Medical myths: why an aging placenta means nothing

Doctors are increasingly using the principles of evidence-based medicine in their work and abandoning outdated methods and treatment regimens. But many hospitals and clinics still make non-existent diagnoses and prescribe useless pills and tests.

In this series of articles we discuss medical practices that are still practiced today but have no scientific basis.

Today we’ll talk about the “aging” placenta. Ultrasound doctor Nelly Andreeva said that gynecologists still scare women with this condition, although in fact such a diagnosis does not exist. And what this disposable organ looks like says little about its functionality.

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Nelly Andreeva

Ultrasound diagnostics doctor at the Fomin Clinic.

What is this diagnosis of aging placenta?

In fact, an aging placenta is not a diagnosis, but a common term. Doctors also use it, but only to explain to the patient what is happening to the placenta.

First you need to figure out why you need a placenta. Essentially, this is a refrigerator from which the child takes the nutrients and hormones necessary for growth. Food for it is supplied by the mother’s body, and does this through the blood vessels that nourish the placenta. And the child takes them through the arteries and veins of the umbilical cord.

The placenta is a disposable organ. Its expiration date coincides with the maximum duration of pregnancy and is 42 weeks. And all this time, changes occur in the placenta: it matures, then reaches the peak of its form and gradually begins to “age.”

These changes can be seen on ultrasound. At first, the placenta is a homogeneous tissue, after 18-20 weeks it is divided into lobes and acquires a wave-like structure. Then the depressions become larger and the lobes stand out more clearly, dense areas of tissue appear. This indicates the “maturity” of the placenta and is more common in later stages.

Previously, it was believed that if the placenta looks mature, but the period is short, this could pose a danger to the fetus.

Doctors assumed that the prematurely aged placenta would not be able to function normally until the end of pregnancy, and the child would suffer in the womb, for example, from hypoxia. Therefore, if ultrasound specialists saw an overly mature placenta, patients were prescribed drugs to maintain the temporary organ.

Why did doctors stop paying attention to the degree of maturity of the placenta?

The classification, which determines the maturity of the placenta, was invented in 1979. Ultrasound machines were completely different back then. Doctors were happy if they were able to see at least some picture, but they never dreamed of Doppler ultrasound, a diagnostic method that allows one to study blood flow.

Therefore, doctors were forced to guess how the placenta functions by its appearance. Using it, they tried to predict how the child was feeling, whether he was lacking nutrients, and whether there were indications for inducing labor or a Caesarean section.

However, modern research showedthat the classification of placental maturity does not have much prognostic value. Simply put, the rate of placental maturation does not in any way affect the ability to carry and give birth to a healthy child. Therefore, now in the official ultrasound examination protocols there is not even a column in which the degree of maturity of the placenta could be noted.

Now doctors can do an ultrasound scan and determine whether everything is in order with the blood supply to the placenta. This tool has high predictive value. Research showthat abnormal blood flow increases the risk of a poor outcome and may indicate both reduced placental function and poor fetal well-being.

But some doctors still talk about the aging placenta?

Of course, no one will write this in the protocol, but they can tell the patient, and she will worry. I have had several cases when women said at the reception: “Oh, my placenta is overripe” or “My placenta is old.”

There is no such diagnosis officially in Russia. There is an order that contains examples of ultrasound protocols, and there is no longer a line about the maturity of the placenta. But if the doctor is used to writing this, he can add an additional die and write something like “corresponds to the classification of granules of such and such a degree.”

And the gynecologist can tell the woman about the aging placenta and even prescribe her heparin derivatives. At the same time, official sources indicatedthat doing this is not recommended.

We do not have medications that could somehow change its structure or slow down its maturation. And all the drugs that were used for this earlier are now recognized as ineffective and are not recommended for use.

It is possible that some doctors continue to prescribe such medications simply to reassure a pregnant woman. For example, if a patient is very worried about the maturity of the placenta, it will be difficult for her to accept the fact that nothing can be done about it.

And then the doctor may prescribe some kind of drug just so that the woman stops worrying so much. Although, of course, it is better to simply explain to the patient that the maturity of the placenta does not affect anything.

Sometimes doctors talk about petrification in the placenta. Does this have anything to do with maturity?

Petrification or calcification is the deposition of calcium salts, due to which the affected area becomes hard. This happens if, as a result of injury, hypoxia or the growth of a benign tumor, the connective tissue forms a scar, and calcium salts accumulate in it.

Calcifications occur, for example, in the mammary gland, lungs, and kidneys. But we cannot say whether they are in the placenta.

Scientists carried out experiments in which the placenta was assessed using ultrasound, CT and MRI, and it turned out that the readings of the devices diverged. The ultrasound beam does not pass through hard tissues, but is repelled from them, and the doctor sees that there is a compaction at the examination site – probably calcification.

But when the same place is looked at on a CT scan, the x-rays pass through easily, and it turns out that it is not calcification at all. It turns out that the object that we saw on the ultrasound was simply part of the placental tissue, which became a little more dense. This only shows that the placenta has its own expiration date and does not indicate any pathology.

Does the placenta have pathological conditions?

There are. Probably the most dangerous thing is placental abruption, when the vessels that attach it to the uterus rupture.

This process is so acute and critical that after 22 weeks of pregnancy it is an indication for early delivery. If the placenta detaches, it will be more dangerous for the baby to remain in the womb, and the doctor will decide to deliver the woman and nurse the baby.

Various placental neoplasms may indicate chromosomal pathology. Since the fetus and placenta are formed from the same set of cells, pathological changes in the latter may indicate that something is wrong with the child.

But neither placental abruption nor neoplasms can be confused with an aging placenta. The degree of its maturity does not indicate that the child is not receiving enough oxygen and nutrients. The opposite is also true – if the placenta looks great, this does not mean that the fetus is well nourished.

How can you tell if the baby is eating well in the womb?

First of all, we pay attention to the size of the child. There are special tables for evaluation, which can be used to determine whether it meets the deadline or not.

Of course, this is not a single number that all children must meet. For example, a mother with a height of 152 cm will most likely have a smaller child than a woman with a height of 190 cm. Therefore, the rating scale does not have strict values, but a certain corridor – the minimum and maximum normal weight.

At critical values, when the fetus is too small for the current stage of pregnancy, the doctor diagnoses fetal growth retardation. This means that the baby is suffering, and the placenta may be to blame. And then the ultrasound doctor will evaluate the blood flow of the placenta using Doppler ultrasound.

After 28 weeks, the doctor may prescribe cardiotocography – the same study when the mother lies for a long time with a sensor on her stomach, hears the baby’s heartbeat and presses a button if she feels that he is moving.

In the third trimester of pregnancy, a pacemaker appears in the baby’s heart – a structure that regulates the heart rate. If we see that during movement or uterine contractions the fetal heart rate increases and decreases at rest, then everything is fine with him. But when there is activity, but the heartbeat does not increase or, worse, falls, it means that something is wrong with the child.

In general, if we again draw an analogy with refrigerators, the device may be shabby in appearance, but of high quality. It will freeze well, and its owner will eat fresh food and grow well. At the same time, some cheap, brand new refrigerator may look great, but all the food in it will go rotten, and the owner will remain hungry.

The appearance of the refrigerator is the determination of the maturity of the placenta by ultrasound, the assessment of its functionality is Doppler, and the well-being of the owner is the growth of the child and his heartbeat on CTG.

What to say to a doctor who talks about an aging placenta?

Three questions need to be asked:

1. Is the baby appropriate for the gestational age?
2. Is everything okay with the blood flow of the placenta?
3. Do I need a CTG?

It may be that the blood flow of the placenta is questionable, but the baby is normal in weight, and everything is fine on CTG. This may mean that at the time of the study the child, for example, sat on his umbilical cord, and therefore there was not much blood flow. But overall everything is fine.

If all indicators are normal, there is nothing to worry about.