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PLACENTAL

HORMONES

DR.A.RATHNA ., M.S ( O&G) ., 1ST YR


PG ., MMC
Placenta
Human placenta develops from two
sources
Fetal component- Chorionic frondosum
Maternal component- decidua basalis

Placental development begins at 6


weeks and is completed by 12 th week
Placenta at Term- Gross
Anatomy
Fleshy
Weight-500gm
Diameter- 15-20 cm
Thickness-2.5 cm
Spongy to feel
Occupies 30% of the uterine wall
Two surfaces- Maternal and fetal
4/5th of the placenta is of fetal origin and
1/5 is of maternal origin
PLACENTAL FUNCTIONS

4 main functions
transport

metabolism

endocrine

immunologic

Placenta essential function in the fetal


growth and development.
PLACENTAL PROTEIN
HORMONES
1. placental lactogen (hPL)
2. chorionic gonadotropin
(hCG)
3. Adenocorticotropin (ACTH)
4. Growth hormone variant
(hGH-V)
5. Parathyroid hormone-
related protein (PTH-rP)
6. Calcitonin
7. Relaxin
8. Inhibins
9. Activins
10. Atrial natriuretic peptide
PLACENTAL PROTEIN
HORMONES11. Hypothalamic-like releasing and
inhibiting hormones
Thyrotropin releasing hormone
(TRH)
Gonadotropin releasing hormone
(GnRH)
Corticotropin-releasing hormone
(CRH)
Somatostatin
Growth hormone-releasing
hormone (GHRH)
12. fetal compartment alpha feto-
protein
13. Maternal compartment
prolactin, relaxin and other
decidual proteins
Human chorionic gonadotropin (hCG)

Glycoprotein
Has biological activity same with LH
Produced
Placenta
Fetal kidney
Also produced by malignant tumors
Presence of hCG in blood and urine of reproductive age
women is almost indicative of the presence of fetal
trophoblasts either in pregnancy or in neoplastic disease
Concentration of hCG in
Serum and Urine
Intact hCG molecule is detectable in plasma of
pregnant women about 7 to 9 days after the
midcycle surge of LH that precedes ovulation
hCG enters maternal blood at time of blastocyst
implantation
Blood levels increase rapidly, doubling every 2
days
Maximal levels attained at about 8 to 10 weeks
gestation
Between the 60th and 80th days after the last
menses - peak levels reach about 100,000
mIU/mL
Concentration of hCG in
Serum and Urine
When the hCG titers exceeds 1,000-1,500 IU/L,
vaginal ultrasonography should identify an
intrauterine gestation
10-12 weeks gestation maternal plasma levels
begin to decline
Nadir - about 20 weeks
Plasma levels are maintained at this lower level
for the rest of the pregnancy
Fetal plasma levels same pattern as the
mother but plasma levels are only 3 percent of
those in maternal plasma
Urine concentration of hCG follows the pattern
of maternal plasma
Significance of Abnormally
High or Low hCG levels
HIGH hCG LEVELS LOW hCG LEVELS
Multifetal Early pregnancy
pregnancy wastage (eg.
Erythrobalstosis Ectopic
fetalis Pregnancy)
Fetal hemolytic
anemia
GTD
Fetus w/ Down
Syndrome
Biological Functions of
hCG
1. Rescue and maintenance of function of the
corpus luteum (continued progesterone
production)
progesterone producing life span of the corpus
luteum of menstruation could be prolonged for
2 weeks by hCG administration
about the 8th day after ovulation or 1 day after
implantation- hCG takes over for the corpus
luteum
Continued survival of the corpus luteum is
totally dependent on hCG
Biological Functions of
hCG
Survival of the pregnancy is dependent on
corpus luteum progesterone until the 7 th
week of pregnancy
Progesterone luteal synthesis begins to
decline at about 6 weeks despite continued
and increasing hCG production
Down regulation of hCG-LH receptors in the
corpus luteum when trophoblasts produce
sufficient progesterone for pregnancy
maintenance
Biological Functions of
hCG
2. Stimulation of fetal testicular testosterone
secretion
Before 110 days no fetal anterior pituitary
LH
At a critical time in sexual differentiation of
the male fetus, hCG enters fetal plasma from
the syncitiotrophoblast, acts as an LH
surrogate and stimulates replication of
testicular Leydig cells and testosterone
synthesis to promote male sexual
differentiation
Biological Functions of
hCG
3. Stimulation of maternal thyroid activity
hCG binds to the TSH receptors of thyroid
cells
LH-hCG receptor is expressed in the thyroid
Possibly, hCG stimulates thyroid activity via
the LH-hCG receptor and by the TSH receptor
hCG has intrinsic thyroid activity and maybe
the 2nd placental thyrotropic substance
Human Placental
Lactogen (hPL)
Also called human chorionic somatomammotropin
or chorionic growth hormone
potent lactogenic and growth hormone-like bioactivity
immunochemical resemblance to human growth
hormone
concentrated in the syncytiotrophoblast like hCG
detected in the trophoblast as early as the 2 nd or
3rd week after fertilization of the ovum
before 6 weeks- hPL is also identified in
cytotrophoblasts
Serum Concentration of
hPL
demonstrable in the placenta within 5 to 10 days
after conception
can be detected in maternal serum by 3 weeks
post fertilization
Maternal plasma concentration rises until about 34
to 36 weeks, with higher levels in late pregnancy
secreted primarily into the maternal circulation
with very little amounts in maternal urine and in
fetal blood and urine
role in pregnancy is mediated through maternal
actions
possibility that hPL serves select functions in fetal
growth
OTHER PLACENTAL PROTEIN
HORMONES
Chorionic Adrenocorticotropin
Proteolytic products of

propiomelanocortin:
o ACTH
o Lipotropin
o eta endorphin
Physiological role of
placental ACTH
Corticotropin-releasing hormone (CRH)
produced within the placenta - stimulates
the synthesis and release of chorionic
ACTH
placental production of CRH
positively regulated by cortisol
important for controlling fetal lung
maturation and the timing of parturition
Oxytocin potent stimulator of CRH and
ACTH placental production
OTHER PLACENTAL PEPTIDE
HORMONES
Leptin
normally secreted by adipocytes
initially believed to be an anti-obesity hormone
now regulates bone growth and immune function
secreted by both cytotrophoblast cells and
syncytiotrophoblast and maternal levels are
significantly higher than in non pregnant women
and that in the fetal circulation
Fetal leptin levels
correlated positively with fetal birthweight
play an important role in fetal development and
growth
Neuropeptide Y
found in the brain, sympathetic neurons
innervating the cardiovascular, respiratory,
gastrointestinal, and genitourinary systems
has been isolated from placental
cytotrophoblasts
Receptors have been demonstrated in the
placenta
treatment of placental cells with
neuropeptide Y causes the release of CRH
Inhibin and Activin
belongs to the transforming growth
factor beta signaling family
Inhibin
glycoprotein hormone, inhibit pituitary FSH
release
produced by the testis, ovarian granulosa cells
and the corpus luteum
placenta produces inhibin alpha-, and beta A
and beta B-subunits
Inhibin A principal bioactive inhibin secreted
during pregnancy
Highest level is at term
Placental inhibin production together with large
amounts of placental sex steroids inhibit FSH
secretion and preclude ovulation during
pregnancy
Activin
closely related to inhibin
enhances FSH synthesis and secretion and
participates in the regulation of the
menstrual cycle
roles in cell proliferation, embryogenesis,
osteogenesis, differentiation, apoptosis,
metabolism, homeostasis, immune response,
wound repair and endocrine function
nerve cell survival factors
has 3 forms: A, B and AB
Progesterone
After 6 to 7 weeks of gestation ovarian
progesterone production is minimal
After about 8 weeks placenta replaces the
ovary as the source of progesterone &
continues to increase production throughout
pregnancy
end of pregnancy - maternal levels of
progesterone are 10 to 5000 times those in
nonpregnant women, depending on the stage
of the ovarian cycle
daily production rate is 250 mg
In pregnancies with multiple fetuses, daily
production rate maybe >6000 mg/day
Progesterone and Fetal
Well-Being
No relationship between placental
progesterone synthesis and fetal well
being
Progesterone biosynthesis may persist
several weeks after fetal death
Role of Progesterone
Prepares and maintains the endometrium
to allow implantation
Has a role in suppressing the maternal
immunologic response to fetal antigens
thereby preventing preventing maternal
rejection of the trophoblast and has a role
in parturition
serves as a substrate for fetal adrenal
gland production of glucocorticoids and
mineralocorticoids
Placental Estrogen
Production
produces huge amounts of estrogens using
blood-borne steroidal precursors from the
maternal and fetal adrenal glands
Normal human pregnancy is hyperestrogenic
state, continually increasing as pregnancy
progresses terminating abruptly after birth
last few weeks of pregnancy - amount of
estrogen produced each day by
syncitiotrophoblast is equivalent to that
produced in 1 day by the ovaries of no fewer
than 1000 ovulatory women
Placental Estrogen
Production
first 2 to 4 weeks of pregnancy - rising levels of
hCG maintain production of estradiol in the
maternal corpus luteum
seventh week of pregnancy maternal corpus
luteum production of both progesterone and
estrogen decreases significantly
there is a lutealplacental transition by the
seventh week, more than 50 percent of
estrogen entering the maternal circulation is
produced in the placenta
transition of steroid milieu from one dependent
on the maternal corpus luteum to one
dependent on the developing placenta
Placental Estriol
Synthesis
Near term, the fetus is the source of 90 percent
of the placental estriol and estetrol precursor in
normal human pregnancy
placenta secretes several estrogens: estradiol,
estrone, estriol, and estetrol
majority of estrogen produced in the placenta -
released into the maternal circulation
the hemochorial nature of the human placenta,
majority of these estrogens - released in to the
maternal circulation
Maternal estriol and estetrol - produced solely
from fetal precursors, have low sensitivity and
specificity as indicators of fetal well-being

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