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7. DEVELOPMENT OF THE PLACENTA

Embryology | Development of the Placenta Medical Editor: Ilia-Presiyan Georgiev

OUTLINE (3) The morula

turns into a blastocyst
I) PRE-IMPLANTATION Lots of water starts flowing into the morula
II) IMPLANTATION
o Forms a water-filled cavity - blastocoel
III) POST-IMPLANTATION
IV) MACROANATOMY The blastocyst consists of
V) FUNCTIONS o Blastocoel
VI) APPENDIX o Outer cell mass
VII) REVIEW QUESTIONS  Will form the trophoblast
VIII) REFRENCES • Will form the placenta
o Inner cell mass
 Will form the embryoblast
I) PRE-IMPLANTATION • Will form the endoderm, mesoderm and
ectoderm that will form the entire structure of
(1) In the ampulla of the fallopian tube the fetus
there are sperm and secondary oocytes in metaphase
2
Their fusion forms the zygote
o Has a lining – zona pelucida
(2) The zygote
divides (cleaves) into 2 cells
o The two-cell stage
o The cells are surrounded by the zona pelucida
It cleaves again into 4 cells
o The four-cell stage Figure 2 A blastocyst.
o The cells are surrounded by the zona pelucida
It cleaves again into 8 cells II) IMPLANTATION
o The eight-cell stage
(1) The uterus lining
o The cells are surrounded by the zona pelucida
It cleaves again into 16 cells consists of
o The sixteen-cell stage o Endometrium
o Forms a hollow ball of cells – the morula o Myometrium
o The cells are surrounded by the zona pelucida o Perimetrium
(2) The endometrium
is divided into two:
Basal part
o Called decidua basalis
o Made up of stratum basalis cells undergone
decidualization
 Bigger cells
 Filled with glycogen
 Filled with lipids
 More sustainable for fertilization
Apical part
o Called decidua functionalis
AfraTafreeh.com o Made of the replication and proliferation of decidua
basalis

(3) The blastocyst

normally attaches to and invades the decidua functionalis
Invading other layers of the uterine lining leads to
complications
o Usually require the uterus to be taken out after giving
birth
Figure 1 Cleavage of the zygote.  Invading the decidua basalis - placenta acreta
 Invading the myometrium - placenta increta
 Invading the perimetrium - placenta percreta

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Forms two types of attachment with the endometrium • Prevents the corpus luteum from becoming
corpus albicans and stimulates it to continue
(i) Loose attachment: to produce progesterone
 Microvilli • The uterine blood vessels are dependent on
• On the trophoblastic cells progesterone
 Pinopodes • If the concentration of progesterone decreases
• Protrude from the decidua functionalis → the vessels spasm
→ ischemia of the surrounding tissue
→ rupturing and sloughing off of the
endometrium lining
(2) The embryoblast
differentiates into:
o Bilaminar disc
 Epiblast
 Hypoblast
o Amniotic cavity
 Above the epiblast
o Primary yolk sac
 Bellow the hypoblast
Figure 3 Loose attachment.

(ii) Tight attachment

 Integrines
• Molecules expressed by the trophoblastic cells
 Selectins
• Contained in carbohydrates on the decidua
functionalis
• Sometimes covered with collagen
 Chemokines
• Released by the trophoblast
• Stabilize the strong connection

Figure 5 Week 1 development.

(B) DAY 9
(1) The syncytiotrophoblast
continues to invade trough the stromal tissue
o Forms spaces of stromal tissue between its
projections - lacunae
Releases proteolytic enzymes
o Break down the blood vessels lining
Figure 4 Tight attachment.
o Allow the blood to seep in the lacunae
These attachments allow the blastocyst to start invading
In result the lacunar spaces are filled with blood and
the stroma of the endometrium and complete the
become intervillous spaces
implantation

III) OST-IMPLANTATION

(A) WEEK 1
(1) The trophoblast
differentiates into
o Cytotrophoblast
 The cytotrophoblastic cells proliferate rapidly
 Their membranes break down
 The cytoplasm and the nuclei fuse with those of
other cells
 Form a big pool of protoplasm and numerous
nuclei without cell borders - the
syncytiotrophoblast
o Syncytiotrophoblast
 Releases hydrolytic enzymes
• Allow it to break the stromal tissue of the
endometrium and invade it Figure 6 Day 9 Development.
 Secretes Human Chorionic Gonadotropin
hormone (hCG)

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(C) DAY 12 (E) WEEK 3

(1) The intervillous spaces (1) The somatopleuric extraembryonic mesoderm
increase in number and fill with more blood invades the primary villi made by cytotrophoblastic cells
o Forms a core inside them
(2) The hypoblast
o The villi are still surrounded by the
(and the primary yolk sac, according to some sources) syncytiotrophoblast
will start producing connective tissue - extraembryonic These villi are called secondary chorionic villi
mesoderm o Can be anchored and floating
Under the cytotrophoblast and above the amniotic
cavity/primary yolk sac
Later will form the chorion of the placenta
o The fetal part of the placenta

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Figure 9 Week 3 development.

(F) WEEK 4
there is already an embryonic folding
The mesodermal cells start differentiating
Figure 7 Day 12 development. o Form capillaries
The chorionic plate (a thick part of the chorion) comes
(D) DAY 14
off the chorionic villi
(1) The extraembryonic mesoderm o Forms the chorionic frondosum
starts breaking down forming: The connecting stalk
o The extraembryonic coelom – an empty space o Forms the umbilical cord
 Between two layers of extraembryonic mesoderm o Connects the chorionic plate with the embryonic
 It will become the chorionic cavity folding
o The somatopleuric extraembryonic mesoderm
(1) In the umbilical cord
 The layer towards the trophoblast
o The splanchnopleuric extra embryonic mesoderm the mesodermal cells form three blood vessels
 The layer towards the amniotic cavity/the primary o One umbilical vein
yolk sac o Two umbilical arteries
o The connecting stalk – connects the two layers  Move out into the chorionic plate and connect to
the chorionic arteries
(2) The cytotrophoblastic cells  The chorionic arteries move up the chorionic villi
proliferate and form primary chorionic villi that: and eventually become cotyledonal arteries
o Penetrate the syncytiotrophoblast  The villi will become tertiary chorionic villas by
o Move out and surround the intervillous spaces week 4
o Form the outer cytotrophoblastic shell

Figure 10 Week 4 development.

(2) There is an exchange
between the tertiary chorionic villas and the maternal
blood in the intervillous spaces
o From the fetus to the mother
Figure 8 Day 14 development.  CO2 and breakdown products
o From the mother to the fetus
 Oxygen, nutrients, even pathogens
This remains the exchange system until week 20

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(G) WEEK 4-8 IV) MACROANATOMY

(1) The tertiary villi
(1) The fetus
Branch out
is located inside the uterus
o Still completely covered by the cytotrophoblast and
It is connected to the uterine lining with the umbilical cord
the syncytiotrophoblast
o Has extraembryonic mesoderm
Purpose - to increase the surface area for exchange
(2) The amniotic membrane
is the layer closest to the fetus
(3) The chorion
is the next layer
o Chorionic fondosum – formed from the continuation
of the extraembryonic mesoderm in the umbilical cord
 The collective name of all chorionic villi
o Chorionic leave - a thin, flat membrane
 The part of the chorion facing the uterine cavity
 Has no extensive villi system
(4) The decidua
is the last layer
o Decidua basalis
 Interacts with the chorionic frondosum
 Both of them collectively form the placenta
o Decidua capsularis
Figure 11 Week 4-8 development.
 The part of the decidua facing the uterine cavity
o Decidua parietalis
(H) WEEK 16-20  The decidua where there is no fetal involvement

(1) Tissue from the decidual membrane Eventually, as the fetus grows, the decidua capsularis will
merge with the decidua parietalis and obliterate the entire
starts to branch in uterine cavity
o The branches are called placental septa
o They separate the tertiary villas into septations -
cotyledons
 Around 15-20 cotyledons
 Each consist of 2-3 tertiary villi
The decidual tissue in them swells up and fills up with
glycogen, lipids, etc.

Figure 14 Macroanatomy.
Figure 12 Week 16-20 development.

(I) WEEK 20 V) FUNCTIONS

(1) The cytotrophoblast
(A) METABOLIC FUNCTIONS
regresses
o Makes the exchange of substances more quick and (1) Gas exchange
more efficient is the primary metabolic function
o From the mother to the fetus
 Oxygen
o From the fetus to the mother
 CO2
(2) Nutrient delivery
Ways of delivery
o Simple diffusion
o Facilitated diffusion
Figure 13 Week 20 development.
o Active transport
 Different types
Types of nutrients
o Glucose
o Amino acids
o Fatty acids
o Water soluble vitamins
 B vitamins

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(3) Natural passive immunity
is conferred by IgG antibodies
The mother has already made antibodies against different
foreign antigens
o Transfers them to the fetus through the placenta
(4) Hemolytic disease of the fetus and newborn
A condition also known as Rhesus disease
A Rh negative mother that have had previously a Rh
positive baby (or a spontaneous abortion of a Rh
positive baby) has created IgG antibodies against the Rh
(Duffy) antigen
o The antibodies then destroy the blood cells that are
Rh positive
There is a medication called Rhogam
o An anti IgG antibody erected against the Rh antigens
o Given to the mother so the immunological reaction is
blocked
 The immunological reaction takes place when the
placenta breaks away during the third phase of
delivery
• Some of the blood that is Rh positive can go
into the mother’s circulation
If the mother is already alloimmunized
o The baby’s middle cerebral artery blood flow is
checked
 Done through a Doppler
 Velocity is calculated based upon fetal anemia
(5) Waste removal
of a lot of different types of waste products
o Urea
o Uric acid, etc.
Figure 15 Metabolic functions of the placenta.
DEVELOPMENT OF THE PLACENTA
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(B) PATHOGENS
(1) Different pathogens
can be transported across the placenta
Most important is the TORCH series
o Toxoplasmosmosis
 Caused by toxoplasma gondii
 Causes significant fetal defects and damage
 Treatment
• Spiramycin if the fetus has not been affected
yet
• Combination of Pyrimethamine and
Sulfadiazine if the fetus has already been
affected
o Others
 HIV
 Syphilis
 Hepatitis (especially hepatitis B)
o Rubella
 Can cause a lot of cardiac and congenital defects
as well as hearing loss.
o Cytomegalovirus (CMV)
o Herpes simplex virus type 2
Another danger that people should be aware nowadays is
the Zika virus as it can be transmitted vertically as well
Bacteria like Listeria monocytogenes
o Comes from pasteurized products and lunch meats
Viruses are the biggest threat because of their ability to
easily cross the placental membrane.
(C) HORMONAL FUNCTIONS
(1) Estrogen and progesterone
Generally produced around 10th -12th week
Take over for the corpus luteum secretion during the rest
pregnancy
Make the endometrial lining thicken up
o Increasing the vasculature
o Provide a nutritive environment
Increase secretion
o Plugs up the cervix with a mucus plug
o Prevent external environment factors from harming
the fetus
Play a crucial role in the development of the fetus
(2) Thyroid hormone
Promotes the development of the central nervous
system
Lack of thyroid hormone can lead to cretinism
o Incomplete development of the CNS
o Can lead to mental retardation
(3) Human placental lactogen
Decreases the insulin release from the pancreas
Acts on the mother’s cells
o Promotes lipolysis
 Provides fatty acids for the baby
o Promotes gluconeogenesis
 Provides glucose for the baby
o Increases the cells insulin resistance
 So it can’t shuttle the glucose into the mom’s cells
(4) Relaxin
Relaxes (increases the laxity of) specific ligaments of the
pubic symphysis
o The pelvic inlet and outlet are widened out
o Ensure easier passage of the baby
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(5) Corticotrophin-releasing hormone VI) REVIEW QUESTIONS
In addition to the mother’s pituitary gland
What is the name of the ball of cells formed in the
Stimulates adrenocorticotropic hormone (ACTH)
16-cell stage of cleaving?
production
a. Zygote
o Stimulates cortisol production
b. Morula
Cortisol plays an important role in lung development and c. Blastocyst
surfactant production d. Blastocoel
If the baby is born prematurely (before 34 week) there is
not enough cortisol Which is a part of the blastocyst?
→ not enough surfactant a. Blastocoel
→ the alveoli of the baby will be collapsed b. Trophoblast
→ it is almost impossible for the baby to get enough c. Embryoblast
strength through the diaphragm and the intercostal d. Primary yolk sac
muscles to pull air in and pop the alveoli open
This leads to infant respiratory distress syndrome Which does not take part in forming a tight
attachment?
a. Integrines
b. Selectins
c. Chemokines
d. Microvilli

Which hormone does the syncytiotrophoblast

secrete?
a. Progesterone
b. Adrenocorticotropic hormone
c. Human Chorionic Gonadotropin hormone
d. Estrogen

Figure 16 Hormonal functions of the placenta. Which week do primary chorionic villi develop?
a. 1
b. 2
c. 3
d. 4

When do cotyledons form?

a. Week 4
b. Week 4-8
c. Week 16-20
d. Week 20

Which layer of the placenta regresses during week

20?
a. Chorion
b. Syncytiotrophoblast
c. Amniotic membrane
d. Cytotrophoblast

Which part of the decidua has no fetal involvement?

a. Decidua basalis
b. Decidua functionalis
c. Decidua capsularis
d. Decidua parietalis

Which medication is not given for toxoplasmosis?

AfraTafreeh.com a. Rhogam
b. Spiramycin
c. Pyrimethamine
d. Sulfadiazine

Which hormone is not produced by the placenta

a. Thyroid hormone
b. Human placental lactogen
c. Human Chorionic Gonadotropin hormone
d. Corticotrophin-releasing hormone

CHECK YOUR ANSWERS

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