Normal fetal development and growth
Louise C Kenny, Jenny E Myers in Obstetrics, 2017
Normal placental development and function from early pregnancy is key to ensuring that the fetus receives adequate oxygen and nutrients from the mother. Placental insufficiency occurs when there is inadequate transfer of nutrients and oxygen across the placenta to the fetus. It can be due to poor maternal uterine artery blood flow, a thicker placental trophoblast barrier and/or abnormal fetus villous development. Placental infarction secondary to the maternal chronic conditions discussed above or acute premature separation as in placental abruption can impair this transfer and hence fetal growth. Recurrent bleeding from the placenta (antepartum haemorrhage) can, over time, compromise placental function, leading to poor fetal growth in the latter part of pregnancy. FGR is discussed further in Chapter 9, Hypertensive disorders of pregnancy.
The Epidemiology and Etiology of Intrauterine Growth Retardation
Asim Kurjak, John M. Beazley in Fetal Growth Retardation: Diagnosis and Treatment, 2020
Placental insufficiency is another phrase commonly used in association with poor growth of the fetus. This begs the question, for more commonly in the Western World, IUGR is associated with a placental bed problem and it is not of necessity the placenta that is insufficient. Unfortunately the obstetrical profession had got into a habit of measuring placental function through the estimation of various aspects of its metabolism, such as the oestriol production or human placental lactogen manufacture. These may have had some relationship to the transfer of nutrients or oxygen but these associations were loose and varying ones; the use of these estimates have mostly been abandoned. Further, all functions of transfer may not go at the same pace. The same baby for whom amino acids and calories have been reduced by poor transfer during pregnancy does not have to suffer from hypoxia in labor due to poor transfer of oxygen. Placental insufficiency as a phrase is therefore probably best avoided in this context for it is too loose a concept and it probably draws attention to the wrong place.
Omics and coagulation disorders in pregnancy
Moshe Hod, Vincenzo Berghella, Mary E. D'Alton, Gian Carlo Di Renzo, Eduard Gratacós, Vassilios Fanos in New Technologies and Perinatal Medicine, 2019
A maternal predisposition to endothelial dysfunction and an impaired trophoblast invasion and maternal spiral arteries remodeling have been proposed as underlying pathogenic mechanisms for these obstetric diseases, by contributing to shallow placental implantation and eventually placental insufficiency (25–33). In turn, placental insufficiency leads to decreased uteroplacental blood perfusion and impaired materno-fetal exchange of nutrients, gases, and waste products (34). Hypoperfusion and endothelial dysfunction appear to be both a cause and a consequence of abnormal placental development, as suggested by the following examples: (1) successful animal models of preeclampsia have involved mechanically reducing uteroplacental blood flow (35,36), and (2) medical conditions associated with vascular insufficiency and endothelial dysfunction (e.g., chronic hypertension, diabetes mellitus) increase the risk of abnormal placentation and development of placentally related complications (20).
Cerebroplacental doppler ratio and perinatal outcome in late-onset foetal growth restriction
Published in Journal of Obstetrics and Gynaecology, 2022
Ozge Kahramanoglu, Oya Demirci, Mucize Eric Ozdemir, Agnese Maria Chiara Rapisarda, Munip Akalin, Ali Sahap Odacilar, Hayal Ismailov, Gizem Elif Dizdarogullari, Aydin Ocal
The CPR may predict earlier delivery in late-onset FGR. Among our patients, 49% of those with abnormal CPR gave birth before term. However, only less than one of five patients in the normal CPR group had a preterm birth. One possible explanation is that the abnormal CPR group had a significantly higher rate of oligohydramnios resulting in a lower biophysical profile score. Accordingly, foetuses with abnormal CPR had a lower birth weight. Both findings may be explained with the association of low CPR and placental insufficiency. Khalil (2017) studied the association between adverse perinatal outcomes and CPR. They evaluated 7944 pregnancies, retrospectively. They didn’t state whether they exclude pregnancies with congenital/chromosomal abnormality. Similar to our results, the mean birth weight of the foetuses with abnormal CPR was lower than those with normal CPR.
Diagnosis of preeclampsia in women with diabetic kidney disease
Published in Hypertension in Pregnancy, 2021
Jakub Kornacki, Daniel Boroń, Paweł Gutaj, Urszula Mantaj, Przemysław Wirstlein, Ewa Wender-Ozegowska
The results of the present study indicate a crucial role of primary chronic hypertension and the degree of primary kidney injury and dysfunction in the development of PE in women with DKD. Both these factors are strong determinants of PE in this group of patients. Proteinuria seems to be the best renal predictive factors of PE from the beginning of pregnancy whereas serum creatinine concentration and CC play such a role mainly in the third trimester of pregnancy. Good metabolic control of diabetes by using an insulin pump seems to be important in the prophylaxis of PE. Placental insufficiency may be helpful in the diagnosis of PE however the presence of this abnormality is not necessary for the development of PE. Probably, this is a reason why aspirin may not be effective in the prevention of PE in this particular group of patients.
Can increased resistance to uterine artery flow be a risk factor for adverse neurodevelopmental outcomes in childhood? A prospective cohort study
Published in Journal of Obstetrics and Gynaecology, 2020
M. M. Okido, H. Bettiol, M. A. Barbieri, A. C. Marcolin, S. M. Quintana, V. C. Cardoso, C. M. Del-Ben, R. C. Cavalli
It is estimated that 13.2% of children and persons younger than 18 years old have some type of cognitive or physical deficit, with significantly greater requirements for medications, specialised equipment and professionals (Boulet et al. 2009; Boyle et al. 2011). Insults suffered during intrauterine and neonatal life play a relevant role in the genesis of developmental disorders. Particularly important during intrauterine and neonatal life are issues related to placental insufficiency (Arcangeli et al. 2012; Mwaniki et al. 2012).
Related Knowledge Centers
- Cardiotocography
- Epigenetics
- Infarction
- Placenta
- Pregnancy
- NONstress Test
- Circumvallate Placenta
- Amnion Nodosum
- Chorionic Villi
- Thrifty Phenotype