Development of the Placenta

Development of the Placenta

The placenta begins to develop upon

implantation of the blastocyst into the maternal
endometrium. The outer layer of the blastocyst
becomes the trophoblast which forms, the outer
layer of the placenta.
Initially, the ovum appears to be covered with
fine, downy hair, which consists of the
projection from the trophoblastic layer. These
proliferate and branch from about 3 weeks after
fertilization, forming the chorionic villi.
The villi become most profuse in the area where
the blood supply is richest, which is in the basal
decidua. This part of the trophoblast is known as
the chorion frondosum and it will eventually
develop into the placenta.
The villi under the capsular decidua being less
well-nourished, gradually degenerated and form
the chorion leave which is the origin of the
chorionic membrane.
The villi erode the walls of maternal blood
vessels as they penetrate the decidua, opening
them up to form a take of maternal blood in
which they float.
The opened blood vessels are known as sinuses,
the areas surroundings the villi as blood spaces.
The maternal blood circulates slowly enabling
the villi to absorb food and oxygen and excrete
waste.
These are known as the nutritive villi. A few villi
are made deeply attached to the decidua are
called anchoring villi. Each chorionic villi is a
branch structure arising from one steam.
Its center consists of mesoderm and fetal blood
vessels and branches of the umbilical artery and
vein. These are covered by a single layer of
cytotrophoblast cell and the external layer of the
villus is the syncytiotrophoblast.
The syncytiotrophoblast is a multinucleate
continuous cell layer, which covers the surface of
the placenta. The means that four layers of
tissue separate the maternal blood from the
fetal blood and make impossible for the two
circulations to mix unless the villi are damaged.
The placenta is completely formed and functioning from 10
weeks after fertilization. In Its early stages it is a relatively
loose structure but becomes more compact as it matures.
Between 12 to 20 weeks of gestation, the placenta weighs
more than the fetus because the fetal organs insufficiently
developed to cope with the metabolic processes of
nutrition.
Later in pregnancy some of the fetal organs such
as the liver, begin to function, so the
cytotrophoblast and the syncytotrophoblast
gradually degenerate and this allows easier
exchange of oxygen and carbondioxide.
The placenta is usually attached to the upper
part of the body of the uterus encroaching to
the fundus adjacent to the anterior or posterior
wall.
In the placenta, embryonic/fetal blood flows into
thousands of tiny projections (villi), when exchanges
occur between the mother and embryo/fetus.
The placenta covers about a quarter of the uterine
surface, thus providing a large surface area for such
exchange. By the 18 to 20th work of pregnancy, the
placenta is fully formed, and is about 450g
The mature placenta is composed of tissues derived from
the embryo, as well as maternal tissues of the endometrium.

The placenta connects to the conceptus via the umbilical

cord, which carries deoxygenated blood and wastes from the
fetus through two umbilical arteries; nutrients and oxygen
are carried from the pregnant person to the fetus through
the single umbilical vein.
The umbilical cord is surrounded by the amnion,
and the spaces within the cord around the blood
vessels are filled with Wharton's jelly, a mucous
connective tissue.
The maternal portion of the placenta develops
from the deepest layer of the endometrium, the
decidua basalis. To form the embryonic portion
of the placenta, the syncytiotrophoblast and the
underlying cells of the trophoblast
(cytotrophoblast cells) begin to proliferate along
with a layer of extraembryonic mesoderm cells.
These form the chorionic membrane, which
envelops the entire conceptus as the chorion.
The chorionic membrane forms finger like
structures called chorionic villi that burrow into
the endometrium like tree roots, making up the
fetal portion of the placenta.
The cytotrophoblast cells perforate the chorionic
villi, burrow farther into the endometrium, and
remodel maternal blood vessels to augment
maternal blood flow surrounding the villi.
Meanwhile, fetal mesenchymal cells derived
from the mesoderm fill the villi and differentiate
into blood vessels, including the three umbilical
blood vessels that connect the embryo to the
developing placenta.
 The function of the placenta

Nutritive function: The fetus obtains its nutrients

from maternal blood.
When the diet inadequate, and then only,
depletion of maternal tissue storage occurs. Thus
to avoid mater tissue storage depletion, a diet rich
in essential food is needed during pregnancy.
Amino acids required for bodybuilding, glucose
for energy production, calcium and phosphorus
for bones and teeth, and iron and another
mineral for blood formation. The transfer of
nutrients from the mothers to the fetus is
achieved by simple diffusion.
• Glucose transferred to the fetus by facilitated
diffusion. Lipids for fetal growth and
development They are transferred across the
fetal membrane or synthesized in the fetus
Amino acids are transferred by active
transport.
Water and electrolytes such as sodium, potassium
and chloride cross through the fetal membrane by
simple diffusion, whereas calcium, phosphorus
and iron cross by active transport. Water-soluble
vitamins are transferred by active transport but
the fat-soluble vitamins are transferred slowly
Respiratory function (to supply oxygen to the fetus or
exchange of gases):
The placenta’s primary function that oxygen is moved
into the baby's bloodstream and carbondioxide is carried
away from the baby. Although, the fetal respiratory
movements take place in utero, and movements are
observed as early as 11 weeks there is no gaseous
exchange. Intake of oxygen and output of carbondioxide
take place by simple diffusion across the fetal membrane.
Excretory Function: Waste products from the
fetus such as urea, uric acid, and creatinine are
to the maternal blood by simple diffusion. Waste
products from the fetus such as carbondiaxide
are the major substance excreted from the fetus
through the placenta.
Barrier function:
Protect the fetus against a certain disease. It prevents most
organisms from passing to the fetus, so it acts as a protective
mechanism. The fetal blood in the chorionic villi is separated
from the maternal blood, in the intervillous spaces, by the
placental barrier, which is composed of the endothelium of
the fetal blood vessels, the villous stroma, the
cytotrophoblast, he syncytiotrophoblast.
However, it is incomplete barrier. It allows the
passage of antibodies, hormones, sedatives, and
some viruses can penetrate. Viruses, however, can
cross freely and may ause congenital abnormalities
as in the case of virus (rubella, chickenpox, measles,
mumps, Oliomyelitis), bacteria (treponema pallidum,
tubercle bacillus), protozoa (Toxoplasma gondii,
• malaria parasites) may be transmitted to the fetus across the so-called
alleged placental barrier and affect the fetus in utero. Various viruses,
bacteria, protozoa can cross the placenta and affect the fetus in utero.
Most drugs can cross the placental barrier and some can be teratogenic
and cause serious damage.Substances with large molecular weight or
size like insulin or heparin are transferred minimally.
• Stores: The placenta also stores glucose in the form of glycogen. It also
stores iron and fat soluble vitamins.
Enzymatic Function: Numerous enzymes are
elaborated in the placenta mentioning only a few of
them are:
– Carbondiamineoxid which inactivates the circulatory
pressure amines,
– Oxytocinase which neutralizes the oxytocin,
– Phospholipose A₂ which synthesis arachidonic acid etc.
Immunological Function: The fetus and the
placenta contain paternally determined antigens,
foreign to the mother but fail to inherit all the
mother's antigens. In spite of this, there is no
evidence of graft rejection. Placenta probably
offers immunological protection against rejection.
Endocrine: The placenta secretes five hormones
that are essential to pregnant human chorionic
gonadotropin (hCG), which is the basis for
pregnancy tests, human placental lactogen (hPL)
estrogen, progesterone, and relaxation.
Human chorionic gonadotropin: The trophoblast (cytotrophoblast
layer of chorionic villi) secretes hCG during early pregnancy. It's a
peek at 7 - 10 weeks of pregnancy to maintain the corpus luteum.
Thereafter estrogen and progesterone are produced by the
placenta and corpus luteum regresses followed by a decreased
level of hCG. Eight to ten days after fertilization, hCG is present in
maternal blood serum, a few days after the missed menstrual
period, hCG is found in maternal urine.
• Estrogen: estrogen are secreted by the corpus
luteum and the adrenal cortex, as well as the
placenta. The placenta secretes primarily the
estrogen, estriol. Essential precursors from the
fetal adrenal glands are used by the placenta
for conversion to estriol.
• Circulatory system: The human heart begins beating during the fourth weeks after
fertilization. contracting at a rate of about 65 beats minute. This increases steadily to about
140 beats/minute immediately before birth.

• Blood: The origin of the blood is from the inner cell mass, along with all the other organs of
its body. The fetus will inherit the genes that determine its blood group from both its parents,
its ABO group and Rhesus factor may, therefore, be the same or different from those of its
mother. The fetal hemoglobin (Hb) is of a different type from adult hemoglobin and i termed
HbF. It is a much greater affinity for oxygen and i reason for this oxygen must be obtained
from the mother's blood in the placental site where the à found in great concentration (18-20
g/dl term). The oxygen tension is lower than in the atmosphere. In utero the red blood cell
has a shorter life span, this being about 90 days by the time the baby is born.
• Fetal Development The fetal stage forms the beginning of the 9th week
after fertilization and continues until birth. At the time, the developing
human is a referral to the fetus. During fetal stage, there is additional
growth and maturation of the organs and body systems. Initially, the
development of the placenta and fetal membranes occurs far more
rapidly than the development of the fetus itself. In fact, during the first
2 to 3 weeks after implantation of the blastocyst, the fetus remains
almost microscopic, but thereafter, the length-weight of the fetus
increases almost in proportion to age.
• The renal tract: By the end of the first trimester, the nephrons become active and
secrete urine. The fetal kidneys begin to excrete urine during the second-trimester
pregnancy and fetal urine accounts for about 70 to 80 percent of the amniotic fluid.
Near term, the urine production rises to 650 ml/ day. Abnormal kidney
development or severe impairment of kidney function in the fetus greatly reduces
the formation of amniotic fluid and can lead to fetal death. The urine is very dilute
and does not constitute a route for excretion since the mother eliminates waste
products, which cross the placenta. It is important in the regulation of the
composition and volume of the liquor amnii.

• Fig: Sizes of embryos and fetus between 3 and 12 weeks gestation

• Skin: From 18 weeks after conception, the fetus is covered with a
white, creamy substance called vernix cascosa. This protects the
skin from the fluid and from any friction against itself. At 16
weeks, the fetus will be covered with downy thin colorless hair
called lanugos and at the same time, the head hair and eyebrows
begin to form. The lanugo is shed again from 36 weeks and a full-
term infant has little left. Fingernails develop from about 10
weeks but the toenails do not form until about 18 weeks.
• The liver: The liver is comparatively large in size
taking up much of the abdominal cavity. especially
in the early months. From the 3 to 6th month of
intrauterine life, the liver is responsible for the
formation of red blood cells, after which they are
mainly produced in the red bone marrow and the
spleen.
• The adrenal glands: The fetal adrenal glands produce the precursors for the
placental formation

• of oestriols. They are also thought to play a part in the initiation of labor.

• Respiratory system: Respiration cannot occur during fetal life because there is no
air to breathe in the amniotic cavity. However, attempted respiratory movements
do take place beginning at the end of the first trimester of pregnancy. During the
last 3 to 4 months of pregnancy, the respiratory movements of the fetus are
mainly inhibited, for reasons unknown, and the lungs remain almost
 Structure of Placenta at term

Placenta at term
The placenta is a round, flat mass about 15-20cm in
diameter, 2.5cm to 3cm thick at its center, and become
thinner peripherally.
It weights approximately one-sixth of baby's (fetus) at
term, it weighs approximately 500 gm.
The placenta usually located in the upper part of the
uterus anteriorly or posteriorly and occupies about 30% of
uterine wall.
The placenta has two surfaces.
The maternal surface: The maternal surface (basal
plate) is rough and spongy and fleshy in appearance.
There is about 15 to 20 lobes, irregular, divided into
convex areas that are called lobes or cotyledons
which are separated by deep grooves or sulci or
furrows.
Numerous small grayish spots are visible. These are
due to the deposition of calcium in the degenerated
areas and are no clinical significance. Blood clot
(fresh or organized) adherent to the maternal
surface, especially if it distorts the cotyledons, may
represent an abruption.
Fig: Placenta
 The Fetal surface

The fetal surface is covered by the smooth white

shiny, transparent appearance and glistening
amnion with the umbilical cord attached at the
center. Branches of the umbilical vessels are visible
beneath the amnion as they radiate from the
insertion of the cord. The anion can be peeled off
from the underlying chorine except at the insertion
of the cord.
 Abnormalities of Placenta and Cord

The placenta is crucial for fetal growth and

survival, performing the most important
functions of many somatic organs before birth.
Thus, pathologic processes interfering with
placental function may result in abnormalities of
fetal growth or development, malformation.
 Placenta succenturiata

A placenta succenturiata is a placenta that has

one or more accessory lobes connected to the
main placenta by blood vessels. No fetal
abnormality is associated with this type.
However, it is important that it be recognized,
because the small lobes may be retained in the
uterus after birth, leading to severe maternal
hemorrhage.
On inspection:
The placenta appears torn at the edge, or torn
blood vessels extend beyond the edge of the
placenta. The remaining lobes are re- moved from
the uterus manually to prevent maternal
hemorrhage from poor uterine contraction.
The ancillary lobes function normally but can be
associated with complications such as placenta
previa or vasa previa.
In addition, the succenturiate lobe(s) may be
retained after the main placental disk has been
delivered. This can result in postpartum hemorrhage
or infection days or weeks after delivery.
Diagnosis
The accessory lobe may be retained in the uterus
after delivery leading to postpartum hemorrha
Inspection of placenta after its expulsion. This is
suspected if a circular gap is detected in membranes
from which blood vessels pass towards the edge of
the main placenta.
Clinical significance
If the succenturiate lobe is retained, after the main placenta
is expelled, it may lead to: Postpartum hemorrhage may be
primary or secondary.
– Sub involution
– Uterine sepsis Polyp formation
– Dangerous fetal hemorrhage at delivery
– Fetal and placenta develops
Management

The diagnosis of the missing lobe is made you

should be recorded and reported to a
immediately. Exploration of the uterus and
removal of lobe under general anesthesia.
Bipartite or duplex or bilobate placenta:
Placenta bilobate (bipartite or duplex) placenta)
may develop as separate and nearly equal parts
and nearly equally sized discs.
The multilobed placenta may develop having
three or more lobes of equal size. The bipartite
cord joins and a short distance from the two
parts of the placenta.
The blood vessels from the separate lobes unite
at one umbilical cord. The umbilical cord is
attached to a connecting chorionic bridge or into
the intervening membranes in-between the two
placental lobes.
Clinical significance

• Probably retained placenta

• Increased incidence of PPH

Management

• Removal of placenta

• Treatment of postpartum hemorrhage

Circumvallated placenta
The chorion membrane begins at the edge of
the placenta and spreads to envelop the fetus;
no chorion covers the fetal side of the placenta.
• In placenta circumvallata, the fetal side of the
placenta is covered to some extent with
chorion. The umbilical cord enters the
placenta at the usual midpoint, and large
vessels spread out from there
They end abruptly at the point where the
chorion folds back onto the surface, however. (In
placenta marginata, the fold of chorion reaches
just to the edge of the placenta.) Although no
abnormalities are associated with this type of
placenta, its presence should be noted.
• In this situation, an opaque ring is seen on the fetal surface of the placenta.
Circumvallate placenta refers to a placenta with an unusually small chorionic
plate. The fetal surface of such a

• The umbilical

• vessels bifurcate

• at the point of inse of the cord.

Placenta presents a central depression
surrounded by a thackened, grayish white ring.
The ring is composed of a double fold of amnion
and chorion with degenerated decidua sinisted
at varying distances from the margin of the
placents.
The ring is composed of a double fold of armion and
chorion with degenerated decidua (vera) and fibrin in
between. Raised white ring around the surface of the
placental disk at a variable distance from the umbilical cord
insertion site; the fetal vessels do not extend beyond the
ring. The extrachorionic tissue constitutes a small
proportion of the placenta and usually does not
compromise fetomaternal exchange
However, these placentas are more prone to
premature separation and second trimester
bleeding is common. It can be a cause of
abortion, antepartum hemorrhage, preterm
labour and intrauterine fetal death.
• Placenta marginata

• A thin fibrous ring is present at the margin of the chorionic plate where the fetal vessels appear to

• terminate Clinical significance:

• There is an increased chance of Abortion

• Hydrorrhea gravidarum (excessive watery vaginal discharge).

• Growth retardation of the baby

• Preterm delivery Antepartum hemorrhage

• Retained placenta or membranes

• Placenta membrane
• The placenta is unduly large and thin. The placenta not only develops from the chorion frondosum but also from the
chorion leave so that the whole of the ovum is practically covered by the placenta.

• Clinical significance

• Encroachment of some part over the lower segment leads to placenta praevia. Imperfect separation in the third stage
leads to postpartum hemorrhage, The chance of retained placenta is more and manual removal becomes difficult.

• Umbilical Cord

• Amnion

• The umbilical cord or funic is developed from the connective stalk or body stalk, which is a band of mesoblastic tissue
stretching between the embryonic disk and the chorion.
• The umbilical cord is normally composed of two

• umbilical arteries and an umbilical vein supported

• by loose gelatinous tissue called Wharton's

• -Umbilical artaries

• Umbilical vein

• Wharton's jelly

• Jelly.The umbilical cord should have a smooth, Fig: Cross-section through the umbilical cord

• white, opaque, shiny appearance with spiraling.

• Fetal and placenta development |

• The umbilical cord or funic narrow, tube-like structure that
connects the developing fetus placenta. The cord is
sometimes called the baby's supply line" or lifeline
between the fetus the placenta in the uterus because it
delivers the nutrients and oxygen the baby needs for non
growth and development and removes waste products.
The umbilical cord begins to form abo five weeks after
conception.
• It becomes progressively longer until 28 weeks of pregnan
reaching an average length of 52 cm with diameter of 1-2
cm. It length at full time as rule is about equal to the
length of the fetus, ie about 52 cm, but it may be greatly
diminished increased causes of differences in card length
are unknown, however the length of the cordis thought to
reflect movement of the fetus in utero.
• The umbilical cord contains two umbilical arteries. One umbilical vein that carries 85% oxygenated blood from the placenta to
the fetus two umbilical arteries which carry deoxygenated (60% oxygenated) blood from the fetus to placenta. The blood
vessels are twisted like a rope and covered by the amnion. The cord contains the vitelline duct. There are no nerves, so cutting
it not painful. The umbilical cord normally inserts centrally or slightly eccentrically and directly into the placental disk.

• Function

• To carry nourishment and oxygen from the placenta to baby and return waste products to the

• placenta from the fetus.

• re

• it
• Clinical significance

• Edema: Mild edema of the umbilical cord is common and of no clinical significance. Massive

• edema (resulting in regional or diffuse cord diameters of greater than 3 cm) can cause vascular

• compromise and is often associated with acute changes in the fetal heart rate pattern.

• Strictures: A stricture may be art factual or the result of torsion or amniotic bands. Strictures can be
important findings, as they have been implicated in the etiology of fetal demise or compromise. Coiling:
The umbilical cord has a characteristic twist or coil. The coiling of the umbilical cord is thought to
protect it from compression, kinking, stretch, and torsion, thus preventing disruption of the blood
supply to the fetus.
• Cord abnormalities

• Abnormal cord insertion:

• Velamentous attachment: The cord does not reach the placenta itself but is
attached to the amniotic membrane over the fetal surface of the placenta. The
umbilical vessels pass in the membrane to reach the placenta. It is easily torn.
Insertion of the umbilical cord is on the chorioamnionitis membranes rather
than on the placenta mass. The branching vessels transverse between the
membranes for a varying distance before they reach and supply the placenta.
• Battledore/ marginal insertion of cord: The cord is
attached to the margin of the pla the manner at a
table tanis bat). If associated with low
implantation of the placent chances of cord
compression in vaginal delivery leading to fetal
anoxia or even death has little clinical significance.
Complication

The velamentous umbilical cord has been associated with several obstetrical complications,
including fetal growth restriction, prematurity, congenital anomalies, and low Apgar score.
Rupture of membranes may also rupture the fetal blood vessels and may cause hemorrhage
and exsanguination of the fetus After birth, a velamentous insertion can make delivery of the
placenta more difficulty.

• because of care given may snap the cord more easily as it is inserted in the fine membranes:

• rather than the thicker placenta.

• Management

• If the presence of fetal bleeding urgent delivery is essential either vaginally or by

cesarean

• section. The infant's hemoglobin should be estimated and if necessary blood

transfusion is carried

• out. If the baby is dead, vaginal delivery is awaited.

• Velamentous insertion of cord

• Abnormal length of umbilical cord

• Length: The average length at term is about 50- 55 cm, with

a wide normal range (35 to 77 cm). About 5% cords are
shorter than 35cm, and another 5% are longer than 80 cm
cause differences in cord length are unknown however the
length of the cord is thought to reflect the movement of the
fetus in utero.
Short cord

Short cord: A short cord is one that is actually short in

length. Usually shorterless than 20 cm or 8. For this reason,
short cords are associated with fetal inactivity often related
to fetal malformations, myopathic and neuropathic
diseases, oligohydramnios, and some syndromes.
Clinical significance of short cord
– The short cord which may lead to: Failure of external version
– Prevent delay descent of presenting part especially during labor.
– Intrapartum hemorrhage due to premature separation of the
placenta.
– Favor malpresentation.
– Fetal distress in labor
– Inversion of the uterus.
• Single umbilical ortery:

• The umbilical cord normally contains two arteries and a single vein
occasionally one u artery is absent, with the left artery absent
more commonly than the right. It may be dow failure of the
development of one artery or due to its atrophy in later months. It
is present 1-2% of cases. Of infants with a single umbilical artery
20% or more are reported to Single umbilical artery
• associated fetal anomalies.

• including abnormalities,

• cardiovascular

• gastrointestinal

• defects, esophageal atresia, a

• variety of renal defects, and

• multiple anomaly syndromes. With

• single umbilical arteries, a 5% -

• 20% perinatal mortality rate has

• been reported, although this

• includes fetuses with severe

• congenital

• anomalies and

• chromosomal defects. Two-thirds

• of deaths occur before the birth of

• the one-third of neonates who die

• postnatal, most have associated

• congenital abnormalities. Those without overt abnormalities may have intrauterine get

• retardation.
• Causes

• The cause of this abnormality is unknown.

• it may be due to failure of development of one artery it may be due to its atrophy in later months.

• Clinical significance

• About one-third of babies born with one umbilical artery will have multiple and set malformations.

• 5% to 20% perinatal mortality rate has been reported Increased incidence of the single umbilical artery is in women with
diabetes, epilep

• preeclampsia, antepartum hemorrhage, oligohydramnios, and polyhydramnios. There is an increased chance of abortion,
fetal aneuploidy, prematurity,intrauterine get retardation, and increased perinatal mortality.
• Hematomas

• Accumulations of blood are associated with a short cord, trauma (umbilical

vessel venipuncte and entanglement. Hematomas due to trauma at delivery
are commonly observed near the co clamp and at the insertion of the cord into
the placental disk. True spontaneous hematomas of umbilical cord do occur
but are rare and often lethal. Spontaneous hematomas present as large
umbilical cord masses and can compress the umbilic

• vein, resulting in fetal death.

• Cord stricture

• Cord stricture is constriction or occlusion of the cord. This condition is found in 19% of fetal demises. Familial recurrence of umbilical cord stricture has been described.

• Cause

• The causes of umbilical cord stricture are unknown. There is a deficiency in Wharton jelly in the umbilical cord in the area of stricture; however,

• this could be posted morbid change.

• Significance

• Most infants with cord stricture are a stillbirth

• Torsion

• The result from fetal movements during which the cord normally becomes twisted. Fetal

• circulation is compromised.
 Fetal Membranes

It consists of two layers (double-membrane):

The amnion (inner layer): the layer nearest the
fetus (facing the amniotic cavity) is the amnion
and the outer layer is the chorion. Fetal
membranes do not contain blood vessels or
nerves.
Amnion
The amnion is also known as an amniotic membrane.
Amnion develops from the inner cell mass As it grows
layer, the amnion forms on the side opposite to the
developing blastocyst. The developing embryo had
drawn the amnion around itself forming a fluid-filled
sac.
This membrane the inner membrane of the fetal sac
lines the amniotic cavity and contains the liquor
amnii. The amnion can be stripped of the chorion
and off the fetal surface of the placenta into the
insertion of the cord. It is a smooth, thin, and shiny/
translucent membrane that is directly enclosing the
fetus and the amniotic fluid.
It is a transparent membrane, which is strong
and pliable. It continues with the umbilical cord
and covers the fetal surface of the placenta and
is also the outer covering of the umbilical cord.
Its internal surface is smooth and shiny and is in
contact with liquor amnii. The outer surface
consists of a layer of connective tissue and is
opposed to the similar tissue on the inner aspect
of the chorion from which it can be peeled off.
When first formed the amnion is in contact with
the body of the embryo but about the fourth or
fifth week, fluid (liquor amnion) begins to
accumulate within it.
Functions
• Contribute to the formation of liquor amnii.
• Intact membranes prevent ascending uterine
infection. Facilitate dilatation of the cervix during
labor.
• Has got enzymatic activities for steroid hormonal
metabolism.
Chorion
The term chorion contains no vessels or nerves. The hole in the
chorion through which the baby has been born will be seen after
delivery. These biochemical changes in the fetal membranes
reduce their integrity and elasticity, make them more vulnerable
to rupture, and may contribute to the initiation of parturition. The
inspection of the fetal membranes following delivery reveals
amnion that is mildly adherent to the fetal side of the chorine.
Amniotic Fluid (Liquor Amnii)
• Amniotic fluid is a clear, slightly yellowish watery
fluid that surrounds the unborn baby during
pregnancy. Amniotic fluid or liquor amnii is the
nourishing and protecting fluid contained by the
amnion of a pregnant women.
.
• Amnion grows and begins to fill mainly with
water around two weeks after fertilization.
After a further 10 weeks, the fluid contains
proteins, carbohydrates, lipids, urea and
electrolytes that aid in the growth of the fetus
Amniotic fluid volume increases steadily throughout
most of the pregnancy about 30 ml at 10 weeks
gestation, 50 ml at 12 weeks, 400 ml at 20 week and
a peak of about liter at 36-38 weeks of gestation.
Amniotic fluid decreases in the late third trimester
(after 38 weeks) with a mean amniotic fluid volume
measure 600 to 800 ml.
Origin of amniotic fluid
• The precise origin of the liquor amnii is not clearly understood. It is
probably of mixed maternal and fetal origin.
• Transudate from the maternal serum across the fetal membranes or
from the maternal circulation in the placenta.
• Transudate across the umbilical cord and fetal surface of the placenta
or secretion from the amniotic epithelium.
• Secretions from the surface of the body of the embryo. The fetal
surface of the placenta .
• FETAL SWALLOWING AND REABSORPTION BY INTESTINE

• 2 EXCHANGE WITH RESPIRATORY TRACT

• REABSORPTION VIA LLINGS

• PLACENTA

• NET WATER MOVEME ACROSS CHORION FO

• TRANSFER ACROSS CHORIONIC PLATE

• EXCHANGE ACROSS FETAL SKIN POSSIBLE ONLY FOR SMALL LIPID SOLUBLE GASES

• FETAL URINE AMMIOTIC FLUIR

Physical feature
• The fluid is fainly alkaline with a low specific gravity of 1.010. It
becomes highly hypotonic maternal serum at term pregnancy.
• An osmolarity of 250 m osmol/ liter is suggestive of fetal maturity.
Color
– In early pregnancy, it is colorless.
– Near term, it becomes pale straw-colored due to the presence of
exfoliated lanuga epidermis cells from the fetal skin. It may look turbid
due to the presence of vernix caseosa.
Composition
In the first half of pregnancy, the composition of the fluid is almost identical to a trans
plasma. However, in late pregnancy, the composition is very much altered mainly de
contamination of fetal urinary metabolites. The composition includes.
– Water 98-99 %
– Solid 1-2%

Organic ( solid constituents)

– Protein-0.3 mg%
– NPN-30 mg%
– Glucose-20 mg% - Uric acid-4 mg% Creatinin-2 mg%
– Urea-30 mg%
– Total lipids
– 50 mg%
Function
• Its main function is protective of the fetus. It
helps to protect the fetus from trauma to the
maternal abdomen
During pregnancy
• Protecting the fetus from outside injury by cushioning sudden blows or
movements. Maintaining a relatively constant temperature around the fetus,
thus protecting the fetus from the heat loss. The fluid distends the amniotic
sac and thereby allows for growth and free movement of the fetus.
• Prevents adhesion between the fetal parts and amniotic sac and enabling the
muscle skeleton to develop properly.
• Allowing the lungs to develop properly.
• Its nutritive value is negligible because of the small amount of protein and
salt content; however, water supply to the fetus is quite adequate,
• During labor

• To equalize the compression on the fetus caused by uterine contraction

• During uterine contraction, it prevents marked interference with the placental circulation so long as the
membranes remain intact.

• It guards against umbilical cord compression. Amnion and chorion are combined to form a hydrostatic
wedge which helps in dilatation of

• the cervix. It contains antibacterial activity. It flushes the birth canal at the ends of first stage of labor

• and prevents ascending infection to the uterine cavity.

Clinical important
• The study of the amniotic fluid provides useful information about the well
being and maturity of the fetus.
• The rupture of the membranes with drainage of liquor is a helper method in
the induction of labor.
• Diagnosis of PROM (ferning test).
• The amniotic fluid that bathes the fetus is necessary for its proper growth and
development.
• It cushions the fetus from physical trauma.
• It provides a barrier against infection.
 Fetal Circulation

Begins to develop toward the end of the third week. The heart starts
to beat at the beginning of fourth week. The critical period of heart
development is from 20 days to 50 days fertilization. Many critical
events occur during cardiac development, and any deviation from
normal pattern can cause congenital heart defects if development of
heart does not occur prope In utero, the fetal lungs and
gastrointestinal system do not function, because the fetus obtain
oxygen and nutrients necessary for its development, growth, and
well being from the mate
• circulation. The waste products of metabolism pass back into the maternal circulation system

• disposal.

• The fetus is connected by the umbilical cord to the placenta, the organ that develops and impl in the
mother's uterus during pregnancy. Through the blood vessels in the umbilical cont fetus receives all the
necessary nutrition. Oxygen and life support from the mother through placenta. Waste products and carbon
dioxide from the fetus are sent back through the umb cord and placenta to the mother's circulation to be
eliminated. Blood from the mother enten fetus through the vein in the umbilical cord. In the fetal circulation
system, the umbilicale transports blood rich in oxygen and nutrient from the placenta to the fetal body.

• Definition: The fetal circulation is the circulatory system of a human fetus, often encompas the entire
fetopleental circulation which includes the umbilical cord and the blood vessels wi the placenta that carry
fetal blood.
• Characteristics

• The placenta is the source of oxygen for the fetus.

• Fetus lung received less than 1 percent of blood volume.

• No gas exchange occurs in the lungs.

• Right atrium of the heart has highest concentration of oxygenated blood.

• Presence of unique structures.

• Three shunts in the fetal circulation

• Fetal circulation consequently differs from the adult one predominantly due to the presence major vascular shunts:" ductus venosus, ductus
arteriosus, and foramen ovale".

• 1142 | Midwifery Nursing, Part-1

• 1.

• The ductus venosus (from the vein to the vein): The venous duct
receives blood from the umbilical vein and directs it to the interior
venacava. This venous duct acts as a liver bypass and moves blood into
the fetal systemic circulation. As the blood from the inferior vena cava
enters the right atrium, most of the well-oxygenated (75%) ductus
venous blood flow of it is shunted directly (straight pathway) into the
left atrium through an opening called the foramen oval (oval opening).
• Foramen ovale: Foramen ovale is a temporary opening
or hole between the right and left atrium of the heart.
Blood is shifting from the right atrium to the left atrium
through the foramen ovale. A small valve, septum
premium is located on the left side of the arterial
septum overlies the foramen ovale and helps prevent
blood from moving in the reverse direction.
• This opening is covered with a flap that allows blood to move from
the right atrium to left atrium only. The more highly oxygenated
blood that enters the left atrium through the foramen ovale is
mixed with a small amount of deoxygenated blood returning from
the pulmonary veins. This left atrial blood is passed on through the
mitral opening into the left ventricle. During ventricular systole,
the left ventricular blood is pumped into the ascending and arch of
the aorta and distributed by their branches to the heart, head,
neck, brain and arms.
• The rest of the fetal blood 25% entering the
right atrium. Blood low in oxygen (40%
saturated) returning from the head via the
superior vena cava also enters the right
atrium.
• Mostly the deoxygenated blood from the superior
venacava in pumped into the right ventricle
(directed downward) through the tricuspid valve
into the right ventricle than to pulmonary artery.
The right ventricular blood with low oxygen content
is discharged into the pulmonary trunk. Only a small
volume of blood enters the pulmonary artery.
• 3. Ductus arteries: It is special connection between the pulmonary artery
and the aorta (descending portion of the aortic arch). Most of the blood
in the pulmonary artery bypass to the aorta. As a result of this
connection, the blood with a relatively low oxygen concentration (40% 02
saturated) which is returning to the heart through the superior vena cava
by possess the lungs. Thus, the aorta and its branches carry mixed
oxygenated and deoxygenated blood. The continuation of blood flow
(65% saturated 02) is into the left ventricle (lower chamber of the heart)
and then to the aorta (the long artery coming from the heart), into the
body.
• Some of it reaches of myocardium through the coronary arteries and some reaches the
brain through the carotid arteries. Some of blood moves from the aorta through the
internal iliac arteries to the umbilical arteries and re-enters the placenta, where carbon
dioxide and other waste product from the fetus are taken up and enter the woman's
circulation. Fifty five percent of fetal cardiac output goes to placenta, leaving only 45% to
pass through all the tissue of the fetus (various parts of the lower regions of the body).

• Main function of these shunts

• The main function of these shunts is to redirect oxygenated blood away from the lungs,
liver and kidney (whose functions are performed by the placenta).
• Superior vena cava

• Ductus arteriosus

• Pulmonary artery

• Pulmonary veins

• Foramen ovale

• Right lung

• Left lung

• Liver

• Ductus venosus

• Inferior vena cava

• Portal vein

• Renal vein and artery

• Umbilicus

• Aorta

• Umbilical vein

• Umbilical arteries

• Hypogastric arteries

• Fig: Fetal circulation

• Circulation Changes at Birth

• Changes are initiated by a baby's first breath. Cessation of placental blood flow, and the initiation of respiration. The structural changes that occur to each structure are as follows:

• Fetal circulation | 145 |

• Umbilical arteries

• The fetal blood supply passes to the placenta through two umbilical arteries from the
internal arteries and returns through an umbilical vein, which passes through the liver,
ductus venosus, joins the inferior vena cava. When the umbilical cord is cut, no more
blood flows through umbilical arteries and vein and they degenerate. Discontinuation of
placental blood flow subsequent fall in pressure causes occlusion of the umbilical arteries
a few minutes follows delivery, Full occlusion of the distal arteries occurs in the months
following birth. Once f occluded, the distal portions of the former umbilical arteries
become the medial umbilic ligaments, found on the anterior abdominal wall. The proximal
portions of the former umb arteries remain open as the superior vesical arteries.
• Umbilical vein

• This vessel remains open for some time after birth, allowing a final volume of blood
approximately 80-100 ml to flow from the placenta into the infant prior to occlusion. Th
cessation of placental circulation results in the collapse of the umbilical vein, the ductus
ven and the hypogastric arteries. The umbilical vein and the ductus venosus closes off
within tw five days after birth, leaving behind the ligamentum teres and ligamentum
venosus of the respectively. Umbilical vein becomes part of the fibrous support ligament
for the lig Eventually, the umbilical vein also obliterates, forming the ligamentum hepatis
teres, which is lower portion of the falciform ligament, which remains intra-abdominally
into adulthood a fibrous connection between the anterior surface of the liver and the
anterior abdominal wall.
• Ductus venosus

• At birth, the ductus venosus collapses: Over time, it obliterates into a ligament termed ligamentum
venosus, a fibrous remnant coursing from the ligamentum hepatis teres to the infera

• vena cava.

• With the first breaths of air, the baby takes at birth, the fetal circulation changes. A larger amou of blood is
send to the lungs to pick up oxygen. Inflation of the lungs reduces the resistance blood flow through the
lungs resulting in increases blood flow from the pulmonary arter Consequently, an increased amount of
blood flows from the right atrium to the right ventricle into the pulmonary arteries and less blood flows
through the foramen ovale to the left atrium h addition, an increased volume of blood returns from the
lungs through the pulmonary veins to t left atrium, which increases the pressure in the left atrium.
• Foramen ovale

• Initiation of respiration opens the pulmonary circulation and lowers dramatically the pulmona arterial
pressure and hence the right atrial pressure. Because of the dramatic increase pulmonary blood flow, the left
atrial pressure increases. The increased left atrial pressure decreased right atrial pressure (due to pulmonary
resistance) forces blood against the sep premium causing the foramen ovale to close. This action functionally
completes the separation the heart into two pumps right and left sides of the heart. This is caused by
increased pressure the left atrium combined with a decreased pressure on the right atrium. Functional
closure occ soon after birth but anatomical closure occurs in about year time.

• Ductus arteriosis:Ductus arteriosis, within few hours of respiration, the muscle wall of the duc arteriosus
contracts probably in response to rising oxygen tension of the blood flowing throug

• 6 Midwifery Nursing, Part-1