Placenta

The placenta is the organ that facilitates nutrient and gas exchange between the maternal and fetal compartments. The full term placenta is discoid in shape. It has a diameter of 15-25 cm, 2-3 cm thick, it weights 0.5 kg. Its umbilical cord is attached to its center.

Shape:

Surfaces:

- It has 2 surfaces:

is smooth and shinny because it is covered by an amniotic membrane. The umbilical cord is attached centrally to this surface. 2- maternal surface: which is rough, reddish, and has 15 20 elevated areas called cotyledons with deep grooves in between made by the decidual septa.

1- fetal surface: which

Development:

Maternal part: decidua basalis. Fetal part: chorionic frundosum.

Villi: -primary chorionic villi. -secondary chorionic villi. -Tertiary chorionic villi.

A- Villi opposite decidua basalis proliferate chorion frondosum. Villi of chorion frundosum are divided into: 1- Anchoring villi: reach decidua basalis. They are used for fixation of the fetus to the uterus. 2- Free villi ( nourishing): do not reach decidua basalis. They are used for nutrition of the fetus. B- Villi opposite decidua capsularis degenerate chorion laeve.

Tertiary chorionic villi contain embryonic blood vessels that develop in loose connective tissue core. These blood vessels connect up with vessels that develop in the chorion and connecting stalk.

Maternal blood is derived to the placenta by spiral arteries in the uterus. Erosion of these maternal vessels to release blood into the intervillous spaces is done by trophoblast cells which invade the terminal ends of spiral arteries.

During the 4th and 5th month, the decidua forms a number of decidual septa, which project into the intervillous space. As a result of this septum formation, the placenta is divided into a number of compartments (cotyledons).

Sructure of placenta

Placental Circulation:

1. Fetal circulation. 2. Maternal circulation. Maternal circulation - Uterine artery Spiral artery intervillous space (where exchange of oxygen and CO2 between mother and baby through the placental barrier) - The venous blood will collect in the marginal vein uterine vein.

Fetal circulation - The CO2 and waist product of the embryo reaches to the placenta through 2 umbilical arteries. These 2 arteries end by capillaries inside the tertiary villi where exchange of CO2 and O2 will occur through placental barrier. - The oxygen reaches the embryo through the umbilical vein.

Perinatal Circulation

Placental (membranes) barrier: -These are layers separating the fetal blood in the villi and maternal blood in the intervillous space. -These layers prevent mixing of the fetal and maternal blood but they allow passage of certain substances throw it. -It is not a true barrier because only few substances are unable to cross it. Most drugs in the maternal blood can pass through it to the fetal circulation and cause major fetal congenital anomalies.

10 weeks

full term

(placental membrane)

- Early in pregnancy (till about 20 week gestation), it is formed of four layers (Fig. 56): a. The endothelial lining the fetal vessels. b. The connective tissue (mesoderm) of the villus. c. The cytotrophoblast layer. d. The syncytiotrophoblast. - After 20 weeks the cytotrophoblasts degenerate so increases the permeability of the placenta.

- Towards the end of pregnancy, a fibrinoid material made of fibrin is formed on the surface of the villi to decrease the permeability, so the placental barrier is formed of this fibrinoid material, the syncytiotrophoblasts, and the endothelium of the fetal blood vessels.

Functions of placental barrier:

1.

2.

3.

4.

It prevents most organisms from passing to the fetus, so it acts as a protective mechanism against damaging factors, many viruses such as Rubella,Coxackie virus, German measles and poliomylitis virus traverse the placenta. These viruses may result in congenital malformations. Transfer the maternal antibodies to the fetus to obtain passive immunity against Diphtheria, Small pox and Measles. Most maternal hormones do not cross the placenta. Some cross it at slow rate as thyroxine. Some synthetic progestin and estrogen can easily cross the placenta . Most of the drugs in addition to cocaine, heroin cross the placenta and cause serious damage.

Functions Of The Placenta

Exchange of gases (lung) Exchange of Nutrients and Electrolytes (GIT) Excretion of waste products (kidney) Transmission of Maternal antibodies (IgG) Hormone Production Progesterone,estrogenic hormones(estriol), HCG and Somatomammotropin

Most hormones dont cross except thyroxine and diethylstilbestrol. Viruses, most drugs and drug metabolites.

The Placental Barrier:

Abnormalities of placenta
1- According to site: Placenta Praevia
the placenta is attached to the lower uterine segment (due to low level of implantation of the blastocyst). It causes severe antepartum haemorrhage. There are three types:

1- Placenta accreta: due to abnormal adhesion between the chorionic villi and the uterine wall. 2- Placenta percreta: The chorionic villi penetrate the myometrium all the way to the perimetrium. - the placenta fails to separate from the uterus after birth and may cause severe postpartum hemorrhage.

2- Placental abnormalities related to the depth of invasion of uterine wall:

3- Abnormalities according to attachment of the umbilical cord:

Velamentous attachment:

The cord does not reach the placenta itself but is attached to amniotic membrane over the fetal surface of placenta. The umbilical vessels pass in the membrane to reach the placenta.

4- Abnormalities according to the number:

. 1- Double placenta (bilobed or bidiscoid placenta).

2- Triple placenta
(trilobed).

3- Accessory placenta (accessory one

or more lobes). It may cause severe postpartum hemorrhage if the accessory lobe is retained in the uterus after labor.

Thank You
Prof.: Dr. Wafaa Abdel-Rahman