Placental insufficiency

Estriol (estra-1,3,5(10)-trien-3,16-a,17-8 -triol) is the major estrogen metabolite found in the urine. It is excreted in the form of its conjugate with glucuronic acid. The determination of this steroid as an index of placental function has become one of the most widely used endocrine determinations. As pregnancy progresses, the excretion increases and reaches very high levels near term. In abnormal fetoplacental function, the levels of estriol will fall in some cases. The fall is usually progressive, and, because of this, serial determinations of urinary estriol must be carried out. The drop in estriol can be taken as evidence of placental insufficiency, and close watch by the physician is indicated, as a continued drop may necessitate Cesarean section to save the life of the infant. 

Like oxytocin, prostaglandins have been responsible rarely for fetal distress and even fetal death (119,120). The risk of fetal death underlines the importance of car-diotocography during prostaglandin (pre)induction. Prostaglandins should be used with extreme caution if there is a risk of placental insufficiency (120). 

In the immediate future, many other common problems of pregnancy and the fetus are likely to be reexamined by proteomics and metabolomics, ultimately identifying the best predictive biomarkers for disease and adverse neonatal outcome. As we have begun to see, pregnancy-induced hypertension (PIH), growth restriction in utero, diabetic pregnancy, and placental insufficiency are but a few of the situations in which early proteomic assessment is likely to play a prominent role in the next several years (Figure 8). 

Plasma amino acid concentrations are high during the first days of life, especiaUy in premature neonates, but they tend to be low in infants with birth weights low for their gestational age because of placental insufficiency. Maternal values are low in the first half of pregnancy. In adults, increased plasma levels of homocysteine have been hnked to increased risk of heart disease (see Chapters 26 and 44). ... 

Placental insufficiency. From a biological standpoint, the placenta is a filtering and hormone-secreting organ that mediates the interaction between mother and fetus. A damaged placenta causes a damaged fetus. Placental insufficiency, for... 

Fetal distress Spontaneous abortion Placental insufficiency... 

Treatment of placental insufficiency has been directed at improving the functional capacity of the placenta by means of hormonal substitution or by improving placental circulation. In many instances, however, the results have been unsatisfactory. We have therefore, considered the possibility of providing the fetus with nutrients independent of placental function. 

Some remarkable observations could be made in cases of placental insufficiency. The diagnosis of a placental insufficiency was made by means of 4 parameters, at least 3 of them had to be positive (cardotocography, excretion of oestriol in the urine, measurement of the biparietal diameters by means of ultrasonics, human placental lactogen). In cases of placental insufficiency, amino acids were given intraamnially up to 12 times. 

Despite the difficulty in interpreting the present findings, the intraamnial supply of amino acids seems to be a promising way to treat placental insufficiency. 

Fig. 3. Placental insufficiency. The effect of amino acids given intra-amniotically on maternal urinary oestriol excretion.

Some of the studies reported on at the conference were controversial, and even though the editors and many of the participants did not agree with some of the views expressed, we felt that the data presented had created sufficient stimulation to justify publication. For example, the very aggressive approach for treatment of the fetus subjected to utero-placental insufficiency outlined by Dr. Heller opens a completely unexplored area of treat-... 

Xanthinol nicotinate (II), which combines representatives of two classes of vasodilators, namely xanthines and nicotinic acid analogs, has been used to improve circulation in a number of clinical and experimental studies. Placental insufficiency, resulting from low placental circulation, was significantly improved in 13 women who received this drug. Xanthinol also improved considerably lower limb circulation in 39 of 41 patients suffering from peripheral vascular disease and who had previously had lumbar sympathectomy. This work S implies that surgical interruption of the lumbar sympathetic pathways did not totally remove vasoconstrictor tone and that xanthinol was able to decrease or abolish the remaining vasoconstriction. 

Henriksen, Tore, and Torun Clausen. 2002. The Fetal Origins Hypothesis Placental Insufficiency and Inheritance versus Maternal Malnutrition in Well-Nourished Populations. Acta Ohstetricia et Gynecologica Scandinavica 81 112-114. 

Gestational psittacosis may rarely affect pregnant women, resulting in pneumonia, sepsis and placental insufficiency. 

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