placental insufficiency

Placental insufficiency is a term given to a situation where the placenta cannot bring enough oxygen and nutrients to the growing fetus.

Clinical presentation

Fetuses may present with intra-uterine growth restriction (IUGR) (especially asymmetrical IUGR).

Pathology

It can be primarily caused by three main mechanisms :

  • impairment in maternal circulation
    • maternal hypertension
    • maternal thrombophilic disorders
  • 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

In chronic placental insufficiency, there is often abnormal umbilical arterial Doppler with traces showing a reduction, absence, or reversal, of end-diastolic flow.

Fetal MRI

Not part of a routine investigation. There are some reports suggesting the presence of restricted diffusion and reduced ADC values on MRI .

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