Hyperplasia of the placenta

Placenta hyperplasia refers to pathologies of its structure and is revealed in cases when the increase in the thickness of the extraembryonic embryonic organ exceeds the accepted physiological parameters typical for a certain gestational age (starting from the 22nd week).

With excessive thickening of the placenta, whose functions include complete life support and regulation of the fetal metabolism, many problems arise due to its normal development.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]

Causes of placental hyperplasia

Having formed by the end of the third month of pregnancy, the baby's place grows with the fetus until 36-37 weeks: 95% of the increase in weight occurs during the last 20 weeks of gestation. The thickness of the placenta is usually measured at the point where the umbilical cord enters into it; Normally the thickness of the placenta reached the final functional maturity varies in the range of 20-35 mm (although individual features should be considered). However, with apparent placental hyperplasia, that is, abnormal proliferation of pericytes of capillary connective tissue, cells of chorionic syncytium or basal plate of the placenta, the thickness of its fetal and maternal parts may exceed 60 mm.

In clinical obstetrics, the causes of placental hyperplasia are associated with:

• hemolytic disease of the fetus, which occurs due to immunological incompatibility of blood of the mother and fetus (Rh-conflict or incompatibility by blood group);
• low hemoglobin in severe form 70-80 g / l and below);
• type I diabetes mellitus (including gestational diabetes arising from the activation of steroid hormones and the hepatic enzyme insulinase);
• complication of pregnancy in the form of gestosis (pre-eclampsia or hypertension of pregnant women);
• TORCH-syndrome (presence of pregnant mycoplasma, cytomegavirus, rubella virus and herpes simplex);
• urogenital infections of the mother (chlamydia, gonorrhea, syphilis);
• transferred during pregnancy by infectious diseases (flu, ARVI, pyelonephritis);
• genetic mutations.

It should be noted that placental hyperplasia in pregnancy is recognized by obstetricians and perinatologists as almost the most obvious sign of hemolytic disease of the fetus.

And the entire list of etiological factors of this pathology in many cases is a consequence of abnormal growth of the blood vessels (angiomatosis) of the stem and intermediate chorionic villi in the process of formation of the placenta and fetal circulation system due to chronic fetal hypoxia.

[11], [12], [13], [14]

Symptoms of placental hyperplasia

Any symptoms of placental hyperplasia experienced by pregnant women are completely absent at first. To reveal the presence of a pathology that proceeds subclinically, it is possible only with the help of a trabdominal echographic (ultrasound) examination.

And only in the course of time - as the gestational age increases - changes in the motor activity (stirring) of the fetus are noted: from intense movements to practically barely perceptible. The fetal heart rate also changes, in particular, the heart rate and heart sounds. At auscultation are listened, and at a cardiotocography the muffled palpitation is fixed; the number of heartbeats changes either towards their rapidity (tachycardia) or slows down to a bradycardia. It should be borne in mind that the norm of the fetal heart rate after the 11-week period is plus or minus 140-160 beats per minute. A sharp decrease in the number of heartbeats (below 120 beats) after a short-term tachycardia speaks of intrauterine oxygen starvation of the fetus (hypoxia).

In diabetes, placental hyperplasia leads to an excess volume of amniotic fluid (polyhydramnios). In cases of gestational diabetes in pregnant women, hyperglycemia, increased insulin synthesis by the pancreas, and metabolic acidosis (increased acidity, pH <7.3) are revealed.

Consequences of placental hyperplasia - fetoplacental insufficiency, that is, the inability of the placenta to perform its functions, which leads to violations of fetal homeostasis, hypoxia, delayed fetal development and the threat of his death as a result of spontaneous abortion.

Diagnosis of placental hyperplasia

Prenatal diagnosis of placental hyperplasia requires the conduct of ultrasound, dopplerography and CTG.

Ultrasound examination of the placenta makes it possible to determine its thickness, and the purpose of dopplerometry (which is conducted after the 18th week of pregnancy) is the investigation of the hemodynamics (direction and velocity of the blood flow) of the cord blood vessels, fetal vessels, and the entire circulatory system of the fetus and placenta.

When performing cardiotocography (CTG), doctors find out not only the heart rate of the fetus (the result is tachogram), but also the intensity of contractions of the uterine muscles (hysterogram).

Also, pregnant women with suspected hyperplasia of the placenta must pass a general and biochemical blood test; a blood test for sugar; blood test for TORCH and RPR; general urine analysis; smear on the urogenital microflora.

[15], [16], [17], [18], [19], [20], [21]

Treatment of placental hyperplasia

Symptomatic treatment of placental hyperplasia is to create the conditions most conducive to normal intrauterine development of the fetus. If possible, etiological therapy is performed (reducing the level of insulin resistance, antimicrobial, antihypertensive, etc.). But in any case, treatment, especially medication, is prescribed only after a complete examination and detection of signs of intrauterine growth retardation.

So, with the immunological incompatibility of fetal and maternal blood, it is often necessary to interrupt pregnancy, but you can take risks and resort to intraperitoneal blood transfusion - intrauterine transfusion of red blood cells with negative Rh (through the cord of the umbilical cord), and today it is the only way to treat this pathology.

To increase the level of hemoglobin in the blood, according to gynecologists, there is little one complete nutrition and it is necessary to use preparations of ferrous iron with vitamin C. For example, capsules Aktiferrin or Ferroplex is recommended to take one capsule twice a day, and a solution of Hemoferon is usually prescribed 15-20 ml once a day (before meals).

In order to normalize the placental circulation in the treatment of placental hyperplasia, physicians often use such pharmacological drugs as Actovegin, Dipiridamol and Trental. Let's find out what they are used for.

Actovegin belongs to the group of biogenic stimulants and as an active substance contains a protein-free extract from the blood of calves. This drug promotes the activation of metabolic processes in cells and is used (one pellet three times daily before meals) for chronic cerebrovascular disorders (for example, after a stroke), as well as in the complex therapy of diabetic polyneuropathies. In the instruction it is noted that Actovegin has no negative effect on the fetus and pregnant woman, but the probability of adverse effects during pregnancy should be taken into account and apply this remedy very carefully.

Angioprotector Dipiridamole (synonyms - Kurantil, Dipiridamol Parsedil, Penselin, Persanthin, Trombonil) refers to vasodilator (vasodilator) drugs that increase the activity of venous blood flow and the level of oxygen in the blood, prevent the formation of thrombi. In some instructions to Dipiridamole, the period of pregnancy is unambiguously assigned to a number of contraindications, in other cases, in the section of indications for use, contains the phrase about the appointment of the drug "for the prevention of placental insufficiency in complicated pregnancies," and the indication that " especially in the second and third trimesters, possibly in cases of extreme necessity. " And in one version of the instructions to Curantil (in fact, the same dipyridamole) it is indicated that it is intended, among other things, for "treatment and prevention of placental insufficiency, which arose as a result of violation of the placental circulation". However, doctors are reminded: first weigh and compare the expected benefit with the possible risks of using this remedy.

The drug Trental (other trade names - Pentoxifylline, Pentilinum, Agapurin, Vazonit) has a positive effect in peripheral circulation disorders in atherosclerosis, diabetic angiopathies, vascular pathology of the fundus, etc. Trental is contraindicated in acute myocardial infarction, expressed vascular sclerosis (cerebral and coronary), as well as during pregnancy and lactation.

Prophylaxis and prognosis of placental hyperplasia

In order to clearly define what measures can provide prevention of placental hyperplasia, go back to the list of causes of this pathology. In general, something can be done with anemia and infections (and then not for everyone). Therefore, doctors advise to plan replenishment in the family and prepare the body in advance, including, after a preliminary examination. Then many complications of pregnancy can be prevented.

And the prognosis of placental hyperplasia depends on the etiology and the degree of negative consequences of the thickening of the child's place for the development of the future child. When all the measures taken have had a positive effect, then, in principle, nothing should prevent the child's birth. But severe fetoplacental insufficiency may require a caesarean section for at least 37 weeks.

Independently placenta hyperplasia can not be detected or cured, so listen to the advice: do not delay with the registration in the women's consultation.