Placental Insufficiency

Evidence 

https://www.ncbi.nlm.nih.gov/books/NBK563171/

Jaimie E. Wardinger; Shashikanth Ambati. 

Placental insufficiency is associated with various obstetric disorders such as pre-eclampsia and intrauterine growth restriction/fetal growth restriction (FGR), both of which predispose to preterm labor, a leading cause of perinatal morbidity and mortality around the world. Poor placental function is most commonly described by the term ‘placental insufficiency’ within the medical community; however, one study highlighted the problem that there is no standardized definition or consensus for the pathognomonic features pertaining to placental insufficiency. However, when fetal growth restriction occurs and when blood flow to the fetus is abnormal, a presumptive diagnosis of placental insufficiency is made. 

This poses many challenges when it comes to studying placental insufficiency in the literature, but the general understanding is that placental insufficiency is a process whereby there is a progressive deterioration in placental functioning such that oxygen and nutrient transfer to the fetus via the placenta is decreased. 

Education 

Placental insufficiency is a condition where the placenta fails to function properly and is therefore unable to adequately resource and supply oxygen and nutrients to the baby from the mother’s bloodstream resulting in the baby not having enough nutrients and oxygen to grow.  The earlier placental insufficiency occurs in pregnancy, the more serious the health risks are for the developing baby. 

Placental insufficiency is not usually considered life-threatening to the mother, though it may be a sign of other maternal conditions such as preeclampsia. Generally, there are no maternal symptoms associated with the condition, however there are indicators to watch out for. These include: 

• Below average weight gain in mother 
• Below average fundal height measurements 

• Decrease in foetal movement. 
• Doctors/midwives providing your care would be checking the growth rate on the fetus and levels of amniotic fluid around the baby to see if growth restriction is occurring. 

 The possible causes of placental insufficiency are: 

• diabetes 

• high blood pressure (hypertension) 
• preeclampsia 
• maternal blood clotting disorders 
• anaemia 
• smoking  

• taking drugs such as cocaine, heroin, and methamphetamine 
• Chromosomal and fetal abnormalities  

When severe and starting early, dangers are higher for the baby and may include: 

• oxygen deprivation which can cause cerebral palsy and other complications such as hypoxic-ischemic encephalopathy (HIE), a brain injury caused by insufficient oxygen in the baby’s brain. 

• low body temperature  
• low blood sugar  
• low blood calcium  
• excessive red blood cell count 
• IUGR also known as Intrauterine Growth Restriction (low birth weight) 

• stillbirth 
• Placental abruption 
• Bleeding and premature contractions 

There are a variety of ways that placental insufficiency can be diagnosed, these include: 

• Ultrasound to measure the size of the foetus 

• Ultrasound to measure the Blood flows to the baby  
• Some ultrasound features of the placenta 

Some centres may offer some blood tests that may suggest placental insufficiency. 

Placenta insufficiency is the most common cause of intrauterine growth restriction (IUGR), a condition in which the foetus is not growing at the expected rate. If IUGR/FGR is diagnosed, then you may be referred to a maternal foetal specialist for regular visits with frequent ultrasounds to check the baby’s wellbeing by looking at the placenta and blood flow. A decrease in blood flow in may be detected, which can progress to absent flow and then reverse flow.  The mother may have low levels of amniotic fluid (oligohydramnios) which can also indicate placenta issues.  

Empowerment 

It is important for you to communicate any concerns or changes that you are experiencing to your doctor. Changes in foetal movement and lack of weight gain may be indicators that some conditions may be starting to occur and close monitoring may be necessary. If you are diagnosed with placenta insufficiency and your baby has IUGR/FGR, your pregnancy will be classed as high risk. Depending on the gestation and severity of the condition your doctor will decide on a treatment plan. In some cases, it may be a ‘watch and wait’ with regular monitoring to observe the baby’s health.  Your doctor may choose to administer steroid injections to help develop the baby’s lungs which can help prevent respiratory distress once your baby is born. In the event of choosing an early delivery, a caesarean section may be the safest delivery option.  

It may now be the time to consider the likelihood of experiencing a premature birth and to ask any questions about what to expect. Perhaps ask to visit the Neonatal Intensive Care Unit (NICU) or Special Care Nursery (SCN) to become familiar with the environment.  

‘I went along for a scheduled appointment with my Obstetrician. I mentioned that the baby hadn’t been moving much and that I didn’t feel like I had got any bigger. He did a quick scan and told me that my baby was very small and had very little amniotic fluid. I was sent to a tertiary hospital to see a maternal foetal specialist. I was asked if I had brought my hospital bag, I was only 28 weeks, I hadn’t even packed one. After a lot of monitoring, this doctor held my hand and said “your baby is very, very sick and if it has any chance of survival your baby needs to be delivered immediately” I was raced off to theatre for an emergency c section. My baby boy was delivered weighing 790 grams at 28.2 weeks, severely growth restricted. My doctor later told me that if he hadn’t been delivered when he was, he wouldn’t have survived another 24 hours. I still get goose bumps whenever I retell that story’ Miracle Mum Megan 

Useful Links

Pregnancy Birth Baby – Placental Insufficiency 

https://www.pregnancybirthbaby.org.au/placental-insufficiency

COPE – Centre for Perinatal Excellence  

https://www.cope.org.au/getting-help/e-cope-directory/

Through the Unexpected – Perinatal Diagnosis 

https://throughtheunexpected.org.au/

Panda - Perinatal Mental Health 

https://panda.org.au/