Phyiciological

changes in
pregnancy, The
fetoplacental
unit
Dr. Onah livinus Nnanyereugo
  The placenta is the intimate
apposition or fusion of fetal
organs to maternal tissues
for the purpose of
physiologic exchange.
Introductio  Basic unit of all placenta
n parenchyma is the
trophoblast.
 Human placenta could be
described as discoid,
deciduate and
haemochorial placenta.
  The normal placenta is blue
red ,rounded flattened ,meaty
discoid organ
 15-20cm in diameter ,2-4cm
in width
 Weighs 400-600gm (one-
Introductio sixth of normal weight of
n newborn.)
 The umbilical cord arises from
any part of the placenta
 Has feto-maternal origin
 At term 4/5th of the placenta
is fetal
  The placenta is formed when
the embryo invades the
endometrium of the uterus
and when the trophoblast
forms the villous chorion.
 Basic unit of all placenta
Placenta parenchyma is the
Developme trophoblast.
nt  Surface cells of blastocyst
known as trophoblast cells
burrows into endometrium of
pregnancy (decidua)
 Formation of
syncytiotrophoblast from
cytotrophoblast.
  Maternal venous sinuses first and
then arteries are opened up to
form lacunae. Lacunae are lined
by syncytial cells.
 Various lacunae are separated by
trabeculae with a core
mesenchymal tissue – villi.
Placenta
Developme  The embryonic body stalk (later
nt to become the umbilical cord)
invades the stromal core to
establish the feto – maternal
circulation.
 By the 17th day after conception
true placental circulation is
established.
 If this step does not occur the
  MATERNAL COMPONENT OF THE PLACENTA
 Decidua basalis
 which is derived from the
endometrium of the uterus located
between the blastocyst and the
myometrium.
Componen  Decidua parietalis
ts of the  which includes all portions of the
Placenta endometrium other than the site of
implantation) are shed as part of
the afterbirth.
 Decidua capsularis
 the portion of endometrium that
covers the blastocyst and separates
it from the uterine cavity, becomes
attenuated and degenerates at
week 22 of development because of
  The maternal surface of the
placenta is characterized by 8–10
compartments called cotyledons
(imparting a cobblestone
appearance), which are separated
by decidual (placental) septa.
 Each cotyledon is supplied by a
Componen major branch of the umbilical
ts of the artery and drained by a major
Placenta 2 branch of the umbilical vein
tributary.
 Each cotyledon is anchored on
more than one villi.
 The maternal surface is dark red in
color and oozes blood due to torn
maternal blood vessels.
  FOETAL COMPONENTS OF THE
PLACENTA
 Tertiary chorionic villi
 Derived from both the trophoblast
and extraembryonic mesoderm,
which collectively become known
as the villous chorion.
 Where the placenta is attached the
Componen branching villi resembles a leafy
ts of the tree (chorion frondosum) whereas
Placenta 2 that portion of placenta covering
the expanding conceptus is
smoother (chorion laeve).
 The fetal surface has a smooth,
shiny, light-blue or blue-pink
appearance (because the amnion
covers the fetal surface), and 5–8
large chorionic (fetal) blood vessels
Chorionic
Villi
  Circumvallate
(circummarginate)
 Succenteuriate lobe
 Bipartite placenta
Placenta  Marginal insertion of
Variations
cord(battledore)
 Placenta membranacea
 Placenta acreta
 Placenta previa
  1st Trimester: Placenta >
foetus
 12-14 weeks: Placenta =
foetus
Placenta  >14 weeks: Placenta <
Size
foetus
 28 weeks: ratio 1:4
 40 weeks: ratio 1:7
  <16 weeks gestation, mainly an
exudate (maternal component)
 >16 weeks, main contribution from
foetal urine output

Liquor
Production
  POLYHYDRAMINOS
 Maternal cause
 Diabete mellitus
 Placental/cord
 Tumours (haemangioma)
 Foetal causes
Liquor  CCF (Anaemia, Rh incompatibility)
Pathology  Problems of swallowing
 Anaecephaly
 Muscullar problems
 Oesophagial/duodenal atresia
 Exudation
 Omphalocele
 Renal
 Nephrotic syndrome
  OLIGOHYDRAMINOS
 Foetal causes
Liquor  Renal (poor urine
Pathology output)
2  IUGR
 Renal agenesis
 Prune belly syndrome
  Metabolism
 Hormone production
Functions
of the  Placental transfer
Placenta  Haematopoietic
 Immunological
  Similar to adult liver or kidney
 Performs many synthetic and
catabolic funtions
 Glycolytic cycle
 Pentose phosphate pathway
Placental
 Tricarboxylic cycle
metabolis
m  Most substances cross the
placenta by active transport
 More than 60 placental
enzymes have been described
 HUMAN CHORIONIC
GONADOTROPIN (hCG)
 A glycoprotein hormone that
stimulates the production of
progesterone by the corpus
luteum.
Placental
Hormone HUMAN PLACENTAL LACTOGEN
Production (hPL) (Human Chorionic
Somatomammotropin)
 A protein hormone that induces
lipolysis, elevating free fatty acid
levels in the mother
 it is considered to be the “growth
hormone” of the fetus.
 ESTRONE, ESTRADIOL , AND
ESTRIOL
 Increases uterine growth and
vascular supply to decidua and
myometrium
 Increases metabolism and
placental enzyme systems
Placental PROGESTERONE
Hormone  A steroid hormone that
Production maintains the endometrium
during pregnancy,
 Used by the fetal adrenal cortex
as a precursor for glucocorticoid
and mineralocorticoid synthesis
 Used by the fetal testes as a
precursor for testosterone
  Primary function is transport
of oxygen and nutrients to the
fetus and reverse transport of
carbon dioxide, urea and other
metabolites back to the
Placental mother.
Transport  In general compounds that are
necessary for the minute by
minute homeostasis eg
oxygen, carbon dioxide,
water, sodium are transported
rapidly by diffusion.
 TRANSPORT
 Simple diffusion
 Dependent on chemical
gradient between fetus and
mother,
 Usually for gases and small
molecules and exogenous
Placental compounds such as drugs.
Transport  Facilitated diffusion:
2  A carrier mechanism.
 It can be saturated at high
doses
 Example is glucose transport
 In steady state glucose in fetal
plasma is about 2/3 of maternal
plasma because of rapid
utilization.
  Active transport
 enzymatic mechanisms that
concentrates substances in
process of transport eg for
essential amino acids and
water soluble vitamins.
 Concentrations are higher in
fetal blood than maternal
Placental blood.
Transport
3  Pinocytosis
 By pseudopodial projection that
encircles particulate
substances.
 It can transport substances to
and from fetal plasma into
maternal plasma eg complex
proteins, small amount of fat
  Leakage
 Gross breaks in placental
Placenta membranes eg in labour,
placental
Transport
disruption( placental
3 abruptio, placenta praevia)
allowing passage of whole
cells.
  Foetal, placental and
maternal compartments
form an integrated
Feto hormonal unit
Placental  This unit creates the
Maternal ENDOCRINE
Unit (FPM) ENVIRONMENT that
maintains and drives the
processes of pregnancy
and prenatal development
Thank You