Placental insufficiency is a condition where there is a reduction in the placenta’s ability to sustain the baby. The placenta or afterbirth is the organ within the uterus where the baby’s blood vessels exchange waste products from the baby’s system for oxygen and other nutrients supplied by the mother’s blood. If the placenta either does not develop normally or starts to deteriorate for some reason, the baby will go short of essential materials for growth. This will be apparent if your uterus is not growing at the expected rate and may be demonstrated by ultrasound. Placental insufficiency can be caused by raised blood pressure, smoking, syphilis, diabetes and bleeding in pregnancy.
You can be reasonably sure that your placenta is functioning well if you are aware of the baby kicking frequently. You can check this for yourself by making your own kick chart. This can be done by charting the baby’s movements, starting at the same time each day, e.g. 9 am. Count each separate movement you feel until you reach ten. Then make a note of the time. More than ten movements during 12 hours is a healthy sign. If the baby does not seem to move this often, or if the time by which it reaches ten each day is getting later and later every day, contact your midwife to get the baby monitored. However a recent study suggests that in fact kick charts are not especially good at predicting problems. Always trust your instinct; if you feel something is wrong, say so, even if you think that admitting to it may jeopardise your chances of a home birth.
Monitoring for placental insufficiency is usually by means of the cardiotocograph or belt monitor. This involves you lying down for half an hour while two belts with transducers are fastened around your abdomen. The baby’s heartbeat is picked up by ultrasound and relayed to a machine which gives a printout. The other transducer measures the strength of any uterine contractions. The printout will supply information about the rate at which the fetal heart is beating and whether there is a good beat-to-beat variation. This should be enough to reassure everyone that your baby is well. If it does not, there are further tests that can be done to assess how well the placenta is functioning. There is also ultrasound; this cannot normally give you a good image of the placenta, although it can be done in specialist centres. If there is some doubt about how well the baby is growing you may be offered a scan at regular intervals in order to chart its progress.
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