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Causes, Symptoms, Treatment, and More

Written by WebMD Editorial Contributors

In this Article

• Causes
• Symptoms
• Complications
• Diagnosis
• Management
• Conclusion

Sometimes the placenta doesn’t grow as it should, or it may get damaged. The result may be a severe condition called placental insufficiency (also known as uteroplacental insufficiency, fetoplacental insufficiency, or placental dysfunction).

When the placenta gets damaged, the damage may reduce the amount of blood circulating between you and the placenta. This low blood flow means fewer nutrients for your baby. This could delay your baby’s growth in the womb.

Causes

There are many reasons why the placenta may not be able to work well. These include:

• Diabetes
• Drug abuse (cocaine, smoking tobacco, amphetamines)
• Late delivery of the baby
• Heart and blood conditions like high blood pressure
• Medical conditions that may cause blood clots‌

Placental insufficiency can also occur if there are developmental issues with the placenta. Some of these issues include.

• Not holding on to the uterus as it should
• A small placenta
• The placenta being the wrong shape
• Bleeding‌

Symptoms

Placental insufficiency is hard to detect, especially for women experiencing pregnancy for the first time. There are usually few or no symptoms.‌

If you’re a mother pregnant with your second or third child, you may notice your belly is not getting as big as your previous pregnancy. You may also realize that your child is moving less.

Complications

Placental insufficiency can have a severe impact on the baby. The condition leads to respiratory failure and dangerously low levels of oxygen in the baby. This can slow down the baby’s growth, induce premature labor, or kill the baby entirely.

Placental insufficiency also exposes children to multiple health problems, like:

• Anemia
• Chronic low blood sugar
• A low platelet count in the blood
• A lack of oxygen flowing to the brain
• Cognitive issues during childhood

Diagnosis

When you get to the doctor or obstetrician, they may perform some tests, like:

• Blood tests, which allow the doctors to determine the baby’s liver health.
• An ultrasound, which allows your doctor to view your placenta, estimate its size and measure how big the baby is.
• Fetal stress, a test that involves keeping track of how fast your baby’s heart is beating.

If you have been pregnant for over six months the doctor may measure the size of your belly to determine whether your baby is growing appropriately.

Quick detection of anything wrong with the placenta will improve your baby’s chances. Always consult a professional when you suspect something is wrong with your baby. 

Management

Your doctor or obstetrician may choose to postpone treatment if you’ve been pregnant for less than six months and examination indicates that the baby is not in danger. You may have to get routine tests to make sure the baby is still developing healthily.‌

If your pregnancy has passed the thirty-seventh week or your baby is in danger, your doctor may induce labor. If labor can’t be induced with medication, you may have to give birth through a cesarean section.‌

There is no available effective treatment for placental insufficiency, but treating any other conditions that may be present, such as diabetes or high blood pressure may help the growing baby.

Once your doctor has diagnosed placental insufficiency, they may monitor you for hypertension. They may assign you to bed rest or refer you to a specialist. The specialist may prescribe some steroids, which may help speed up the development of your baby’s lungs. This may increase the baby’s chances of survival if you deliver prematurely.

You may get a prescription for low-dose aspirin and vitamin supplements. These may help the placenta attach itself to the uterus. If your pregnancy has reached a viable stage, the best treatment may be to induce labor.

Conclusion

The best way to manage placental insufficiency is early detection. Avoid abusing drugs, drinking alcohol, and smoking. Make sure you’re getting good prenatal care, and consult your obstetrician if you think anything’s wrong.

Low placenta

Home / Gynecologist / Low placenta

Placenta is a temporary organ that is formed in the body of a pregnant woman in order to maintain a connection between her body and the fetus. She filters the blood , which the unborn baby feeds on, cleansing it of toxins and other harmful substances.

This pathology can be very dangerous in some cases, while in others it goes away without any treatment and does not bring problems.

Types of location of the placenta

Usually the placenta is attached to the posterior wall of the uterus closer to its bottom . It is worth noting that the uterus is an inverted vessel, and its bottom is located on top. This is the best option for the location of the placenta. However, this does not always work out. In some cases, the placenta is attached to the anterior wall. Which is also not a pathology.

The low position of the placenta during pregnancy is much more dangerous. If the placenta is located low, it is subjected to stronger pressure from the fetus, and even with any external influence, the risk is damage to the placenta or its detachment increases. In addition, in the later stages, an actively moving baby can also damage the placenta, or squeeze the umbilical cord.

A placenta is said to be low when there is less than 6 cm between its lower edge and the os of the uterus. The anterior wall has a greater tendency to stretch, and migration is also characteristic of it, however, the direction of migration is opposite: usually the placenta moves in the opposite direction, down to the cervix.

An even more complex and dangerous pathology of the location of the placenta is its partial or complete presentation . Previa is a condition when the placenta partially or completely obscures the cervix of the uterus.

Causes of low placenta

Many causes of low placenta are due to internal factors - diseases during pregnancy and the condition of the female genital organs . They can be:

• damage to the mucous membrane of the uterus;
• inflammatory processes;
• infections;
• previous abortions;
• miscarriages in the past;
• cesarean section;
• various gynecological operations;
• pathology of the structure, development, functioning of the uterus;
• multiple pregnancy;
• unhealthy lifestyle: active smoking, excessive alcohol consumption;
• previous diseases of the uterus: endometritis, fibroids;
• parity - many births in the past;
• the woman's age is over 35 years.

Curettage of the uterus in the past is the main cause of this pathology. Damage to the mucosa prevents the fetal egg from gaining a foothold in the upper segment of this organ, and it remains below, at the neck.

Symptoms of low placenta

The danger of this pathology is that it practically does not manifest itself. Usually, signs that not everything is in order with the placenta are the result of already running and irreversible processes - for example, its detachment. It can be:

• drawing pains, feeling of heaviness in the abdomen;
• bloody discharge with a low location of the placenta is an alarm signal that it is necessary to call an ambulance;
• freezing of the fetus in the womb for a long time, or, conversely, its too violent activity - this is caused by hypoxia;
• on ultrasound with such a pathology in 50% of cases is the wrong presentation of the fetus;
• in 30% of cases, women suffer from severe toxicosis.

A pregnant woman herself cannot suspect that she has a low placenta. This can only be seen on planned ultrasounds, which must be passed by everyone. After an ultrasound examination, they can not only clarify or refute the diagnosis, but also determine the type of pathology.

Treatment and prevention of low placentation

Management of pregnancy with low placentation is always very careful. A woman will have to undergo ultrasound many times, limit physical activity and stop sexual activity. For a long time, increased uterine tone can provoke detachment of an improperly located placenta, from there bleeding, and possible death of the fetus as a result of acute hypoxia, if placental abruption is large. Bleeding can even provoke a gynecological examination of the cervix, therefore, for no particular reason, doctors try not to conduct examinations on the chair.

Listen to the doctors and hope for the best. Many women give birth on their own or by caesarean section of healthy babies with low placenta previa.

If you need help from an experienced gynecologist, sign up for a consultation by calling 8 (49244) 9-32-49, 8 (910) 174-77-72.

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Case of successful completion of pregnancy with placenta accreta

Placenta ingrowth in patients with a uterine scar after previous caesarean section operations is an extremely important problem that is actively discussed in modern obstetrics. This type of complication is increasingly being diagnosed in women with repeated pregnancies after caesarean section operations, the number of which continues to be high due to the expansion of indications for operative delivery. During delivery, massive bleeding inevitably occurs, which poses a danger to the life of the mother.

Previously, when placenta accreta, surgeons made a radical decision - they removed the uterus, which, however, did not reduce blood loss and, moreover, deprived the patient of reproductive function in the future.

Today it is possible to perform organ-preserving surgeries using methods of temporary reduction of the blood supply to the uterus (devascularization), such as temporary occlusion of the common iliac arteries with balloon catheters, embolization of the uterine arteries, ligation of the internal iliac arteries, creation of tunnels in the broad ligament of the uterus with temporary placement of a Folley catheter on lower segment area. An innovative organ-preserving surgical technique is used - a bottom caesarean section with metroplasty (excision of a section of the uterus with placenta ingrowth). Blood loss is replenished by reinfusion of own blood using the Cell Saver apparatus.

Clinical case: Pregnant D., 37 years old, was admitted to the maternity hospital with a referral from a antenatal clinic doctor for delivery. The patient had a history of a caesarean section, during this pregnancy an ultrasound examination diagnosed placenta previa and suspected placenta ingrowth. On an outpatient basis, additional diagnostics were performed - MRI, the diagnosis was confirmed.

Considering placenta previa and suspected placenta accreta, a decision was made at 37-38 weeks of gestation to perform a planned delivery by caesarean section in an X-ray operating room.

Delivery was carried out by two teams of doctors: obstetrician-gynecologists - Ivan Osokin and Vasily Grabovsky - and X-ray surgeons Alexander Vanyukov and Sergey Bondarenko. During the operation, placenta ingrowth was confirmed on a fairly large (6 cm in size) area of ​​the anterior wall of the uterus. Given this feature, a caesarean section was performed in the area of ​​the uterine fundus, as a result of which a live full-term baby was born.

After the birth of the child, the doctors had to perform an operation to excise a section of the uterus with an ingrown placenta. To avoid massive bleeding, radiologists performed a temporary occlusion of the common iliac arteries.

Comments by the head of the Department of X-ray Surgical Methods of Diagnosis and Treatment Alexander Evgenievich Vanyukov:
- Usually, for this procedure, a puncture of the left and right common femoral arteries is performed. However, the puncture of the femoral arteries is associated with severe discomfort for the patient, because. requires prolonged immobilization of the limb and tight bandaging in the area of ​​the surgical wound with median access for caesarean section. Also, for the puncture of the femoral artery, a greater number of postoperative hematomas and bleeding. Based on this, we decided to use the left and right radial arteries as arterial access. These are the arteries of the hand. Our part of the work begins after the birth of the child, so as not to expose the newborn to radiation exposure. Under x-ray navigation using a C-arm, a puncture of the left and right radial arteries was performed. Balloon catheters were passed through the aorta and placed in the left and right common iliac arteries. From that moment on, we were ready to perform intra-arterial hemostasis (ie stop bleeding) at any second. This time, emergency hemostasis was not required, and before surgeons began to separate the ingrown part of the placenta from the uterine body, we inflated the balloon catheters in the common iliac arteries, thereby cutting off the blood flow in the vessels supplying the uterus. When the placenta was removed and the body of the uterus was sutured, the balloons were deflated to ensure there was no bleeding. Then the balloons and guiding catheters were removed, and bandages were applied to the puncture site. This technique made it possible to preserve the uterus and avoid massive blood loss.

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