OB Lecture 1 - PLACENTA AND PLACENTAL HORMONES

USTMED ’07 Sec C - AsM

Posterofundal (upper 1/3) of uterus – implantation of blastocyst

Called morulla while in fallopian tube
Called blastocyst in the uterus
Called endometrium in the non-pregnant state
Called decidua in pregnant state

Trophoblast – cells surrounding blastocyst

Chorion frondosum – cells surrounding blastocyst; tree-like
projections; protrusions from trphoblast

Avascular trophoblast – due to expansion of amniotic cavity (?)

1. placental arm – villi, trophoblast and fetal & maternal

blood present
2. paracrine arm – membrane coverings
a. chorion - avascular
b. amnion - avascular
c. deciduas – vascular

Decidua Vera (DV) = DC + DP

Amnion
- membrane that contains A.F. (1L)
- > ____ = diabetic
- <500 mL = renal system failure

- avascular membrane
- solute & water transport to maintain AF homeostasis
- produces endothelin-1 – causes vasoconstriction –
decreases blood flow
- produces parathyroid hormone related protein
- produces enkephalinase
- modulates chorionic vessel tone and blood flow

Placenta
- provides insight into prenatal life
- helpful in caring for neonate
- plan future care for mother/child

Trophoblast
- attachment of blastocyst to the uterus
- nutrition
- endocrine function

Trophoblast – producer of Human Chorionic Gonadotropins

(HGC)
1. cytotrophoblast
- germinal cell
- cAMP
- on FM (?)
Trophoblast 1. trohpoutronectin
2. trophoblastic glue
3. facilitates separation of
tissue at delivery
2. syncitiontrophoblast
- secretory cell

Umbilical cord = 2 arteries + 1 vein (fetus can survive with only

1 artery
- fetal blood (deO2 blood) enter chorionic plate then passes
to the chorionic villi
- approx 50 cms (longer – might strangulate baby; or shorter
– tug on placenta = death)
- covered by wharton’s jelly

Factors Regulating Blood Flow

- BP (hypotensive – due to bleeding, etc.)
- Intrauterine pressure
- Type of uterine contractions
- Factors affecting arteriolar walls (endothelin-1 –
vasoconstrictor)
Fetal Surface
- shiny and glistening Placental Hormone – Human Placental Lactogen (HPL)
- course of vessels = chorionic vessels – branches of - chorionic somatotropin
umbilical arteries - chorionic growth hormone
- attachment of umbilical cord - syncitiotrophoblast
- central or paracentral only (not - detected on 2nd or 3rd week of fertilization
in periphery coz the amount of
blood going to umbilical vein - structurally related to human growth hormone and human
will lessen therefore less prolactin
nutrition, O2 and perfusion) - gestational diabetes – because HPL has anti-insulin effect

Maternal Surface HPL synthesis

- attachment of cotyledons - stimulated by insulin
- rough - Inhibited by PGE2 and PGF 2 alpha
- greatest hormone in humans
- present w/in 5-10 days after conception
Placental aging - proportional to placental mass
- decrease of syncitial thickness - concentration rises until 34-36 wks AOG
- loss of Langhan’s cells
- Fibrin deposits Metabolic Actions of HPL
- obliteration of blood vessel villi - lipolysis and increase circulating free fatty acids (baby
- thickened basement membrane
therefore does not starve)
- increased capilliaries
- anti-insulin
- decrease stroma
- incrase maternal insulin
- * abnormal placenta
- CHON synthesis
- vesicular/grape-like tissue Hydatidifor - a.a. for transport of fetus
- contains water m mole

HPL is increased in
Placental Hormones – Estrogen
- bronchogenic carcinoma
- pregnancy is hyperestrogenic state
- hepatoma
- syncitiontrophoblast
- lymphoma
- ovaries 2-4 wks post-ovulation
- pheochromocytoma
- 7th week >50% placenta
- precursors
o DHEA
o Androstenedione - fin -
o Testosterone
AsM
Decrease Estrogen
- Fetal anencephaly
- maternal adrenal dysfunction
- materal ovarian androgen producing tumors
- placental sulfatase deficiency
- decrease fetal adrenal utilization of LDL
- deficiency in fetal LDL synthesis
- glucocorticoid treatment
- placental aromatase deficiency

Placental Hormone – Progesterone

- syncitiontrophoblast
- utilization of maternal LDL
Cholesterol

Cytochrome P450

Pregnenolone

3B Hydroxysteroid dehydrogenase isomerase

Progesterone

Placental Hormone – HCG

- syncitiotrophoblast
- alpha and beta subunits
- structurally related to LH, FSH and TSH
- Alpha sub-units identical
- Beta sub-units are distinct

HCG
- Beta sub-unit is the basis for pregnancy kit
- increase bet 9-10 wks of AOG
- amt is directly related to no. of trophoblast
- doubles every 2 days
- Fcn:
• rescue and maintains corpus luteum
• stimulate Leydig cells of the fetal testes
• induces ovulation (infertile women)
- increase HCG
• multiple pregnancies
• fetal hydrops
• H-mole
• choriocarcinoma