THE PLACENTA

SHALINE ASENWA
(Obstetrics Nursing & Midwifery)
2018
 THE PLACENTA
• Learning outcomes
– Describe placenta development
– Explain placenta circulation
– Describe term (mature) placenta
– Describe the umbilical cord
– Describe the membranes
– Describe the amniotic fluid
 The Placenta
• The placenta is also known as afterbirth and is a thick
and a disc shaped organ.
• The placenta is an organ that connects the mother
and the developing embryo

• Nutrients and oxygen diffuse into the developing

embryo and carbon dioxide and wastes diffuse out
through the placenta

• The mother’s blood and the embryo’s blood never

mix, but pass by each other separated by the placenta.
 Cont..
• The placenta is larger than the embryo or fetus during
early pregnancy and appears to be low lying on
ultrasound.
• The fetus grows faster than the placenta and the placenta
is about one sixth the weight of the fetus at the end of a
term pregnancy and is implanted in the upper uterus.
• The fetal side is smooth, with branching vessels covering
the membrane covered surface.
• The maternal side is rough where it attaches to the
uterus.
Placenta Development
 Cont..
The three decidual layers are:
 The decidua basalis, which underlies the developing
embryo and forms the maternal side of the placenta.
 The deciduas capsularis, which overlies the embryo and
bulges into the uterine cavity as the embryo and fetus
grow.
 The deciduas parietalis, which lines the rest of the
uterine cavity.
• By about 22 weeks of gestation, the deciduas capsularis
fuses with deciduas parietalis, filling the uterine cavity
Cont..
 Chorionic villi
• Chorionic villi are tiny, finger-like growths found in the
placenta.
• The genetic material in chorionic villus cells is the
same as what is in fetal cells
• Each chorionic villus consist of a mesoderm and fetal
blood vessels (capillaries)
• Mesoderm and the blood vessels are covered by two
layers:
1. cytotrophoblast (Inner layer) which produces
human chorionic gonadotropin (HCG) hormone
2. Syncytotrophoblast (outer layer)
 Placental Circulation
• Deoxygenated fetal blood passes through umbilical arteries to the
placenta.
• At the junction of umbilical cord and placenta, the umbilical
arteries branch radially to form chorionic arteries.
• Chorionic arteries, in turn, branch into cotyledon arteries.
• In the villi, these vessels eventually branch to form an extensive
arterio-capillary-venous system, bringing he fetal blood
extremely close to the maternal blood;
• The maternal blood rich in oxygen and nutrients is delivered to
the placenta bed by spiral arteries
• Transfer of gases (O2 & CO2)and nutrient take place by diffusion
and osmosis
• There is no intermingling of fetal and maternal blood that occurs.
 Cont.
• Exchange of substances between mother and
fetus occurs within the intervillous space of
the placenta.
• About 150 ml of maternal blood is contained
within the intervillous space, and it is changed
about three or four times per minute.
 Appearance of a term placenta
• The placenta is round, flat mass about 20cm in diameter and
2.5cm thick at its centre.
• It weighs approximately one-sixth of the baby's weight at term.
• The maternal blood gives the maternal surface a dark red colour
and part of the basal decidua will have been separated with it.
• The amnion covering the foetal surface gives it a white shiny
appearance.
• The surface is arranged in about 20 lobes separated by
sulci( furrows).
• Presence of three blood vessels, two umbilical arteries and one
umbilical vein.
Term Placenta
Section of Umbilical Cord
True knot of the cord
 Functions of The Placenta
• Respiration: the fetus obtains oxygen and
excretes carbon dioxide through the placenta.
• Nutrition: amino acid ,glucose, fatty acids ,
vitamins and mineral salts are carried in the
maternal blood and transmitted through the
placenta to the fetus
• Storage – Placenta metabolizes glucose, stores it
in the form of glycogen and convert it to glucose
as required. It can also store iron and fat soluble
vitamins.
 Cont..
• Excretion: carbon dioxide and other waste products pass
from the fetus to the maternal blood through the
placenta.
• Endocrine function: The placenta secretes hormones that
are essential to fetal life e.g. human chorionic
gonadotropin (HCG), progesterone, estrogen and human
placental lactogen (HPL).
• Placenta barrier- placenta filters some harmful substances
from the mother so that they do not reach the fetus but
some substance e.g. antibodies, rubella virus and HIV are
able to cross the placenta to the fetus.
 Fetal membranes and amniotic
fluid

• The two fetal membranes are amnion(inner membrane) and

the chorion (outer membrane). The two membranes are so
close as to be one, although they can be separated. Together
they are often called the bag of waters.
• If they rapture in labor, amnion and chorion usually rupture
together, releasing the amniotic fluid within the sac.
• Chorion - thick, opaque, friable and peels up to die edge of
the placenta.
• Amnion - smooth, tough, translucent and peels up to the
insertion of the cord.
 Cont..
 Amniotic fluid protects the growing fetus and promotes
normal prenatal development. Amniotic fluid protects the
fetus by:
• Cushioning against an impact to the maternal abdomen
• Providing a stable temperature
 Amniotic fluid promotes normal prenatal development by:
• Allowing symmetric development of the fetus as body surfaces
fold toward the midline
• Keeping the membranes from adhering to developing fetal
parts.
• Providing room and buoyancy for fetal movement.
 Cont..
• Normal volumes of amniotic fluid varies with duration
of pregnancy. The average of amniotic fluid volume
include;
• 12 w: 50 ml
• 24 w: 500 ml
• 36 w: 1000 ml & decreases thereafter.
• At term: The normal range in a singleton
pregnancy is large: 500-1000 ml
 Disorders of amniotic fluid volume
•polyhydramnios
Excessive amniotic fluid volume.
This may occur when the fetus has severe malformation of the central
nervous system or gastrointestinal tract that prevents normal ingestion of
amniotic fluid.
•Oligohydramnios
Marked deficiency of the amniotic fluid volume (below the
normal limits).
Oligohydramnios may occur because the kidneys fail to develop,
urine excretion is blocked, or placental blood flow is
inadequate.
 
 Placenta and membranes examination
• Measure the length of the umbilical cord (normal average 50cm)
• Inspect the cord for presence of any knots and Wharton's jelly.
• Identity the three blood vessels (2 arteries and 1 vein)
• Determine the insertion of the cord. There are four types of cord
insertion.
• Central insertion - in the middle of the placenta
• Lateral insertion - not exactly at the center of placenta
• Battledore insertion - at the edge of the placenta
• Velamentous insertion - not directly inserted on placenta but just
on the membranes.
 Cont..
• Examine the maternal and fetal surfaces. Maternal
surface is dark red in color while fetal surface is white,
shinny and covered by amnion.
• Check for presence of crystal substances on maternal
surface which would imply post-mature placenta.
• Check the lobes/cotyledons for completeness. Should
be 18-22 average 20.
• Presence of a hole is on evidence of missing lobe.
• Follow the blood vessels to rule out extra lobe because
extra lobes are usually linked by blood vessels.
 Abnormalities of the placenta
• Succenturate lobe - an extra lobe which may
be left behind and cause PPH and infections.
• Placenta bipartite - placenta divided into two
but joined together
• Placenta circumvallate - placenta with double
membranes.
Placenta bipartite
Placenta circumvallate
 END
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