During the second and third trimester, doctors use ultrasound diagnostics to determine the degree of maturity of the placenta. Not every mother-to-be has an idea of what it is about, and this is a very important indicator while carrying a baby. In this article we will tell you what the degree of maturity of the "child's place" is and what it should be normal at different times.
What it is?
The placenta is a temporary organ, its tasks and functions are limited by the duration of pregnancy, and after the birth of a baby, there is no need for a “child's place”. But during the period of carrying a baby, you cannot do without a placenta - it protects the baby, provides him with access to oxygen, vitamins, water, minerals, removes the baby's waste products, carbon dioxide into the mother's body, produces many hormones that are necessary for carrying a baby and preparing milk glands of a woman to breastfeeding. Even the slightest disturbance in the activity of the placenta can lead to very serious consequences for the health or life of the child and his mother.
The placenta does not appear immediately after conception; it forms gradually. Approximately 8 days after fertilization, the egg, which has become a blastocyst, descends into the uterus, where it has to gain a foothold on one of the walls, densely growing into the endometrium with chorionic villi. The chorion is at the site of ingrowth and is the predecessor of the future placenta. From this moment, the formation of a "child's place" begins.
By 12-14 weeks of gestation, the young placenta begins to function, but does not yet have certain delineated forms. The placenta acquires its final shape by 18-20 weeks of pregnancy. The growth of the "child's place" continues until the middle of the second trimester, after which the placenta no longer grows.
By birth, the temporary organ of life support for a child growing in the womb gradually loses its functions, “grows old”, developing a resource. The aging process is monitored by doctors on ultrasound and assessed at maturity. If the placenta for some reason begins to age prematurely, the baby does not receive enough oxygen and nutrition, its development may slow down, and hypoxia associated with a lack of oxygen can cause irreversible processes in its nervous system, brain, musculoskeletal system, and also cause intrauterine death of the baby.
The young placenta is constantly increasing its thickness, it grows with new blood vessels. In the second half of pregnancy, growth stops, the placenta retains its thickness for some time, and then it becomes not spongy, as in the beginning, but more dense due to calcium deposition. The functionality of the "baby seat" is also gradually dying out.
Maturity degrees
There are four degrees of maturity for a "child's place". The zero degree corresponds to the initial stage of the placenta functioning. If the doctor claims that the degree of maturity is 0, this means that the "child's place" is young, full of strength and possibilities and fully provides the child with everything necessary for his growth and further development.
The first degree of maturity means that changes have already begun in the placenta - it has stopped growing and gaining thickness. On ultrasound, such a placenta is defined as even, with a slight wavy membrane and single echogenic inclusions.
The second degree speaks of pronounced degenerative processes. In some places, the placenta may become thinner, denser, salt deposits become obvious to the ultrasound doctor. Depressions in the membrane become more visible.
The third degree of maturity is a completely mature placenta. On ultrasound, its visual division into lobes is noticeable, the membrane is covered with deep depressions, the structure changes - salt deposits become more extensive, echogenic areas on the ultrasound monitor merge into larger areas.
In addition, there are intermediate stages. For example, a woman can, according to the results of an ultrasound, be given a 0-1 degree of maturity of the placenta or 1-2 degrees. This means that during visual examination, the doctor found signs of a transition from one basic degree to another, but this transition has not yet been completely completed.
Standards
Normally, before the 30th week of pregnancy, a woman should have a zero degree of maturity of the "child's place". After 27 weeks, a 0-1 transitional degree can be determined, and it will be considered conditionally normal if there are no other complications of pregnancy, for example, previa or the marginal position of the placenta. Before the third trimester, the placenta is considered immature in a healthy and normal pregnancy.
From 30 to 34 weeks, the first stage of maturity of the "child's place" is usually observed. If during this period the ultrasound detects 1-2 degrees, this is regarded as an unambiguous pathology - premature aging. The dynamics of aging of the placenta by week further proceeds more intensively. From 35 to 38 weeks, women are normally diagnosed with a second degree of maturity, and after 38 weeks - a transitional 2-3 degree.
Shortly before childbirth, ultrasound can determine the third degree and this should not be the basis for worries - all processes, if they are timely, are compensated in the human body, and therefore the mature placenta copes with its duties quite well, if a woman, for example, 39 -40 week of pregnancy.
To visualize the aging process of the placenta in a normal, uncomplicated pregnancy more clearly, see how it looks in the table.
Table of normative values of the degrees of maturity of the placenta by week
Causes of Premature Aging
If the placenta ages within the time frame established in obstetrics, then aging is called physiological, that is, quite natural. If the “child's place” has matured ahead of time, we are talking about premature aging of the placenta, and this is a very alarming pathology that requires compulsory medical care.
The reasons for the premature maturation of the "child's place" may be different. Most often this happens in pregnant women who could not or did not want to part with bad habits - smoking and addiction to alcohol, at least for the time of gestation. Also, women who have had infectious diseases during pregnancy, including ARVI and influenza, are at risk for premature maturation of the placenta.
Quite often, the placenta ages prematurely in women with a negative Rh factor who are carrying their Rh-positive babies against the background of a developed Rh-conflict, as indicated by the antibody titer in the pregnant woman's blood. Early aging of the "child's place" often accompanies pregnancy in women with diabetes mellitus, as well as those who are used to taking medications for any reason without consulting a doctor.
Expectant mothers who are exposed to harmful substances (household chemicals, toxins, paints and varnishes, solvents) or radioactive radiation are also at risk. Doctors tend to believe that the stages of maturation of the placenta proceed faster than the standard time in women living in large cities, where the ecological situation leaves much to be desired.
The factor of premature aging often depends on heredity - the daughter runs the risk of repeating the pregnancy scenario of her mother. Aging can also be caused by some anomalies in the structure of the placenta itself, which were formed during the laying of this temporary organ.
Also, the most common causes of premature aging of the "child's place" are:
- gestosis, late toxicosis in the expectant mother;
- hypertension, drops in blood pressure;
- the presence of facts of detachment at different stages of pregnancy, placenta previa;
- multiple pregnancy;
- hormonal disorders in the body of the expectant mother.
Causes of pathological immaturity
Another deviation from the norm is the pathological immaturity of the placenta. It is much less common, but it is an equally dangerous situation. If a woman has 35 weeks of pregnancy, and the placenta remains immature and its degree 0 or 0-1 is determined by ultrasound, then the doctor has every reason to believe that such a "child's place" also does not cope with the functions assigned to him by nature.
An immature placenta cannot provide a growing child with the necessary amount of oxygen and nutrients, which leads to the birth of a low-weight baby and developmental delay, as well as to fetal hypoxia.
As the baby grows, the placenta and umbilical cord "pump" more and more blood both from the baby with metabolic products and to him - enriched with oxygen and vitamins. An immature placenta cannot provide uninterrupted blood flow in this mode. It retains the waste products of the crumbs, as well as carbon dioxide, which negatively affects the condition of the child and the health of the placenta itself.
Predictions are less favorable than with premature aging of the placenta, since not always medicine can affect the maturation of this temporary organ. Stillbirth is not excluded, as well as the birth of children with severe mental disabilities, paresis and paralysis, disorders of the central nervous system due to chronic hypoxia during pregnancy.
The reasons that can lead to slow maturation and development of the placenta are also quite diverse. Most often, such a violation occurs in women who, even before pregnancy, suffered from diabetes mellitus, as well as in expectant mothers who were diagnosed with gestational diabetes already during the gestation period. Pregnant smokers and drinkers are the second in the list of probable patients diagnosed with pathological immaturity of the placenta.
Nicotine and alcohol, especially with systematic use, slow down natural processes and suppress the production of necessary sex hormones.
An immature "child's place" is often diagnosed in women who are carrying a child against the background of exacerbation of chronic diseases of the liver, kidneys, heart and blood vessels. Hemostasis (blood clotting) disorders are also a risk factor.
If an immature placenta is found, a woman is definitely recommended to undergo additional diagnostics aimed at establishing the risks of having a child with chromosomal and genetic pathologies, as well as severe malformations of internal organs. It is this "inhibited" behavior of the placenta that is characteristic of pregnancies with sick and terminally ill babies.
Treatment
First of all, a woman should calm down and pull herself together - nervous shocks and prolonged stress create no less dangerous prerequisites for placental pathologies than a pregnant woman's contact with chemicals or viral ailments. With the premature aging of the "child's place", the doctor usually decides in favor of hospitalization of the expectant mother in a gynecological hospital. If the gestational age has not exceeded 36 weeks, then she will be given conserving therapy and monitor the baby's condition.
For treatment, drugs are used that improve uteroplacental blood flow, as well as antispasmodics, so that the uterus is less likely to tone up. Vitamin preparations for the baby are also injected drip.
A woman is recommended to take oxygen cocktails. The state of the placenta is closely monitored, repeating ultrasound every few days with a mandatory assessment of the speed and intensity of blood flow in the uteroplacental vessels.
If the gestational age at the time of detection of the premature aging of the "child's seat" exceeds 36 weeks, the doctor may suggest early delivery. This will depend on the specific situation and the degree of maturity. Sometimes a decision is also made about hospitalization and daily monitoring of the child's condition.
The expectant mother is given CTG every day to make sure that the baby does not start showing signs of oxygen starvation. When such signs appear, preservation therapy is canceled and an early birth or cesarean section is performed.
When late maturation of the placenta is detected, if the degree of its maturity does not reach the norm, a stationary regime is also recommended for the woman. Treatment is prescribed after establishing the absence of fetal malformations. If genetic tests or amniocentesis confirm that the baby is healthy, and an expert ultrasound does not show signs of anomalies in the structure of his organs, then the treatment is the same as in premature aging - vitamins, drugs to improve blood flow in the uterus and placenta, as well as mild sedatives to calm down.
If the child is sick, the woman is offered to terminate the pregnancy. If the baby is rejected, it is kept with standard therapy.
If hormonal disorders are the cause of immaturity, hormonal treatment may be recommended to the woman, which should accelerate the growth of the placental tissue and the expansion of the blood vessels in it.
The specific drug and dosage is determined by the attending physician, it is advisable to undergo such treatment under the supervision of specialists in a hospital setting.
The baby's condition is also monitored by ultrasound, ultrasound and CTG (after 28-30 weeks). If signs are found that indicate severe discomfort and suffering of the baby in the womb, a decision is also made about early delivery to save the child's life. Usually, a caesarean section is performed and subsequently the premature baby is nursed with the assistance of experienced neonatologists in a well-equipped intensive care unit.
What is considered a deviation?
A deviation should be considered a significant difference in the state of the placenta of a pregnant woman from the standard values. If a woman has 30 weeks of pregnancy, and the ultrasound showed 0-1 degree of maturity of the "child's place", this is a conditional norm. And if the degree is already the first or the first or second, then the woman needs to go to the hospital as soon as possible to start treatment.
The most stringent requirements apply to the norms at the transition of 1-2 and 2-3 degrees. At 1-2 degrees, the child usually cannot yet live independently or may be born deeply premature. Saving such a baby from the mother's womb, where he lacks nutrition and oxygen, doctors are at risk, because the baby may not survive because of his own immaturity and unpreparedness for life in this world.
Any deviation should be assessed by a doctor, and not by the pregnant woman herself. Only the doctor will tell you in what situation and under what concomitant diagnoses the degree of maturity will be the norm or will turn out to be pathology. The decision is also made taking into account the individual characteristics of the course of the gestational period.
Prevention
Not always a woman can influence the processes taking place in the placenta, but she can completely reduce the risks of her premature aging or pathological immaturity. To do this, you need to give up bad habits, do not drink pills and syrups without the knowledge of the doctor, as well as eat correctly and in a balanced way and breathe more fresh air. Move harmful chemicals away.
For the degree of maturity of the placenta by week, see the following video.
