruption - as a result of which the detached area does not perform its functions.

Factors that significantly increase the risk of the syndrome pathological aging placenta are:
any injury to the uterus from the outside: as a result of blows, falls; any injury to the walls of the uterus: as a result of previous abortions or complicated previous births; bad habits of the expectant mother: smoking and drinking alcoholic beverages; deficiency or excess body weight of the pregnant woman; diagnosed anemia in a pregnant woman; use of certain medications during pregnancy; gestosis; multiple pregnancy; previous infectious diseases during pregnancy.

Important: The combination of several of these factors greatly increases the risk of early maturation of the placenta in a pregnant woman.

What to do if you are diagnosed with “early aging of the placenta”?

1. Firstly, it is necessary to clarify the nature of the aging of the placenta in this particular case. Perhaps we are talking about physiological aging of the placenta - then this is a variant of the norm and does not require any intervention.
2. If the aging of the placenta premature, then the pregnant woman herself does not need to do anything. The treatment tactics and strategy are determined by the doctor. It is important for a pregnant woman to strictly follow all medical recommendations.
3. It may be necessary to undergo additional studies using Doppler ultrasound and cardiotocography to evaluate the degree intrauterine comfort of the unborn child. This is a smart step on the part of the doctor - after all, all further treatment (if necessary) will be aimed specifically at improving the condition of the fetus.
4. You should be more careful To recommendations doctors, which intend « rejuvenate placenta». This V root illiterate expression. Process aging placenta irreversible, Can only slow down his And prevent harmful consequences For child.
5. At easy degrees violations blood circulation V system « mother—child» Maybe limit yourself outpatient treatment And permanent observation with sides treating doctor.
6. IN serious cases pregnant woman doctor Maybe recommend lie down V hospital, to maximum eliminate fetoplacental failure. Not costs to risk health his future child And refuse from treatment – V like this case risk heavy consequences increases many times.
7. In time stationary treatment pregnant woman are introduced medicinal drugs With purpose improvements blood supply, saturation blood nutritious substances And oxygen. At necessity held treatment related diseases.
8. Emergency delivery – extreme measure, which applies only V case full loss placenta their functions. IN such situations caesarean section – the only one way save life future to kid.

Important: At timely detection early aging placenta And literate further conducting pregnancy Can to avoid practically everyone complications, related With this pathology pregnancy.

Video - what is the placenta and what is it intended for

Prevention premature aging placenta

Specific prevention this state Not exists. For Togo, to maximum secure myself And his child from all kinds of pathologies pregnancy, future mommy should only:

• exclude or minimize All factors risk early aging placenta;
• during pass All medical examinations And Ultrasound—screenings;
• follow recommendations treating doctor.

Premature aging placenta occurs for many reasons and can occur in any woman expecting the birth of a baby. This condition requires adjustment, but with a responsible attitude it allows you to carry and give birth to a child normally. A pregnant woman must follow all doctor’s orders and take care of her health.

Functions of the placenta

The placenta is an independent organ of the female body, unique in that it appears only during pregnancy. It has the shape of a disk and performs intermediary functions between the body of the mother and the child. This organ works in two directions - it delivers oxygen, vitamins, microelements and nutrients to the fetus and at the same time removes waste products.

The placenta completes its formation in the first 12 weeks after the zygote attaches to the walls of the uterus. Up to 8 months, the placenta continues to grow simultaneously with the growth of the fetus. The organ serves as a connection between the fertilized cell and the maternal body, is a barrier against infections and harmful substances and protects the fetus from mechanical damage. Early development placenta ahead of normal indicators leads to the fact that the child does not receive the protection and nutrition he needs.

Causes of premature ripening of the placenta

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One of the pathologies of pregnancy is considered to be premature (early) maturation of placental tissue, which threatens preterm pregnancy. It can be caused by one or more factors that complicate the gestation process. It can be:

• bad ecology;
• complications and threat of miscarriage due to abortion, endometritis, adenomyosis, fibroids;
• diseases of a pregnant woman (somatic or endocrine);
• functional disorders (cyst, adnexitis, other ovarian diseases);
• infectious diseases, both genital and respiratory, rotavirus.

There is a high probability of early aging of the placenta in patients with diabetes mellitus, hypertension, impaired renal function, hypo- and hyperthyroidism. Chronic gestosis increases the load on the uteroplacental complex and forces the baby's place to work with greater activity. In the first trimester, the body compensates for this load, and then the blood supply to the fetus deteriorates, and accelerated growth begins, and then premature maturation of the placenta.

The problem of premature development of the placental organ is typical for cases of isoserological incompatibility between mother and baby. When does it occur with different Rh factors in the blood? hemolytic disease, the fetus needs a more intensive blood supply, the load on the organ increases, and the aging of the placenta accelerates. Premature placental maturation poses a serious risk of miscarriage.

The placenta matures early in women who smoke, as well as those who are overweight or underweight. Those who do not lead are also susceptible to pathology. healthy image life, moves little, drinks alcohol, drugs, as well as pregnant women who limit their diet, for example, not eating meat. The risk increases under hazardous working conditions: heavy physical activity, strong vibration, chemicals, radiation. Early maturation of the placenta in the first and second trimesters can be compensated.

Degrees and signs of premature aging of the placenta

The placenta normally develops according to a schedule in accordance with the week of pregnancy:

• formation and growth - in 1-2 trimesters;
• active growth - at 30-35 weeks;
• maturity - at 35-39 weeks;
• aging - until the moment of childbirth.

Doctors examine the condition of the organ for a period of 5-6 months, with 21 weeks considered the so-called equator. At this moment, the placenta reaches a thickness of 23-30 mm, it is well developed and attached to the wall of the uterus. If the placenta matures ahead of schedule, this is considered a variant of the norm. Premature ripening sometimes begins as early as 27-29 weeks, but it does not require intervention - medical supervision is sufficient.

Further growth occurs with a regularity of 1-1.5 cm in 7 days. The thickness of the placenta walls reaches 36.5-46 mm at 8-9 months. If growth occurs faster, then the risk of placenta aging ahead of normal dates increases. This means that the woman’s body and the child’s place work under increased load.

There are 3 degrees of pathology. The first degree means that the organ begins to age while still in the active growth phase. The second degree is detected in the phase of placenta maturity, when gas exchange decreases, and the child may experience oxygen starvation. The third degree occurs when the aging organ begins to prepare for the birth process. Sometimes doctors have to resort to caesarean section to save the baby's life.

Based on her state of health and external signs, the woman does not notice the development of pathology. It is possible to diagnose accelerated maturation of an organ using ultrasound, which is why it is so important not to miss the follow-up examination.

Fetal movements in the abdomen can indicate the presence of abnormalities. If the child is too active or moves unusually little, then such changes indicate oxygen starvation. This is how stages II and III of premature maturation of the placenta manifest themselves.

There are also cases of delayed development of the placental organ. Doctors determine why this happens with the help of a comprehensive examination, but the reasons are identical - infections, chronic diseases, disturbances in the functioning of the hormonal and endocrine systems of the body. If the gestation period is long, then hospitalization is indicated for an immature placenta.

How dangerous is this phenomenon?

The first degree of premature aging of the placenta does not require urgent intervention, because does not threaten the life of a woman or the safety of pregnancy. It can become a reason for the development of malnutrition - a slight growth retardation. The onset of the second degree is dangerous when the old baby’s place is diagnosed before 32 weeks, or the third - before 37. If the pathology progresses, then the weak degree threatens to become more severe, so it is important to see a doctor in time and follow his instructions.

The main danger is the oxygen starvation of the fetus associated with the pathology. With hypoxia, developmental delays and a decrease in the rate of development of the child are possible. The stronger the signs that the placenta has matured ahead of time, the higher the danger, because The blood supply to the baby's place deteriorates, and disorders may develop that lead to premature birth and, in rare cases, to fetal death.

What consequences threaten if the placenta matures prematurely is difficult to predict. The process can be slowed down, but if you do not pay attention to this, the child will suffer. In severe cases, placental abruption begins and the amniotic fluid, urgent medical attention is required. Early maturation in in this case does not mean that the child will develop faster and better than normal. Indications for urgent consultation with a doctor are the cessation of the child’s movements or his active movements.

Diagnostic measures

The maturation of the placenta is almost invisible to the expectant mother. It is also not determined by a blood test or external examination. Ultrasound helps to identify pathology. Instrumental methods can detect thickening of the walls of the organ, which is why routine screening is so important.

If suspicion arises, the doctor may prescribe an additional Doppler examination. This technique allows you to check the state of placental blood flow, assess whether the growing child is sufficiently supplied with oxygen and useful substances. Dopplerography helps monitor the stages of pregnancy.

The condition of the baby in the womb can also be used to judge the normal course of the pregnancy process. For this purpose, cardiotocography is used - a method of monitoring the vital activity of the fetus. Doctors listen to his heartbeat, count his movements, detect hypoxia and assess its degree. To clarify the diagnosis, a biochemical blood test of the expectant mother may be prescribed.

Treatment of early aging of the placenta

If a woman is diagnosed with early maturation of the placenta, doctors prescribe maintenance therapy. Treatment consists of overcoming fetoplacental insufficiency and eliminating the problems that caused the pathology. It is necessary to eliminate harmful factors, quit smoking and avoid passive smoking, treat infections, and fight late toxicosis.

If the cause of early aging is a woman’s chronic disease, then it is necessary to adjust the intake medicines or choose other medications, strictly follow a diet. At the same time, medications are prescribed to improve placental blood flow. At this time, it is better to go to the hospital and be under constant medical supervision. It is recommended to take vitamins and medications that reduce the tone of the uterus.

Features of pregnancy and childbirth

With a correct and attentive attitude to one’s own health, the discovery of an aging child’s place will not become an obstacle to a successful pregnancy. It is important to follow your doctor's orders, lead a healthy lifestyle, eat well and get adequate rest. Using a blood test, the doctor will determine what the body is lacking and prescribe vitamins and drug therapy.

With this diagnosis, the gynecologist regularly monitors the stages of placental development and fetal growth. An additional examination may be prescribed, and the woman is often admitted to the hospital for safekeeping. All this does not prevent you from giving birth to a child naturally on time. Maintenance therapy helps overcome dangerous manifestations of pathology.

Premature aging of the placenta - this term scares Russian doctors of many expectant mothers. Why is this diagnosis so dangerous, on what basis is it made and how is the pathology treated?

The placenta, popularly known as the “child’s place,” is an organ that is formed in a pregnant woman and functions until the birth of the child. It is thanks to the placenta that nutrients and oxygen can be delivered to the baby. And the baby’s development depends on the condition of the placenta. If he does not have enough nutrition, there is a high probability of delaying his development, and in severe cases, even death.

How and why the placenta ages

During pregnancy, the placenta changes and slowly develops its resource. Doctors know 4 degrees of placenta maturity: 0,1,2,3. 0 - the placenta is in perfect order. Grade 3 usually occurs at 38 weeks or more. These degrees are determined by the ultrasound diagnostic doctor. The structure of the placenta, its structure, and thickness are taken into account. Premature ripening of the placenta is diagnosed at the slightest deviation from the norm.

Why does the “childhood” of some women quickly “grow old”? Usually a whole range of problems are to blame. This is the uncontrolled use of various medications (including dietary supplements, vitamins), viral diseases (influenza, acute respiratory infections, ARVI, etc.), smoking, drinking alcohol and drugs, etc. But more often, the causes of premature aging of the placenta remain unclear .

How dangerous is the pathology and what are its consequences?

Perhaps we need to start with how this diagnosis is made correctly. Many doctors write it without any reason. And the maturation of the “baby place” is considered accelerated if the degree of maturity at a period of up to 32 weeks exceeds the second, or the doctor puts the third degree at a period of less than 36 weeks. And then, this “diagnosis” is not a diagnosis at all, but a point to which the doctor should pay attention, and, most likely, conduct additional examination. And this is an ultrasound with a study of fetal blood flow and cardiotocography (CTG). That is, premature aging of the placenta at 32, 33, 34 weeks is not a death sentence at all, and often not even a reason for concern. As for incorrect diagnoses, our Russian doctors are very fond of talking about this pathology, giving the first degree of maturation at up to 30 weeks instead of zero. It is not right. What consequences of premature aging of the placenta are still possible? It all depends on how bad the condition of the placenta was and what specific disturbances in the child’s development it led to. Most often, this is the birth of low birth weight babies.

How to treat?

Unfortunately, it will not be possible to return the “children's place” to its original state. Many mothers, having read about the dangers of premature aging of the placenta, ask their doctor to prescribe medications that will help the baby receive the nutrients and oxygen it lacks. But you should try to do something only if there are signs of fetal suffering. And they are detected by Dopplerography and CTG; ultrasound also helps in diagnosis, because with its help you can measure all parts of the child’s body and tell with a very high degree of probability whether he has a developmental delay. If yes, and it lasts more than 2 weeks, the woman will be admitted to a hospital for treatment. In difficult situations it may be suggested C-section before the expected date of birth.

How is this pathology treated? As we wrote earlier, the placenta cannot be “cured.” But the baby can be helped a little. For this, the woman is given glucose preparations, some medications that are prescribed for respiratory failure, and also those that reduce the tone of the uterus.

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Pregnant women are afraid of the “old placenta” like fire, because most of them will be sent to a hospital, where they will be even more frightened by the possible loss of the child, its retardation in growth and development, and, of course, more than one liter of physiological solutions will be injected into the woman’s body together with others medicines. They will “rejuvenate” the placenta! Apparently, many doctors have no idea that “rejuvenating” the placenta is a manifestation of illiteracy.

Let's talk about the structure of the placenta and which placental inclusions are normal and which are not. The placenta develops gradually from trophoblast villi in the first and second trimesters of pregnancy; that is, the growth and development of the placenta is a process that takes a certain period of time. The specific mechanism of blood supply allows the exchange of oxygen and nutrients between mother and child without mixing two different circulatory systems - mother and fetus. Thus, the placenta is a kind of bridge between the mother’s body and the baby’s body. Since the placenta is a derivative of the fetus, that is, it develops from certain cells of the fetal egg, often with disorders of fetal development, disturbances in the development of the placenta are observed, as well as changes that are not signs of a “normal” placenta.

The placenta has the unique ability to perform its function even if abnormalities occur on the part of the mother or fetus, as well as with partial damage or detachment. The presence of inclusions in the placenta is not always a sign of poor function, since the function can be performed efficiently until the end of the entire pregnancy. Doctors often talk about placental insufficiency based on only one ultrasound sign, without even looking at the condition of the fetus. The worst thing is that medications are prescribed that have nothing to do with the treatment of placental insufficiency.

Let's discuss the question of what it means to be “deficient” of something from a medical point of view. When they talk about kidney, heart, or liver failure, they mean, first of all, functional failure, that is, the organ ceases to fully perform its function. If an organ does not perform its function, who suffers from it? Naturally, the entire body of a sick person. When we talk about the function of the placenta, what is its role? First of all, the exchange of nutrients, oxygen, carbon dioxide between mother and child. Secondly, the protective function - the placenta does not allow many substances and microorganisms to enter the fetal body, being a good barrier. Thirdly, the placenta produces a number of important biological substances that are necessary for the normal development of the child and the course of pregnancy in general. If the placenta does not perform its function correctly or completely, then who will begin to suffer from such a problem? Not mother! Child first. How does the child suffer? Without receiving enough substances and oxygen, he may be stunted in growth or may show signs of oxygen starvation - hypoxia. Often, ultrasound doctors do not look at the development of the fetus, but after “digging” in the placenta and uterine vessels, they immediately issue a conclusion: placental insufficiency. What about the fruit? If the heart rate is indicated (and it is almost always normal), then this is already good. And this is how they usually write: “The fruit is without features. No pathology was detected." And not a word more. So, if nothing bad is detected on the child’s part, doesn’t this mean that the placenta is coping with its function and the baby is growing and developing as expected?

If we talk about the functional failure of an organ, it can occur acutely or develop gradually (chronically). Acute failure is serious condition requiring emergency assistance. Acute placental insufficiency occurs when placental abruption, especially damage large sizes. In most of these cases, the only treatment option will be urgent delivery, and saving the child and mother (due to bleeding).

Chronic functional failure occurs slowly, without serious danger to the human body, until all compensation mechanisms stop working. For its development there must exist certain conditions: organ failure, ever-present risk factor, time. For example, heart failure cannot occur in a person with healthy heart and normal blood pressure even in old age. Against the background of cardiovascular diseases, heart failure is a complication and often requires serious measures in terms of treatment.

If a person abuses alcohol, then the liver and pancreas for a long period of time compensate for the load and increased metabolic process, neutralizing alcohol in the body, but with damage at the level of the cells of these organs in the form of pancreatitis and cirrhosis of the liver, liver failure, pancreatic insufficiency and a number of other problems. Impending functional failure of an organ can be recognized using a number of diagnostic tests, biochemical indicators of blood and other body fluids, since all processes in our body, including disease, begin at the level of chemical reactions. With regard to chronic placental insufficiency, certain prerequisites must exist in order for this deficiency arose and developed to the extent that deviations in the development of the fetus appear. What are these prerequisites? On the maternal side, these can be general diseases, most often high blood pressure (pregnant hypertension) and diabetes as well as smoking, drug use, and alcohol use. These can also be infectious diseases, especially acute viral diseases. On the part of the child and the placenta, these may be malformations of the placenta or fetus, fetal hydrops, placental abruption, and a number of other problems. Again, not all women with high blood pressure experience placental insufficiency, especially if the woman controls her blood pressure with medications.

Thus, changes in the placenta do not mean poor function of this organ, and vice versa, the absence of changes does not always guarantee good functioning of the placenta. And the criterion for assessing the work of the placenta will always be the state of the “final result” of its function - the condition of the fetus. Of course, there are other assessments of placental function, but these are not necessarily the levels of some hormones that some doctors check so carefully. The approach to the study of any issue should be comprehensive, not superficial, and have a logical sequence. If the condition of the fetus is normal, it is unlikely that the pregnancy is threatened by some kind of placental insufficiency, and even more so against the background of excellent health of the mother and the absence of bad habits. Therefore, sometimes the conclusions of some doctors about placental insufficiency against the background of good development child and wellness mother. Such conclusions bring nothing but chaos and fear into the life of the expectant mother and, moreover, lead to the creation of a vicious circle of endless examination and treatment.

What, in fact, “scares” doctors, especially ultrasound doctors, about the placenta so much that they immediately suggest that the woman undergo intensive treatment (the same for all cases). It is not the disease that is being treated, but the ultrasound signs! Most of all, doctors “cling” to the thickness of the placenta and its inclusions - “calcifications”, by which they judge its old age.

Up to 20 weeks, the placenta grows and develops, so most often the size and thickness of the fetal place, as well as the place of its attachment, are examined using ultrasound later, after 20 weeks, if the pregnancy is not accompanied by bleeding or fetal growth retardation. If pregnancy proceeds with complications, examination of the placenta using ultrasound is carried out earlier.

The placenta weighs 1/6-1/7 of the weight of the fetus and at birth weighs 500-600 g. On the maternal side, it has about 20 lobules. The umbilical cord is usually attached in the center of the baby's place, and in rare cases in other places in the placenta.

So, what is usually looked at and measured on an ultrasound, and why are conclusions made that sometimes do not correspond to the truth? How do you know if the research was done correctly or with errors? It is always important to know the placement of the placenta, and most often women are terrified (because they are diligently frightened) of placenta previa, when the attachment and formation of the placenta occurs very close to or in the area of ​​the internal os of the cervix. Fortunately, in most cases, as the placenta grows, its edges “migrate,” that is, they move away from the cervix, which is a good sign regarding the prognosis of pregnancy. But even if a woman has central placenta previa, this does not mean that she should lie almost motionless throughout her pregnancy. It is extremely rare that there is a need to “preserve” pregnancy using strict bed rest. Bed rest, on the contrary, has too much side effects and serious complications, and should not be abused under any circumstances.

Further, doctors often scare women with hypertonicity of the uterus, especially at the placenta insertion site. “It’s terrible, I have hypertonicity of the uterus and I’m being put on hold!” The fact is that at the site of attachment of the placenta, the structure of the internal lining of the endometrium has a certain specificity, and the muscular layer of the uterus can and should be “slightly tense.” This place contains a large number of venous vessels and is called the retroplacental complex. It is precisely this that is very often confused with muscle contractions of the uterus and is called “hypertonicity.” The use of color Doppler ultrasound helps to see the difference between the retroplacental complex and local (local) contraction of the uterus. In addition, the use of ultrasound sensors, irritation of the anterior wall of the abdomen and cervix with vaginal sensors can provoke contractile activity of the uterus, which an inexperienced doctor will “attribute” to hypertonicity.

Doctors are interested in the thickness of the placenta - there are also many “scary” conclusions here. Since the formation of the placenta is usually completed by fourth month pregnancy, then the thickness is measured at the formed placenta, and not before, with the exception of those cases where the size of the placenta goes beyond the acceptable limits for a mature placenta. Normally, after 20 weeks, the thickness of the placenta should be from 1.5 to 5 cm. Some doctors take 4 cm as the upper mark, however, in most cases, a thickness of up to 5 cm will not be a pathology (and normal fetal development will be evidence of this norm). Again, errors in measuring placental thickness begin with incorrect markings on the ultrasound image. Sometimes the ultrasound shadow of the fetus, especially when the placenta is attached to the posterior wall of the uterus, is mistaken for the placenta, and the muscular layer of the uterus and the retroplacental uterine complex will also be mistakenly considered as part of the placenta. If the thickness measurement is not carried out strictly perpendicular to the walls of the placenta, then the thickness may also be determined incorrectly. The thickness of the placenta also depends on its shape, and the shape can be in the form of a cake (then the placenta is thin) or spherical (then the placenta is thicker). In most cases, these types of children's places are not a pathology unless other changes or abnormalities are detected in them.

The retroplacental complex (RPC) is a very important part of the uterus, which includes a portion of the inner lining of the uterus, the muscular layer of the uterus and contains a large number of vessels that collect venous blood from the placenta. The width of the retroplacental complex can reach 1 cm, and the RPC is often mistakenly included in the “composition” of the placenta when measuring its thickness. In addition, RPC can be taken not only for “hypertonicity”, but also for hemorrhage, fibromatous nodes and other inclusions.

A “thin” placenta (less than 1.5 cm) is observed less frequently than a “thick” placenta, and is often the result of a malformation of the fetal place. The fetus is usually stunted. Rarely, a thin placenta is observed with this serious complication, like preeclampsia, which we will talk about in another chapter. This type of placenta can occur in women with congenital diabetes mellitus (Type 1).

A “thick” placenta (more than 5 cm) occurs in a number of diseases of the mother and fetus (acquired diabetes mellitus (Type 2), “Rh-conflict”), and may be a sign of edema of the fetal place in a number of cases viral infections mother (we are talking about primary infection with viruses, and not carriage of viruses), as well as with syphilis. In women with high blood pressure (hypertension), the placenta may be spherical in shape, so its thickness is often increased. A number of malformations of the placenta may be accompanied by greater thickness.

If the thickness of the placenta is more or less than the permissible norms, hasty treatment cannot be prescribed, because it is impossible to “cure” the placenta, just as it is impossible to rejuvenate it. Therefore, applications for “placenta treatment” are a manifestation of medical illiteracy. In addition to thickness, it is always important to take into account the structure of the placenta, and as I mentioned earlier, the condition of the baby. And here another unpleasant surprise awaits pregnant women - calcifications. “Oh, you, dear, have so much calcium. We will look for hidden infections. We will rejuvenate the placenta, otherwise you won’t carry it to term” – aren’t these the words most often heard by an “unhappy” pregnant woman?

By 12 weeks of pregnancy, the placenta becomes uniform in structure (homogeneity), but from the middle of the second trimester and in the third trimester, inclusions or formations may appear in the placenta, which will not always be a sign of something bad and dangerous for the fetus - in the form of cysts or lumps. The doctor’s task is to clearly determine the difference between “bad” and “good”, and monitoring the condition of the placenta and fetus over a certain period of time (2-4 weeks) will help him in this.

The deposition of calcium salts (phosphates) in the placenta is a normal, physiological phenomenon, and by the end of the second - beginning of the third trimester, calcium deposits can be noticed in the placenta in 50% of women; at the time of birth, in more than 75% of cases, the placenta has calcium deposits inclusions.

The problem is also that when performing an ultrasound, the homogeneity of the placenta and the presence of calcifications will depend on the “technical setting” of the contrast of the image on the screen of the ultrasound machine. To understand this, remember how the image of a black and white screen changes if you add contrast or reduce brightness. In such cases, the image “ripples”, doesn’t it?

Previously, the degree of placental calcification determined the maturity of the fetal lungs, that is, the child’s readiness for life outside the uterus. However, many studies have shown that there is no relationship between the amount of calcium deposits and the maturity of the fetal lungs. The classification of the degree of maturity of the placenta is used less and less in practice, since the determination of the degree (gradation) of maturity depends on what the specialist performing the ultrasound sees, that is, this is a subjectively dependent determination. When doctors found out that the degree of maturity of the placenta does not have much practical significance in relation to the prognosis of pregnancy, it was assumed that the degree of maturity of the placenta is important in cases of maternal diseases (hypertension, diabetes mellitus, etc.), as well as in cases of growth and development abnormalities fetus But it turns out that these statements do not have serious clinical evidence, that is, this is just a theoretical assumption - practice shows that it is not placental calcification that is important in relation to pregnancy prognosis. But if you have been diagnosed with the degree of maturity of the placenta, then you should know that the norm is considered to be 1 and 2 degrees of maturity after 27 weeks of pregnancy, and 3 degrees of maturity after 32 weeks of pregnancy. If your maturity level is less, it’s okay, no need to worry. At the time of birth, half of the placentas with calcifications have the first degree of maturity, in almost 40% of cases the placenta has the second degree of maturity, and up to 20% have the third degree. This means that after 32 weeks, the first, second and third degrees of placental maturity are a manifestation of the norm. Therefore, the practical significance of determining the maturity of the placenta decreases significantly with the progress of pregnancy.

Rumors that the placenta of primiparous women has fewer calcium inclusions compared to the placenta of multiparous women has also been refuted by clinical studies. The number of calcium inclusions does not depend on the number of pregnancies. Also, no relationship was found between the number of inclusions and the age of the pregnant woman. The dependence of placental calcification on the season of the year has not been confirmed, although this was suggested in earlier clinical studies in the 70-80s.

Premature placental maturity is observed in pregnant women who smoke (5-15 cigarettes per day), and in such women, stage 3 placental maturity at the time of birth is more common. It is known that many women who smoke give birth to children with stunted growth, that is, small children. But when the placentas of the third degree of maturity of smoking women were compared with non-smoking women, the number of fetuses that were stunted was the same in both groups. This means that it is not the degree of vision (“aging”) of the placenta that plays a role in intrauterine growth retardation.

Returning to calcifications, their deposition is a normal (I repeat, normal) process of maturation (not aging!) of the placenta. Because if you find fault with the word “aging,” a logical question arises: doesn’t the fetus, with growth and development, age every day? Doesn’t a pregnant woman grow old during these nine months of bearing her offspring? So let's call a spade a spade. Modern obstetrics does not recognize placental calcification as a pathological sign.

There may be other inclusions in the placenta, which are not always a sign of a serious problem. For example, inclusions of fibrin (a breakdown product of blood) are often found, which is the result of small hemorrhages into the placental tissue in the form of tumor-like or thread-like deposits. Accumulations of blood (hematomas) as a result of small infarctions of the placenta occur in 25% of cases towards the end of pregnancy and at the time of birth.

Of all placental tumors, two types are more common: chorioangioma and teratoma. Small tumors most often do not affect the course of pregnancy. Women whose tumors are large require careful monitoring.

Cyst-shaped inclusions are also often detected during ultrasound. Single cysts usually do not pose a risk for pregnancy. Multiple cysts require medical attention and observation, as they may be a manifestation of trophoblastic disease. Hasty conclusions should not serve as a reason for premature termination of pregnancy.

With regard to the pregnancy prognosis (and this is what women are most often interested in), it is important to understand that from the point of view of modern medicine (I repeat: modern medicine, and not the medicine of 20 years ago) the placenta is abnormal. When it comes to the shape and structure of the placenta, the number of lobes is abnormal, because normally, although the baby’s place has up to 20 lobes, as a whole it consists of one large lobe. Two or more lobes of the placenta are not common (up to 3% of cases), usually one lobe is more developed, and the other is additional. In such cases, the woman is at risk for placental abruption and bleeding. There are also a number of other pathological forms of the placenta.

The size of the placenta also plays a role in pregnancy prognosis. Some doctors tried to measure the volume of the placenta, but it turned out that the volume of the placenta does not play a significant role in the performance of its function. And the place where the placenta is attached plays a role, it correct height and development, which is easier to determine by measuring the thickness of the placenta.

Placenta accreta poses a particular danger. Normally, between the placenta and the muscular layer of the uterus there is a corresponding layer that does not allow chorionic villi to penetrate into the muscular layer of the uterus. But in a number of cases, the development of this “protective” layer is disrupted, and such a disruption is most often observed in women who have undergone uterine surgery (cesarean section, removal of fibromatous nodes, abortion). In 2/3 of cases, not only placenta accreta is observed, but also placenta previa.

There are three forms of placenta accreta, depending on the degree of penetration of the chorion into the wall of the uterus and even beyond it: placenta accreta, placenta increta, placenta percreta. The last two types of placenta are the worst option, when the placental villi penetrate the entire muscular layer of the uterus, reaching the outer lining and beyond the uterus. Such a placenta can grow into bladder or rectum, causing bleeding from these organs. Doctors mistakenly make other diagnoses (kidney stones, hemorrhoids, etc.), which leads to incorrect management tactics for such pregnant women. Therefore, if bloody discharge appears in urine or feces, it is necessary to undergo a thorough examination. Previously, in most cases, such a pregnancy ended in termination with the removal of the uterus and part of the damaged organ, but recently doctors have begun to use conservative treatment methods - after childbirth, the placenta is left in the uterine cavity and in some cases chemotherapy is prescribed.

In addition to changes in the placenta, changes in the membranes and umbilical cord can also be a manifestation of both normal and abnormal conditions. If any abnormalities in the development of the fetus are detected, a decision must be made to continue the pregnancy or terminate it, taking into account the duration of the pregnancy and the viability of the fetus outside the mother's body. If the fetus develops normally, without growth retardation, then such a pregnancy can be observed until birth.

Returning to the issue of placental insufficiency, I would like to touch upon the modern point of view on biochemical indicators of placental function, which are still used by some doctors in post-Soviet countries. In the late 60s and early 70s, a number of countries measured the level of the female hormone estriol, and it was assumed that women with low levels of this hormone had a significantly lower chance of bearing and giving birth to a child than with normal levels of this hormone. However, as practice has shown, this type of diagnosis had low sensitivity for most pregnancy complications, that is, in a number of serious obstetric problems, estriol levels were normal. In addition, it turned out that women with a normal pregnancy and normal outcome may also have low estriol levels. The course and outcome of pregnancy does not depend on the level of estriol. Therefore, this type of analysis has lost its practical value.

A little later, they began to determine another hormone - placental lactogen, however, in this direction, the data obtained were very contradictory and insignificant. It turned out that clinical studies to determine the relationship between lactogen levels and pregnancy outcomes were carried out very chaotically, with large errors. In addition, it turned out that deviations in lactogen levels from the norm were in the same number of women, both in the high-risk group and in the no-risk group. The outcome of high-risk pregnancies was taken into account, leading to the suggestion that lactogen levels are associated with poor pregnancy prognosis. But the pregnancy outcome in other groups (low risk and control) was missed, which from a scientific point of view reduces the practical value of such a clinical study to zero. Unfortunately, some doctors in post-Soviet countries still use the determination of biochemical blood markers to determine the function of the placenta, while abroad this type of diagnosis is a thing of the past.

The same can be said about the passion of our doctors for determining the “hormonal mirror” of a pregnant woman by studying cytological (cellular) smears from the surface of the cervix and vagina. For foreign doctors, such determination of hormonal levels has become history, and, simply put, why guess by cells when the levels of all necessary hormones and other substances can be determined in the blood? But behind all the biochemical tests lies one more truth - they are too expensive both for the budget of the medical institution and for the pregnant woman (depending on whose pocket the payment comes from), and with regard to the pregnancy prognosis, they are not very informative.

Thus, when talking about the placenta and its function, it is always important to look at the “end result” of its influence - the fetus. Let me remind you once again that there is no treatment for the placenta, its “rejuvenation,” and everything that Soviet and post-Soviet doctors prescribe is a tribute to old dogmatic traditions and reinsurance. You can treat a mother’s disease, and in some cases (rare cases) you can treat fetal diseases, but the approach must be individual and depend on the type of disease and the availability of appropriate medications in the obstetrics arsenal.