THE PLACENTA

Early Development of Placenta

• A complex and vital organ which serves as the
interface between the mother and the developing
fetus.

• Necessary for fetal health and maturity

• Formed from the trophoblastic layer of the zygote

which is the outer cell mass of the blastocyst.

• Produces hCG hormone that maintains early

pregnancy.
 Implantation
• Once the blastocyst comes into contact with the
endometrium, the trophoblast layer
(syncytiotrophoblast) adheres to the endometrial
surface

• By 10th day, the blastocyst is completely buried in

the endometrium/decidua

• The decidua secretes cytokines and protease

inhibitors that modulate/control trophoblast
invasion
 Chorionic villi
• Formed from the finger-like projections of the
trophoblast from about 3 weeks after fertilization

• The villi become most profuse In the Decidua

basalis (highly supplied with blood). This part
known as chorion frondosum, develops into the
placenta.

• The blastocyst is surrounded by the decidua

capsularis where it projects into the uterine cavity.
 Cont

• The villi under the decidua capsularis

gradually disintegrate forming the chorion
laeve, the origin of chorionic membrane.

• The remaining decidua is called decidua

parietalis, which later joins the chorion on
the opposite wall of the uterus when decidua
capsularis thins and disappears as the fetus
enlarges and grows to fill the uterus
Decidua structure
The villi erode the walls of maternal blood
vessels , opening them up to form a pool of
blood supply (sinuses) in which they float.

Slow maternal circulation enables the

nutritive villi to absorb food and oxygen and
excrete waste. Anchoring villi remain
attached to the decidua.

Each chorionic villus consists of mesoderm,

fetal blood vessels, and branches of umbilical
artery and vein.
4 layers separate the fetal and maternal
blood from mixing:

Syncytiotrophoblast,

cytotrophoblast,

villi connective tissue and

 fetal capillary endothelium.

The Mature Placenta
• The placenta is completely formed and
functioning 10 weeks after fertilization.

• It weighs more than the fetus between 12-20

weeks due to underdeveloped fetal organs.

• The cytotrophoblast and

syncytiotrophoblast degenerate later in life
allowing easier gaseous exchange
Functions
Respiration-Source of gaseous exchange between
the mother and fetus. Oxygen enters fetal blood
by simple diffusion & carbondioxide leaves to the
mothers bloodstream.

Nutrition- Passage for nutrients from the mother

to the fetus e.g glucose, amino acids, vitamins,
water, macro & micro-nutrients.

Storage - Metabolizes glucose and stores it in

form of glycogen & reconverts it glucose when
required. Can also store iron and the fat-soluble
vitamins.
Excretion-
Mainly Carbondioxide. Minimal of urea & uric acid
due to very little tissue breakdown. Bilirubin excreted
as Red Blood Cells

Protection
Provides limited/ selective barrier to infections such as
Neisseria gonorrhea ( infects during birth).Many
viruses and bacteria however cross the placenta barrier.

They include: HIV, Rubella virus, Treponema pallidum,

varicella/ Herpes Zoster Virus, Herpes Simplex virus,
CMV, Hepatitis B, Listeria monocytogenes, malaria
parasites
• Chemicals such as alcohol, nicotine from
cigarretes,and most drugs cross the
placental barrier and can cause congenital
abnormalities, miscarriages, affect
developmental milestones.

• Some drugs are harmless and are

positively beneficial to the baby e.g folic
acid, ferrous/iron tablets, penicillins that
treat maternal syphilis.
Protection continued:
Transports maternal antibodies (IgG) to the
fetus, conferring passive immunity for the first
3 months of extrauterine life –such as TT
antibodies.

Endocrine
produces hCG (secreted in maternal
urine)which stimulate growth and activity of the
corpus luteum; estrogens; progesterone, Human
placental lactogen (hPL)
 QUIZ
List 30 drugs that are contraindicated
/not safe in pregnancy. Where possible,
indicate the effects to the fetus

Very Very important for a midwife to

know which drugs are safe to be used
in pregnancy
 Placental Circulation
• Maternal blood rich on oxygen and nutrients is
pumped into the intervillous space by 80-100
spiral arteries in decidua basalis.

• It spurts toward the chorionic plate and flows

slowly around the villi, eventually returning to
the endometrial veins and the maternal
circulation.
• About 150mls of maternal blood is in the
intervillous, which is exchanged 3 or 4 times/
minute
Fetal blood, low in oxygen and rich in
carbondioxide and other waste products, is
pumped by the fetal heart towards the
placenta along the 2 umbilical arteries and
transported along their branches to the
capillaries of the chorionic villi where
exchange of nutrients takes place.

Blood rich in oxygen and nutrients is

returned to the fetus via the umbilical vein
Placental villi Blood circulation
Amniotic fluid
Is clear, alkaline liquid contained in the
amniotic sac
Functions
Distends amniotic cavity allowing fetal
growth and movement and permitting
symmetrical musculoskeletal development

Equalizes pressure and protects the fetus

from jarring and injury

Maintains a constant intrauterine

temperature protecting the fetus from heat
loss
Protects the placenta and umbilical cord
from uterine contractions pressure when
membranes are intact.

Helps in cervical dilatation and

effacement during labor

Lubrication of birth canal during birth

For studying fetal functions/status-detect
abnormalities and detecting fetal distress

Nutritional support
Origin of Amniotic Fluid
Fetal and maternal origin.

Secreted by the amnion, fetal kidneys- fetal

urine (from 10th week), maternal vessels in
the decidua and fetal vessels exudates in
the placenta

The water in amniotic fluid is exchanged

approximately every 3 hours
Components of Amniotic Fluid

99% water and 1% dissolved matter including

food substances and waste products, fetus skin
cells, vernix caseosa and lanugo

Amniocentesis is aspiration of amniotic fluid

for examination.
Volume

Amniotic fluid amount increases with gestation

and is greatest at 38 weeks=1litre then
diminishes until term to about 800mls.

Conditions associated with Amniotic Fluid

Volume:
Polyhydramnios= Amount exceeding 1500mls
Oligohydramnios= Amount less than 500mls
The umbilical cord
Formed by the 5th week of pregnancy.

Extends from the fetal surface of the placenta

to the umbilical area of the fetus and is covered
by amniotic membrane

Originates from the duct that forms btn the

amniotic sac and the yolk sac and transmits 1
vein and 2 arteries used for gaseous exchange,
passage of nutrients and waste products.

No nerves in the umbilical cord.

 Cont.

• Normally measures between 40-50 cm long and 1-2 cm in

diameter.
• A short cord measures less than 40 cm

• Too long cord more than ?70 cm may wrap around or tie
the neck/body of the fetus or form true knots=occludes
blood flow especially during labour.
• A nuchal cord (NC) is a term given to situation where
there are one or more loops of umbilical cord wrapped
around the fetal neck for ≥360°

• Nuchal cord is caused by movement of the fetus through

a loop of cord
 False KNOT in Umbilical Cord
• Its normal findings.
• Occurs due to localised collection of
Wharton's’ jelly containing a loop of
umbilical vessels.
• Result from kinking of the blood vessels to
accommodate length of cord.
 TRUE KNOTS ON THE CORD
• Caused when the fetus passes through a loop
of the cord. If tight, will cause Asphyxia.
• Arise from fetal movements and are more
likely to develop during early pregnancy, when
relatively more amniotic fluid is present and
greater fetal movements occurs.
• Incidence is 1-2%
• True knots are also associated with advanced
maternal age, multiparity, monoamniotic
twins and long umbilical cords.
• Monochorionic-monoamniotic twins are
identical twins that share same amniotic sac
and placenta, but separate umbilical cords.
• Monochorionic-diamniotic twins who share a
placenta but not an amniotic sac.
• All fraternal twins are dichorionic-have
separate placenta.
 The placenta at term

 Round flat mass about 20 cm in diameter and 2.5

cm thick at its centre.

 Weighs about one-sixth of the baby’s weight

• Maternal surface is dark red due to maternal

blood and part of separated basal decidua.
Normal cord insertion is at the centre of the
placenta( central location)-90%.
• Eccentric cord insertion –lateral insertion more
than 2cm away from the margin of placenta
 Maternal Surface

 Maternal surface arranged in about 20

cotyledons (lobes) {made of lobules},
separated by sulci/furrows.

 It may feel slightly gritty due to lime salt

deposits- (normal findings)
 Cont
• Fetal Surface
• Has a shinny appearance due to the amnion
covering.
• Has visible branches of umbilical vein and
arteries, spreading out from the cord
insertion area.
 The membranes
• Two membranes: Amnion & Chorion
Amnion-
• Fetal part of the membrane, smooth, tough,
shinny, translucent.
• Formed from the embryoblast.
• Tears up-to cord insertion
• It lines the chorion and placenta surface up
to the outer surface of the umbilical cord.
The Chorion

• Thick, opaque, easily friable membrane

derived from the trophoblast.

• Its continuous with the chorionic plate,

which forms the base of the placenta and
adheres closely to the uterine wall
(maternal surface membrane).
• Separates upto the edges of the placenta
Fetal & Maternal sides of a Term placenta
Placenta & Cord Abnormalities

Succenturiate placenta
• Has an extra lobe separate from the main
placenta and joined to it by blood vessels
running through membranes to reach it.

• If retained after birth, may cause PPH

and infection.
• Diagnosed by presence of a hole in the
membrane with vessels running to it.
Succenturiate placenta
Succenturiate placenta
Circumvallate placenta

• Has an opaque ring on the amnion, formed by a

doubling back of the amnio-chorionic
membrane

• The chorionic plate on the fetus’ side of the

placenta is slightly too small.

• Over time, a ring of raised tissue develops and

the ends of the placenta start to turn inward.
 Complications of circumvallate placenta

Associated with prematurity, prenatal bleeding,

placenta abruptio which can cause fetal death,
pregnancy loss, multiparity, and premature
rupture of membranes, low birth weight
babies.
Circumvallate placenta
Bipartite placenta-
• Lobes separated into 2 complete
different portions of placenta each with
a cord.
• Different from one of twin pregnancy.

• Tripartite- Lobes separated into 3

different parts.
Bipartite placenta with villamentous cord
insertion
A vellamentous cord insertion
In this case, the cord is inserted into the membranes
some distance from the edge of the placenta and the
vessels run through it to the placenta.

NO cause of alarm if the placenta is normally

positioned (Posterior & Upper part).

If low-lying placenta, there is risk of bleeding when

membranes rupture (vasa praevia –blood vessels
pass across the uterine os)
A villamentous cord Insertion
 Battledore insertion

• Cord inserted on the edge of the placenta

Battledore Insertion
Did You Know?