What is placental insufficiency?

The placenta delivers oxygen and nutrients to your baby. Placental insufficiency is when the placenta does not work properly. It’s not very common but it is serious, and can affect the growth and wellbeing of your baby.

If you have placental insufficiency, your baby may not grow as expected, leading to complications during pregnancy or birth.

What causes placental insufficiency?

Placental insufficiency occurs because the placenta doesn’t implant and grow properly in your uterus, or because it’s damaged. Sometimes there is no obvious cause.

The risk of placental insufficiency can be increased if you have medical conditions or other risk factors, such as:

• diabetes
• pre-eclampsia
• blood clotting conditions
• certain infections
• if you smoke drink alcohol or use illegal or recreational drugs
• high blood pressure, kidney problems or heart disease
• if you have had complications earlier in this pregnancy, particularly heavy bleeding
• older age during pregnancy (older than 40 years)
• if you have previously had a small baby, pre-eclampsia or stillbirth

How is placental insufficiency diagnosed?

Placental insufficiency may be picked up during your routine antenatal visits and tests.

Your doctor or midwife will measure and track the growth of your uterus and the baby. Placental insufficiency may be diagnosed during a routine ultrasound if your baby isn’t growing as expected.

Sometimes pregnant women may notice that their tummy isn’t growing, is smaller than in previous pregnancies or their baby isn’t moving as much. If you have any concerns during your pregnancy, contact your midwife or doctor immediately.

Diagnosing placental insufficiency early is important for the health of the mother and baby.

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What are the risks to you and your baby?

Placental insufficiency can lead to problems both for mother and baby.

For the mother, it can be linked to conditions such as:

• pre-eclampsia
• other problems with the placenta, including placental abruption (when the placenta comes away from the wall of the uterus)
• preterm labour and delivery

If the placenta does not develop properly, it can also lead to problems for your baby. When the baby doesn’t get enough oxygen and nutrients, it can prevent normal growth and development. This is known as fetal growth restriction (FGR).

Some of the challenges that babies with FGR can have include:

• breathing or heart problems
• low oxygen levels at birth
• difficulty maintaining body temperature
• trouble feeding and gaining weight
• infection
• bleeding on the brain (called ‘intraventricular haemorrhage’)
• problems with their eyes and vision
• problems with their bowel

These conditions are more likely in premature babies.

How is placental insufficiency managed?

If your doctor suspects placental insufficiency, they will keep a close eye on how your baby is growing and developing. They will monitor you and your baby regularly and may arrange for you to give birth in a major hospital with appropriate medical support.

You will be asked to keep a record of your baby's movements and let your medical team know if you notice any changes.

At any stage of your pregnancy, if you are concerned about your baby's movements, contact your midwife or doctor immediately. Do not wait until the next day. A slowing down of movement may be a sign that your baby is unwell.

You will likely need more frequent ultrasounds and have regular monitoring of your baby’s heart rate to assess their growth and wellbeing.

Treatment will depend on the stage of the pregnancy. If you’re under 37 weeks, your doctor may recommend waiting for as long as possible and keeping a close eye on the baby. But if there are signs that your baby is not well, it may be safest to induce labour or deliver your baby with a caesarean.

If your baby hasn’t been growing as expected, they may require additional support from the medical team at birth. The team will care for your baby, keep them warm and may help them to breathe with an oxygen mask or breathing tube.

Your baby may need to be transferred to the neonatal intensive care unit (NICU) or special care nursery for extra care.

It’s important to see your doctor or medical team as soon as possible if you have any concerns when you are pregnant. If you have bleeding and/or significant pain, call triple zero (000) for an ambulance or go to your nearest hospital emergency department.