THE PLACENTA

by
BIS MUNDIA
RN/RM/BSc/MSc student – Midwifery, Women and
Child health
General objective

 By the end of the lecture/discussion, you should be able to acquire

knowledge about the placenta and be able to apply this knowledge in
your practice.
Specific objectives

1.Define the placenta

2.Describe the development of the placenta, the four layers, shape, size
and structure.
3.Describe the umbilical cord.
4.Explain the functions of the placenta.
5.Outline the abnormalities of the placenta.
Introduction

 The placenta is a circular or disc shaped organ with the chorionic

membranes extending outwards from the edges to form a sac.
 The umbilical cord is attached to the centre of the fetal side of the
placenta.
Introduction cont’

 All the nourishment which the baby derives from the mother is
obtained through the placenta, which permits an exchange of
nutrients from the maternal blood stream through the placental
membranes into the fetal blood stream.
Introduction cont’

 The placenta is a remarkable organ originating from the trophoblastic

layer of the fertilized ovum.
 It is the functional unit on which the fetus in utero depends (Fraser &
Cooper 2006).
Placenta Development

 After fertilization, the ovum appears to be covered with a fine downy

hair which consists of the projections from the trophoblastic layer.
Placenta Development Cont’

 The area where we find the chorion frondosum, the projections will
erode the decidua further and get in contact with maternal blood.
 The eroded blood vessels in the maternal blood are known as
sinuses and the area in between as intervillus spaces while the
projections are known as villi
Placenta Development Cont’

 The villi that absorb nutrients and oxygen from the maternal blood
and excrete waste into the maternal blood are known as nutritive
villi.
 The villi that stabilize the placenta are known as anchoring villi
 The chorionic villus which is the functional unit of the placenta has
the mesoderm and fetal blood vessels as well as branches of the
umbilical artery and veins.
 Placenta layers

The villus is made up of four layers namely;

 Cytotrophoblast
 Syncytiotrophoblast
 Mesoderm and
 Capillary wall.
Placenta layers cont’

 SYNCYTIOTROPHOBLAST:
 This is an outer layer (syncytial cells) with the cells which continue to
secrete the proteolytic enzymes and so continue to invade the
decidua and nourish the blastocyst.
Placenta layers cont’

 CYTOTROPHOBLAST: (LANGHAN’S LAYER)

 It is closely attached to the outer syncytial layer. The cells of this
inner cytotrophic layer begin to secrete a hormone known as human
chorionic Gonadotrophin (HCG) which is very similar to the
luteinizing hormone (LH) of the pituitary glands.
 These two layers of cells, therefore, form the outer membrane of the
trophoblast.
Placenta layers cont’

 MESODERM:
 At the central part of the embryonic plate is the mesoderm.
 This row of mesoderm cells is continuous with the mesoblast cells
within the chorionic, villi which later develop into the fetal blood
vessels.
Placenta layers cont’

 CAPILARY WALL: This is the inner most layer, it has a lot of capillaries
which are congested and dilated, these are known as sinusoids
Placenta

 SITUATION- it is situated in the upper uterine segment.

 SHAPE-It is a flat, roughly circular structure.
 SIZE- the placenta has a diameter of about 20-22cm and the
thickness at the centre is about 2-2.5cm,
 It gets thinner towards the circumference
 Weighs about 500-600grams or 1/6 of the baby’s weight at term.
Placenta

The placenta is made up of two surfaces; the maternal and fetal surface.
Maternal surface
 Maternal surface is the part that is attached to the uterine wall or on
the decidua. It is dark red in color attributed to the maternal blood
where the placenta is attached.
Placenta

 When you to touch it, it feels rough due to the degeneration process
and has about 16-20 lobes or cotyledons.
 Each lobe or cotyledon consists of a unit or several chorionic villi.
 The lobes are separated by sulci grooves or furrows into which the
villi dip to form septa or walls or ridges.
 The intervillus space contains about 150mls of blood which is
changed at least three times per minute
Placenta

 Small deposits of fibrin, lime salts and calcium cover the thin layer of
the trophoblast which is visible to naked eyes and feels gritty to
touch.
 It also looks like fine grounded egg shells known as calcareous
degeneration or calcification due to degeneration seen in post mature
or mature placenta.
Placenta

 If a large area of placenta has calcifications, it becomes fibrous and

white and is known as infarct which makes the placenta to be
inefficient.
Placenta

Fetal surface
 This is the area of placenta that faces the fetus in utero. It is bluish
grey in color, smooth and shiny in appearance. It has the umbilical
cord inserted into it usually at the center.
 The umbilical vein and arteries radiate from the cord, lost deep into
the substance of the placenta before reaching its circumference
 The branching of blood vessels from the umbilical cord can be likened
to the branching of roots on the tree.
 The fetal surface is covered by two membranes, the amnion and
chorion.
MATERNAL SURFACE
FETAL SURFACE
The Amnion

 This is a tough translucent membrane which lines the amniotic cavity

and is derived from the inner cell mass; it covers the placenta and
the umbilical cord.
 Secretes amniotic fluid and forms the fetal sac.
 It can be stripped off the chorion as far as the insertion of the
umbilical cord.
The Chorion

 This is a thick opaque and frail membrane which is continuous with

the placental edge and cannot be separated from it.
 It lies next to the decidua and because of it being fragile; its pieces
can remain in utero after delivery.
THE CHORION AND AMNION
Amniotic fluid

 Amniotic fluid is a clear pale, straw colored fluid consisting of 99%

pure water whilst the remaining 1% is dissolved solid matter including
food substances and waste products.
 In addition, fetus sheds skin cells, vernix caseosa and lanugo into the
fluid
Amniotic fluid cont’

 The source of the amniotic fluid is thought to be both fetal and

maternal. It is secreted by the amnion, especially the part covering
the placenta and umbilical cord.
 The total amount of amniotic fluid increases throughout pregnancy up
to about 900mls until the 38th week, then it diminishes slightly until
term when slightly 800mls remains.
Amniotic fluid cont’

 If the total amount exceeds 1500mls, the condition is known as

Polyhydrominios.
 If the amniotic fluid is less than 400mls then it known as
Oligohydraminous
Functions of Amniotic fluid

 To distend the amniotic sac and allow for growth and free movement
of the fetus.
 To equalize pressure and protect the fetus from jarring and injury.
 The fluid maintains a constant temperature for the fetus and provides
a small amount of nutrients.
Functions of Amniotic fluid cont’

 During labor as long as the membrane is intact, the fluid protects the
placenta and umbilical cord from pressure of uterine contractions.
 Aids in effacement of the cervix and dilatation of the uterine Os
especially where the presentation is poorly applied.
The Umbilical cord

 This is a flexible structure containing blood vessels and attaching a

fetus to the placenta during gestation (Margaret Adams 1983)
 The umbilical cord is derived from the duct which forms the yolk sac
and amniotic sac
The Umbilical cord

 At term, it is seen extending from the fetal umbilicus to the fetal

surface of the placenta.
 It is continuous with the fetal skin at the umbilical stump.
 The other name for the umbilical cord is funis.
 It is about 40-50cm in length and 1-2cm in diameter.
 If the length is less than 40cm, it is considered short but the long
cord has no limit.
The Umbilical cord cont’

 The length of the cord allows the fetus free movement without
traction of the placenta, however if the cord is too long it tends to
wind around the fetal body e.g. neck, trunk or limbs and may also
become knotted
Structure of the cord

 The amnion covers the cord as well as the fetal surfaces of the
placenta.
 There are three blood vessels that curl around the cord in spiral form.
 Umbilical vein (1) which carries oxygenated blood and nutrients from
maternal circulation to fetal circulation.
 Umbilical arteries (2) which carry deoxygenated blood from the fetal
circulation to the maternal circulation.
Structure of the cord cont’

 Wharton’s jelly – is a jelly like substance (gelatin) which surrounds

the blood vessels. It is derived from the mesoderm and the thinness
or thickness of the cord depends on the amount of the Wharton’s
jelly. It usually helps to protect the blood vessels from being pressed
by pressure.
 The umbilical cord has no nerves or lymphatic glands.
Functions of the Placenta

1.Storage
2. Excretion
3. Respiration
4. Protective
5. Endocrine
6. Nutrition
7.Transfer (Transport)
8. Stabilization
(SERPENTS)
Storage

 The placenta metabolizes glucose which is stored as glycogen and

the same is converted to glucose when need arises.
 It also stores some iron and some water soluble vitamins which are
liberated to the baby when need arises.
 The placenta also stores some hormones which it produces.
Excretion

 The main substance excreted from the fetus through the placenta is
carbon dioxide, urea, bilirubin and uric acid are also excreted into the
maternal circulation.
Respirations

 In utero there is no pulmonary exchange of gases, therefore

respiratory function is performed by the placenta by obtaining oxygen
from the maternal circulation to the fetal circulation and excreting
carbon dioxide from the fetal circulation to the maternal circulation.
 This is done by a process of simple diffusion
Protective

 The placenta acts as a barrier to passage of bacteria, viruses and

other forms of pathogens.
 However smaller types of bacteria e.g. Treponema Pallidum can
penetrate the placenta barrier. Viruses can freely cross the placenta
and infect the fetus e.g. rubella, HIV.
 Most drugs also cross the placenta to the fetus; some are beneficial
while others are harmful to the fetus.
Protective cont’

 Beneficial drugs include penicillin and an example of harmful drugs is

Tetracycline.
 Towards the end of pregnancy, immunoglobulins cross the placenta to
the fetus to confer immunity which can be eminent in the fetus up to
three months of life.
 Only antibodies present in the mother will be passed to the fetus.
Endocrine

 The endocrine function of the placenta helps in the maintenance of

pregnancy and development of the fetus;
Human Chorionic Gonadotrophin(HCG)
 This hormone is produced by the Cytotrophoblast of the chorionic villi
as early as the 9th day after conception and reaches its peak
between the 7th - 10th weeks of pregnancy. The levels fall as
pregnancy advances.
Endocrine cont’

 The hormone functions by stimulating the growth and activity of the

corpus luteum. The hormone is excreted in the mother’s urine and
forms a basis for immunological tests.
 Oestrogen
 As the activity of the corpus luteum declines, then the placenta takes
over the production of estrogen and large amounts are produced
through the placenta.
 Estrogen levels in the maternal urine or serum can be used as an
index for fetal/placental wellbeing.
Endocrine cont’

 In later pregnancy, higher levels of estrogen become dominant with

fetal steroids leading to production of prostaglandins which in turn
lead to production of oxytocin
 Estrogen stimulates the growth of uterine function and functional
duties of the breasts.
 In late pregnancy, estrogen enhances uterine muscles to be sensitive
to the action of oxytocin which later initiates onset of labor.
Endocrine cont’

 Progesterone
 This hormone is produced by the Syncytiotrophoblast layer of the
placenta about the 12th week until before onset of labor when there
is reduction in the levels.
 Large amounts of progesterone are synthesized from maternal
cholesterol as the placenta lacks the enzyme to convert it to
Oestrogen.
Endocrine cont’

 It facilitates implantation of the fertilized ovum and reduces motility

and enhances breast development.
 It works well on tissues developed by estrogen.
 It facilitates implantation of the fertilized ovum and reduces motility
and enhances breast development.
 It works well on tissues developed by estrogen.
Relaxin

 Produced by the corpus luteum and its production continues until the
late stage of pregnancy.
 It prepares the genital tract for pregnancy and labor by softening and
relaxing the connective tissues.
 It enhances ripening and softening of the cervix. Peak levels are just
before onset of labor.
 Human Placental Lactogen (HPL)

 When the levels of HCG fall, the levels of HPL rise which continue
until the 36th week then they begin to fall.
 It is associated with fetal growth and changes the maternal glucose
metabolism
Nutrition

 Nutrients like proteins, carbohydrates and fats are broken down into
simpler forms which are able to cross the placenta e.g. carbohydrates
into glycogen, proteins into amino acids and fats into fatty acids.
 Water soluble vitamins cross the placenta barrier while fat soluble
vitamins cross the barrier with difficulty and mainly at the end of
pregnancy.
 The amino acids are rapidly transported, thus the levels of fetal
amino acids are usually higher than that of mother.
Transfer of substances

 Substances transfer to and from the fetus by a variety of transport

mechanisms such as:
 Simple diffusion of gases and lipid soluble substances, water pores
transfer water soluble substances, facilitated diffusion of glucose,
active transport against concentration.
Stabilization

 Those chorionic villi which pass deeply into the decidua and anchor
the placental firmly stabilise the structure which is so vital for fetal
development.
Abnormalities of the placenta

There are abnormalities that can occur in the placenta or the cord.
On the placenta
Placenta Succenturiata
 This is where a small lobe is present, separate from the main
placenta, joined to it by blood vessels that run through the
membranes to reach it.
 The danger is that the small lobe may be retained in utero after the
placenta is born, and if not removed may lead to infection and
hemorrhage.
Abnormalities of the placenta cont’

 Therefore the midwife must examine every placenta for completion

 Fetal anoxia can be caused either by the presenting part of the fetus
pushing against the vessels connecting the lobe with the placenta, or
by the membranes rupturing and involving the vessels.
Abnormalities of the placenta cont’

 Vasa praevia -is the term used to describe blood vessels within the
placenta membranes which lie below the presenting part.
 If the membranes rupture, involving these presenting blood vessels,
there is consequent danger to the fetus because of blood loss
Placenta Succenturiata
Placenta circumvallta

 This is when an opaque ring is seen on the fetal surface of the

placenta.
 It is formed by a doubling back of chorion and amnion and may result
in the membranes leaving the placenta nearer the center instead of
at the edge.
Circumvallate placenta
Placenta circumvallate
Bipartite Placenta

 Presence of two complete and separate parts each with a cord

leaving it.
 The bipartite cord joins a short distance from the two parts of
placenta.
Bipartite Placenta
Bipartite Placenta
Tripartite placenta

 Here three distinct parts are present.

Abnormalities on the cord

 1. Lateral cord insertion - where the umbilical cord is inserted

laterally at the placenta and usually does not cause harm.
 2. Battledore – the cord is attached to the edge of the placenta.
Unless the battledore is fragile it does not cause any problem.
Battledore
Velamentosa

 The cord is inserted into membranes of the amniotic sac some

distance from the edge of the placenta.
 It is more dangerous if placenta is situated in the lower segment as
the blood vessels may pass across the uterine Os
Velamentosa
Summary

 The placenta is a circular or disc shaped organ with the chorionic

membranes extending outwards from the edges to form a sac.
 It is the functional unit on which the fetus in utero depends, it links
the fetus to its mother.
 It develops from the trophoblastic layer of the fertilized ovum.
 It has the maternal surface which has about 16-20 cotyledons
separated by the grooves or sulci, the fetal surface faces the baby.
Summary cont’

 The fetal surface is covered by two membranes, the amnion and

chorion.
 It has the functions of Storage, Excretion, Respiration, Protection,
Endocrine,Nutrition and stabilisation. Hormones that are produced by
the placenta are Human Chorionic Gonadotrophin, Oestrogen,
Progesterone, Relaxin, Human Placental Lactogen.
Summary cont’

 Placenta abnormalities include; placenta Succenturiata,

Circumvallate placenta tripartite placenta, bipartite placenta,
Battledore and Velamentosa
Assignment

Read and make short notes on the pathological conditions of the

placenta i.e.
 Premature degeneration
 Infarcts
 Edema
 Excessive size
References

Fraser M.D. Cooper M.A. & Nolte A.G.W (2006). Myles Textbook for
Midwives, African Edition. Elsevier, Churchill, Livingstone.
Sellers P. M. (2009). Midwifery. A textbook and reference book for
Midwives. Juta & Co Ltd.
Verralls S. (1993). Anatomy and Physiology applied to Obstetrics.
3rdedition. Churchill Livingstone