Placenta and Amniotic Fluid

Dr.Zahraa Noah (C.A.B.O.G.)

Department of Obstetrics and Gynecology

College of Medicine / Mosul University

• Objectives

• To understand the development and circulation of the placenta

• To understand the origin and composition of the amniotic fluid

Placental Development

• The human placenta is discoid, because of its shape hemochorial, because of direct contact
of the chorion with the maternal blood and deciduate because some maternal tissue is shed
at parturition.

• The placenta develops from two sources. The principal component is fetal which develops
from the chorion frondosum (Trophoblast) and the maternal component consists of decidua
basalis.

• Trophoblast forms the placenta and fetal membranes (chorion and amnion).

• Th trophoblast diffrentiates 7-9 days after fertilization into cytotrophoblast and

synctiotrophoblast.

Placenta is formed by the trophoblast:

• The trophoblast differentiates into syncytiotrophoblast and
cytotrophoblast.
• The cytotrophoblast rests on the mesoderm.
• Small cavities appear in the syncytiotrophoblast called as
Lacunae.
• The lacunae are separated from one another by partitions
of syncytium called as trabeculae.
The syncytiotrophoblast grows into the endometrium
(Decidua).

As the endometrium is eroded, some of the maternal blood vessels are opened up and blood from
them fills the lacunar space. So, lacunae have maternal blood.
Each trabeculas is, initially made up entirely of syncytiotrophoblast.

Later cells of cytotrophoblast begin to multiply and grow into each trabeculas. This is called as
Primary villi

• These cells of cytotrophoblast are called as villous cells.

• Some cells of cytotrophoblast. The extravillous cells invade decidua and spiral arterioles of
the mother and make spiral arterioles resistant to vasopressors called as trophoblastic
invasion. This helps in maintaining uteroplacental circulation.

• If thus fails to happen female develops PIH (incomplete trophoblastic invasion).

 Soon thereafter, fetal blood vessels can be seen in the mesoderm forming the core of each villus.
The villus is called as Tertiary villus.
Thus the maternal blood in the lacuna is never in direct contact with fetal blood. They are separated
by :

• Syncytiotrophoblast

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• Cytotrophoblast
• Basement membrane
•
if
Mesoderm
• Endothelium of fetal capillaries
I Togeather called placental barries or placental membrane

Maternal arterial blood enters the intervillous space by 15th day after fertilization and by 17th day
fetal blood vessels are functional and placental circulation is established

An increase in thickness of the villous membrane is seen in cases with IUGR and cigarette smokers.

Th placenta, at term, is almost a circular disk with a diameter of 15–20 cm and thickness of 3 cms at
its center.

It weighs 500 gm.

¥
It presents two surfaces, fetal and maternal, and a peripheral margin.

maternal
fetal
a

cord
umbilical
 Fetal surface is covered by the smooth and
glistening amnion with the umbilical cord
attached at or near its center. At term, about
four-fifths of the placenta is of fetal origin.
Maternal surface is rough and spongy. Maternal
- -

blood gives it a dull red color.

It has 10–38 convex polygonal areas known as

-

lobes which are limited by fissures, The total

number of placental lobes remains the same

→
throughout gestation and individual lobes
continue to grow.

A cotyledon or lobule is the functional unit of

placenta originating from a main (stem villus
primary).

←%ÉÉg€→5É= .

Placental membrane
Placental Circulation
g)%
• Uteroplacental circulation
• Fetoplacental circulation

's Uteroplacental circulation is concerned with the circulation of the maternal blood through the
intervillous space.
* A mature placenta has a volume of about 500 mL of blood; 350 mL being occupied in the villi system
and 150 mL lying in the intervillous space.

The uteroplacental blood flow at term is 450-650 ml/min

Fetoplacental circulation

The two umbilical arteries carry the impure blood from the fetus to the placenta.
They enter the chorionic plate underneath the amnion and branch repeatedly to form the chorionic
arteries which are end arteries.
-
↳÷

Their branches are called as truncal arteries. Each truncal artery supplies one main stem villus and
thus one cotyledon.
The oxygenated blood then returns to the fetus via single umbilical vein.
The fetal blood flow through the placenta is about 400 mL/min

The uteroplacental circulation is established 10–12 days after fertilization.

• Fetoplacental circulation is established 21 days postfertilization.
• Uterine blood flow at term = 750 ml/min (non pregnant 50 ml/min)
• Uteroplacental blood flow at term = 450–650 ml/min
• Fetal placental blood volume at term = 125 ml/kg
II.
( D. →
←Mie
'

3- Aw .

⇐ Nisi
Placental Pathology 5
Id
→
thrombosis

①• Placental infarction: These are the most common placental lesion. If they are numerous,
placental insuffiency may develop. When they are thick, centrally located and randomly
distributed, they may be associated with preeclampsia or lupus anticoagulant. Thy can also
hyper tesirn
.

lead to placental abruption. Wj ¥-1

17h20
• Placentomegaly (big placenta) is seen in:
is – Multiple pregnancies
– Diabetes mellitus
– Maternal anemia → ¥-5
Éu
IN – Macrosomy
– Hydrops fetails (immune and nonimmune)
– Syphilis
– Toxoplasma CMV infection.
⑤
• Small placentas are seen in:
– Postdate
– IUGR
– Placental infarct

ñ* Abnormal Placenta
•÷ Succenturiate placenta When a small part of placenta is separated from the rest of placenta.
A leash of vessels connecting the mass to the small lobe traverse through the membranes. It
can be retained leading to PPH, sub involution, uterine sepsis and polyp formation
↓
partum hemorrhage
post
éi↳ .

ÑoI
 circumvallate placenta When the peripheral edge of the placenta is
covered by a circular fold of amnion and chorion and fetal surface has
a central depression.
It can lead to abortion, APH, IUGR, Preterm delivery

Battle dore placenta Placenta with umblical cord attached to its

margin rather than in center WTF

Fetal Membranes
→
•'s 1. Amnion is the innermost fetal membrane, avascular. It provides almost all tensile strength
Ñ% of the fetal membranes. It lacks
u smooth muscle cells, nerves, lymphatics and blood vessels. It is now being considered as a
§
,
≥
derivative of fetal ectoderm.
This layer is formed between 10-11 days after fertilization.

• 2.Chorion is Formed 8 days after fertilization. Chorion frondosum forms placental villi.
:*
'

Chorion leave gets merged with amnion

÷ • 3. Yolk sac
4. Allantois- diverticulum which arises from hindgut and grows into the connecting stalk

Umbilical Cord
←
• Umbilical cord extends from the fetal umbilicus to the fetal surface of the placenta or
chorionic plate.
It develops from the connecting stalk.
In the early fetal life, cord has 2 arteries and 2 veins but later right umbilical vein disappears,
leaving only the original left vein (i.e. Left is left) Thus at term umbilical cord has 2 arteries
and 1 vein.

• Normally, the umblical cord is inserted at the center of the fetal surface of the placenta
 Structure and Function

• Its length is ≈ 55 cm, Range is between 30-100 cm (If it is < 32 cm it is considered abnormally
A short).

⇐
Folding and tortuosity of the vessels within the cord itself creates false knots (which are
essentially varices).
The two arteries are smaller in diameter than the veins.

The O2 Supply to fetus is at the rate of 5 ml/kg min and this is achieved with cord blood flow
of 105–320 ml/min

*Abnormalities of Cord Insertion

*
E-

⇐
⇐I.
*
if
umbilical
brane

µgi-
-

linen
 Amniotic Fluid → 11*13*61
Important Facts

• Specific gravity of Amniotic fluid: 1.008 to 1.010.

• Osmolality: 250 mosm/L.

• It is completely replaced in 3 hours.

• Rate of amniotic fluid turn over is 500 cc/hr.

•
☒ ⇐
a→W%
Volume of Amniotic fluid maximum is between 36-38 weeks (1L) and then decreases such
that at term it is roughly 800-900 ml

Composition of Amniotic Fluid

• Water-98-99%
• Solids-1-2%-include, organic solids like proteins, glucose, lipid, urea, uric acid, creatinine
and hormones like Prolactin, insulin and renin
• Inorganic solids are Na, K and Cl

Amniotic fluid originates both from maternal and fetal sources:

• In early pregnancy As an ultrafitrate of maternal plasma.

• By beginning of the second trimester It consists of extracellular fluid which diffuses through the
fetal skin.

• After 20 weeks Cornifiation of skin prevents this diffusion and amniotic fluid is composed of fetal
urine.

Colour of Amniotic Fluid

←
• Early pregnancy it is Colourless

• Near term it is Pale straw coloured due to presence of exfoliated lanugo hairs and epidermal cells
from the fetal skin

*Abnormal colour of amniotic flid

– Green (meconium stained) - fetal distress/breech or transverse position/Listeria infection
* – Golden yellow - Rh incompatibility (Because bilirubin levels are increased in amniotic fluid in case
of Rh incompatibility).
– Greenish yellow (saffon) - postmaturity.
– Dark coloured - concealed hemorrhage.
– Dark brown (tobacco juice) in case of IUD →
intra uviterine death
I
-

1.
#Function of Amniotic fluid
,
☆ Its main function is to protect the fetus.
During pregnancy:

(1) It acts as a shock absorber, protecting the fetus from possible extraneous injury

/
(2) Maintains an even temperature

ñ ⇐
 8€ (3) The fluid distends the amniotic sac and thereby allows for growth and free movement of the
-

fetus and prevents adhesion between the fetal parts and amniotic sac
I I

=
(4) It has some nutritive value.

¥ During labor: The amnion and chorion are combined to form a hydrostatic wedge which helps in
'

☒ dilatation of the cervix.

Assesment of Amniotic Fluid

The assessment of amniotic fluid is an integral part of antepartum fetal assessment.

Techniques used for measurement of Amniotic fluid ultrasonographically:

Amniotic flid index (AFI): is calculated by dividing the uterus into four quadrants and measuring the
largest vertical
pocket of liquor in each of the four quadrants. The sum of the four measurements is the AFI in cm.
The range of 5-25 cm
is considered normal. Less than 5 is considered significant oligohydramnios.
Single deepest pocket (SDP): is the depth of a single cord free pocket of amniotic fluid. The normal
range is 2-8 cm. Over
8 cm is considered polyhydramnios. Less than 2 cm is considered as oligohydramnios

• References

• Williams obstetrics

• Sakshi Arora obstetrics

• Dutta textbook in obstetrics and gynecology

• MRCOG part 1 review guide