Obstetrics

-Dr.Sundus Lec: -2
Oct-06-4

THE PLACENTA

The placenta is composed of

choroin frondosum which is fetal in origin containing fetal blood vessel with.1
.fetal blood
intervillous spaces between the villi filled with maternal blood.2
.(decidual plate maternal in origin (decidua basalis.3

From the 14th week of pregnancy ,fibrous septa will grow from
The decidual plate toward choroin frondosum ,dividing the placeta incompletely into
15 to 20 units called cotyledone .They grow from decidua basalis towards choroin
frondosum with out reaching it ,each correspond to a main villus stem and made up of
between 10 to 20 lobules,each lobule correspond to the opening of a maternal
.uteroplacental vessel. The placenta must be examined after delivery
The cytotrophoblast after 12th week become thinner in the villi of the
placenta to decrease the thickness of the placental barrier . Later after the second half
of the pregnancy ,another layer disappear which the mesoderm to facilitate exchange
across the placental barrier which is the tissue that separate the of the mother from
: that of the fetus and it is composed of

. trophoblast ,cytotrophoblast and syncytiotrophoblast.1

. mesoderm .2
. wall of fetal blood vessel.3

This barrier become thinner in terminal villi for proper exchange of gases
. ,nutrients ,waste ,drugs, and even organisms
The barrier is thickened in maternal hypertention as there will be degenerative
. changes ,fibrinoid deposition leading to thicker wall and lower exchange

PLACENTAL CIRCULATION
:It has the following features
no mixing of maternal and fetal blood,but this may occur at accidental.1
. hemorrhage giving immunological problem
the maternal blood passes from maternal arteries in the decidual plate to IVS.2
then to mmaternal veins ,bypassing capillary stage (arterio-venous fistula).which is
.physiological
maternal blood pass towards the villi by contraction of the uterine muscle and.3
.pressure jet of maternal blood coming from arteries

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THE UMBILICAL CORD

Formed at the area of the embryonic stalk ,consist of extra embryonic mesoderm
called Warton jelly ,in which fetal vessels are embedded ,feta capillary are collected in
the cotyledone to form 2 arteries and one vein .The arteries join the iliac a. of the fetus
and the vein connected to the hepatic circulation of the fetus (reversible circulation)
.i,e vein carry oxygenated blood from the placenta
At birth the umbilical cord is about 50 cm long ,2cm thickness ,containing
warton jelly and blood vessels with fales knots formed by local increase in warton
.jelly ,on rare occasion the cord may contain 1 or 2 true knots

The placenta at birth is circular ,about 15 to 20 cm in diameter ,2-3 cm thick

. ,and nearly 500g in weight which is related to the weight of the fetus

The placenta being thicker at the center ,has 15 to 20 cotyledone and 2

: surfaces

.maternal,rough,irrigular,formed by choroin frondosum.1

.Fetal ,covered by the smooth amnion.2

Numerous small grayish spots are frequently seen on the maternal surfaces which
represent Ca deposits in degenerating areas ,which are more in placetea after term
.,they are of no clinical importance called aging process
The umbilical cord reach the fetal surface of the placenta at about it is middle
,rarely at the edge. The placenta grow to vast extent in the 1st half of pregnancy
,while in the 2nd half ,the growth decline opposite to the growth of the fetus . At term
weight of the placenta is sixth fetal weight ,while at 12th week weight of the placenta
.=weight of the fetus

PLACENTAL FUNCTION
: Placental barrier.1
the most important function , factors that affect exchange of material across this
: barrier are
.a – total surface area available for exchange
.b – Rate of fetal and maternal circulation
c – Nature of substance which transfer across the placenta which depend on
molecular weight , fat soluble or not and finally ionization , ionized more difficult
.than non ionized

: The mechanism by which material transport across the placenta include

a – Simple diffusion , substance pass from high concentration or pressure
compartment to the lower until equilibrium is reached ex, gases ( O2 + CO2 ) , water ,
.minerals this means according to pressure gradient

b – Facilitated diffusion : pass from one compartment to another regardless of

pressure gradient but by certain substances called carrier system ex natural sugar ,
.soluble vit

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c – Active transport : transport against pressure gradient , hence energy is required
.ex heavy metals , like iron , a.a
: d – Special mechanism : like

Pinocytosis : high molecule or long chain a.a and protein will be engulfed from – 1
maternal blood by microvillous border of villi and pass gradually to fetal blood,
similarly transfer of antibody ( passive immunity ) like measles and German measles
which protect the baby in the first 6 – 8 months of life , later on disappear. Similarly
harmful abtibodies may be transferred across the placenta like abtithyroid abtibody
.( causing critin baby or anti Rh Ab causing haemolysis ( Rh isoimmunization
Simple leakage : brake in the wall of the fetal capillary which allow – 2
material to pass from fetal blood to the mother like fetal RBC which if antigenically
. different it will provoke an immune response leading to the production of Ab

: Respiratory function – 2
The placenta will act as a lung for the baby providing him with oxygen and carry
CO2 to the maternal circulation. The capacity of fetal blood to carry oxygen is higher
than adult ( fetal blood carry 21 volume / ml were as maternal blood carry just 14 vol /
ml ) , this is due to fetal Hb which have higher affinity to oxygen called HbF which
have 2 alfa and 2 gama chain unlike adult Hb called HbA which have 2 alfa and 2 beta
.chin

: Nutritional function – 3
: The main nutrient transfer across the placenta are
.a – CHO require to produce energy like simple sugar by simple diffusion
b – PTN small chains transfer by active transport while larger molecular weight
. and long chains by penocytosis
c – Lipid, fatty acids and triglyceries transferred and synthesized by the placenta
., used for growth and development of the fetus
d – Vit and minerals

:Production of hormones and enzymes called placental markers – 4

: The main hormones produced by the placenta are

HCG : glycoprotein produced by the cytotrophoblast and by the baby, ealy in – 1

pregnancy it can be detected in materanl blood form the tenth day of conception
( before the woman misses her period ). Reach maximum level at about 10 – 11 week
then decline slowly reaching a plateau after 12 week and remain till the end of
pregnancy

.Action : a - it maintain the life of CL beyond 14 days

. b – delay maternal immune response
c – it form the bases for diagnosis of pregnancy. In urine it requires a
higher concentration so it become positive 10 days to 2 weeks post amenorrhea. The
test in blood is an immunological test ( RIA ) to detect the B – subunit of HCG ( HCG
has 2 subunit alfa and beta ), alfa subunit is similar to other hormones like LH, FSH
and TSH and may be confused with them while the beta subunit is specific to HCG.
.This test is used to diagnose early pregnancy and follow up trophoblastic disease
d – Therapeutic role in recurrent miscarriage

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: HPL – 2

protein produced by cyncytiotrophoblast also called chorionc growth hormone or

chorionic prolactin. Detected from the forth week of pregnancy and increase till term
.Action : a – growth promoting activity like GH
b – Lactogenic effect , the diabetogenic effect of pregnenecy is partly due
to this hormone
c – since the fetus not contribute to its production it was used to asses
placental function especially in cases of recurrent miscarriage, threatened miscarriage
.and placental disfunction

: Oestrogen – 3

Steroid hormone produced by the placenta as well as the fetus from

cholesterol .In female there are 3 types ;estradiol, estroil and estrone,a combination of
.3 (total oestrogen) which is estimated in blood and urine of pregnant woman

Estroil is produced by the placenta as well as fetal liver ,adrenal ,so it is the
one used to asses fetoplacental unit i.e function and wellbeing of fetus and placenta.
The greater in amount in pregnancy is estroil ,the most active biologically in non –
. pregnant state is estradoil

In the 1st 3 months produced by the CL, then by theplacenta and fetus ,estrogen level
increase and reach max level at 36 week ,then the plateau from 37 to 40 week
.thereafter decrease as HPL

: Action
a- growth of the uterusand vascular bed which allow growth of the fetus .
. b-act on the duct system of the breast to prepare for lactation
c-estimation of total estrogen or estroil in urine or blood seirly to give idea
.about fetal and placental function
.d-teratogenic if uesd in early pregnancy

: Progesteron-3
steroid hormone produced by the the cyncytiotrophoblast from cholesterol .the
fetus not contribute to it is production .it level increase gradually untill 36 week and
.continue until labour start

: Action
. a-promotion of growth of decidua
.b- promotion of secretion of decidual cells
.(c-improve circulation in the decidual bed (placental plate
d- increase membrane potential of the myometrium ,so induces relaxtion of
. the muscle during pregnancy
.e- affact renal system and glandular epithelium of the breast

: Uses of progesterone
. a- for placental function

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.b- theraputic to support the early pregnancy

;Alfa feto protien-5

Produced by the fetal membrane and yolk sac of the baby ,also by the placenta
.and fetal liver

It appear in the blood from the 8th week of pregnancy ,usually estimated in maternal
blood or amniotic fluid because it is increase in certain fetal abnormality like fetal
neural tube defect ,in cases of abortion but it also increase in cases of twin ,the action
.not well known

: The main enzymes produced by the placenta

.a-oxytonase
.b-insulinase
.c- lactic DH
.d- heat stable alkaline phosphatase
. there exact role not well known

: The placental marker

Important protien produced by the placenta from early pregnancy ,used to diagnose it
: early which is important in infertility . The imported markers are
. EPF- EARLY PREGNANCY FACTOR
. SPP1 -specific pregnancy protein 1
.PAPPA –pregnancy associated placental protein a
.PP5 –placental protein 5
.the action of these is to ameliorate maternal immune response to the fetus

Written By:
Rand Aras Najeeb