Placental insufficiency is a term given to a situation where the placenta cannot bring enough oxygen and nutrients to the growing fetus.
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Clinical presentation
Fetuses may present with intra-uterine growth restriction (IUGR) (especially asymmetrical IUGR).
Pathology
It can be primarily caused by three main mechanisms 4:
-
impairment in maternal circulation
maternal hypertension
maternal thrombophilic disorders
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impairment in fetal circulation
placental implantation over a fibroid
vascular thrombosis (e.g. placental infarction)
Risk factors
maternal narcotic (cocaine/heroin) use
Radiographic assessment
Ultrasound
may show a reduction in fetal biometric parameters, i.e. showing a picture of IUGR
amniotic fluid volumes may be low, i.e. oligohydramnios
In chronic placental insufficiency, there is often abnormal umbilical arterial Doppler with traces showing a reduction, absence, or reversal, of end-diastolic flow.
MRI
Fetal MRI is not part of a routine investigation. There are some reports suggesting the presence of restricted diffusion and reduced ADC values and globular placenta on MRI 2,7.
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