THE PLACENTA
Objectives:
At the end of the lecture, the student should be able to:
Describe the development of the placenta
Describe the structure and functions of the placenta
Describe the amniotic fluid and umbilical cord
Enumerate the anatomical variations of the placenta
and umbilical cord
Development of the Placenta
Pre-Implantation
- The development of the placenta begins during
implantation of the blastocyst (Fig 1a).
- The 32-64 cell blastocyst contains two distinct
differentiated embryonic cell types: the outer
trophoblast cells andthe inner cell mass (Fig 1b).
- The trophoblast cells form the placenta. The inner cell
mass forms the fetus and fetal membranes.
- The trophoblast cells interact with the endometrial
decidual epithelia to enable the invasion into the
maternal uterine cells.
- The endometrium increases in vascularity and
undergoes a series of structural changes in a process
known as decidualization in preparation for
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implantation; hence the endometrium is referred to as
the decidua in pregnancy.
- The decidua has regions named according to its
relationship to the implantation site (Fig 2a).
• The decidua basalis lies between the developing
embryo and the stratum basalis of the uterus at the
implantation site.
• The decidua capsularis covers the developing
embryo separating it from the uterine cavity.
• Thedecidua vera (otherwise known as thedecidua
parietalis ) lines the remainder of the uterine cavity.
Implantation
Implantation involves two stages: prelacunar and
lacunar.
Prelacunar stage:
- 7 days’ post conception the blastocyst makes contact
with the decidua and the process of placentation
begins.
- The process of implantation is extremely aggressive:
chemical mediators, prostaglandins and proteolytic
enzymes are released by both the decidua and the
trophoblasts and maternal connective tissue is invaded.
- Nearby maternal blood vessels ensure there is
optimum blood flow to the placenta.
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- Normal implantation occurs on the anterior or
posterior wall of the body of the uterus. The most
common ectopic implantation site is in the ampulla of
the Fallopian tube.
- The trophoblast cells differentiate into the outer
multinucleated syncytiotrophoblast and the inner
mononucleated cytotrophoblast . (Fig 2b)
- The syncytiotrophoblast is responsible for producing
hormones such as Human Chorionic Gonadotropin
(hCG) by the second week, which is used in pregnancy
testing.
Lacunar stage:
- Increasing numbers of syncytiotrophoblasts surround
the blastocyst and small lakes form within these cells
known aslacunae . (Fig 2c).
- Meanwhile, the cytotrophoblast begins to form
primary chorionic villi (finger-like projections) (Fig 3)
which penetrate and expand into the surrounding
syncytiotrophoblast.
- In the 3rd week, extra-embryonic mesoderm grows
into these villi, forming a core of loose connective
tissue, at which point these structures are called
secondary chorionic villi .
- By the end of the third week, embryonic vessels begin
to form in the embryonic mesoderm of the secondary
chorionic villi, making themtertiary chorionic villi .
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- The cytotrophoblast cells from the tertiary villi grow
towards the decidua basalis of the maternal uterus and
spread across it to form a cytotrophoblastic shell. The
villi that are connected to the decidua basalis through
the cytotrophoblastic shell are known asanchoring villi .
- Villi become most profuse in the area where the blood
supply is richest, the decidua basalis. This part of the
trophoblastic layer known as the chorion frondosum
develops into theplacenta . The villi under the decidua
capsularis gradually degenerate due to lack of nutrition
forming the chorion leave , which is the origin of the
chorionic membrane.
- The syncytiotrophoblasts surrounding the villi erode
the walls of the maternal vessels forming a lake of
maternal blood enabling the villi to absorb nutrients and
oxygen and to excrete waste. These are known as the
nutritive villi .
- Villi growing outward within the intervillous space
from the stem (anchoring) villi are calledbranching villi
and provide surface area for exchange of metabolites
between mother and fetus.
- Thelayer of Nitabusch is a collaginous layer between
the endometrium and myometrium which assists in
preventing invasion further than the decidua.
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Fig 1a: Development of the blastocyst Fig 1b: Structure of the blastocyst
and embryo
Fig 2b: synctiotrophoblast
and cytotrophoblast
Fig 2a: Regions of the Decidua
Fig 2c: Lacunae 5
and primary villi Fig 3: The Chorionic Villi
Placenta
Introduction
A placenta is a temporary organ that connects the
developing fetus through the umbilical cord to the
uterine wall of the mother (Fig 4a).
Location
The placenta is located at the *anterior or posterior
part* of the upper uterine segment.
Size
Diameter = 20cm
Thickness = 2.5cm thick at the center
Shape
The placenta is discoid in shape that is it has a shape
like a disc
Weight
The placenta weighs 470g or weighs approximately 1/6
of the baby's weight
Surfaces
The placenta has two surfaces (Fig 4b)
- Maternal and
- Fetal surfaces
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Maternal surface:
- This surface is also called the*Basal plate*
- Colour : It is dark red in colour due to the maternal
blood and partial separation of the basal decidua
- Lobes : The surface has up to 40 lobes (cotyledons)
which are separated by sulci (furrow). These lobes are
further divided into lobules.
Fetal surface:
- This surface is also called the*Chorionic plate*
-Colour : It has a shiny appearance due to the amnion
covering it.
- Blood vessels: There are two umbilical arteries and
one umbilical vein
-Umbilical cord: This is inserted into the fetal surface
normally in the centre.
- Amnion: This is a smooth, tough and translucent
membrane that is derived from the inner cell mass. The
amnion can be peeled off the surface of the chorion.
- Chorion: It is a thick, opaque and friable membrane
derived from the trophoblast. It cannot be separated
from the placenta because it is derived from the same
trophoblastic layer as the placenta.
Fig 4a: A. Maternal surface of the Placenta B. Fetal surface of the Placenta
Fig 4b: Maternal and Fetal
Surfaces showing the Amnion
andChorion
Functions of the placenta
The placenta performs a variety of function and they
include;
- Storage
- Endocrine
- Respiration
- Protection
- Excretion
- Nutrition
- Transfer
It can be remembered using the pneumonic
*SERPENT*
Storage
- Stores glucose in the form of glycogen
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- Stores iron and fat soluble vitamins
Endocrine
- The placenta produces steroidal hormones like
oestrogens and progesterone. Oestrogens influence
uterine blood flow, enhance RNA and protein synthesis
- Progesterone maintains the myometrium in a quiet
state during pregnancy.
- The placenta also produces protein hormones like
human chorionic gonadotrophin (hCG) which helps to
stimulate the corpus luteum to produce mainly
progesterone.
- Other protein hormones include human placental
lactogen, human placental growth hormone.
Respiration
- The placenta is involved in gaseous exchange to and
from the fetus
Protection
- The placenta provides a limited barrier to infection.
- Few bacteria can penetrate the placenta except
treponema of syphilis and the tubercle bacillus.
- Some virus can also penetrate like HIV, hepatitis.
- The placenta filters high molecular weight substances
so not all drugs cross the placenta barrier.
Excretion
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- The main substance excreted from the fetus is
carbondionxide.
- Bilirubin is also excreted as a result of RBC breakdown.
Nutrition
- Nutrients like amino acids, glucose are required for
growth and energy; calcium and phosphorus for bones
and teeth ; iron for blood formation pass through the
placenta.
- Water, vitamins and minerals also pass
- Fats and fat soluble vitamins (A, D & E) find it difficult
to cross especially in the later stages of pregnancy.
Transfer
Substances are transfered by a variety of transport
mechanisms such as
- Simple diffusion of gases
- Water pores transfer water soluble substances
- Facilitated diffusion of glucose
- Active transport against concentration gradients of
ions, calcium and phosphorus
- Endocytosis of macromolecules
Anatomical variations of the placenta
- Succenturiate lobe of placenta
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- Curcumvallate placenta
- Bipartite placenta
- Tripartite placenta
- Battledore insertion of the cord
- Velamentous insertion of the cord
Succenturiate lobe of placenta (Fig 5a)
This type of placenta has a small extra lobe that is
separate from the main placenta and joined to it by
blood vessels that run through the membranes to
connect it.
Fig 5a: Succenturiate Lobe
of Placenta
Circumvallate placenta (Fig 5b)
Here, there is an opaque ring on the fetal surface of the
placenta formed by a doubling back of the fetal
membrane onto the fetal surface of the placenta.
Fig 5b: Circumvallate Placenta
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Bipartite placenta (Fig 5c)
This type of placenta has two complete and separate
lobes where the main umbilical cord divides to supply
both lobes.
Fig 5c: Bipartite
Placenta
Tripartite placenta
This type of placenta has three complete and separate
lobes where the main umbilical cord divides to supply
the three lobes.
Battledore insertion of the cord (Fig 5d)
Here, the umbilical cord is attached to the edge of the
placenta instead of the center
Fig 5d: Battledore
insertion of the cord
Velamentous insertion of the cord (Fig 5e)
Here, the umbilical cord is inserted into the membranes
some distance away from the edge of the placenta.
Fig 5e: Velamentous
12 insertion of the cord
Amniotic fluid
- Amniotic fluid is a clear alkaline and slightly yellowish
liquid contained within the amniotic sac.
- It is derived essentially from the maternal circulation
across the placental membranes and exuded from the
fetal surface.
- The fetus contributes to the amniotic fluid through
metabolism in small quantities of urine and fluid from
its lungs.
- This fluid is returned to the fetus by intramembranous
flow across the amnion into the fetal vessels and
through the mechanism of the fetus swallowing.
Functions of the amniotic fluid
- Distends the amniotic sac allowing for the growth and
free movement of the fetus and permitting symmetrical
musculoskeletal development.
- It equalizes pressure and protects the fetus from
jarring and injury.
- Maintains a constant intrauterine temperature,
protecting the fetus from heat loss and providing it with
small quantities of nutrients.
- In labour, as long as the membranes remain intact the
amniotic fluid protects the placenta and umbilical cord
from the pressure of uterine contractions.
- It also aids effacement of the cervix and dilatation of
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the uterine os, particularly where the presenting part is
poorly applied.
Constituents of the amniotic fluid
- 99% water
1% include
~Food substances
~ Waste products
~ Skin cells
~ Vernix caseosa
~Lanugo
- Abnormal constituents of the liquor, such as
meconium.
- Aspiration of amniotic fluid for diagnostic examination
is termedamniocentesis .
Volume of amniotic fluid
During pregnancy, amniotic fluid increases in volume
as the fetus grows: from 20 ml at 10 weeks to
approximately 500 ml at term.
The umbilical cord (funis)
The umbilical cord, which extends from the fetal
surface of the placenta to the umbilical area of the
fetus, is formed by the 5th week of pregnancy. It
originates from the duct that forms between the
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amniotic sac and the yolk sac, which transmits the
umbilical blood vessels.
Functions
The umbilical cord transports oxygen and nutrients to
the developing fetus, and removes waste products.
Structure
Fig 6: Structure of the umbilical cord
The umbilical cord contains two arteries and one vein
(Fig 6).
The blood vessels are enclosed and protected by
Wharton’s jelly, a gelatinous substance formed from
primary mesoderm.
The whole cord is covered in a layer of amnion that is
continuous with that covering the placenta.
There are no nerves in the umbilical cord, so cutting it
following the birth of the baby is not painful.
Measurements
Diameter = 1–2 cm Length =50 cm
Note: Short cord = <40cm Long cord = No particular
length but anything more than the normal length will be
considered long.
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