The placenta is the baby’s lifeline during pregnancy, it’s an organ which grows in the womb and is connected to the baby via the umbilical cord; it provides baby with Oxygen and nutrients which pass from your blood supply into the placenta and are then carried to your baby via the umbilical cord; carbon dioxide and other waste products are also carried away from the baby by the umbilical cord to the placenta and then into your bloodstream for disposal. Hormones produced by the placenta help your baby grow and develop; It offers your baby protection against bacterial infections while in the womb, and towards the end of pregnancy it passes antibodies from you to your baby which should give him or her immunity for about three months after birth. However, it only passes on antibodies that you already have. Alcohol, nicotine and other drugs can also cross the placenta and can cause damage to your unborn baby.
Placental insufficiency (also called placental dysfunction or uteroplacental vascular insufficiency) is a serious pregnancy complication, and usually occurs when either the placenta does not develop properly or it is damaged.
With placental insufficiency, the placenta is unable to provide the baby with adequate oxygen and nutrients; and without this the baby cannot grow and thrive. This can lead to low birth weight, premature birth, birth defects and stillbirth; therefore diagnosing placental insufficiency early is vital for improving the outcome for both mum and baby.
It is often linked to blood flow problems. While maternal blood and vascular disorders can trigger it, medications and lifestyle habits are also possible triggers. You are more at risk of having placental insufficiency if you are overdue, have diabetes, chronic high blood pressure (hypertension), blood clotting disorders, anaemia, are a smoker, or take drugs (especially cocaine, heroin, and methamphetamine); it may also occur if the placenta doesn’t attach properly to the uterine wall.
There may be areas of dead tissue, called infarcts, within the placenta which result in reduced blood flow in those areas; often these are caused by a problem with the vessels within the placenta. Certain conditions are known to increase the number of infarcts within the placenta, such as pregnancy-induced hypertension. Infarcts don’t usually affect the unborn baby; however, in certain cases and especially in women with severe hypertension, the reduced placental blood flow may be enough to cause poor growth and even stillbirth.
Regular antenatal (prenatal) appointments are essential as there are no maternal symptoms for placental insufficiency. However, the mother may notice that her bump appears small or her baby may be moving less than expected.
A pregnant lady who has placental insufficiency is at greater risk of preeclampsia, placental abruption, and preterm labour and delivery. However, the risks are far greater to the growing baby and the risks for the baby include:
- Oxygen deprivation at birth (which can cause hypoxic ischemic encephalopathy (HIE), seizures, brain damage and cerebral palsy)
- Learning disabilities
- Low blood sugar
- Low blood calcium levels
- Excess red blood cells
- Premature labour
Diagnosis and Management
Regular antenatal care can improve outcomes as it helps your provider to diagnose placental insufficiency earlier. A range of Tests are used to diagnose placental insufficiency; these include: taking measurements of the fundal height during routine antenatal appointments, pregnancy ultrasound scans to measure the size of the placenta, the size of the baby, and check the placental blood flow, non-stress test to measure the baby’s heart rate, movements and contractions, and sometimes you may have a blood test to check the alpha-fetoprotein levels in the mother’s blood.
If you have high blood pressure or diabetes then treating these can help to improve the baby’s growth. Placental insufficiency can’t be cured but if it’s detected early enough then it can be managed with regular antenatal care. The consultant may recommend looking for any signs of preeclampsia, more frequent appointments, regular ultrasound and foetal doppler scans and if necessary admission to hospital so that it can be continuously monitored. You should also pay very close attention to your baby’s movements and kicks, and any changes in these should be assessed straight away. If there is concern about premature birth then you may receive steroid injections; these dissolve through the placenta and strengthen the baby’s lungs.
In future pregnancies, you are likely to be monitored much more frequently with many more ultrasound and doppler scans and more antenatal appointments. Your consultant may suggest you take low dose aspirin, although you should speak to your doctor first about this, and may also suggest anticoagulant injections such as Fragmin or Lovenox… this will however depend on the reasons for your placental insufficiency. If you have diabetes then this will be carefully monitored and a suggested treatment plan will be put in place; and any bad habits such as smoking or drug misuse should be addressed.
There really isn’t very much that can be done to prevent this from happening. However, careful monitoring and good antenatal should improve the outcome.