ASSESSMENT OF

PLACENTA
 INTRODUCTION
• The placenta is remarkable organ, originating
from trphoblastic layer of fertilized ovum . It
links closely with the mother”s circulation to
carry out functions that the fetus is unable to
perform for itself during intrauterine life
 
 Development of the placenta
•Development of the placenta and fetus is a
continuous process that begins four days after
fertilization.The placenta is develop from two
sources.The principal component is fetus which
develops from chorionic frondosum and maternal
component consist of decidua basalis. Development
of the placenta and fetus is a continuous process
that begins at the time of fertilization. Four days
after fertilization, the morula (a solid mass of
blastomere cells) enters the uterus,a fluid filled
cavity appear in the morula known as blastocyst.
 cont

•Around the blastocyst ,a single layer of cells known as

trophoblast ,
•the remaining cells clump together at one end known
as Inner cell mass —which form the embryo and
amnion .
• Trophoblast — a thin outer cell layer which form the
placenta and chorion.
•Placenta is completely formed an functioning at 12
weeks after fertilization
•
 cont
• Four days after fertilization, the trophoblasts–
the major cell type of the placenta–begin to
make human chorionic gonadotropin a
hormone which insures that the endometrium
will be receptive to the implanting embryo.
Over the next few days, these same
trophoblasts attach to and invade into the
uterine lining, beginning the process of
pregnancy
 Characteristics of the Normal Placenta
• The placenta is almost  circular in shape,15-
20 cm in diameter and 2–2.5 cm in thickness
(greatest thickness at the center and become
thinner peripherally). Its weighs approximately
500 grams. It has a dark reddish-blue or
maroon color. It connects to the fetus by an
umbilical cord of approximately 55–100 cm in
length that contains two arteries and one vein.
 cont

• On the maternal side, chorionic villous

tree structures are grouped into lobules
called cotyledons. The maternal surface
of the placenta should be dark maroon in
color and should be divided into lobules
or cotyledons. The structure should
appear complete, with no missing
cotyledons
 cont

• The fetal surface of the placenta should be shiny, gray

and translucent enough that the color of the
underlying maroon villous tissue may be seen.
• The structure should have abundant Wharton's jelly,
and no true knots.The normal cord contains two
arteries and one vein.
• During the placental examination, we should count
the vessels in either the middle third of the cord or
the fetal third of the cord, because the arteries are
sometimes fused near the placenta and are therefore
difficult to differentiate.Fetal membranes are usually
gray, wrinkled, shiny and translucent..
 Fetoplacental 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
arteriocapillary venous system, bringing the fetal
blood extremely close to the maternal blood; but
no intermingling of fetal and maternal blood
occurs placental barrier
 Function of placenta
 

• During interautrine life no pulmonary exchange of gases can take

place so fetus obtain oxygen and excrete corbon dioxide through
the placenta
•Excretory function :- waste product from the fetus such as urea,
uric acid and creatinine are excreted to the maternal blood by
simple diffusion
•Nutrition and immunity The perfusion of the intervillous spaces
of the placenta with maternal blood allows the transfer of nutrients
and oxygen from the mother to the fetus and the transfer of waste
products back from the fetus to the mother. Nutrient transfer to the
fetus is both actively and passively mediated by proteins called
nutrient transporters that are expressed within placental cells
 cont

• Storage placenta metabolise the glucose , stores in

the glycogen and re-convert it to glucose as required.
It also store iron and fat soluble vitamins
• Protection fetal membrane act as protective barrier to
fetus against noxius agent circulating in mother’s
blood. limited barrier to infection, few bacteria,virus
& protozoa can penetrate the placenta
• Progesterone is necessary to maintain endometrial
lining of the uterus during pregnancy. This hormone
prevents preterm labor by reducing myometrial
contraction. Levels of progesterone are high during
pregnancy.
 cont

• Endocrine
During pregnancy. hCG ensures that the corpus
luteum continues to secrete progesterone and
estrogen. Progesterone is very important during
pregnancy because when its secretion decreases, the
endometrial lining will slough off and pregnancy will
be lost. HCG suppresses the maternal immunologic
response so that placenta is not rejected. Estrogen
contributes to the woman's mammary gland
development in preparation for lactation and
stimulates uterine growth to accommodate growing
fetus.
 Abnormalities of the Placenta

• Placentas less than 2.5 cm thick are associated

with intrauterine growth retardation of the fetus.
• Placentas more than 4 cm thick have an
association with maternal diabetes mellitus, fetal
hydrops and intrauterine fetal infections.
• An extremely thin placenta may represent
placenta membranacea. In this condition, the
entire uterine cavity is lined with thin placenta.
Placenta membranacea is associated with a very
poor fetal outcome
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• Placental Shape
Extra placental lobes are important, primarily
because they may lead to retained placental
tissue. Blood may be adherent to the maternal
surface of the placenta, particularly at or near
the margin. If the blood is rather firmly
attached, and especially if it distorts the
placenta, it may represent an abruption. The
dimensions and volume of the placenta should
be estimated
Succenturiate lobe.
 . Velamentous cord
Bilobed placenta
insertion.
Circumvallate placenta.
 Evaluating placental completeness
• The maternal surface of the placenta should be
inspected to be certain that all cotyledons are
present. Then the fetal membranes should be
inspected past the edges of the placenta. Large
vessels beyond these edges indicate the
possibility that an entire placental lobe (e.g.,
succenturiate or accessory lobe) may have
been retained All or part of the placenta is
retained in placenta accreta, placenta increta
and placenta percreta
 cont
• During assessment of placenta , the health
care professional should have complete
knowledge of anatomical structure of
placenta, only then he/she will be able to
do appropriate examination of placenta to
identify abnormality & prevent
complication
 SUMMARY
• Today we have discussed about the
definition, development , normal
characteristics, functions and Potential
Abnormalities of the placenta