Placenta and Fetal Membrane

• Human placenta is discoid, haemochorial and

deciduous
• It is attached to the uterine wall and
establishes connection through the umbilical
cord.
• Immunological acceptance of the fetal graft by
the mother.
 DEVELOPMENT
• Develop from two component.
– Fetal - chorion frondosum
– Maternal - decidua basalis.
• Interstitial implantation is completed on 11th
day
• blastocyst - surrounded on all sides by lacunar
spaces around cords of syncytial cells,
trabeculae.
• 13th day trabeculae develops in to stem villi
which connect the chorionic plate with the
basal plate.
 Continue…
• Primary, secondary and tertiary villi are
developed from the stem villi.
• Arterio-capillary-venous system in each villus
is completed on 21st day.
• This makes connection with the
intraembryonic vascular system through the
body stalk- umbilicus
• Lacunar spaces become confluent (3rd-4th
week), form multilocular receptacle lined by
syncytium - intervillous space.

• Decidua capsularis becomes thinner beginning

at 6th week and both the villi and the lacunar
spaces in the abembryonic area get
obliterated - chorion laeve.
Exuberant growth and proliferation of the
decidua basalis and enormous division and
sub-division of the chorionic villi in the
embryonic pole . These two form placenta.
• Placenta formation begins at 6th week and is
completed by 12th week.
• Until the end of the 16th week, the placenta
grows both in thickness and circumference.
• There is little increase in thickness but it
increases circumferentially till term.
 Placenta at Term
Gross Anatomy-
• Circular disc with a diameter of 15-20 cm and
thickness of about 3 cm at its centre.
• It thins off towards the edge.
• spongy and weighs about 500 gm.
• Proportion to the weight of the baby 1: 6 at
term and occupies about 30% of the uterine
wall.
• It has two surfaces, fetal and maternal, and a
peripheral margin.
 Fetal Surface
• Covered by the smooth and glistening amnion
with the umbilical cord attached at or near its
centre.
• Branches of the umbilical vessels are visible
beneath the amnion.
• Amnion can be peeled off from the underlying
chorion except at the insertion of the cord.
• At term four-fifths of the placenta is of fetal
origin.
 Maternal Surface
• Rough and spongy.
• Maternal blood gives it a dull red colour.
• thin greyish, shaggy layer which is the
remnant of the decidua basalis.
• Maternal surface is mapped out into 15-20
convex polygonal areas known as lobes or
cotyledons
• which are limited by fissures.
• Each fissure is occupied by the decidual
septum which is derived from the basal plate.
• Numerous small grayish spots due to
deposition of calcium in degenerated areas.
• Maternal portion of the placenta - less than
one fifth of the total placenta.
• Only decidua basalis and the blood in the
intervillous space are of maternal origin.
 Margins
• Peripheral margin of the placenta is limited by
the fused basal and chorionic plates
• Continuous with the chorion laeve and
amnion.
• Chorion and the placenta are one structure
but the placenta is a specialised part of the
chorion.
 Attachment
• The placenta is usually attached to the upper
part of the body of the uterus encroaching to
the fundus adjacent to the anterior or
posterior wall with equal frequency.
• The attachment to the uterine wall is effective
due to anchoring villi connecting the chorionic
plate with the basal plate.
Separation : Placenta separates after the birth of
the baby and the line of separation is through
the decidua spongiosum.
 STRUCTURES
The placenta consists of two plates.
– Chorionic plate
– Basal plate
• Between the two plates lies the intervillous space
containing the stem villi with their branches, the space
being filled with maternal blood.
• AMNIOTIC MEMBRANE : It consists of single layer of
cubical epithelium loosely attached to the adjacent
chorionic plate. It takes no part in formation of the
placenta.
• CHORIONIC PLATE: From within outwards, it consists of
– Primitive mesenchymal tissue containing branches of umbilical
vessels
– A layer of cytotrophoblast and syncytiotrophoblast.
– The stem villi arise from the plate.
– It forms the inner boundary of the choriodecidual space.
BASAL PLATE : It consists of the following structures
from outside inwards.
1. Part of the compact and spongy layer of the decidua
basalis.
2. Nitabuch's layer of fibrinoid degeneration of the outer
syncytiotrophoblast at the junction of the
cytotrophoblastic shell and decidua.
3. Cytotrophoblastic shell.
4. Syncytiotrophoblast .
• Basal plate is perforated by the spiral branches of the
uterine vessels through which the maternal blood
flows into the intervillous space.
• At places, placental or decidual septa project from the
basal plate into the intervillous space but fail to reach
the chorionic plate. Areas between the septa are
known as cotyledons (lobes).
INTERVILLOUS SPACE:
• Bounded on the inner side by the chorionic plate
and the outer side by the basal plate, limited on
the periphery by the fusion of the two plates.
• Lined internally on all sides by the
syncytiotrophoblast and is filled with slow
flowing maternal blood.
• Numerous branching villi which arise from the
stem villi project into the space and constitute
chief content of the intervillous space.
STEM VILLI:
• These arise from the chorionic plate and extends to the basal plate.
• With the progressive development—primary, secondary and
tertiary villi are formed.
• Functional unit of the placenta is called a fetal cotyledon or
placentome, which is derived from a major primary stem villus.
• These major stem villi pass down through the intervillous space to
anchor onto the basal plate.
• About 60 stem villi persist in human placenta.
• Each cotyledon contains 3-4 major stem villi.
• The villi are the functional unit of the placenta.
• The total villi surface, for exchange, approximately varies between
10 to 14 square metres.
• The fetal capillary system within the villi is almost 50 km long.
• While some of the villi are anchoring the placenta to the decidua,
the majority are free within the intervillous space and are called
nutritive villi.
• Blood vessels within the branching villi do not anastomose with the
neighbouring one.
 Structure of Terminal Villous
• In early placenta, each terminal villus has got the
following structures from outside inward :
1. Outer syncytiotrophoblast
2. Cytotrophoblast
3. Basement membrane
4. Central stroma containing fetal capillaries, primitive
mesenchymal cells, connective tissue and a few
phagocytic (Hofbauer) cells.
• In placenta at term, syncytiotrophoblast becomes
relatively thin at places overlying the fetal capillaries
and thicker at other areas containing extensive
endoplasmic reticulum.
• Hofbauer cells are round cells that are capable of
phagocytosis and can trap maternal antibodies crossing
through the placenta.
 Placental Circulation
• Blood in two systems
– Uteroplacental circulation
– feto-placental circulation
• UTERO-PLACENTAL CIRCULATION : Circulation
of the maternal blood through the intervillous
space.
• Mature placenta has a volume of about 500
ml of blood
• 350 ml in the villi system and 150 ml in the
intervillous space.
 Continue….
• intervillous blood flow at term is 500-600 ml
per minute.
• villi depend on the maternal blood for
nutrition,
• Pressure in the intervillous space is about 10
to 15 mm Hg during uterine relaxation
• 30-50 mm Hg during uterine contraction.
• Fetal capillary pressure in the villi is 20-40 mm
Hg
Arterial circulation :
• 120-200 spiral arteries open into the intervillous space
• cytotrophoblastic invasion into the spiral arteries
initially upto the intra-decidual portion - 12 weeks.
• Endothelial lining is replaced
• musculo-elastic media is destroyed and replaced by
fibrinoid material.
• Secondary invasion of trophoblast between 12-16
weeks extending upto radial arteries within the
myometrium.
• Thus spiral arteries are converted to large bore
uteroplacental arteries.
• Net effect is funnelling of the arteries which reduces
the pressure of the blood to 70-80 mm Hg and
increases the blood flow.
 Continue….
• Secondary invasion of trophoblast 12-16
weeks upto radial arteries in the
myometrium.
• spiral arteries are converted to large bore
uteroplacental arteries.
• Net effect -reduces the pressure of the blood
to 70-80 mm Hg and increases the blood flow.
Extravillous trophoblast -do not take part in villous
structure
– Endovascular replaces the endothelium of spiral arteries.
– Interstitial that invades inner third of the myometrium.
• Further invasion is limited by the NK cells to prevent morbid
adhesion of placenta
• Defects in trophoblast invasion and failure to establish maternal
circulation correctly leads to PIH, IUGR
Venous drainage:
Drains through the uterine veins which pierce the basal
plate randomly like the arteries. (Ramsey and Co-
worker 1963,1966)
Summary of intervillous haemodynamics
• Volume of blood in mature placenta - 500 ml
• Volume of blood in intervillous space -150 ml
• Blood flow in intervillous space - 500-600 ml/minute
• Pressure in intervillous space Uterine relaxation10-15
mm Hg, uterine contraction 30-50 mm Hg
• Pressure in the in uterine artery 70-80 mm Hg
• Pressure in the draining uterine vein - 8 mm Hg
Circulation in the intravillous space
• Arterial blood enters the space under pressure
• Lateral dispersion occurs and reaches the chronic
plate. Villi help in mixing and slowing of blood
flow.
• Mild Stirring effect by the villi pulsation aided by
uterine contraction help migration of the blood
towards the basal plate and thence to the uterine
veins.
• Spiral arteries are perpendicular and the veins are
parallel to the uterine wall. Thus during
contraction, larger volume of blood is available
for exchange
FETO-PLACENTAL CIRCULATION :
• The umbilical arteries carries the impure blood from the fetus. They
enter the chorionic plate.
• Underneath the amnion, each supplying one half of the placenta.
• Arteries break up into small branches which enter the stems of the
chorionic villi.
• The blood flows into the corresponding venous channels.
• Maternal and fetal blood streams flow side by side, but in opposite
direction.
• This counter current flow facilitates material exchange between the
mother and fetus.
Summary of fetal haemodynamics
• Fetal blood flow through the placenta is about 400 ml per minute.
• Pressure in the umblical -60 mmHg artery
• Pressure in the umblical vein – 10 mmHg
• Fetal capillary pressure – 20-40 mmHg
• O2 saturation Umblical artery Umblical vein
50-60% 70-80%
PO2 20-25 mmHg 30-40 mmHg
FETO-PLACENTAL CIRCULATION :
• Two umbilical arteries carries the impure blood
from the fetus.
• They enter the chorionic plate each supplying one
half of the placenta.
• Arteries break up into small branches which enter
the stems of the chorionic villi.
• blood flows into the corresponding venous
channels.
• Maternal and fetal blood streams flow side by side,
but in opposite direction.
• counter current flow facilitates material exchange
 Fetal haemodynamics

• Fetal blood flow through the placenta is about

400 ml per minute.
• Pressure in the umblical -60 mmHg artery
• Pressure in the umblical – 10 mmHg
• Fetal capillary pressure – 20-40 mmHg
• O2 saturation Umblical artery Umblical
vein
50-60% 70-80%
PO2 20-25 mmHg 30-40 mmHg
PLACENTAL BARRIER :
• partition between fetal and maternal circulation.
• Not a perfect barrier - fetal blood cells are found
in maternal circulation so also the maternal blood
cells
• Barrier consisting of
– Syncytiotrophoblast
– Cytotrophoblast
– Basement membrane
– Stromal tissue and
– Endothelium of the fetal capillary wall with its
basement membrane.
– 0.025 mm thick .
– Near term thin zones alpha zones for gas exchange
and thick beta zones are for hormone synthesis.
 Placental Ageing
• limited life span,
• process involves both the fetal and maternal components.
VILLI CHANGES :
• Decreasing thickness of the syncytium and appearances of
syncytial knots.
• Partial disappearance of trophoblast cells.
• Decrease in the stromal tissue including Hofbauer cells).
• Obliteration of some vessels and marked dilatation of the
capillaries.
• Thickening of the basement layer of the fetal endothelium
and the cytotrophoblast.
• Deposition of fibrin on the surface of the villi.
• DECIDUAL CHANGES :
• There is an area of fibrinoid degeneration where
trophoblast cells meet the decidua. This zone is known
as Nitabuch layer.
• This membrane limits invasion of the decidua by the
trophoblast. membrane is absent in placenta accreta.

INTERVILLOUS SPACE :
syncytium covering the villi and extending into the
decidua of intervillous space undergoes fibrinoid
degeneration and form a mass entangling –white
infarct
inconsistent deposition of fibrin called Rohr's stria at the
bottom of the intervillous space and surrounding the
fastening villi.
 PLACENTAL FUNCTION
The main functions of the placenta are:
• Transfer of nutrients and waste products
between the mother and fetus.
• Respiratory *Excretory * Nutritive
• Endocrine function : Produces both steroid
and peptide hormones.
• Barrier function.
• Immunological function.
• Factors for placental transfer from mother to fetus
A- Substance property
– Lower molecular weight
– Lipid Solubility
– Ionized nonionized form
– Lower pH, protein binding
B- Maternal properties
• Drug concentration in the maternal blood
• Uterine blood flow
• Concentration gradient on either side
C- Placental property,
• Lipid membrane of placenta enhances transfer
• Total surface area of placental membrane
• Functional integrity and thickness of placental barrier.
 Respiratory Function
• Starts at 11 wks – fetal respiratory movement
• Oxygen supply to the fetus 8ml/kg/min
• Cord blood flow 165-330 ml/min
Excretory Function
• Urea, Uric Acid and Creatinine are excreted by simple
diffusion
Nutritive Function-Fetus obtains nutrients from maternal
blood
• Glucose lipid water and vitamins transferred by
diffusion
• Amino acid transferred by active transport
• hormones cross the placenta at slow rate.
Enzymatic Functions
• Diamine oxidase- inactivates circulatory pressure
• Oxytocinase
• Phospholipase A2
Barrier Function
• Substances of high molecular weight of more
than 500 Daltons are held up but there are
exception.
• Rate of drug transfer increase in late pregnancy
• Maternal infection during pregnancy by virus,
bacteria or protozoa may cross the barrier
 Immunological Function
• Placental hormone, early pregnancy factor,
PAPP-A, steroid and chorionic gonadotropin
have immunosuppressive effect.
• Shift of maternal response from cell mediated
to humoral immunity.
• Villous trophoblast do not express HLA class I
or class II.
 Fetal Membrane
• Consist of 2 layers
Chorion
– Outer layer
– Represents the reminant of chorion leave
– Internally attached with amnion
– Externally it is covered by vestiges of trophoblastic
layer and decidual cells of the fused decidua
capillaries and parietalis .
Amnion
– Inner layer, smooth and shiny
– It is in contact with liqour amnii
– Outer layer is opposed to inner aspect of chorion from
which it can be peeled off.
Function
– Formation of liqour amnii
– Prevent ascending uterine infection
– Facilitate dilatation of cervix during labour
– Has got enzymatic activity for steroid hormone
metabolism
– Rich source of glycerophospholipid containing
arachidonic acid.