Placental Development “Tho placentas a vital connecting organ between the matoral uterus andthe foetus. It supports the developing fetus, in utero, by supplying nutrons, ei blood supoly. ing waste products ofthe fetus and enabling gas exchange via the maternal In this article, we shal ook atthe development ofthe placenta Pre-l The implantation lopment of he pacanta begins rng implantation ofthe blstocyt ‘Tne 32-64 call blastocyst contain two distinct iferentiated embryonic eal types: tho outer trophoblast cols and the inner coll mass, The trophoblast calls form the placenta, The inner cel mass forms the foetus and foetal membranes. Implantation (On the 6 day, asthe zona pellucida disintegrates, the blastocyst "hatches; allowing implantation to take place, The trophoblast calls interact withthe endometrial deciduel epithelia to enable the invasion into the maternal uterine cals. ‘The embryo then secretes proteases to allow deep invasion into the uterine stroma. Implantation is inertial Normal implantation occurs on the anterior or pateror val fhe body ofthe uterus. The mast commen ectopic implantation siti inthe ampulla ofthe Fallopian tube. (On the 6 cay of development, the trophoblast alle ciferentite into the outer multinucleated syncytiotrophoblast, hich erodes maternal tissues by sending aut projections, an the inner manonucleated cytattophablas, whichis actively proliferating, “The syneytrephobast i responsible for producing hormones such as Human Chorlonie Gonadotropin (hCG) by the second week, whichis used in pregnancy testing Post-Implantation (On day 8, lacunae or spaces form within the syneytiotrophoblast. The syncytitrophoblast also erodes maternal tissues allowing maternal blood from Uterine spiral arteries to enter the lacunar network. Thus early uteroplacenta culation is established bythe end of week 2 Mesnwtile, the cytovophoblast begins to form primary cherlonic vill (finger-like projections) which penetvate and expand into the surounding syneytiottophoblas.n the 3% week, extra-embayonic mesoderm grows into these vill forming & core of loose connective tissue, at which point these structures are called secondary chorionic ilfy the end of the tht week, emoryonic vessel begin to form inthe embryonic mesoderm cf the secondary chorionic vill, making them tertiary chorionic vit ‘Te eytotrophoblast call from the tertiary vil grow towards the decidua basis ofthe maternal uterus and spreae across itt form a eytorephobastic shell The vl hat are connected to the decidua basalis through the cyttrephblastc shell are known as anchoring vil. Vili growing outward within the interillous space from the stem (anchoring) vil recalled branching vill and provide surface area for exchange of ‘metabolites between mother and fetus. Imagining the vill as wee-tke projections can help visualise thel structure. Establishment of Circulation Maternal spiral arteries undergo remodeling to produce low resistance, high blood flow conditions in order to meet the demands of the foots, Ccytotrophoblast cells invade the maternal spiral arteries and replace maternal endothelum, They undergo an epithelia to endothelial ferentiation, hich inereases the diameter and reduces the resistance ofthe vessels Pre-eclompsi is 8 trophoblastic disorder velated to fled or incomplete diferentation of eytorophoblastic cells during the eptheil to endothelial transformation Placental Barrier The first trimester Inthe frst trimester (0-18 weeks), the surface ofthe chorionic vill s formed by the syncytitrophoblast. These cells rest on layer of eytotrophoblastc. cells that in tun cover a core of vascular mesoderm. Therefore, the placental beter isrlatively hick ‘The surface area for exchange dramatically inreases by full-term (27-40 weeks) The placental barrier beneath the syncytitrophoblasis lost ‘much thinner and the cytotrophoblast layer The placental barter isnot a true barer as it allows many substances to pass between the maternal and foetal circulations. Unfortunately, his means various crags (29. heroin, cocaine) and viruses (eg. CMY, rubella, measles) can enter the foetal ciculaton. As the maternal blood inthe itevilous spaces is separated frm the foetal blood by chorion derivatives, the human placenta is known asthe haemocherial type. The second and third trimesters ‘As the prognancy advances, the chorion frandosum (the "bushy" chorion) is forme! as mare vill develop on the embryonic pole. On the foetal surface, the placenta is covered by the chorionic plate; on the maternal side it is bordered by the decidua basal of which the deciual plate is most intimately incorporated into the placenta During the fourth ane fth months, the decidua form decidual septa which project int the itevilus space but do not ein the chorionic pat. These septa have a core of maternal tissue but are covered by a lyer of syncytial cells. tal es there ie @ syncytial layer that separates maternal blood in intervilouslkes rom fostaltssue of he vill The septa divide the placenta into compartments called cotyledons. Cotyledons receive their blood supply through 80-100 spiral arteries that pierce the decidua plateFull-Term Placenta {At full term the placenta is disoid in shape witha dlameter of 15-25em, approximately 3 em thick and weighs about 600-600g, At birth i torn from the uterine walang around 20 minutes ater the birth ofthe child itis expelled trom the uterine cavity, “The maternal side wll have 18-20 bulging areas which are the cotyledons, covered by 2 thin layer of decidua basalis, The fully grown placenta contin intervilous lakes. These structures will hold approximately 150 mL of maternal loa, This s renewed 2-4 tmes ger minut A chotionic plate covers the fetal surface, The chorionic vessels converge toward the umbilical cord, These area numberof large arteties and veins. The armrion covers the layer of chorion. The umbilical cord usually attaches inthe middle ofthe placenta, perpendicular tot, A velamentous insertion may ‘cur ifthe umbilical cord insets outsice of the placent, but thisisrare End of Pregnancy ‘The aim of the changes that occur to the placenta atthe end of pregnancy isto reduce exchange between the matemnal and fetal circulations, These changes ae a ‘ollons: Increase nthe fibrous tissue inthe core ofthe vies ‘Thickening of feta capilry basoment membranes Obiterative changes in small capris of he vit Deposition of fbrinoid on the surface ofthe vil nthe junctional zone and in the chorion plate DDepastion of rina results in infarction ofan intevillous lake or sometimes an entire cotyledon, which subsequently turns whish in colour, + ical Relevance - Placental Abruption cental abruption is when a port or all of, the placenta separates prematurely fom the uterine wall and is an important couse of antepartum haemorrhage. it occurs following 2 rupture of matemal vessels within the basellyer of the endometrium. Blooé accumulates end ‘eauses the placenta to split from the basal ayer. The detached portion is unable to function which ean lead to rapid oetslcompromis portant sk factor for this include previous placental abruption, pre-eclampsia, abnormal lie of the foetus, polyhydramnios, smoking, multiple pregnancy, underlying thrombophilia and abdominal traums, The most predictive factor i placental abruption in» previous pregency Yom ly present with painful vaginal bleeding during their prognancy. On examination the uterus may be woody (tense) and painful palpatio Management of placental abruption should consist of Maternal resuscitation using an ABCDE approach TG to sssess/montor foetal wellbeing ifthe woman is past 26 weeks gestation anti-0 within 72 hours ofthe onset of bleeding if the woman is rhesus 0 negative Emergency delivery/Induction of lbour/Conservatve management and monitoring ofthe foetus depending on the degree offFurther information on placental abruption can be found here