Oryza Sativani 130110110058 (C5)

Amnion

Structure : The inner surface, bathed by amnionic fluid, is a single layer of cuboidal epithelium derived from embryonic ectoderm. This epithelium is attached firmly to a distinct basement membrane that is connected to the acellular compact layer, which is composed primarily of interstitial collagens. On the outer side of the compact layer, there is a row of fibroblast-like mesenchymal cells derived from embryonic disc mesoderm. There also are a few fetal macrophages in the amnion. The outermost layer of amnion is the relatively acellular zona spongiosa, which is contiguous with the second fetal membrane, the chorion laeve. The human amnion lacks smooth muscle cells, nerves, lymphatics, and importantly, blood vessels. Development : Early during implantation (at 7th or 8th day of embryo development) a space develops between the embryonic cell mass and adjacent trophoblasts. Small cells that line this inner surface of trophoblasts have been called amniogenic cells. It is initially a minute vesicle, which then develops into a small sac that covers the dorsal surface of the embryo. As the amnion enlarges, it gradually engulfs the growing embryo, which prolapses into its cavity. Distension of the amnionic sac eventually brings it into contact with the interior surface of the chorion laeve. Apposition of the chorion laeve and amnion near the end of the first trimester then causes an obliteration of the extraembryonic coelom. The amnion and chorion laeve, although slightly adherent, are never intimately connected and can be separated easily. Amnion Cell Histogenesis : Epithelial cells of amnion are derived from fetal ectoderm of the embryonic disc. In addition, there is a layer of fibroblast-like mesenchymal cells derived from embryonic mesoderm. Early in human embryogenesis, the amnionic mesenchymal cells lie immediately adjacent to the basal surface of the epithelium. At this time, the amnion surface is a two-cell-layer structure with approximately equal numbers of epithelial and mesenchymal cells. Simultaneously with growth and development, interstitial collagens are deposited between these two layers of cells. As the amnionic sac expands to line the placenta and then the chorion frondosum at 10 to 14 weeks, there is a progressive reduction in the compactness of the mesenchymal cells. These cells form a continuous uninterrupted epithelium on the fetal amnionic surface. Amnion Epithelial Cells : The apical surface of amnion epithelium is repleted with highly developed microvilli that are consistent with a major site of transfer between amnionic fluid and amnion. This epithelium is active metabolically, and these cells synthesize tissue inhibitor and fetal fibronectin. In term pregnancies, amnionic expression of prostaglandin endoperoxide H synthase, amnionic epithelium participates in the "final common pathway" of labor initiation. Epithelial cells may respond to signals derived from the fetus or the mother, and they are responsive to a variety of endocrine or paracrine modulators. Amnionic epithelium also synthesizes vasoactive

Reference: Williams Obstetrics 23rd edition

Oryza Sativani 130110110058 (C5)

peptides, including endothelin and parathyroid hormone-related protein. It seems reasonable that vasoactive peptides produced in amnion gain access to adventitial surface of chorionic vessels. Thus, amnion may be involved in modulating chorionic vessel tone and blood flow. Amnion-derived vasoactive peptides function in other tissues in diverse physiological processes. After their secretion, these bioactive agents enter amnionic fluid and thereby are available to the fetus by swallowing and inhalation. Amnion Mesenchymal Cells : Mesenchymal cells of the amnionic fibroblast layer are responsible for other major functions. Synthesis of interstitial collagens that comprise the compact layer of the amnionthe major source of its tensile strengthtakes place in mesenchymal cells. These cells also synthesize cytokines that increases in response to bacterial toxins and IL-1. This functional capacity of amnion mesenchymal cells is an important consideration in the study of amnionic fluid for evidence of labor-associated accumulation of inflammatory mediators. Anatomy of the Amnion : Placental amnion covers the placenta surface and thereby is in contact with the adventitial surface of chorionic vessels. In the conjoined portion of membranes of diamnionic-dichorionic twin placentas, fused amnions are separated by fused chorion laeve. Thus, aside from the small area of the membranes immediately over the cervical os, this is the only site at which the reflected chorion laeve is not contiguous with decidua. With diamnionic-monochorionic placentas, there is no intervening tissue between the fused amnions. Amnion Tensile Strength : During tests of tensile strengthresistance to tearing and ruptureit is found that the decidua and then the chorion laeve gave way long before the amnion ruptured. Amnion provides the major strength of the membranes. Its tensile strength resides almost exclusively in the compact layer, which is composed of cross-linked interstitial collagens I and III and lesser amounts of collagens V and VI. Interstitial Collagens : Collagen I is the major interstitial collagen in tissues characterized by great tensile strength, such as bone and tendon. In other tissues, collagen III is believed to make a unique contribution to tissue integrity, serving to increase tissue extensibility and tensile strength. For example, the ratio of collagen III to collagen I in the walls of a number of highly extensible tissuesamnionic sac, blood vessels, urinary bladder, bile ducts, intestine, and gravid uterusis greater than that in nonelastic tissues. The tensile strength of amnion is regulated in part by interaction of fibrillar collagen with proteoglycans such as decorin, which promote tissue strength. Compositional changes at the time of labor include a decline in decorin and increase in hyaluronan resulting in loss of tensile strength. Metabolic Functions : Amnion is metabolically active, involved in solute and water transport for amnionic fluid homeostasis, and produces an impressive array of bioactive compounds. It is responsive both acutely and chronically to mechanical stretch, which alter amnionic gene expression. This in turn may trigger both autocrine and paracrine responses to include production of matrix metalloproteinases, IL-8, and collagenase. Such factors may modulate changes in membrane properties during labor. Amnionic fluid : The clear fluid that collects within the amnionic cavity that creates a physical space for fetal skeleton to shape normally, promotes normal fetal lung, and helps to avert compression of the umbilical cord. The fluid normally reaches 1 L by 36 weeks and decreases thereafter to less than 200 mL at 42 weeks. Measurement of this fluid is by using amnionic fluid index (AFI). AFI was reasonably reliable in determining normal or increased amnionic fluid but was inaccurate in diagnosing oligohydramnions. Diminished fluid is termed oligohydramnions, and more than 2 L of amnionic fluid is considered excessive and is termed hydramnios or polyhydramnios. Hydramnios is frequently associated with fetal malformations. Clinical manifestation is edema, preeclampsia, severe dyspnea, and only be able to breathe in upright position. Oligohydramnios is less common and frequently has a poor prognosis. Adhesions between the amnion may entrap fetal parts and cause serious deformities, including amputation. Moreover, because the fetus is subjected to pressure from all sides, musculoskeletal deformities such as clubfoot are observed frequently. Reference: Williams Obstetrics 23rd edition