1.03A  
August  1,  2016  
THE  PLACENTA  AND  FETAL  MEMBRANES  
Dr.  Teresita  Cadiz-­‐Brion  
Department  of  Obstetrics  and  Gynecology  

TOPIC  OUTLINE     • Free  blastocytic  stage  –  no  implantation  

I. Development  of  the  Placenta   • Implantation  of  the  blastocyst  
II. Structural  Differences  of  Chorionic  Villi  in  Early  and  Late   o Disappearance  of  the  zona  pellucida  
Pregnancy   signals  the  implantation  of  the  blastocyst.  
III. Fetal  Compartments   o Apposition  –  adherence  to  endometrial  
DAYS  5  –  6  
IV. Placental  Circulation   surface  (most  commonly  occurs  on  the  
V. Fetal  and  Maternal  Circulation   upper  posterior  uterine  wall)  
a. Fetal  Circulation   • The  blastocyst  buries  itself  into  the  decidua  as  
b. Maternal  Circulation   it  goes  along.  
c. Amnion   • Erosion  by  the  trophoblast  into  the  epithelial  
VI. Umbilical  Cord   DAYS  7  –  8   cells  of  the  surface  endometrium  
    • Blastocyst  invades  deeply  into  endometrium.  
  • Blastocyst  is  completely  buried  and  covered  
DAY  9  
DEVELOPMENT  OF  THE  PLACENTA   by  the  decidua  (decidua  capsularis).  
• Differentiation  of  the  trophoblast  where:  
• Fertilization  signals  start  of  a  cascade  of  events  that  will  ensure  the  
o Synctitium  becomes  contiguous  with  
nourishment  and  growth  of  the  product  of  conception  (at  this  
point,  it  is  called  a  zygote).   synctitiotrophoblast  –  contiguous  with  
decidua  and  later  on,  maternal  blood.  
o Inner  layer  of  primitive  mononuclear  
DAY  10  
cells  become  cytotrophoblast.  
• Formation  of  lacunar  networks  
o The  eroded  spiral  arteries  form  a  
lacunar  network  in  which  maternal  blood  
occupies  the  space.  
• Implantation  
o Impetus:  provided  by  trophoblast  
o Limitation   of   trophoblast   invasion   –  
provided  by  maternal  deciduas  
• Implanted  blastocyst  has  2  poles:  
a) Outer   pole   –   extends   to   the   uterine  
cavity   and   becomes   covered   by   the  
chorion   frondosum   and   decidua  
capsularis  
b) Inner   pole   –   buried   in   the   decidua   to  
form  the  placenta  
• Trophoblast  proliferation  and  invasion  
o The   trophoblast   provides   for  
attachment   of   the   blastocyst   to   the  
decidua.  
DAY  12   o Syncytiotrophoblast   is   permeated   by   a  
  system   of   intercommunicating   channels  
  of  trophoblastic  lacunae  or  small  cavities.  
    With   endometrial   invasion,   maternal  
Figure  1.  Cleavage  of  the  zygote  and  formation  of  the  blastocyst.  A  to  D  show     blood   vessels   (spiral   arteries)   are  
various  stages  of  cleavage.  E  and  F  are  sections  of  blastocysts.  Zona  pellucida  has     tapped   to   form   lacunae   which   soon   will  
disappeared  by  the  late  blastocyst  stage.    
  fill   with   blood   (occurs   in   functionalis  
 
  layer).  
OVULATION  
NOTABLE  OCCURRENCES   • Villous  trophoblasts  give  rise  to  the  
AGE  
chorionic  villi,  which  primarily  transport  
DAYS  0  –  2   • Cleavage  of  the  zygote   oxygen  and  nutrients  between  the  fetus  and  
• Morula  enters  the  uterine  cavity.   the  mother.  
• The  zygote  undergoes  slow  cleavage  for  3  days   • Extravillous  trophoblast,  which  migrates  
in  the  fallopian  tube  (starting  from  the   into  the  decidua  and  myometrium,  can  be  
ampulla),  eventually  turning  into  a  blastocyst.   subdivided  into  endovascular  and  interstitial  
DAY  3   • Kinks  in  the  fallopian  tube,  decrease  in  the   trophoblast.  
rate  of  zygote  movement,  and  cessation  of   a) Interstitial  trophoblast  –  invades  the  
zygote  movement  are  possible  causes  for   deciduas  and  eventually  penetrates  the  
ectopic  pregnancy  occurring  in  the  fallopian   myometrium  to  form  placental  bed  
tube.   giant  cells;  also  surrounds  spiral  arteries  
• Formation  of  blastocyst   b) Endovascular  trophoblast  –  invades  
DAYS  4  –  5   o Inner  cell  mass:  embryo   and  transforms  the  lumen  of  spiral  
o Outer  cell  mass:  trophoblast   arteries  to  create  low  resistance  blood  

1  of  4   [  OB  Girls  ⏐  Faye,  Gabby,  Jade,  Jelyn,  Vien  ]                  

 
 The  Placenta  and  Fetal  Membranes  
 
vessels  that  is  characteristic  of  the   STRUCTURAL  DIFFERENCES  BETWEEN  EARLY  AND  
placenta   LATE  PREGNANCY  
• Lacunar  period  –  lacunae  join  together  to  
 
form  a  complicated  labyrinth  partitioned  by  
solid  trophoblastic  columns  (forerunner  of   FEATURE   EARLY  PREGNANCY   LATE  PREGNANCY  
primary  villi)   Syncytial  layer   thick,  abundant   thinner  in  knots  
• Formation  of  primary  and  secondary  villi   Cytotrophoblast   ↑ prominence,   ↓ prominence,  
• Trophoblast-­‐lined  labyrinthine  channels  form    volume    volume  
intervillous  space.   Hoffbauer  cells   ↑ prominence,   ↓ number  
• Solid  cellular  columns  form  primary  villous  
abundant  
stalk.  
DAYS  13  –  19   Chronic  stroma   ↑ abundant,  loose   ↓ minimal, dense  
• Secondary  villi  form  when  solid  stalks  are  
invaded  by  mesenchymal  cords.   Fetal  capillaries   ↓ prominent, number   ↑ prominent, number  
• Formation  of  amnion  and  stalk    
• Body  stalk  will  become  the  umbilical  cord.   FETAL  COMPARTMENTS  
• Amnion  -­‐  fetal  membrane  nearest  to  the  fetus  
• Tertiary  villi  forms  when  angiogenesis  
occurs  in  situ  of  mesenchymal  core  of  
secondary  villi  (histologically  considered  late  
pregnancy)  
o In  absence  of  angiogenesis,  villi  become  
cystic  Hydatidiform  mole  (H.  mole).  
o H.  mole  can  cause  bleeding,  ectopic  
pregnancy  or  abortion.  
DAYS    19  –  21  
• Fetoplacental  circulation  is  established  on  Day  
17.  
o Blood  vessels  of  the  embryo  are  
connected  with  the  chorionic  blood  
vessels  –  fetal-­‐placental  circulation  is  
completed.  
• Fetal  capillaries  form  in  situ  and  tap  umbilical    
vessels.   Figure  2.  Decidualized  endometrium  covers  the  early  embryo.  Three  portions  of  the  
• Chorionic  frondosum  forms.   decidua  capsularis,  basalis  and  parietalis,  or  vera)  are  also  illustrated.  
• Chorionic  villi  in  contact  with  the  decidua    
basalis  proliferate,  forming  chorion   • Chorion  frondosum  –  leafy  chorion;  becomes  the  fetal  
frondosum  (leafy  chorion),  which  is  the  fetal   compartment  
component  of  the  placenta.   • Decidua  basalis  –  becomes  the  maternal  compartment  
• Intervillous  space   Decidua  vera  –  decidua  capsularis  +  decidua  parietalis  
DAYS  21  –  40   •
o Roof  forms  from  chorionic  plate.  
 
o Floor  forms  from  cytotrophoblasts  
from  the  cell  column.   PLACENTAL  CIRCULATION  
• Placental  septa  –  consist  of  decidual  tissue   • Fetal  surface  of  the  placenta  is  covered  by  the  amnion  where  the  
encasing  trophoblastic  elements  with  fetal  and   fetal  chorionic  vessels  course.  
maternal  components   • Maternal  surface  –  divided  into  irregular  lobes  by  furrows  
• Cotyledon  formation  –  growth  until   produced  by  septa,  which  consist  of  fibrous  tissue  with  sparse  
definitive  placenta  forms   vessels  confined  mainly  to  their  bases  
• Anchoring  villi  –  extend  from  chorionic  plate  
to  the  decidua  
• Stem  villi  –  arborescence  and  end  freely  in  the  
intervillous  space  placental  cotyledon  
• The  blood  supply  and  villous  nature  of  chorion  
frondosum  becomes  lost  and  avascular  
chorion  laeve  or  chorion.  
DAYS  40  –  50   • Amnion  and  chorion  both  make  up  the  
placental  membrane;  the  placental  membrane  
myometrium  does  not  change.  
• The  placenta  has  two  components  that  
become  intimately  related:  
a) Chorion  frondosum  –  fetal  
compartment  
b) Decidua  basalis  –  maternal  decidua  
capsularis  which  merged  with  decidua  
parietalis  to  form  decidua  vera,  thereby  
obliterating  the  uterine  cavity    
• Cellular  proliferation  ceases.  
DAYS  225  -­‐  
• Cellular  hypertrophy  continues.  
267  
• Growth  up  to  term  
 
 

2  of  4   [  OB  Girls  ⏐  Faye,  Gabby,  Jade,  Jelyn,  Vien  ]          

 
 The  Placenta  and  Fetal  Membranes  
 
• Fetal  circulation  is  along  the  villous  tree  while  the  maternal   end-­‐diastolic  flow  will  appear  and  be  maintained  throughout  normal  
circulation  occurs  in  the  intervillous  space.   pregnancies.    
• There  are  no  formed  arteries  connecting  the  mother  and  the  baby,    
instead,  maternal  blood  enter  the  placenta  through  the  spiral   Maternal  Circulation  
arteries  via  fountain-­‐like  bursts  (this  is  possible  due  to  the  low   • Maternal  circulation:  
resistance  vessels  which  replaced  the  spiral  arteries),  which  contain   o Flows  into  amorphous  space  lined  by  syncytiotrophoblast,  
higher  oxygen  levels  than  when  it  bursts  up.  As  the  blood  spurts,  it   rather  than  endothelium  
will  be  drained  and  would  go  back  to  the  mother.   o Returns  through  maternal  veins  without  arteriovenous-­‐like  
o There  is  a  possibility  of  a  breakthrough  of  blood  at  this  part  if   shunts  
there  is  an  incompatibility  of  blood  between  the  mother  and   • Entrance:  maternal  blood  à  basal  plate    à  chorionic  plate  via  
baby,  which  would  cause  haemolysis,  as  with  the  case  of   maternal  arterial  pressure  before  lateral  dispersion  occurs    
haemolytic  disease  in  newborns.   • Maternal  blood  traverses  the  placenta  randomly  without  
• In  the  intervillous  space,  the  blood  of  the  mother  washes  along  the   preformed  channels.  This  is  aided  by  maternal  arterial  pressure.  
intervillous  space,  facilitating  an  exchange  across  the  epithelium  of   • The  number  of  arterial  openings  into  the  intervillous  space  becomes  
the  fetal  capillaries  via  the  chorionic  villi  (this  is  why  it  is  the   gradually  reduced  by  cytotrophoblast  invasion.  
placenta  that  accomplishes  the  fetal  exchange  of  blood  and  wastes).   • Drainage:  through  venous  orifices  in  the  basal  plate  and  enters  
• The  blood  vessel  that  brings  the  blood  to  the  baby  is  the  umbilical   uterine  veins  after  bathing  the  external  microvillus  surface  of  
vein  (oxygenated),  while  the  umbilical  arteries  (deoxygenated)   chorionic  villi  
carry  the  blood  back  to  the  mother.   • Principal  factors  regulating  blood  flow  in  the  intervillous  space:  
• It  is  important  that  the  baby  makes  a  transition  from  this  type  of   o Arterial  blood  pressure  
circulation  at  birth  when  it  is  able  to  take  in  air.   o Intrauterine  pressure  
  o Pattern  of  uterine  contractions  
Always  remember:   o Factors  that  act  on  arterial  walls  
TWO  ARTERIES,  ONE  VEIN    
Arteries  –  Deoxygenated,  Vein  –  Oxygenated   Amnion  
 
• An  avascular,  tough,  and  tenacious  but  pliable  membrane  (at  term)  
FETAL  AND  MATERNAL  CIRCULATION   • Provides  almost  all  tensile  strength  of  the  fetal  membrane  
Fetal  Circulation   • Developed  from  amniogenic  cells  that  line  the  inner  surface  of  
trophoblasts  in  the  space  between  the  embryonic  cell  mass  
• It  is  contiguous  with  the  amniotic  fluid.  
• Produces  vasoactive  peptides,  growth  factors,  and  cytokines  
• Distinguishable  during  7th  or  8th  day  of  embryonic  development  in  
humans    
• Distention  of  the  amniotic  sac  brings  it  into  contact  with  the  chorion  
laeve.  
• Lacks  smooth  muscle  cells,  nerves,  and  lymphatics  
• Layers:  
o Inner  surface:  
§ Uninterrupted,  single  layer  of  cuboidal  epithelium  
§ Bathed  by  amniotic  fluid  
§ Attached  to  a  basement  membrane  connected  to  acellular  
compact  layer  (composed  of  interstitial  collagen)  
o Outer  surface  of  compact  layer:  
§ Row  fibroblast-­‐like  mesenschymal  cells  (widely  dispersed  
at  term)  
§ With  few  fetal  macrophages  
o Outermost  layer:  
§ Acellular  zona  spongiosa  
§ Contiguous  with  the  second  fetal  membrane,  the  chorion  
  laeve  
Figure  3.  Fetal  circulation   • Development:  
  o Space  develops  between  embryonic  cell  mass  and  adjacent  
• Deoxygenated  venous-­‐like  fetal  blood  flows  to  placenta  through  two   trophoblasts  (during  early  implantation).  
umbilical  arteries.   o Amniogenic  cells  –  precursors  of  amnionic  epithelium  
• As  the  cord  joins  the  placenta,  these  vessels  branch:   o Initially  a  minute  vesicle  à  sac  covering  dorsal  embryo  surface  
o Beneath  the  amnion   o As  it  enlarges,  it  engulfs  the  growing  embryo,  which  then  
o Within  the  villi  à  capillary  networks  in  the  terminal  villous   prolapses  into  its  cavity.    
branches   o Upon  the  end  of  the  first  trimester:  
• Blood  with  significantly  higher  oxygen  content  returns  via  a  single   § Apposition  of  the  mesoblast  of  the  chorion  laeve  and  the  
umbilical  vein  to  the  fetus.     amnion  causes  the  extraembryonic  coulomb  to  be  
• Chorionic  vessels/placental  surface  –  branches  of  the  umbilical   obliterated.    
vessels  that  traverse  along  the  fetal  surface  of  the  placenta  in  the   § Amnionic  and  primary  chorionic  plate  mesenchyme  fuse  
chorionic  plate   together.    
• Chorionic  arteries  always  cross  over  chorionic  veins.   § Formation  accomplished  by  expansion  of  the  amniotic  sac  
• Truncal  arteries  –  perforating  branches  of  the  surface  arteries  that   also  surrounding  the  connective  stalk  and  the  allantois,  
pass  through  the  chorionic  plate   and  joins  these  structures  to  form  the  umbilical  cord  
• Before  10  weeks,  there  is  no  end-­‐diastolic  flow  pattern  within  the   • In  twin  pregnancy:  
umbilical  artery  at  the  end  of  the  fetal  cardiac  cycle,  but  at  10  weeks,   o 2  amnions,  1  chorion    
o 1  amnion,  1  chorion    

3  of  4   [  OB  Girls  ⏐  Faye,  Gabby,  Jade,  Jelyn,  Vien  ]          

 
 The  Placenta  and  Fetal  Membranes  
 
o 1  amnion,  2  chorions    
• AMNION  is  near  the    FETUS;  CHORION  near  the  MOTHER  
 
UMBILICAL  CORD  
• Extends  from  the  fetal  umbilicus  to  the  fetal  surface  of  the  placenta  
(chorionic  plate)  
• Ave.  length:  55  cm    
o Too  long  –  may  coil  on  baby’s  neck  
o Too  short  –  rupture  placenta  
• Range:  30-­‐100  cm  
• Ave.  diameter:  0.6-­‐2.0  cm  
• Exterior:  dull  white,  moist,  and  covered  in  amnion  
• Derived  from  body  stalk  
• Can  be  regarded  as  fetal  membrane  anatomically  
• Extracellular  matrix  is  a  specialized  connective  tissue  called  
Wharton’s  jelly  
• Blood  flows  from  umbilical  vein  and  takes  a  path  of  least  resistance:  
o Ductus  venosus  à  IVC  
§ Resistance  controlled  by  sphincter    
o Hepatic  circulation  (small  openings)  
§ Liver  à  hepatic  vein  à  IVC  
• Blood  exits  via  two  umbilical  arteries  
o Anterior  branches  of  internal  iliac  artery  
o Remnants:  medial  umbilical  ligaments  
 

 
Figure  4.  Cross-­‐section  of  umbilical  cord  
 

4  of  4   [  OB  Girls  ⏐  Faye,  Gabby,  Jade,  Jelyn,  Vien  ]