DEVELOPMENT OF PLACENTA

INTRODUCTION

The placenta - remarkable organ. Originating from the trophoblastic layer of the
fertilized ovum itself, it links closely with the mother fetus circulation to carry out
functions which the fetus is unable to perform for itself during intra-uterine life.

DEVELOPMENT OF PLACENTA

Initially the ovum appears to be covered with a fine, downy hair, which consists
of the projections from the trophoblastic layer.

These projections proliferate and branch from about 3 weeks after fertilization,
forming the chorionic villi.

The villi become most profuse in the area where the blood supply is richest, that is
called basal dcidua.

This part of the trophoblast is known as the chorion frondosum, it will eventually
develop into the placenta.

The villi under the capsular decidua, being less well nourished, gradually
degenerate and form the chorion laeve which is the origin of the chorionic membrane.

The villi erode the walls of maternal blood vessel as they penetrate the decidua,
opening them up to form a lake of maternal blood in which they float.

The opened blood vessels are known as sinuses.

The maternal blood circulates slowly,enabling the villi to absorb food and oxygen
& excreate urine. These are known as Nutritive villi.
 A few villi are more deeply attached to the decidua and are called anchoring villi.

Each chorionic villi is a branching structure arising from one stem.

Totally 4 layers separate the maternal blood and fetal blood

1.Mesoderm and fetal blood vessels(center)

2.Branches of umbilical artery & vein(center)

3.Single layer of cytotrophoblast cell(Inner)

4.External layer syncitiotrophoblast.(Outer)

The placenta is completely formed and functioning from 10 weeks after

fertilization.

Between 12 & 20 weeks gestation the placenta weighs more than the fetus

CIRCULATION THROUGH THE PLACENTA

Fetal blood, low in oxygen, is pumped by the fetal heart towards the placenta
along the umbilical arteries.

Transported along their branches to the capillaries of the chorionic villi.

With oxygen the blood is returned to the fetus via the umbilical vein.

FUNCTIONS OF PLACENTA

1.Respiration:
 Pulmonary exchange does not takes place in the uterus.

The fetus must obtain oxygen & excrete Co2 through the placenta.

O2 from mothers hemoglobin passes to fetal blood by simple diffusion & fetus
passes CO2 into maternal blood.

2.Nutrition

Amino acids - body building,

Glucose - energy

Calcium & phosphorus- bones & teeth

Iron & other minerals blood formation

Placenta is able to select those substances required by the fetus

Proteins are transferred across the placenta as amino acids, carbohydrates as

glucose & fats as fatty acids.

3.Storage:

Placenta metabolises glucose, stores it in the form of glycogen & reconverts it in

to glucose as required.

It also store iron and fat-soluble vitamins.

4.Excretion:
 Main substance excreted from the fetus is Co2.

Billirubin also be excreted as RBCs.

Amounts of urea & uric acid excreted are very small.

5.Protection:

Placenta provides a limited barrier to infection

Treponema of syphilis & tubercle bacillus, few bacteria can penetrate.

Viruses can cross freely and may cause congenital abnormalities.

6. Endocrine:

A. HCG :

This is produced by the cytotrophoblastic layer of the chorionic villi.

It excretes through urine.

Its function is to stimulate the growth & activity of the corpus luteum.

B. Oestrogen:

When the activity of corpus luteum declines, the placenta takes over the
production of estrogen.

C. Progesterone:

This is made in syncitial layer of placenta. It may be measured in the urine as

 pregnanediol.

D. HPL: It has a role in glucose metabolism in pregnancy. As the HCG level falls, the HPL level
rises and continues to do so throughout pregnancy.

APPEARANCE OF PLACENTA

The placenta is a round, flat mass about 20 cm in diameter & 2.5 cm thick at its centre. It
weighs approximately 1/6th of the weight at term.

Maternal surface:

Maternal blood gives this surface a dark red colour. The surface is arranged in about 20
lobes, the lobes are made up of lobules.

Fetal surface:

The amnion covering the fetal surface of the placenta gives it a white, shiny appearance.
Branches of the umbilical vein & arteries are visible, spreading out from the insertion of
the umbilical cord which is normally in the centre.

The fetal membrane.

It consists of a double membrane. The outer membrane is the chorion, the inner is amnion
which contains amniotic fluid.

Chorion- This is a thick, opaque, friable membrane derived from the trophoblast.

Amnion- This is a smooth, tough, translucent membrane derived from the inner
cell mass.

Functions:

Contribute to the formation of liquor amnii

Intact membrane prevent ascending uterine infection.

Facilitate dilatation of cervix during labour.

 Has got enzymatic activities for steroid hormonal metabolism.

AMNIOTIC FLUID

Origin:

The source of amniotic fluid is thought to be both fetal and maternal.

It is secreted by the amnion, especially that which covers the placenta and
umbilical cord.

Fetal urine also contributes to the volume from the 10 th week of gestation
onwards.

Volume:

It measures about 50 ml at 12 weeks, 400ml at 20 weeks and reaches peak of 1

liter at 36-38 weeks.

If the total amount exceeds 2000 ml, the condition known as polyhydramnios, and
if less than 300 ml, the term is oligohydramnios.

Such abnormalities are often associated with congenital malformations of the

fetus.

Physical features :

The fluid is faintly alkaline with low specific gravity of 1.010. It becomes highly hypotonic
to maternal serum at term pregnancy.

Colour:

In early pregnancy, it is colourless, but near term, it becomes pale straw coloured due to
presence of exfoliated lanugo and epidermal cells from the fetal skin.

Abnormal colour:
 Meconium stained (green) is suggestive of fetal distress

Golden colour In Rh incompatibility

Greenish yellow seen in postmaturity.

Dark colour- In concealed accidental hemorrhage

Dark brown Amniotic fluid is found in IUD

Composition:

It includes water 98-99% and solid 1-2%. The following are the solid constituents;

a. Organic:

--Protein- 0.3 gm% --Glucose-20mg%

--Urea 30mg --NPN- 30mg %

--Uric acid- 4mg% --Creatinine -2mg %

--Total lipids 50mg %

--Hormones ( prolactin, insulin & renin)

b. Inorganic : The concentration of the sodium, chloried & pottassium is almost the same as
that found in maternal blood.

c. Suspended particles : It incluides lanugo, exfoliated sqamous epithelial cells from the fetal
skin, vernix caseosa.sss

Function:

During pregnancy-

Act as a shock absorber, protecting the fetus from injury.

 Maintains an even temperature.

Allows for growth & free movement of the fetus.

During labour-

The amnion & chorion are combined to from a hydrostatic wedge which helps in
dilatation of the cervix.

It flushes the birth canal.

Clinical importance:

Provides useful information about the health status & also maturity of the fetus.

Intra amniotic instillation of chemicals used as method of induction of abortion.

To detect for polyhydramnios & oligohydramnios.

ROM is helpful method in induction of labour.

UMBILICAL CORD

The umbilical cord or forms the connecting link between the fetus & placenta.

Development:

The umbilical cord is developed from connective stalk which is band of mesoblastic
tissue stretching between the embryonic disc and the chorion. Initially, it is attached to the
caudal end of the embryonic disc. As a result of cephalocaudal folding of the embryo and
 simultaneous enlargement of the amniotic cavity. As the amniotic cavity enlarges out of
proportion to the embryo & becomes distended with fluid. The embryo is carried more &
more into the amniotic cavity with simultaneous elongation of the connective stalk. It is a
future umbilical cord.

Structures

Covering epithelium

Whartons jelly

Blood vessels- 2 arteries, 1 vein

Remnant of umbilical vesicle & its vitelline duct

Allantois

Obliterated extra embryonic coelom.

Characteristics

It is about 50 cm in length

Diameter average 1.5 cm.

Thickness is not uniform

Presents of nodes or swelling.

Swellings may be due to dilatation of the umbilical vein or local collection of

whartons jelly.
Attachment:

In the early period, the cord is attached to the ventral surface of the embryo close
to the caudal extremity.

But as the coelom closes & the yolk sac atrophies, the point of attachment is
moved permanently to the centre of the abdomen at 4th month.

The attachment may be central,marginal or even on the chorionic laeve at varying

distance away from the margin of the placenta, called velamentous insertion.

ABNORMALITIES OF PLACENTA AND CORD

There is a marked variation in the morphology including size, shape and weight of the placenta.

Placenta succenturiata:

One or more small lobes of placenta, size of a cotyledon, may be placed at varying
distance from the main placental margin. A leash of vessels connecting the main to the
small lobe traverse through the membranes.

Placenta Extrachorialis

Two types are described;

- Circumvallate placenta

- Placenta marginata

Circumvallate Placenta

The fetal surface is divided into a central depressed zone surrounded by a

thickened white ring which is usually complete.

The ring is composed of a double fold of amnion and chorion with degenerated
deciduas and fibrin in between.
 Vessels radiate from the cord insertion as for as the ring and then disappear from
view.

The peripheral zone outside the ring is thicker and edge is elevated and rounded.

Placenta marginata :

A thin fibrous ring is present at the margin of the chorionic plate where the fetal vessels
appear to terminate.

Bipartite placenta:

Two complete an d separate lobes are present, each with a cord leaving it. There are also
two umbilical cords, these do not joint at any point.

Tripartite placenta:

There will be three distinct lobes.

CORD ABNORMALITIES

Battledore placenta :

The cord is attached to the margin of the placenta. If associated with low implantation of the
placenta, there is chance of cord compression in vaginal delivery leading to fetal hypoxia
and even death.

Vellamentous Placenta:

The cord is attached to the membranes. The branching vessels traverse between the membranes
for a varying distance before they reach and supply the placenta.

ABNORMAL LENGTH OF THE CORD

The cord may be too long or short.

Short cord: The cord may be true or commonly relative due to entanglement of the cord round
any fetal part.

Long cord: The presence of a long cord is that there is increased chance of cord prolapse , cord
entanglement round the neck or the body. True knot is rare. False knot are the result of
accumulation of whartons jelly or due to varices.