Causes and treatment of heterogeneous placental structure. Heterogeneous placenta - is it dangerous? Echostructure of the placenta with dilated urinary tracts

The placenta is the most valuable organ of the female body during pregnancy. Its main functions are to deliver the required amount of nutrients to the fetus and provide it with oxygen. The normal course of pregnancy, as well as childbirth, directly depends on the state of development of the child's place. In addition, the embryonic organ performs protective functions, preventing various infections from reaching the child, and ensures that it is supplied with a sufficient amount of hormones that allow the fetus to grow and develop.

Diagnosis of the condition of the placenta is extremely important and should be carried out throughout pregnancy using ultrasound (ultrasound).

This method makes it possible to timely detect any abnormalities in the development of an embryonic organ. And the faster pathologies are detected, the greater the chances of successful treatment. Using ultrasound, doctors determine its structure, location,... During such a study, the expectant mother may be diagnosed with a heterogeneous structure of the placenta.

Reasons for heterogeneity

In most cases, the heterogeneous structure of the embryonic organ should not be a cause for concern, because is the norm. The final formation of the placenta occurs at , after which its structure should remain unchanged until the thirtieth week. And if at this time any changes occur in the structure of the baby’s place (the doctor may detect echo-negative areas or other inclusions), then these changes can cause serious disruptions in the functioning of the placenta.

The main reasons for such disorders may be the presence of any infection in the mother’s body or the consequences of drinking alcohol, anemia, smoking, etc. The heterogeneous structure of the placenta can provoke a disruption of blood flow between the pregnant woman and the fetus, which will result in a slowdown in the intrauterine development of the child and a difficult birth. If, during an ultrasound, changes in the structure of the baby's place are detected, then there is nothing to worry about, and the pregnancy proceeds normally. Sometimes changes in the placenta that are detected on are considered normal, provided that the child continues to develop fully and according to his due date. Ultrasound examination can detect the following phenomena associated with a violation of the structure of the child's place:

• Structure of the placenta with expansion of the intervillous spaces (intervillous spaces). The urinary tract is the place in the embryonic organ where metabolism occurs between the mother and the fetus. As pregnancy progresses, the baby requires more and more nutrients to grow and support vital functions. To meet its needs, profit center increases. The expansion of this space does not lead to, but does not exclude it either. Additional research is not carried out when expanding the MVP.
• Heterogeneous structure of the child's place with calcifications. These accumulations of calcium salts prevent the embryonic organ from performing its functions effectively enough. As a rule, calcifications are detected in the placenta after (in 50% of cases). At later stages (after 37 weeks), the presence of calcifications does not pose any threat to pregnancy, because this is due to the natural aging of the placenta.

Treatment

The heterogeneous structure of the child's place may be associated with or, as well as its. In this case, additional studies may be prescribed, such as Doppler, cardiotocography.

Complete restoration of the heterogeneous structure of the placenta is impossible. However, there are medications that normalize the tone of the uterus, oxygen delivery, and improve blood circulation. The absence of stressful situations and all kinds of worries also have a positive effect. And the key to a normal pregnancy is the timely implementation of the necessary diagnostics, proper nutrition and a healthy lifestyle.

The placenta is one of the most important temporary organs of pregnancy. Just a few decades ago, the function of the placenta could be assessed only indirectly - by the condition of the fetus itself. If the fetus is fine, then the placenta is working well. With the development of medicine and, especially, ultrasound diagnostics, it has become possible to examine the placenta in utero.

What is placental hyperplasia?

Hyperplasia is an ancient Greek word meaning “excessive development”, “increase”. This term applies to any organ of the human body. In the case of the placenta, the term hyperplasia usually refers to an increase in its thickness, mass and circumference. However, with an ultrasound scan it is possible to accurately measure only the thickness of the placenta, so they start from this indicator. I would like to note that a single ultrasound examination is not competent to diagnose placental hyperplasia. Dynamic monitoring of the pregnant woman, the opinion of several doctors, and extensive studies are necessary. Moreover, independent assessment of ultrasound results is unacceptable.

Hyperplasia or diffuse thickening of the placenta implies its swelling, as well as a compensatory increase in the number of structural units. There are several reasons for this:

1. Infections. This is perhaps the most common cause of thickening of the placenta. Bacteria, viruses and other foreign agents can penetrate the uterine cavity, amniotic membranes and waters both ascending from the vagina and through the bloodstream from other foci. The placenta is rarely infected in isolation. Inflammation of the baby's place is called placentitis and very often it is combined with inflammation of the membranes and intrauterine infection of the fetus. With the development of the inflammatory process, swelling of the placenta occurs and an apparent increase in its thickness.
2. Immunological conflict between mother and fetus, for example due to the Rh factor. In this case, the picture will be similar to an infectious process, only the placental tissue is affected not by viruses and bacteria, but by the mother’s antibodies. In simple terms, in this case the mother’s body tries to kill the fetus and all temporary organs of pregnancy, mistaking them for foreign.
3. Severe or long-term gestosis. With gestosis, blood pressure rises, protein appears in the urine and swelling increases, including hidden ones. Such hidden edema also includes placental edema. In addition, gestosis affects the vascular network of the placenta, also leading to edema.
4. Severe anemia in the mother. When the hemoglobin level drops below 80 g/l, the fetus begins to experience oxygen starvation. In this case, the placenta begins to grow compensatoryly in order to increase the area of ​​​​gas exchange and thus help the fetus.
5. Natural feature. There is no need to exclude the possibility of placenta enlargement simply as a development option. Often large children have massive placentas, or this feature is passed on through generations.

Very often, thickening of the placenta is combined with polyhydramnios or oligohydramnios, as well as expansion of the intervillous spaces (IVS) of the placenta.

In the first two cases, these are additional manifestations of infection or immune conflict. The expansion of the urinary tract indicates that the placenta is trying to compensate for its function. Isolated expansion of the urinary tract is not a diagnosis, but may only imply an infectious process, anemia, fetoplacental insufficiency, or simply a developmental feature.

Symptoms and diagnosis of placental hyperplasia

• The placenta is deprived of pain innervation, therefore, with the initial signs of its damage, nothing bothers the pregnant woman. Typically, the main symptoms appear weeks or even months later.
• The main symptoms of dysfunction of the placenta are signs of oxygen starvation of the fetus: growth retardation, disruption of fetal-uterine blood flow, acute hypoxia. The woman notes a decrease in fetal movements and a decrease in its activity. During the examination, the doctor pays attention to a decrease in the growth rate of the pregnant woman’s abdomen, poor heart rate or cardiotocography.

• If thickening of the placenta is detected at the next ultrasound, it is necessary to perform a so-called diagnostic search - a series of examinations to identify possible causes:
• Complete blood count, urine test and blood biochemistry to look for inflammatory changes, as well as determine hemoglobin and ferritin levels.
• Vaginal culture and smear, testing for sexually transmitted infections and the TORCH group.
• Determination of the level of antibodies to the Rh factor and blood groups to exclude Rh sensitization.
• Consultations with a therapist and cardiologist to exclude gestosis, an infectious disease specialist in complex cases of intrauterine infection.

Continuous CTG monitoring and Doppler ultrasound of the fetus are included in the monitoring protocols for such pregnant women.

Placental hyperplasia: consequences for mother and baby

Since the placenta is a temporary organ for the existence of the fetus, the consequences of disruption of its functions affect mainly the child:

• chronic;
• fetal growth restriction;
• acute fetal hypoxia;
• intrauterine fetal death;
• premature birth.

The danger for the mother is not so much the placental hyperplasia itself, but the cause that caused it. Preeclampsia and eclampsia, infectious process, severe anemia certainly threaten the health and life of a woman.

Treatment of placental thickening

Therapy for placental hyperplasia consists of treating the immediate cause that caused this complication:

• Antibacterial and antiviral therapy in case of infection.
• Treatment of gestosis, as well as early delivery.
• Treatment of Rh conflict, consisting of periodic intrauterine blood transfusions to the fetus and plasmapheresis of the mother. In this case, the fastest possible delivery is also indicated with mandatory prevention of Rh conflict with anti-Rhesus immunoglobulins in the next pregnancy.
• Therapy with iron supplements for anemia in a pregnant woman, as well as red blood cell transfusion if hemoglobin decreases below 75 g/l.

Considering the impaired function of the placenta, the use of various drugs that improve placental blood flow is indicated: Curantil, Actovegin, Piracetam, Pentoxifylline.

Alexandra Pechkovskaya, obstetrician-gynecologist, especially for website

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The placenta is an important organ of the female body that facilitates the transport of nutrients to the fetus and provides sufficient oxygen. The final formation of the organ occurs at the 6th week of pregnancy, so the heterogeneous structure of the placenta should not bother the mother.

Norms and deviations

What does the heterogeneous structure of the placenta mean? During the process of bearing a child, the placenta changes structure and is characterized by the degree of maturity at a certain period. It also happens that the second stage of maturity occurs earlier than 34 weeks. This does not indicate an uneasy development of pregnancy.

Structure. The condition of the organ can be clearly seen at 12 weeks. The homogeneous structure of the placenta is characterized by a smooth chorale covering. The indicator refers to zero degree and indicates homogeneity.

Thickness. Using an ultrasound examination, the thickness of the organ is determined. Up to 32 weeks it increases and normally is no more than 30 mm. Rapid thickening or, conversely, a decrease indicates the process of premature aging of the organ. The reasons are: mismatch of the Rh factor, development of an infectious disease, diabetes of the woman.

Indicators of heterogeneity There may be inclusions of various natures, areas of echo-negative state. They indicate a disruption in the functioning of the placental organ. A heterogeneous placenta with hyperechoic inclusions indicates serious disorders that affect the development of the child.

During the examination, great attention is paid to the thickness of the placenta at 20 weeks of pregnancy. The normal value is from 1.5 cm to 5 cm. If the placental organ is thin and less than 1.5 cm, then there is a risk of fetal underdevelopment. But this phenomenon is quite rare.

Diagnostics

The ultrasound procedure is an important stage in monitoring the condition of the body during pregnancy. Diagnostics allows us to detect the formation and accumulation of calcifications, tumors and the threat of detachment.

Degrees of heterogeneity:

1. 1st degree. Homogeneity is noticeably lost. Characteristic changes in the structure appear;
2. 2nd degree. Formation of areas similar to a comma;
3. 3rd degree. The process of salt deposition on dead parts of tissue is significantly enhanced. Calcification occurs.

During the ultrasound, the location of the placenta in the uterus is determined with millimeter precision. Starting from the 10th week, the doctor records the location of the fetus. The third examination procedure shows the stage of development of the child and identifies initial pathologies.

The ultrasound examination method allows us to identify not only changes in the embryonic organ, but also determine the thickness, exact location, and stage of maturity. Since the final development takes place at 16 weeks of gestation, the structure should not change until the 8th month.

The practice of conducting ultrasound examinations includes cases of expansion of the intervillous space. MVP is the space in the embryonic organ where metabolism between mother and fetus occurs. As the child grows, the amount of nutrients consumed increases.

Timely diagnosis makes it possible to detect calcifications on dead tissues. This is a common phenomenon associated with the natural aging of the embryonic organ. The doctor keeps the volume of salt formation under control. After 33 weeks of gestation, the number of calcifications may increase sharply. The rate of growth and development of the child must correspond to the degree of deterioration of the placenta. Only in this case there is no need to worry.

Causes and symptoms

The main reasons for heterogeneity of the placenta may be infectious diseases, even those that existed before, or the negative consequences of drinking large quantities of alcohol and smoking. This leads to disruption of blood flow from mother to baby. Oxygen starvation of the fetus or the fading of the pregnancy process occurs. A striking symptom is a change in the movement of the child inside. Quitting smoking and alcohol reduces the risk of placental defects

If changes occurring in the structure are detected by a doctor at week 30, this fact is normal in development. The main condition is the absence of serious abnormalities in the fetus. The reasons for heterogeneity are most often a combination of incorrect actions of the mother, including nervous experiences. The more comfortable and calm the mother is, the better the unborn baby will feel. The psycho-emotional state determines the state of the female body.

You should refrain from contact with sick people, as you can become infected with an infectious disease. And this is another negative factor leading to improper development of the structure.

20 - 27 weeks.

A heterogeneous structure of the placenta at 20 weeks is a common phenomenon among mothers. In case of a negative change in the condition of the organ, the ultrasound procedure will immediately report the initial stage of the pathology. The placenta may remain heterogeneous until the 27th week; after this period it returns to normal. Do not panic, each individual organism has its own developmental characteristics.

30-32 weeks. Upon reaching 30 weeks, the structure of the organ should become homogeneous. If at 30-32 weeks the structure remains heterogeneous, then this indicates the presence of pathology in the female body. A heterogeneous placenta at 32 weeks indicates a serious pathology occurring in the body.

Treatment and childbirth

A heterogeneous placenta during pregnancy is directly related to hypoplasia and hyperplasia. The doctor prescribes medications to improve uterine tone, blood circulation and proper oxygen delivery to the fetus. As an additional method - a healthy lifestyle and giving up bad habits. An ultrasound scan before the due date is also a necessary aspect of health monitoring.

Treatment of heterogeneity of the placenta:

1. elimination of stress and depression;
2. decreased tone, hypoxia;
3. therapy of diseases: hypoplasia and hyperplasia;
4. delivery.

A woman should strictly follow the doctor’s recommendations and take medications if they have been prescribed. Monitoring of fetal development should take place at all stages of gestation. If you follow the rules and lead a healthy lifestyle, then there is no need to fear for the unborn child and childbirth.

The tactics for managing childbirth with placental insufficiency are prescribed by the attending physician based on the condition of the woman’s body. Premature aging of the placental organ is an abnormal indicator that even causes concern to the doctor. With proper treatment, the problem can be corrected.

Calcifications

Calcifications are salt formations that are deposited on areas of dead organ tissue. The placental organ contains multiple blood vessels. They transport vital substances to the unborn child. In case of vessel spasm or failure, it leads to the death of the area. Calcium salt deposits form on dead areas of tissue.

The deposition of calcifications in the placenta can result from:

• pathological process of the uterus;
• severe anemia;
• gestosis and its manifestations;
• infection and chronic diseases;
• sexually transmitted diseases;
• bad habits.

In order for the pregnancy to proceed positively, periodic examinations by a doctor are required. A modern way of observing the process is the ultrasonic method, that is, ultrasound. With its help, pathology is identified in the early stages and calcifications are detected in areas.

Symptoms.

In the case of a single deposition of calcifications, the woman will not feel discomfort. This will not harm the unborn child. If multiple foci of salt deposits form on dead tissue, this seriously harms the fetus. With a strong phenomenon, the woman notices a change in the nature of the child’s behavior inside. He becomes too active or, on the contrary, calms down. Impaired functioning results in failure to perform adequate life support functions. The child does not receive oxygen. In severe cases, the death of the fetus inside the female body occurs.

Treatment. It is impossible to completely remove salt deposits inside the body. To begin with, the doctor establishes the specific cause of the appearance of salts and tries to eliminate the possibility of relapse. If salts were noticed late in pregnancy, and their quantity is small, then periodic examinations of the woman in labor are prescribed. The doctor monitors the situation using ultrasound and monitors the heterogeneous placenta with calcifications. The examination reveals a large number of foci of salts, but the functioning of the placental organ can proceed without disturbance. If the fetus continues to receive the necessary vital substances, then taking therapeutic drugs is not required.

Complications. If dysfunction is detected, if the fetus suffers from lack of oxygen and nutrition, the doctor prescribes appropriate treatment. It includes taking medications that normalize blood circulation, as well as vitamins. Additional drugs in treatment are stimulants of the metabolic process.