Placental Insufficiency - Specialists and Information

If blood flow to the placenta is impaired, or if the placenta is not functioning properly, this is referred to as insufficiency (inadequacy, weakness). 

In this case, the unborn child does not receive an adequate supply of oxygen and nutrients. If this deficiency goes unrecognized and untreated, and the resulting oxygen deprivation can have serious health consequences for your baby.

Healthy placenta @ Artemida-psy /AdobeStock

There are three types of placental insufficiency, each with different causes:

• Acute form (develops within minutes or a few hours)
• Subacute form (develops over a few days)
• Chronic form (develops over the course of several weeks or months)

In most cases, the treating physician detects placental insufficiency during routine prenatal checkups. The symptoms are evident in your unborn child. 

When the placenta is not functioning properly, the fetus is often smaller or less active than normal. The amount of amniotic fluid is also often lower than in a healthy pregnancy.

Many pregnant women do not notice any symptoms in themselves. This creates the risk of being unaware of placental insufficiency. 

Common symptoms include:

• High blood pressure 
• High blood pressure combined with increased protein in the urine (preeclampsia)

If you have a chronic form of the condition, this may be indicated by minimal weight gain and a comparatively small abdominal circumference.

Acute placental insufficiency is a medical emergency and is life-threatening for your baby. The placenta may suddenly detach from the uterine wall (premature placental abruption). 

Symptoms include severe abdominal pain or spontaneous bleeding. Seeking immediate medical attention is crucial to saving the fetus. 

Depending on the cause of the acute placental insufficiency, an emergency delivery by cesarean section (emergency C-section) is unavoidable. 

If left untreated, the baby’s life is at significant risk. Long-term consequences for the child may include developmental delays and severe mental and physical disabilities.

In most cases of acute placental insufficiency, doctors must immediately terminate the pregnancy via emergency cesarean section @ samrith /AdobeStock

The causes of placental insufficiency vary considerably and are often related to risk factors. 

Causes in acute cases include:

• Premature placental abruption
• Circulatory disorders of the umbilical cord or
• Maternal eclampsia (seizure)

Another possibility is vena cava compression syndrome, in which the fetus exerts pressure on the inferior vena cava. This disrupts blood flow to the expectant mother’s heart.

In subacute and chronic placental insufficiency, the damage progresses more slowly but still requires medical treatment. 

Several underlying conditions can trigger this, such as:

• Diabetes
• Kidney disease
• High blood pressure, or 
• preeclampsia

In addition, the use of nicotine, alcohol, and drugs is considered a relevant risk factor.

It is essential to attend regular prenatal checkups during pregnancy. These allow for the early detection of any placental insufficiency. 

Your gynecologist will first ask you about how you’re feeling and any pre-existing medical conditions. Then, they’ll perform an ultrasound examination. Based on the size of the baby in relation to the gestational week, they’ll assess the baby’s development.

A baby that is significantly smaller than expected is an initial indication of an inadequate supply of nutrients. A small or unusually shaped placenta is also indicative of placental insufficiency. 

To supplement the diagnosis, your doctor will perform a CTG (cardiotocography). This is a test in which your gynecologist monitors your contractions and the fetal heart rate.

If necessary, additional imaging procedures may be considered.

By measuring the fetal heart sounds, the CTG allows for an assessment of the baby’s oxygen supply @ Kzenon /AdobeStock

In acute cases, the doctor will take emergency measures, usually in the form of early induction of labor, often via cesarean section.

In less acute cases, hospitalization for monitoring and regular checkups may be necessary. In addition, the pregnant woman should take it easy physically. 

In cases of chronic placental insufficiency, your doctor—a specialist in obstetrics and gynecology—will work with you to develop a birth plan. This plan outlines the specific measures to be taken if there are concrete signs of deterioration.

In general, placental insufficiency itself cannot be treated. Therapeutic measures are directed at the underlying conditions. Your doctor will treat these to minimize risks. Taking it easy and maintaining a healthy lifestyle are also advisable.

The course of the condition varies and depends on the severity of the placental insufficiency. Compared to a pregnancy without complications, there is an increased risk of stillbirth. 

The threshold for viability in premature infants is the 25th week of pregnancy. Therefore, this is classified as an extremely preterm birth with very high risks to the infant.

Premature infants born after the 35th week of gestation have a good prognosis for normal development.

Due to the inadequate supply of nutrients to the child in cases of placental insufficiency, there is a significant risk of various diseases later in life.

These include, for example:

• Severe obesity
• Diabetes
• Atherosclerosis (hardening of the arteries) and
• High blood pressure

The earlier placental insufficiency is diagnosed and treated, the more effectively complications can be prevented. Unfortunately, a cure is not always possible.

In the worst-case scenario, the fetus may die in utero. However, in many cases, a cesarean section or early induction of labor is possible to protect the baby.