Placental hyperplasia

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

When the placenta, whose functions include complete life support and regulation of the metabolism of the fetus, thickens excessively, many problems associated with its normal development arise.

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Causes of placental hyperplasia

Having formed by the end of the third month of pregnancy, the placenta grows together with the fetus until the 36th-37th week: 95% of its weight increase occurs during the last 20 weeks of gestation. The thickness of the placenta is usually measured at the point where the umbilical cord enters it; normally, the thickness of the placenta that has reached its final functional maturity fluctuates in the range of 20-35 mm (although individual characteristics should be taken into account). However, with obvious placental hyperplasia, that is, abnormal proliferation of pericytes of the capillary connective tissue, cells of the chorionic syncytium or the basal plate of the placenta, the thickness of its fetal and maternal parts can 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 the blood of the mother and fetus (Rh conflict or blood group incompatibility);
• low hemoglobin levels in severe form (70-80 g/l and below);
• type I diabetes mellitus (including gestational diabetes, which occurs due to the activation of steroid hormones and the liver enzyme insulinase);
• pregnancy complication in the form of gestosis (preeclampsia or arterial hypertension of pregnant women);
• TORCH syndrome (the presence of mycoplasma, cytomegavirus, rubella virus and herpes simplex in a pregnant woman);
• urogenital infections of the mother (chlamydia, gonorrhea, syphilis);
• infectious diseases suffered during pregnancy (flu, acute respiratory viral infections, pyelonephritis);
• genetic mutations.

It should be noted that placental hyperplasia during pregnancy is recognized by obstetricians and perinatologists as perhaps 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 proliferation of blood vessels (angiomatosis) of the stem and intermediate chorionic villi in the process of formation of the circulatory system of the placenta and fetus - due to chronic hypoxia of the fetus.

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Symptoms of placental hyperplasia

At first, pregnant women do not experience any symptoms of placental hyperplasia. The presence of a pathology that occurs subclinically can only be detected using a transabdominal echographic (ultrasound) examination.

And only with time - as the gestational period increases - changes in the motor activity (movement) of the fetus are noted: from intense movements to almost barely perceptible. Fetal heart rate indicators also change, in particular, the heart rate and heart sounds. Auscultation reveals, and cardiotocography records, a muffled heartbeat; the number of heartbeats changes either towards their acceleration (tachycardia) or slows down to bradycardia. It should be borne in mind that the norm of fetal heart rate after the 11-week period is considered to be plus or minus 140-160 beats per minute. A sharp decrease in the number of heartbeats (below 120 beats) after short-term tachycardia indicates intrauterine oxygen starvation of the fetus (hypoxia).

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

The consequences of placental hyperplasia are fetoplacental insufficiency, that is, the inability of the placenta to perform its functions, which leads to disturbances in fetal homeostasis, hypoxia, delayed fetal development and the threat of its death as a result of spontaneous abortion.

Diagnosis of placental hyperplasia

Prenatal diagnosis of placental hyperplasia requires ultrasound, Doppler ultrasound and CTG.

Ultrasound examination of the placenta makes it possible to determine its thickness, and the purpose of Doppler ultrasound (which is performed after the 18th week of pregnancy) is to study the hemodynamics (direction and speed of blood flow) of the umbilical artery, fetal vessels, as well as the entire circulatory system of the fetus and placenta.

When performing cardiotocography (CTG), doctors determine not only the fetal heart rate (the result looks like a tachogram), but also the intensity of uterine muscle contractions (hysterogram).

Pregnant women with suspected placental hyperplasia must also undergo a general and biochemical blood test; a blood sugar test; a blood test for TORCH and RPR; a general urine test; a smear for urogenital microflora.

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Treatment of placental hyperplasia

Symptomatic treatment of placental hyperplasia consists of creating conditions that are most favorable for normal intrauterine development of the fetus. If possible, etiologic therapy is carried out (reducing the level of insulin resistance, antimicrobial, antihypertensive, etc.). But in any case, treatment, especially drug therapy, is prescribed only after a full examination and detection of signs of intrauterine growth retardation of the fetus.

Thus, in case of immunological incompatibility of the blood of the fetus and mother, it is often necessary to terminate the pregnancy, but one can take a risk and resort to intraperitoneal hemotransfusion - intrauterine transfusion of red blood cells with a negative Rh (through the umbilical artery), and today this is the only way to treat this pathology.

To increase the level of hemoglobin in the blood, as gynecologists believe, one complete diet is not enough and it is necessary to use preparations of divalent iron with vitamin C. For example, capsules Aktiferrin or Ferroplex are recommended to be taken one capsule twice a day, and the solution Hemoferon is usually prescribed 15-20 ml once a day (before meals).

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

Actovegin belongs to the group of biogenic stimulants and contains a protein-free extract from calf blood as an active substance. This product helps to activate metabolic processes in cells and is used (one tablet three times a day before meals) for chronic cerebrovascular disorders (for example, after a stroke), as well as in the complex therapy of diabetic polyneuropathies. The instructions note that Actovegin does not have a negative effect on the fetus and the pregnant woman, but the likelihood of adverse effects during pregnancy should be taken into account and this product should be used very carefully.

The angioprotector Dipyridamole (synonyms - Curantil, Dipyridamole Parsedil, Penselin, Persantin, Trombonil) refers to vasodilators (vasodilating) drugs that increase the activity of venous blood flow and the level of oxygen in the blood, and prevent the formation of blood clots. In some instructions for Dipyridamole, the period of pregnancy is clearly listed among the contraindications, while in other versions, in the section on indications for use, there is a phrase about prescribing the drug "for the prevention of placental insufficiency in complicated pregnancies", as well as an indication that "use during pregnancy, especially in the second and third trimesters, is possible in cases of extreme necessity." And in one version of the instructions for Curantil (actually, the same dipyridamole), it is indicated that it is intended, among other things, for the "treatment and prevention of placental insufficiency resulting from impaired placental circulation." However, doctors are reminded to first weigh and compare the expected benefits with the possible risks of using this drug.

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

Prevention and prognosis of placental hyperplasia

To clearly determine what measures can prevent placental hyperplasia, go back to the list of causes of this pathology. In general, something can be done with anemia and infections (and not with all of them). Therefore, doctors advise planning an addition to the family and preparing the body in advance, including by undergoing a preliminary examination. Then it will be possible to prevent many pregnancy complications.

And the prognosis of placental hyperplasia depends on the etiology and the degree of negative consequences of thickening of the placenta for the development of the future child. When all the measures taken have given a positive effect, then, in principle, nothing should interfere with the birth of the child. But severe fetoplacental insufficiency may require a cesarean section at a period of at least 37 weeks.

Placental hyperplasia cannot be detected or treated on its own, so listen to this advice: do not delay registering with a women's health clinic.