PLACENTA AND FOETAL

MEMBRANES
JOHN AYUBA

1
 Extraembryonic/fetal membranes
 Definition: - structures
that develop from zygote
but do not form any part
of the embryo proper
 Examples:-
1) Amnion,
2) Yolk sac,
3) Allantois,
4) Chorion,
5) Placenta,
6) Umbilical cord 2
 At birth, placenta, umbilical cord, and other
extraembryonic membranes are separated from
the fetus and expelled from uterus as an
afterbirth.
 Knowledge of extraembryonic membranes is
essential to perform prenatal diagnostic
procedures such as amniocentesis and chronic
villous biopsy

3
 Amnion
 Thin extraembryonic membrane
 Loosely envelops embryo forming an amniotic sac
filled with amniotic fluid.
 The amniotic sac is lined by ectodermal cells of
inner cell mass and amniogenic cells of trophoblast.
 As the amniotic sac enlarges during the late
embryonic period (at about 8 weeks) due to collection
of more amniotic fluid within it, the amnion
gradually surrounds the whole embryo and
ensheathes the developing umbilical cord.
 The amniotic cavity grows at the expense of
extraembryonic celom, which gets obliterated and 4
Formation of
amnion.
Amnion consists
of two layers:
1. Outer layer -
somatopleuric
layer of
extraembryonic
membrane
2. Inner layer -
amniogenic
cells.
5
 Amniotic Fluid
 Clear, watery fluid containing salt, sugar, urea,
and proteins.
 Derived from:
A. Amniotic cells by filtration or secretion
B. Fetal urine when kidneys start functioning
C. Secretion of lung cells
D. Secretion by placenta.

6
 Constituents of Amniotic Fluid
1. Metabolites and hormones HUMAN
CHORIONICGONADOTROPIN & HUMAN
PLACENTAL LACTOGEN (HCG, HPL).
2. Cells that are sloughed off from fetal lungs,
placenta, and amniotic sac (all these cells have
same genetic composition).
3. Fetal urine.

7
 Functions of the Amniotic Fluid
1. Permits symmetrical development and growth.
2. Provides a water-cushion to protect the developing
embryo and fetus from jolts that the mother may
receive.
3. Maintains a consistent pressure and temperature.
4. Allows free fetal movements important for
musculoskeletal development and blood flow.
5. Forms hydrostatic bag (bag of waters) that helps in
dilatation of the cervix at the beginning of the labor.
N.B. The addition of fetal urine and swallowing of
amniotic fluid by the fetus maintains the quantity of
8
the amniotic fluid to the optimum.
 CLINICAL CORRELATION
1. Amniocentesis
 Aspiration of amniotic fluid for diagnostic
purposes.
 Usually done at 14th or 15th week of
pregnancy, when the amniotic sac contains
175–225 ml
Purpose:
(a) to examine the chromosomes in cells of
amniotic fluid for detection of genetic
diseases such as Down’s syndrome plus sex
of fetus;
(b) to detect defective enzyme involved in the
formation of myelin sheath in Tay-
Sachsdisease by biochemical techniques;
(c) to detect neural tube defects i.e presence of
high level of α-fetoprotein indicates neural 9
 CLINICAL CORRELATION
2. Oligohydramnios:
 Volume of amniotic fluid < 400mL.
 Normal amount of fluid at full-term is 700–1000 ml.
Causes
1) Placental insufficiency with reduced placental blood flow
2) Agenesis of kidneys
3) Loss of amniotic fluid due to preterm rupture of amnion.
3. Polyhydramnios:
Excessive accumulation of amniotic fluid (e.g., 2000 ml or
more) .
Causes:
4) Esophageal atresia
5) Defects of central nervous system 10
 Yolk Sac

 Endodermal sac
lying ventral to
the embryonic
disc .

11
 DEVELOPMEMT OF YOLK SAC
 Develops from the cavity of blastocyst (blastocele) and
passes through following three stages of development.
1. Primary yolk sac
2. Secondary yolk sac
3. Tertiary yolk sac or definitive yolk sac i.e remnant of
the secondary yolk sac. As embryo folds, it takes up
most of the yolk sac inside the body of the embryo to
form primitive gut. The portion of yolk sac not taken
up inside the body of the embryo is termed
tertiary/definitive yolk sac. It communicates with the
mid-gut via vitellointestinal duct.

12
 Functions of yolk sac
1. Hemopoiesis - produces
blood for the embryo until
the liver is formed during
the sixth week.
2. Formation of primitive
gut - Its dorsal portion
forms the primitive gut.
3. Formation of primordial
germ cells
4. Formation of allantois -
A small diverticulum
that arises from the caudal 13
 CLINICAL CORRELATION
Meckel’s diverticulum:
The stalk of the yolk sac (vitellointestinal duct)
usually detaches itself from the mid-gut by the
sixth week and the yolk sac gradually sinks as the
pregnancy advances. But sometimes it persists as
Meckel’s diverticulum

14
 Allantois (Allantoenteric Diverticulum)

 It is a small
diverticulum that
arises from the caudal
part of the yolk sac
during the third week.
 It develops and
grows into the
connecting stalk
 After the folding of
embryo, the allantois
is connected with the
dilated terminal part
of the hindgut called
cloaca. 15
 FUNCTIONS OF ALLANTOIS
1. It is vascularized by allantoic vessels that later
become fetal umbilical arteries and vein.
2. In adults, it is represented by median umbilical
ligament.
3. Contributes a to the formation of urinary
bladder.
N.B. In lower animals, the allantois acts as a
reservoir of urine. In humans,it is a vestigial
structure
16
 CLINICAL CORRELATION
Urachal cyst, sinus, or fistula:
 The extraembryonic portion of allantois degenerates
during the second month of intrauterine life.
 The part of intraembryonic portion gets incorporated
into apex of urinary bladder and the remaining part
involutes to form a thick urinary tube called urachus.
 After birth, the urachus becomes a fibrous cord
called median umbilical ligament , which extends
from apex of urinary bladder to the umbilicus.
 Failure of urachus to obliterate/fibrose leads to the
formation of urachal cyst, sinus,or fistula
17
 CHORION
 Highly specialized
extraembryonic membrane
 Participates in the
formation of the placenta.
 Formed by the
somatopleuric layer of
extraembryonic mesoderm
and trophoblast.
 Numerous small fingerlike
projections arise from its
surface called villi.
18
 CHORION
 On the side of decidua
capsularis, the chorion
villi regress/disappear,
leaving a smooth surface
called chorion leave
(smooth chorion).
 On the side of decidua
basalis, the chorion villi
contribute the fetal portion
of the placenta.
 It is called chorion
frondosum (leafy chorion). 19
 PLACENTA
 Placenta is a highly vascular disc-like structure
attaching unborn child (fetus) to mother’s
uterine wall.
 Consists of two components: maternal and
fetal.
 Fetal component develops from chorion and
maternal component develops from the
endometrium of the uterus.
 Placenta provides exchange of gases, nutrients,
and metabolic waste products between mother
and embryo.
20
The placental membrane is made
up of five layers. From
the maternal side to fetal side
these are:
1.Syncytiotrophoblast
2. Cytotrophoblast (up
to 20 weeks)
3. Basement
membrane of
cytotrophoblast
4. Mesoderm in the
core of villus
5. Endothelium and
basement membrane
of fetal capillaries.
21
 PLACENTA DEVELOPMEMT

1. Formation of chorion
frondosum and
chorion laeve
a) Small finger-like
projections arise from
chorion (trophoblast
and underlying
mesoderm) into the
decidua.
b) Initially chorionic villi
are formed all around
the chorionic sac.
22
 Formation of chorion frondosum and chorion laeve

a) As the chorionic sac enlarges

the chorionic villi in relation to
decidua capsularis get
compressed and degenerate. As a
result, this part of chorion
becomes smooth and is now
called chorion laeve.
b) The chorionic villi in relation to
decidua basalis grow extensively
into the decidua basalis. This
part of the chorion is called
chorion frondosum. 23
2. Formation of trabeculae and
intervillous spaces
(a) The cells of trophoblast
proliferate and lose their cell
membranes to form a
continuous sheet of cytoplasm
containing many nuclei called
syncytiotrophoblast.
(b) Trophoblast differentiats into
two layers:
1. Cytotrophoblast
2. Syncytiotrophoblast
24
(b) Syncytiotrophoblast grows
rapidly and erodes the
decidua basalis
(c) Small cavities (lacunae)
appear in thickened
syncytiotrophoblast.
(d) Lacunae increase in size
and lie radially around the
developing embryo
(blastocyst) separated from
each other by portions of
syncytiotrophoblast termed
trabeculae(villous
primordia). 25
(c) Syncytiotrophoblast further
erodes the blood vessels of
the endometrium
(d) Blood enters into the lacunae
along with the secretions of
the endometrial glands.
(e) Later lacunae communicate
with each other around the
trabeculae and form the
intervillous spaces.
(f) Thus, each trabeculus gets
surrounded all around by the
blood-filled space in the
endometrium. 26
Development of Villi
There are three types of villi that develop
in succession:
1. Primary villi:
The cytotrophoblast forms fingerlike
projections that invade the trabeculae
in its center surrounded by a layer of
syncytiotrophoblast
2. Secondary villi:
The extraembryonic somatopleuric
mesoderm lying deep to the
cytotrophoblast invades the center of
each villus.
3. Tertiary villi:
The blood vessels develop in the
mesoderm of the secondary villi. The
secondary villus with blood vessels in
27
its mesoderm is called tertiary villus
 Anchoring villi
 The cells of
cytotrophoblast in the
apical region of each
villus proliferate and
pass across the
syncytiotrophoblast to
form a continuous layer
of cytotrophoblast on the
surface of decidua
called cytotrophoblastic
shell which completely
cuts off the
syncytiotrophoblast from
28
the decidua basalis.
 The
cytotrophoblastic
shell fixes
(anchors) all villi
to the decidua .
 These villi are
now called
anchoring villi
attached at one
end with chorion
(fetal side) and
with the decidua at
the other end
29
The branching pattern of anchoring villus is as
under:
1) Truncus chorii
2) Ramus chorii
3) Ramuli chorii

30
 The anchoring villi give
off numerous offshoots
that grow and move freely
into intervillous paces as
free villi.
 In addition to this, the new
villi are further added
from chorionic side; thus
converting the intervillous
spaces into a ‘bag of
vascular sponges.’

31
 The formation of cytotrophoblastic shell divides
the syncytiotrophoblast into outer and inner
layers.
 Outer layer undergoes fibrinoid degeneration to
form Nitabuch’s layer.

32
Lobulation of Placenta
 After formation of anchoring villi, a number of
septae grow inward from the uterine endometrium
into the intervillous spaces and divide the placenta
into (15–20) lobes called cotyledons.
 Each cotyledon contains 2–3 anchoring villi.

33
 Placental Barrier or Placental Membrane
 Placental membrane prevents mixing of maternal
and fetal blood in the placenta.
 The intervillous spaces are filled with maternal
blood derived from endometrial arteries and
drained by endometrial veins.
 The chorionic villi contain fetal blood vessels.
 The maternal blood in the intervillous space is
vessels present in the villi by placental membrane
called placental barrier.

34
 Constituents of Placental Membrane
The placental membrane
is made up of five layers
namely :
1. Syncytiotrophoblast
2. Cytotrophoblast (up to
20 weeks)
3. Basement membrane of
cytotrophoblast
4. Mesoderm in the core of
villus
5. Endothelium and
basement membrane of 35
 In later part of pregnancy, as
the fetus and its nutritional
demands increase the
placental membrane becomes
thin to increase the efficiency
of transport of nutrients across
it.
 In early pregnancy the
placental membrane is about
0.025 mm thick and 0.002 mm
thick in late pregnancy.
 At the end of pregnancy the
efficiency of placental
membrane reduces due to
deposition of fibrinoid
material on the surface of the 36
Factors responsible for
thinning of placental
membrane in late
pregnacy
1. Syncytiotrophoblast
becomes thin.
2. Cytotrophoblast
disappears from the
villi.
3. Two basement
membranes disappear.
4. Endothelial cells of
fetal capillaries become 37
 Functions of Placenta
1. Exchange of gases:
 O2 from maternal blood to fetal blood and CO2
from fetal blood to maternal blood.
 A full-term fetus takes about 20–30 ml of O2 per
minute from the maternal blood. Therefore, even
a short interruption of O2 supply to the fetus may
prove fatal.
2. Transport of nutrients :
 Carbohydrates, fats, proteins, amino acids,
vitamins, and electrolytes .

38
 Functions of Placenta cont…
3. Excretion of waste products of metabolism i.e
urea, uric acid, etc., into the maternal blood.
4. Transmission of maternal antibodies :
 Maternal antibodies (IgG), α-globulins, and
immunoglobulins can cross the placental barrier to
provide passive immunity to the fetus against
infections/diseases e.g diphtheria, measles, and
poliomyelitis but not against chicken pox and
whooping cough.

39
 Functions of Placenta cont…
5. Barrier function:
 barrier to many bacteria and organisms. Some of
these or their toxins manage to cross the barrier and
may cause fetal defects such as rubella, syphilis,
etc. It also acts as a barrier for maternal hormones
such as ACTH and TSH.
6. Storage function :
 stores glycogen, calcium, and iron in early months
of pregnancy. Later this function is taken over by
liver soon.
40
 Functions of Placenta cont…
7. Production of hormones:
(a) Progesterone(by the end of the fourth month) in sufficient
amount to maintain
pregnancy.
(b) Estrogens,which promotes uterine growth and
development of mammary
gland.
(c) HCG, which has an effect similar to luteinizing hormone
(LH) of the pituitary
gland.
(d) Somatomammotropin ( HCS), which has an anti-insulin
effect on maternal blood causing increased plasma level of
glucose and amino acids in maternal blood, and enhances41
 Congenital Anomalies of the Placenta

Anomalies
Due to
Abnormal
Shape

42
 Congenital Anomalies of the Placenta

Anomalies of
placenta due
to abnormal
attachment
of the
umbilical
cord.

43
 Abnormal sites of implantation within the
uterus:
 Normally the blastocyst implants
along the posterior wall of the
cavity of body of the uterus and the
developed placenta is attached to
the upper uterine segment(upper
two-third of the body).
 Occasionally, the blastocyst
implants near the internal os and
then the developed placenta is to
the lower one third of the body of
uterus a condition termed placenta
previa. 44
Degrees of placenta previa:
A-First degree: attachment
does not extend up to the
internal os.
B- Second degree : attachment
extends up to the internal
os but does not cover it.
C-Third degree : placenta edge
covers the internal
os but when the os dilates
during child birth the placenta
no longer occludes it.
D- Fourth degree ‘central
placenta previa.’: Placenta
completely covers/bridges the
internal os even when the os is
45
fully dilated during childbirth.
 Umbilical Cord
 A long cord-like structure
 Attaches fetus to uterine wall via placenta.
 Covered by glistening amniotic membrane.
 The cord is twisted and presents false knots.
N.B.
The umbilical cord has natural twists because the
umbilical vein is longer than the umbilical arteries.

46
 Umbilical Cord

Measurements (At Full-term)

Length: 50–55 cm (about 2 ft)
Breadth: 1–2 cm

47
 Umbilical Cord Development
 Develops from connecting stalk (part of extraembryonic
mesoderm in which the extraembryonic celom does not
develop).
 Initially, the connecting stalk is attached to the roof of
amniotic cavity at one end and trophoblast at the other
end.
 Gradually, with the further development of embryo , it
becomes narrower and moves to the caudal end of the
embryo.
 Later with the formation of tail fold, it moves ventrally
in the region of umbilicus .
 Now it connects the embryo with chorion . As the
placenta develops the connecting stalk connects the fetus48
 Umbilical Cord
 Umbilical vessels develop in the connecting stalk
 The primary mesoderm of connecting stalk
undergoes mucoid generation to form a gelatinous
substance called Wharton’s jelly.
 Wharton’s jelly protects the umbilical vessels.
 As the amniotic cavity enlarges it obliterates the
extraembryonic celom and forms a tubular sleeve
around the umbilical cord.

49
UMBILICAL CORD

50
 Contents of Umbilical Cord
1. Two umbilical arteries
2. One umbilical vein (left umbilical vein)
3. Wharton’s jelly
4. Remains of allantoic diverticulum
5. Remains of vitellointestinal duct (remnant of
yolk sac)

51
 Clinical correlation
Cord prolapse:
 This is prolapse of the cord through the uterus during
parturition (child birth) .
 In this condition, the cord is likely to be compressed
between fetal head and pelvic wall of mother. This may
lead to hypoxia to the fetus.
Cord round the neck:
 In about one-fifth of all deliveries, the cord may
encircle the neck of the fetus and may cause
strangulation.
Too short cord :
 Create difficulty in parturition by pulling the placenta
 Knot
52