From the Guidelines
Placental insufficiency is a condition where the placenta fails to deliver adequate oxygen and nutrients to the developing fetus, potentially leading to growth restriction and other complications, and its management focuses on close monitoring and timely delivery to minimize adverse outcomes, as recommended by recent guidelines 1.
Effects of Placental Insufficiency
The effects of placental insufficiency can be severe and include:
- Intrauterine growth restriction (IUGR)
- Preeclampsia
- Stillbirth
- Neurodevelopmental delay
- Childhood and adult obesity
- Metabolic disease
Management of Placental Insufficiency
The management of placental insufficiency involves:
- Frequent prenatal visits, typically every 1-2 weeks
- Regular ultrasounds to assess fetal growth, amniotic fluid levels, and blood flow through the umbilical cord using Doppler studies
- Low-dose aspirin (81-100mg daily) started before 16 weeks of pregnancy to prevent placental insufficiency in high-risk women
- Antenatal corticosteroids like betamethasone (12mg intramuscularly, two doses 24 hours apart) to accelerate fetal lung maturity if early delivery is anticipated
- Timely delivery, with severe cases potentially requiring delivery as early as 32-34 weeks, while milder cases may continue to term with monitoring, as recommended by the American Journal of Obstetrics and Gynecology 1.
Key Recommendations
- Umbilical artery Doppler studies are universally advised in suspected small-for-gestational-age pregnancies 1
- Cerebral Doppler studies can influence surveillance and/or delivery timing in late-onset fetal growth restriction 1
- Corticosteroids should be used before birth at <34 weeks 1
- Magnesium sulfate should be used for neuroprotection in early-onset fetal growth restriction (<32 weeks) 1
Conclusion is not allowed, so the answer will continue without one.
The evidence-based national guidelines for the management of suspected fetal growth restriction emphasize the importance of early pregnancy risk selection, low-dose aspirin treatment for women with major risk factors for placental insufficiency, and smoking cessation to prevent small-for-gestational-age babies 1. The guidelines also recommend routine third-trimester scanning for women with major risk factors and serial scanning in the third trimester for women with suspected small-for-gestational-age pregnancies 1.
From the Research
Effects of Placental Insufficiency
The effects of placental insufficiency can be severe and long-lasting, impacting the fetus and placenta with consequences on cardiovascular, metabolic, and neurological development up to adulthood 2. Some of the key effects include:
- Fetal growth restriction (FGR), which is the second cause of perinatal death after prematurity and can complicate up to 6% of all pregnancies 2, 3
- Chronic fetal hypoxia due to poor placental perfusion, leading to placenta-mediated FGR 4
- Abnormalities in uterine artery and umbilical artery Doppler, resulting in adverse perinatal outcomes 5
- Increased risk of perinatal morbidity and mortality, particularly in cases of early FGR (<32 weeks) 3
- Potential long-term consequences, including cardiovascular, metabolic, and neurological disorders in adulthood 2
Placental Dysfunction and FGR
Placental dysfunction is a major contributing factor to FGR, with maternal vascular malperfusion being the most common placental disease contributing to FGR 4. The features of maternal vascular malperfusion can be identified on placental pathology, and antepartum diagnostic methods, such as placental imaging and uterine artery Doppler, are evolving 4. Additionally, angiogenic growth factors, such as placenta growth factor and soluble fms-like tyrosine kinase-1, play an important role in diagnosing and managing FGR 4.
Diagnostic Methods
Various diagnostic methods are used to evaluate placental function and detect FGR, including:
- Ultrasound examinations to assess placental morphology and blood flow 5
- Doppler velocimetry to evaluate uterine artery and umbilical artery blood flow 5, 3
- Magnetic Resonance Imaging (MRI) to assess placental function and detect hypoxia 6
- Placental imaging and uterine artery Doppler to identify maternal vascular malperfusion and diagnose FGR 4