Feto placental insufficiency (Dysfunction of Placenta)

1. It is one of the most important problems of
Obstetrics, Neonathology and Prenatology.
The functional insolvency of the Placenta is the
basic reason for:
- fetal distress; delay of the uterine fetation;
- fetal traumas during the labor;
- increasing of the prenatal mortality;
- it promotes to high frequency of the somatic
and infectional morbidity of the newborns;
- disorders of the physical and mental
development of a child.

2. - primary incompetent pregnancy;
- infertility in anamnesis;
- pregnant women with operations on the uterine
appendages;
- during pregnancy with leomyoma;
- when pregnancy is complicated with acute
persist TORCH-infeciton;
- during pregnancy with operation on the uterus;
- when pregnancy is inductional (EKO)

3. The Secondary Feto-Placental Insufficiency appears when
placental formation process is over. It is caused by some extra
influences - first of all these are diseases which pregnant woman
was suffering during pregnancy.
Regarding its progress The Primary and the Secondary Feto-
Placental Insufficiency are divided into:
- acute;
- chronic.
In pathogenesis of the acute FPI the acute disorder of the
decidesial perfusion plays a great role. It leads towards the
significant circulatory disorders in the Placenta. It often rises under
the following conditions:
- the premature separation of the normal placental position;
- the placental presentation;
- the prolapse of the umbilical cord's knots;
- the prolapse of the small parts of the Fetus.
In the pathogenesis of the chronic FPI the main meaning is taken
by gradually decidesial perfusion which occurs as a result of
lowering of the compensatory-adaptive reactions as the reply for
the actions of the pathological conditions of the mother's
organism.

4. Compensative FPI develops when there are:
- threat of interruption of pregnancy;
- non-typical forms of the late gestation (edema of pregnancy, light pre-
eclampsia).
Sub-compensative FPI develops during pregnancy with extra-genital pathology.
De-compensative FPI develops in time of hypertensive forms of the late gestation.
During physiological gestation placental vessels are found in the condition of
delitescence and do not react on contractive stimulus. This circumstance
provides equal entering of oxygen and nutritional substances to the fetus.
Refractoriness of the placental vessels and the mother's system of blood
circulation are provided with products of the endothelial factors of relaxation:
- prostysyclin;
- nitrous oxide.
The activity of these prostenoids is the basic condition of the adaption of the
mother's vessels towards increasing load on the blood circulation and it also
provides systematic vesodelitescence and lowering of AD under the progressive
pregnancy.
primary
secondary
acute
chronic
relative
absolute
compensative
sub-compensative
de-compensative
FPI
FPI
FPI

6. 1. Insufficient invasion of trophoblast into the
spiral arteries of the Uterus. In consequence
with it the less amount of the mother's vessels
is involved in the placental blood circulation.
2. The disorders of the products of the factors
which provide delitescence of the placental
vessels. These are prostycyclin and nitrous
oxide. Lowering of prostysyclin and nitrous
oxide biosynthesis in the uterine and feto-
placental blood circulation is accompanied
by the vessels’ spasm in this area and
"separation" of the mother's blood circulation
from the fetal one.

7. 1. Social:
- Age of woman (after 30 years
old);
- High emotional and psychic
factor (lonely and
unprotected women);
- Alcohol, smoking drugs;
- Insufficient food, physical job.
2. Somatic:
- Hypertension;
- Vegetative dystonia;
- Diabetes;
- Cordial diseases;
- Lung, kidney, blood diseases.
3. Obstetric and Gynecological
factors:
- Infantility;
- Defects of the uterine growth;
- Tumors;
- Disorders of the Menses;
- High reproductive activity;
- Incompetent pregnancy;
- Antenatal fetal mortality;
- Delivery of the children with
little weight.
4. Complications in time of
pregnancy.
- Gestologic;
- Threat of the interruption of
the pregnancy;
- Multiple pregnancy;
- Placental presentation;
- Genital infections;
- Anti-phosphate syndrome;
5. Inborn pathology in
consequence of radiation.

8. The diagnosis of FPI is determined regarding with following
reasons:
- anamnesis results;
- progressive pregnancy;
- clinical-laboratory investigations;
- morphological and immuno-morphological investigation of
Placenta;
- examination of homeostatic system;
- Ultra Sound Investigation (USI) in the 1st, 2nd, 3rd trimester
of
pregnancy;
- dopirometria;
- investigation of estradiol placental location and
progesterone in blood.

9. During USI it is necessary to value:
- intrauterine fetal condition;
-the length of the Cervix and diameter of the intro pharynx of
the Cervix;
- Placenta's location, its thickness, structure, "stage of formation";
-presence of the uterine walls' tension;
- the signs of the less or much amniotic fluid;
- the character of motory and respiratory activity.
To make bio-profile of the Fetus:
- non-stress test (reactiveness of the fetal movements, fetal
cardiac activity after its motory activity);
- respiratory movements of the Fetus;
- motory activity of the Fetus;
- fetal tone;
-size of the amniotic fluid.
The Appraisement of the fetal bio-profile.
7-10 scores - satisfactory fetal condition
5-6 scores - doubtless test (repeat in 2-3 days)
4 scores and lower - pathological appraisement of the fetal bio-
profile (question about delivery is decided).

10. Prognosis of the unfavorable factors of FPI
development in the 1st
trimester:
- low placentation of the fetal ovum;
- delay its sizes from the sizes of normal gestation;
- indistinct vision of the embryo;
- presence of chorion separation parts.
In labor it is necessary to diagnose in time:
- abnormalities of the uterine contractility;
- fetal distress;
- it is necessary to take decision about cesarean
section timely.