The placenta and fetal membranes

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Introduction
 The placenta and fetal membranes separate the fetus
from the endometrium.
 An interchange of substances, such as nutrients and
oxygen, occurs between the maternal and fetal
bloodstreams through the placenta.
 The vessels in the umbilical cord connect the
placental
 with the fetal circulation.
The chorion, amnion, yolk sac (umbilical vesicle) and
 allantois constitute
The placenta the fetalsite
is the primary membranes.
of nutrient and gas
exchange between the mother and fetus.
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 The placenta is a fetomaternal organ that has two
components:
A fetal part that develops from the chorionic sac
A maternal part that is derived from the
 endometrium
The placenta and umbilical cord form a transport
 system
for substances passing between the mother and
fetus.
materials and carbon dioxide pass from the fetal blood
Nutrients
through and oxygen
the placenta to thepass fromblood.
maternal the maternal blood
through the placenta to the fetal blood, and waste

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Functions of the Placenta
 The placenta has three main functions:
– Metabolism (e.g., synthesis of glycogen)
– Transport of gases and nutrients
– Endocrine secretion (e.g., human chorionic
gonadotropin [HCG])
 These comprehensive activities are essential for
maintaining pregnancy and promoting normal fetal
development.

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Placental Metabolism
 The placenta, particularly during early pregnancy,
synthesizes
– glycogen,
– cholesterol, and
– fatty acids,
 which serve as sources of nutrients and energy for the
embryo/fetus.

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Placental Transfer
 The transport of substances in both directions between the
fetal and maternal blood is facilitated by the great surface
area of the placental membrane.
 Almost all materials are transported across the placental
membrane by one of the following four main transport
mechanisms:
– simple diffusion,
– facilitated diffusion,
– active transport, and
– pinocytosis.

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Placental endocrine synthesis and secretion
 The syncitiotrophblast of the placenta protein
synthesis
and steroid hormone.

A. Protein
human Hormones synthesis by placenta
chorionic gonadotropin
B. human chorionic somatomammotrophin
C. human chorionic Thyrotrophin
D. human chorionic Corticotropine
 Steroid Hormones
A. Estrogen and progesterone

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Figure 7-9 Diagrammatic illustration of transfer across the placental membrane
(barrier). The extrafetal tissues, across which transport of substances between
the
mother and fetus occurs.
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The Decidua
 Decidua refers to the functional layer of the
endometrium in a pregnant woman that separates from
the remainder of the uterus after parturition (childbirth).
 The three regions of the decidua are named according to
their relation to the implantation site.
The decidua basalis
 is the part of the decidua deep to the conceptus that
forms the maternal part of the placenta.
is the part of the decidua between the blastocyst and
the muscle wall of the uterus.

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 Decidua capsularis
is the superficial part of the decidua overlying the
conceptus.
is the part decidual between the blastocyst and
of the
cavity of
uterus.
 is the rest of the deciduas lining the wall of the uterus.
 Decidua parietalis

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Development of the Placenta
• Early placental development is characterized by the rapid
proliferation of the trophoblast and development of the
chorionic sac and chorionic villi.
• By the end of the third week,
the anatomic arrangements
necessary for physiologic
• exchanges between
A complex vascular the mother
network is established in the placenta
and her
by the embryo
end of theare established.
fourth week, which facilitates maternal-
embryonic exchanges of gases, nutrients, and metabolic
waste products.

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 Chorionic villi cover the entire chorionic sac until the
beginning of the eighth week.
 The decidua capsularis, the layer of decidua overlying the
implanted chorionic sac, forms a capsule over the external
surface of the sac.
 As the conceptus enlarges, the decidua capsularis bulges
into the uterine cavity and becomes greatly attenuated.
 Eventually the decidua capsularis contacts and fuses with
the decidua parietalis, thereby slowly obliterating the
uterine cavity.

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 By 22 to 24 weeks, the reduced blood supply to the decidua
capsularis causes it to degenerate and disappear.
 After disappearance of the decidua capsularis, the smooth
part of the chorionic sac fuses with the decidua parietalis.
 These villi soon degenerate producing a relatively
avascular
 bare area, the smooth chorion.
This bushy
 Growth in thearea of the
size and chorionic
thickness of thesac is the villouscontinues
placenta chorion
rapidly until the fetus is approximately 18 weeks old (20
weeks' gestation)

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• As a result, the amnion and smooth chorion soon fuse to
form the amniochorionic membrane.
• This composite membrane fuses with the decidua
capsularis and, after disappearance of this capsular part of
the decidua, adheres to the decidua parietalis .
• It is the amniochorionic membrane that ruptures during
labor (the expulsion of the fetus and placenta from the
uterus).
• Preterm rupture of this membrane is the most common
event leading to premature labor.
• When the membrane ruptures, amniotic fluid escapes
through the cervix and vagina to the exterior.

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 The placenta has two parts
– The fetal part of the placenta is formed by the villous
chorion. The chorionic villi that arise from it project
into the intervillous space containing maternal blood.
– The maternal part of the placenta is formed by the
decidua basalis, the part of the decidua related to the
fetal component of the placenta.

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 The fetal part of the placenta (villous chorion) is attached
to the maternal part of the placenta (decidua basalis) by
the cytotrophoblastic shell,
 Endometrial arteries and veins pass freely through gaps
in the cytotrophoblastic shell and open into the
intervillous space.
 The intervillous space of the placenta, which contains
maternal blood, is derived from the lacunae that
developed in the syncytiotrophoblast during the second
week of development.

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• The intervillous space of the placenta is divided into
compartments by the placental septa; however, there is
free communication between the compartments because
the septa do not reach the chorionic plate.
 By the end of the fourth month, the decidua basalis is
almost entirely replaced by the cotyledons.
 Each cotyledon consists of two or more stem villi and their
many branch villi.

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 Maternal blood enters the intervillous space from the
endometrial arteries in the decidua basalis.
 The spiral arteries pass through gaps in the
cytotrophoblastic shell and discharge blood into the
intervillous space.
 This large space is drained by endometrial veins
that also
 penetrate theveins
Endometrial cytotrophoblastic
are found shell.
over the entire surface of
the decidua basalis.

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Placental Circulation
 The branch chorionic villi of the placenta provide a large
surface area where materials may be exchanged across the
very thin placental membrane ("barrier") interposed
between the fetal and maternal circulations.
 It is through the numerous branch villi that arise from the
stem villi that the main exchange of material between the
mother and fetus takes place.
 The circulations of the fetus and the mother are separated
by the placental membrane consisting of extrafetal tissues.

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Fetal Placental Circulation
 Poorly oxygenated blood leaves the fetus and passes
through the umbilical arteries to the placenta.
 At the site of attachment of the umbilical cord to the
placenta, these arteries divide into several radially disposed
chorionic arteries that branch freely in the chorionic plate
before entering the chorionic villi.
 The blood vessels form an extensive arteriocapillary-
venous system within the chorionic villi, which brings the
fetal blood extremely close to the maternal blood.

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Maternal Placental Circulation
 The maternal blood in the intervillous space is
temporarily outside the maternal circulatory system.
 It enters the intervillous space through 80 to 100 spiral
endometrial arteries in the decidua basalis.
 These vessels discharge into the intervillous space
through gaps in the cytotrophoblastic shell.
 The blood flow from the spiral arteries
 The welfare of the embryo and fetus
depends more on the adequate
bathing of the branch villi with
maternal blood than on any other
factor.
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 Umbibcal vein Umbilical arteries
(02'rich blood) (02·poor blood)

Fetal circulation

ChC)IlOC'IpICl Stumpo!
ale maln stem
Main stem vilus ""Ius

Placental seplum

Myometrium
Endometrial Endometrial
veins arteries

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© Elsevier. Moore 8. Persaud: The Developing Human 8e • www.studentconsult.co
 Reductions of uteroplacental circulation result in fetal
hypoxia and intrauterine growth restriction (IUGR).
 Severe reductions of uteroplacental circulation may result
in fetal death.
 The intervillous space of the mature placenta contains
approximately 150 mL of blood that is replenished three
or four times per minute.
 The intermittent contractions of the uterus during
pregnancy decrease uteroplacental blood flow slightly;
however, they do not force significant amounts of blood
out of the intervillous space.

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The Placental Membrane
 The placental membrane is a composite structure that
consists of the extrafetal tissues separating the maternal
and fetal blood.
 Until approximately 20 weeks, the placental membrane
consists of four layers :
– Syncytiotrophoblast,
– Cytotrophoblast,
– Connective tissue of villus and
– Endothelium of fetal capillaries.

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• After the 20th week, histologic changes occur in the
branch villi that result in the cytotrophoblast in many of
the villi becoming attenuated.
• As a result, the placental membrane consists of three
layers in most places.
• In some areas, the placental membrane becomes
markedly thin and attenuated.
• At these sites, the syncytiotrophoblast comes in direct
contact with the endothelium of the fetal capillaries to
form a vasculosyncytial placental membrane.
• So as the pregnancy increase the placental membrane
decrease in thickness.

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The Placenta and Fetal Membranes after Birth
 The placenta and fetal membranes are extruded from the
uterus after birth.
 The placenta commonly has a discoid shape, with a
diameter of 15 to 20 cm and a thickness of 2 to 3 cm.
 It weighs 500 to 600 g, which is approximately one sixth
the weight of the average fetus.
 When villi persist elsewhere, several variations in
placental shape occur:
– accessory placenta,
– bidiscoid placenta, and
– horseshoe placenta.
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 Umbibcal vein Umbilical arteries
(02'rich blood) (02·poor blood)

Fetal circulation

ChC)IlOC'IpICl Stumpo!
ale maln stem
Main stem vilus ""Ius

Placental seplum

Myometrium
Endometrial Endometrial
veins arteries

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© Elsevier. Moore 8. Persaud: The Developing Human 8e • www.studentconsult.co
Maternal Surface of the Placenta
Small in size
Derived from endometrium
Dull, red
Size compartmetalized
35 lobes the cotyloden

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Fetal Surface of Placenta
• The umbilical cord usually attaches to the fetal surface of
the placenta, and its epithelium is continuous with the
amnion adhering to the fetal surface.
• The fetal surface of a freshly delivered placenta is
smooth
• and shiny because it is covered by the amnion.
The chorionic vessels radiating to and from the umbilical
• cord are clearly visible through the transparent amnion.
The umbilical
chorionic vessels
vessels, branch
which enteron
thethe fetal surface
chorionic to form
villi and form
the arteriocapillary-venous system

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Amnion and Amniotic Fluid
• The thin but tough amnion forms a fluid-filled,
membranous amniotic sac that surrounds the embryo and
fetus
• As the amnion enlarges, it gradually obliterates the
chorionic cavity and forms the epithelial covering of the
umbilical cord
Amniotic Fluid
• Amniotic fluid plays a major role in fetal growth and
development.
• Initially, some amniotic fluid is secreted by amniotic cells;
most is derived from maternal tissue and interstitial fluid
by diffusion across the amniochorionic membrane from
the decidua parietalis
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 Fluid is also secreted by the fetal respiratory and
gastrointestinal tracts and enters the amniotic cavity.
 The daily rate of contribution of fluid to the amniotic cavity
from the respiratory tract is 300 to 400 mL.
 Beginning in the 11th week, the fetus contributes to the
amniotic fluid by excreting urine into the amniotic cavity.
 By late pregnancy, approximately 500 mL of urine is added
daily.
 The volume of amniotic fluid normally increases slowly,
reaching approximately
– 30 mL at 10 weeks,
– 350 mL at 20 weeks, and
– 700 to 1000 mL by 37 weeks.

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 Circulation of Amniotic Fluid
 Composition of Amniotic Fluid
• Amniotic fluid is an aqueous solution in which undissolved
material (desquamated fetal epithelial cells) is suspended.
• Amniotic fluid contains approximately equal portions of
organic and inorganic salts.
• Half of the organic constituents are protein; the other half
consists of carbohydrates, fats, enzymes, hormones, and
pigments.
• As pregnancy advances, the composition of the amniotic
fluid changes as fetal excreta (meconium [fetal feces] and
urine) are added.

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Significance of Amniotic fluid
 The embryo, suspended in amniotic fluid by the umbilical
cord, floats freely.
 Amniotic fluid has critical functions in the normal
development of the fetus.
 The buoyant amniotic fluid Permits symmetric external
growth of the embryo and fetus
 Acts as a barrier to infection
 Permits normal fetal lung development

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 Prevents adherence of the amnion to the embryo and fetus
 Cushions the embryo and fetus against injuries by
distributing impacts the mother receives
 Helps control the embryo's body temperature by
maintaining a relatively constant temperature
 Enables the fetus to move freely, thereby aiding muscular
development in the limbs.
• Assists in maintaining homeostasis of fluid and electrolytes

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THE YOLK SAC ( umbilical vesicle)
 It is a sac which lies ventral to the embryonic disc.
 There are 3 stages of yolk sac as follows:
1. Primary yolk sac (it is the earliest)
 This is a small cavity which is formed in the blastocys
stage.
 Its roof is formed by the primary endoderm
 Its wall is formed by the exocoelomic membrane (from
1ry mesoderm)
2. Secondary yolk sac:
 The primary yolk sac is converted into the secondary yolk
sac in the stage of chorionic vesicle.
 It sends a diverticulum into substance of the connecting
stalk
 T h i s called allantois or a l l a n t o -enteric iverticulum.
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3. Definitive yolk sac:
 It is the last stage and is formed after folding
 As a result of folding a part of the yolk sac is enclosed
within the embryo to from the gut.
 The part inside the head fold is called foregut
 The part inside the tail fold is called hind gut
 The part between the two lateral folds is called midgut.
 The definitive yolk sac is connected to the midgut by the
vitillo-intestinal duct.
 As a result of expansion of the amnion, the vitello-
intestinal duct and definitive yolk sac are incorporated
inside the umbilical cord.
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Functions of the yolk sac:
1. The yolk sac is involved in the early nutrition. It transmits
the nutritive fluid to the embryo before (utro placental
circulation) the function of the placenta is established.(2-3
wk).
2. Its surrounding mesoderm is the site of the appearance
of primordial germ cells, which migrate in the 3 week to
the site of the future gonads (testes, or ovary).
3. It is surrounding mesoderm is a site for the formation of
blood cells and blood vessels.(3-6wk)
4. Incorporated in to the primitive gut.(4wk)

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DESCRIBE THE FORMATION, STRUCTURE OF THE UMBLILICAL CORD?
Formation:
 The umbilical cord is formed as a result of the following
factors:
1. Folding of the disc: it brings the connecting stalk
ventrally and forms the umbilical orifice
2. Expansion of the amniotic cavity leads to elongation of
the cord.

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Structure of the cord:
 The umbilical cord contains the following structures:
1. A tubular covering of amninotic shealth
2. Whartons jelly: it a derived from the of
primary mesoderm the connecting
stalk. It forms a protective layer for the
3. umbilical vessels
4. The distal part of the allantois
 The
Theumbilical vessels
arteries carry (two arteries
no oxygenatd blood and
whileone vein).
the vein
carries oxygenated blood.
• The umbilical cord is about 50cm at full term.

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 These structures undergo the following changes:
1. The right umbilical vein and vitello-intestinal duct
disappear completely leaving trace.
2. The left mbilical vein is obliterated and becomes the
ligamentium teres of the live
3. The 2 umbilical arteries are obliterated and becomes the
medial umbilical ligament
4. The allantiois becomes the urachus which is obliterated
and becomes the median umbilical ligament.
 The cord appears twisted due to the fact that the umbilical
arteries are longer the umbilical vein.

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 A very short cord may cause
premature separation of the
placenta from the wall of the uterus
during delivery.

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