THE PLACENTA AND ITS

ABNORMALITIES
Dr. Robinson E. Mbu
Senior Lecturer

DR. R.E. MBU 2006

PLAN

Introduction
Objectives
Structure
Foetal circulation
Maternal circulation
Functions
The placental unit
Placental abnormalities
The umbilical cord
DR. R.E. MBU 2006

INTRODUCTION

The concept of placenta was first

introduced by REALDUS COLUMBUS in 1559
MOSSMAN defined the placenta in 1937
As that part of the foetal membranes fused
to the uterine mucosa
Embryologically
Throphoblasts are formed
By the blastocyst
As early as 72hrs. after fertilization
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INTRODUCTION contd

The throphoblasts proliferate rapidly

And invade the surrounding decidua
Soon after implantation
As invasion of the endometrium
proceeds
Maternal blood vessels are invaded
Forming intervillous spaces
DR. R.E. MBU 2006

OBJECTIVES

Holistic understanding of the

placenta

Structure
Function
Abnormal forms
Etc.

DR. R.E. MBU 2006

STRUCTURE

Measures 15-20cm in diameter

2-3cm thick
Weighs 1/6th of the foetus ( ~ 500gms)
Has two surfaces :
Foetal surface which contains :
The shinning amnion
Under which are vessels plastered by the chorion
Both arteries and veins
Insertion of the umbilical cord

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STRUCTURE contd

Maternal surface:

Contains irregular lobes

Divided by septa
Made up of connective tissue
There are usually 16-18 of these irregular
lobes
Called COTYLEDONS
Formed during placentogenesis
They only become larger as pregnancy
advances
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STRUCTURE contd

No new cotyledons are formed

after this period
The placenta is located usually
Anteriorly or posteriorly
Near the fundus

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FOETAL CIRCULATION

Foetal blood flows from the placenta

Through two unbilical arteries
In which deoxygenated or venous blood
is transported
The vessels branch repeatedly and form
capillary networks
In the terminals
Oxygenated blood returns to the foetus
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FOETAL CIRCULATION contd

From the placenta

Through the single umbilical vein

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MATERNAL CIRCULATION

Maternal blood reaches the placenta

Propelled by maternal arterial pressure
There is no admixture of maternal and
foetal blood
Venous exits are scattered at random
Over the entire base of the placenta

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FUNCTIONS OF THE
PLACENTA

Exchange functions:

Waste products from the placenta

Cross the placental membrane
To the maternal blood
Oxygen, nutrients and protective
antibodies
Leave from the mother across the
placental membrane
To the foetus
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PLACENTAL FUNCTIONS contd

Endocrine functions:

Chorionic gonadotropin
HPL
Chorionic thyrotropin
Chorionic adrenocorticotropin
Hypothalamic-like releasing
hormones of the placenta
Pregnancy specific protein
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ENDOCRINE FUNCTIONS contd

Estrogens
Progesterone
Prolactine

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PROTECTIVE FUNCTION

Destroys the following :

Bacteria
Viruses
Plasmodium
Fungi
ETC.

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THE PLACENTAL UNIT

VF=Foetal vessels, TC=Connective tissue
VM=Maternal vessels

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PLACENTAL AGING

Decrease in thickness of syncytium

Partial disappearance of cytotrophoblasts
(LANGHANS CELLS)
Decrease in stroma
Thickening of basement of the endothelium
and trophoblasts
Obliteration of certain vessels
Deposition of fibrin
On the surface of the villi/intervillous space
Decrease in efficiency of placental exchange
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PACENTA ABNORMALITIES

Placenta Bipartita , Tripartita

Circumvallate or Circummarginate placenta
Succenturiate placenta
Battledore placenta
Placenta acreta
Placenta increta
Placenta percreta
Placenta praevia
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PLACENTA BIPARTITA ,
TRIPARTITA

Two or three placentas

With equal dimensions
Attached to one umbilical cord
Clinical importance is that
One of them may left in-utero
After a normal delivery
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BIPARTITE AND TRIPARTITE

PLACENTAS

Annotated

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CIRCUMVALLATE OR
CIRCUMMARGINATE PLACENTA

1% of placentas
Small central chorionic plate ( small
placenta)
Surrounded by a thick whitish ring
Composed of a double fold
Of amnion and chorion
Predisposes to premature marginal
separation
APH, premature delivery, premature death.
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CIRCUMVALLATE PLACENTA

Annotated

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SUCCENTURIATE PLACENTA

Inappropriately divided placenta

One large placenta
And a small ( succenturiate) lobe
Clinical significance is that the
small lobe
Could be forgotten in-utero
Following a normal delivery
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SUCCENTURIATE PLACENTA

Annotated

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BATTLEDORE PLACENTA

Placenta
Where the cord
Is inserted marginally
Clinical significance is that umbilical
vessels
Could run through membranes
And may rupture
Causing foetal bleeding ( VASSA PRAEVIA )
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BATTLEDORE PLACENTA

Annotated

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THE CRETAS

Placenta Acreta
Throphoblastic invasion of the
endometrial basement membrane

Placenta Increta
Invasion of the myometrium

Placenta Percreta
Perforation of the uterus
These are all histological diagnoses
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PLACENTA PRAEVIA

Presence of the placenta

In the lower uterine segment
( LUS)
Formed from 28 weeks of
gestation
Revisit PLACENTA PRAEVIA
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THE UMBILICAL CORD

30-100 cm long ( ~ 55 cm)

1-2.5 cm thick
Has two arteries and one vein
The vessels are embedded in a whitish
substance
Called WHARTON JELLY
Inserted centrally , laterally or marginally
There is also velamentous insertion
This is a rare insertion
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THE UMBILICAL CORD

contd

In velamentous insertion:

The cord stops at some distance

Before sending down vessels
Like the maize stem
These vessels could be found in the
lower uterine segment
And may bleed during contractions
Or vaginal examination
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UMBILICAL CORD INSERTIONS

Annotated

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