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What is the cause for placental insufficiency?

Q: My doctor found out in my 8th month through doppler test that I had severe placental insufficiency oligohydramnios and severe IUGR and had 23 week baby in my 33rd week. 6th month u/s had showed normal reports. So my doctor advised me to terminate my pregnancy as the baby would not be normal and I accepted her advice. Now, I went through all kind of tests like TORCH, Thyroid test, APA test and other small tests... all came out negative. I did nothing or didn't take anything to have caused it. I'm otherwise a perfectly healthy woman who doesn't have any sort of medical problems. Please tell me what could be the reason of this placental insufficiency? What other tests should I take to find the cause? If I get pregnant what should I do if such thing happen again? Please provide me some solution for this nightmare... I would be very grateful to you.

A:I am sorry for what happened. The reasons for placental insufficiency are very difficult to ascertain, if it is a symptom. I mean placental insufficiency is a fact that not enough blood and nutrition is going through the placenta to the baby. It is a concept rather than a disease, meaning that it is a group of disorders of fetal growth. It is actually what we call an escape diagnosis meaning whenever we are not sure we give the disease a non-specific name and try to explain things. From what you have written it is more likely that the baby itself was not too well meaning thereby that there could be a congenital malformation of the baby. One possibility is that unknowing you ruptured the bag of waters and the baby just choked inside without enough water (amniotic fluid) - the baby will not grow and premature rupture of the bag of waters as it is called, can explain all this. I am wondering if you have already aborted this baby? If you have, was an autopsy done at all?? If yes, what did it say? TORCH is a test often performed. But seldom helps in making a diagnosis. In other words is almost always useless so is the thyroid test, but anyway it is good that they are ok. It is good that APAs are negative, it was important to have ruled out that and it is good that it is ok as well and from what you have written you make no mention of any disease in you like high blood pressure and diabetes etc. If you do not have a chronic disease and you did not take any harmful medicines or exposure to Xrays, well in that case, the problem was either primarily with the placenta or with the baby itself as in form of deformity (which we will never know if you do not have an autopsy report). Either way it was most probably a problem with the feto-placental unit and since next pregnancy it will be a new baby and a new placenta the problem should not recur. Anyway it occurs more commonly in the first pregnancy. So you should not be too worried too much about the next pregnancy. Of course you should be under the care of a gynaecologist from the first three months or so but should not get too paranoid. Get a triple test done at 16 weeks (beta HCG, Alpha fetoproteins and serum Oestriol) and a detailed ultrasound at 20 weeks to exclude an abnormal baby and the rest of the pregnancy should be uneventful. You have a chance that the placental insufficiency may recur but the chance is so low that you should not be worried. Meanwhile plan a pregnancy as soon as you can feel upto it emotionally. You do not really need any more tests though some specialists may ask for a karyotyping for both you and your husband but it is not obligatory... and in all probability the report will be normal. I hope that this mail answers most of your queries. In case there are more please feel free to ask. I wish you all the best for your next pregnancy.

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