Chorionfrondosumanddeciduabasalis

corionfrondosoydeciduabasal

Intheearlyweeksofdevelopment,villicover
theentiresurfaceofthechorion(Fig.8.7).As
pregnancyadvances,villiontheembryonic
polecontinuetogrowandexpand,givingrise
tothechorionirondosum(bushychorion).
Villiontheabembryonicpoledegenerate,and
bythethirdmonth,thissideofthechorion,
nowknownasthechorionlaeve,issmooth.

Enlasprimerassemanasdedesarrollo,
vellosidadescubrentodalasuperficiedel
corion(Fig.8.7).Amedidaqueavanzael
embarazo,lasvellosidadessobreelbotn
Continuarpoloembrionarioparacrecery
expandirse,dandolugaralarondosum
corion(corionespeso).Vellosidadesenel
polodegeneradaabembryonic,yparaeltercer
mes,esteladoOfthecorion,ahoraconocido
comoelcorionleve,eslisa.

Thedifferencebetweentheembryonicand
abembryonicpolesofthechorionisalso
reflectedinthestructureofthedecidua,the
functionallayeroftheendometrium,whichis
shedduringparturition.Thedeciduaover
thechorionfrondosum,thedeciduabasalis,
consistsofacompactlayeroflargecells,
decidualcells,withabundantamountsof
lipidsandglycogen.Thislayer,thedecidual
plate,istightlyconnectedtothechorion.The
deciduallayerovertheabembryonicpoleis
thedeciduacapsularis(Fig.8.10A).With
growthofthechorionicvesicle,thislayer
becomesstretchedanddegenerates.
Subsequently,thechorionlaevecomesinto
contactwiththeuterinewall(deciduapari
etalis)ontheoppositesideoftheuterus,and
thetwofuse(Figs.8.10to8.12),obliterating
theuterinelumen.Hence,theonlyportionof
thechorionparticipatingintheexchange
processisthechorionfrondosum,which,
togetherwiththedeciduabasalis,makesup
theplacenta.Similarly,fusionoftheamnion
andchoriontoformtheamniochorionic
membraneobliteratesthechorioniccavity
(Fig.8.10A,B).Itisthismembranethat
rupturesduringlabor(breakingofthewater).

Ladiferenciaentrelospolosembrionariasy
abembryonicdelcorionsereflejatambinen
laestructuradeladecidua,lacapafuncional
delendometrio,queesderramadaduranteel
parto.Ladeciduasobreelcorionfrondoso,la
deciduabasal,consisteenunacapacompacta
declulasgrandes,clulasdeciduales,con
abundantescantidadesdelpidosyglucgeno.
Estacapa,laplacadecidual,est
estrechamenteconectadaalacapadecidual
chorion.Thesobreelpoloabembryonicesla
deciduacapsular(Fig.8.10A).Conel
crecimientodelArticulovescorinica,esta
capaseestiraydegenera.Posteriormente,el
corionleveentraencontactoconlapared
uterina(deciduaparibusetalis)enellado
opuestodeltero,ylosdosfusibles(Figs.
8.10a8.12),borrandoellumenuterino.Por
lotanto,lanicaporcindelcorionparticipar
enelprocesodecambioeselcorion
frondoso,que,juntoconladeciduabasal,
conformalaplacenta.Delmismomodo,la
fusindelamniosyelcorionparaformarla
membranaamniocentesisobliteralacavidad
corinica(Fig.8.10A,B).Estaesla
membranaqueserompeduranteelparto
(roturadelagua).

STRUCTUREOFTHEPLACENTA

ESTRUCTURADELAPLACENTA
Bythebeginningofthefourthmonth,thepla
centahastwocomponents:(1)afetalportion,
formedbythechorionfrondosumand(2)a
maternalportion,formedbythedecidua
basalis(Fig.8.10B).Onthefetalside,the
placentaisborderedbythechorionicplate
(Fig.8.13);onitsmaternalside,itisbordered
bythedeciduabasalis,ofwhichthedecidual
plateismostintimatelyincorporatedintothe
placenta.Inthejunctionalzone,trophoblast
anddecidualcellsintermingle.Thiszone,
characterizedbydecidualandsyncytialgiant
cells,isrichinamorphousextracellularmate
rial.Bythistime,mostcytotrophoblastcells
havedegenerated.Betweenthechorionicand
decidualplatesaretheintervillousspaces,
whicharefilledwithmaternalblood.Theyare
derivedfromlacunaeinthe
syncytiotrophoblastandarelinedwith
syncytiumoffetalorigin.Thevilloustrees
growintotheintervillousbloodlakes(Figs.
8.8and8.13).
Duringthefourthandfifthmonths,the
deciduaformsanumberofdecidualsepta,
whichprojectintointervillousspacesbutdo
notreachthechorionicplate(Fig.8.13).These
septahaveacoreofmaternaltissue,buttheir
surfaceiscoveredbyalayerofsyncytial
cells,sothatatalltimes,asyncytiallayer
separatesmaternalbloodinintervillous
lakesfromfetaltissueofthevilli.Asaresult
ofthisseptumformation,theplacentais
dividedintoanumberofcompartments,or
cotyledons(Fig.8.14).Becausethedecidual
septadonotreachthechorionicplate,contact
betweenintervillousspacesinthevarious
cotyledonsismaintained.
Asaresultofthecontinuousgrowthofthe
fetusandexpansionoftheuterus,thepla

Porelprincipiodelacuartameses,la
placentatienedoscomponentes:(1)una
porcinfetal,formadoporelcorionfrondoso
y(2)unapartedelamadre,formadaporla
deciduabasal(Fig.8.10B).Enelladodel
feto,laplacentaesderedBorporlaplaca
corinica(Figura8.13.);ensuladomaterno,
esconfinadoporladeciduabasal,delos
cualeslaplacadecidualseincorporams
ntimamenteenlaplacenta.Enlazonade
unin,trofoblastoyclulasdecidualesse
entremezclan.Estazona,quesecaracteriza
porclulasgigantesdecidualesysincitiales,
esricaenmaterialamorfoextracelular.Enese
momento,lamayoradelasclulasdel
citotrofoblastosehandegenerado.Entrelas
placascorinicasydecidualessonlos
espaciosintervellosos,queestnllenoscon
blood.TheymaternasederivandeNAElacu
enelsincitiotrofoblastoysealineancon
sincitiodeorigin.Thefetalrbolesvellosos
crecenenloslagosdesangreintervellosos
(Figs.8,8y8,13).
Durantelosmesescuartoyquinto,ladecidua
formaunaseriedetabiquesdeciduales,que
proyectoenespaciosintervellososperono
lleganalaplacacorinica(Fig.8.13).Estos
septoshaberunncleodetejidomaterno,
perosusuperficieestcubiertaporunacapa
declulassincitiales,demodoqueentodo
momento,unacapacytialsincronizacin
separalasangrematernaenintervillagos
Lousdetejidofetaldelosvilli.Asresultado
deestaformacindeseptum,laplacentase
divideenunnmerodecompartimientos,o
cotiledones(Fig.8.14).Debidoaquelos
tabiquesdecidualesnolleganalaplaca
corinica,semantieneelcontactoentrelos

centaalsoenlarges.Itsincreaseinsurface
arearoughlyparallelsthatoftheexpanding
uterus,andthroughoutpregnancy,itcovers
approximately15%to30%oftheinternal
surfaceoftheuterus.Theincreaseinthickness
oftheplacentaresultsfromarborizationof
existingvilliandisnotcausedbyfurther
penetrationintomaternaltissues.

espaciosintervellososenlosdiversos
cotiledones.

FULLTERMPLACENTA

PlacentaatrminoCOMPLETO

Atfullterm,theplacentaisdiscoidwitha
diameterof15to25cm,isapproximately3
cmthick,andweighsabout500to600g.At
birth,itistornfromtheuterinewalland,
approximately30minutesafterbirthofthe
child,isexpelledfromtheuterinecavityas
theafterbirth.Whentheplacentaisviewed
fromthematernalside,15to20slightly
bulgingareas,thecotyledons,coveredbya
thinlayerofdeciduabasalis,areclearly
recognizable(Fig.8.14B).Groovesbetween
thecotyledonsareformedbydecidualsepta.

Altrmino,laplacentaesdiscoideconun
dimetrode15a25cm,esde
aproximadamente3cmdeespesor,ypesa
alrededorde500a600g.Alnacer,quees
arrancadodelapareduterinay,
aproximadamente30minutosdespusdel
nacimientodelnio,esexpulsadodela
cavidaduterinocomoelafterbirth.Whenla
placentasevedesdeelladomaterno,de15a
20zonasligeramentesaltones,los
cotiledones,cubiertosporunafinacapade
deciduabasal,sonclaramentereconocibles
(Fig.8.14B).Ranurasentreloscotiledonesse
formanportabiquesdecidual.

Thefetalsurfaceoftheplacentaiscovered
entirelybythechorionicplate.Anumberof
largearteriesandveins,thechorionicvessels,
convergetowardtheumbilicalcord(Fig.
8.14A).Thechorion,inturn,iscoveredbythe
amnion.Attachmentoftheumbilicalcordis
usuallyeccentricandoccasionallyeven
marginal.Rarely,however,doesitinsertinto
thechorionicmembranesoutsidetheplacenta
(velamentousinsertion).

Comoresultadodelcontinuocrecimientodel
fetoylaexpansindeltero,laplacenta
tambinseagranda.Suaumentodela
superficieparalelaamsomenosladela
expansindeltero,yduranteelembarazo,
quecubreaproximadamente15%a30%dela
superficieinternadelaumentouterus.Theen
elespesordelosresultadosplacentade
arborizacindelasvellosidadesexistenteyes
nocausadoporunamayorpenetracinenlos
tejidosmaternos.

Lasuperficiefetaldelaplacentaest
totalmentecubiertaporlaplacacorinica.Un
nmerodegrandesarteriasylasvenas,los
vasoscorinicas,convergenhaciaelcordn
umbilical(Fig.8.14A).Lacorion,asuvez,
estcubiertaporelamnios.Launindel
cordnumbilicalesnobajadealiado
excntricoyocasionalmenteincluso
marginal.Raravez,sinembargo,hacequese
insertanenlasmembranasexternascorinicas
delaplacenta(insercinvelamentosa).

CIRCULATIONOFTHEPLACENTA
Cotyledonsreceivetheirbloodthrough80to
100spiralarteriesthatpiercethedecidual
plateandentertheintervillousspacesatmore
orlessregularintervals(Fig.8.13).Pressure
inthesearteriesforcestheblooddeepintothe
intervillousspacesandbathesthenumerous
smallvilliofthevilloustreeinoxygenated
blood.Asthepressuredecreases,bloodflows
backfromthechorionicplatetowardthe
decidua,whereitenterstheendometrialveins
(Fig.8.13).Hence,bloodfromtheintervillous
lakesdrainsbackintothematernalcirculation
throughtheendometrialveins.
Collectively,theintervillousspacesofa
matureplacentacontainapproximately150
mLofblood,whichisreplenishedaboutthree
orfourtimesperminute.Thisbloodmoves
alongthechorionicvilli,whichhaveasurface
areaof4to14m2.Placentalexchangedoes
nottakeplaceinallvilli,however,onlyin
thosethathavefetalvesselsinintimate
contactwiththecoveringsyncytial
membrane.Inthesevilli,thesyncytiumoften
hasabrushborderconsistingofnumerous
microvilli,whichgreatlyincreasesthesurface
areaandconsequentlytheexchangerate
betweenmaternalandfetalcirculations.The
placentalmembrane,whichseparates
maternalandfetalblood,isinitiallycompose
offourlayers:1)theendothelialliningof
fetalvessels,2)theconnectivetissueinthe
villuscore,3)thecytotrophoblasticlayer,and
4)thesyncytium.Fromthefourthmonthon,
theplacentalmembranethinsbecausethe
endothelialliningofthevesselscomein
intimatecontactwiththesyncytialmembrane,
getakyincreasingtherateofexchange.
Sometimescalledtheplacentalbarrier,the
placentalmembraneisnotatruebarrier,as
manysubstancespassthroughitfreely.

CIRCULACINDELAPLACENTA
Cotiledonesrecibensusangreatravsde80a
100arteriasespiralesqueperforanlaplaca
decidualyentranenlosespaciosintervellosos
aintervalosmsomenosregulares(Fig.
8.13).Presinenestasarteriasimpulsala
sangreprofundamenteenlosespacios
intervilLousybaalasnumerosaspequeas
vellosidadesdelrbolvellosoenlasangre
oxigenada.Amedidaquelapresin
disminuye,lasangrefluyehaciaatrsdela
placacorinicahacialadecidua,dondeentra
enlasvenasendometriales(Fig.8.13).Porlo
tanto,lasangredeloslagosintervellosos
drenadenuevoenlacirculacinmaternaa
travsdelasvenasendometrial.
Enconjunto,losespaciosintervellososdeuna
placentamaduracontienenaproximadamente
150mldesangre,quesereponesobretreso
cuatrovecesporminuto.Estasangrese
muevealolargodelasvellosidades
corinicas,quetienenunasuperficiede4a14
m2.elintercambiodelaplacentanotiene
lugarentodaslasvellosidades,sinembargo,
sloenlosquetienenlosvasosfetalesen
contactontimoconlamembranaquecubre
sincitial.Enestasvellosidades,elsincitioa
menudotieneunbordeencepilloconstade
numerosasmicrovellosidades,loqueaumenta
engranmedidaelreasuperficialyporlo
tantoeltipodecambioentrelascirculaciones
maternayfetal.Lamembranadelaplacenta,
queseparalasangrematernayfetal,se
componeninicialmentedecuatrocapas:1)el
revestimientoendotelialdelosvasosfetales,
2)eltejidoconectivoenelncleodelas
vellosidades,3)lacapadecitotrofoblstica,y
4)sincitio.Apartirdelcuartomes,la
membranaplacentariaseadelgazaporqueel

Becausethematernalbloodintheintervillous
spacesisseparatedfromthefetalbloodbya
chorionicderivative,thehumanplacentais
consideredtobeofthehemochorialtype.
Normally,thereisnomixingofmaternaland
fetalblood.However,smallnumbersoffetal
bloodcellsoccasionallyescapeacross
microscopicdefectsintheplacenatal
membrane.

revestimientoendotelialdelosvasosen
contactontimoconlamembranasincitial,
getakyelaumentodelatasadecambio.A
vecessedenominalabarreraplacentaria,la
membranadeplacentanoesunaverdadera
barrera,yaquemuchassustanciaspasana
travsdellibremente.Debidoaquela
sangrematernaenlosespaciosintervellosos
seseparadelasangrefetalporunderivado
corinica,laplacentahumanaseconsidera
queesdeltipohemochorial.Normalmente,no
haymezcladesangrematernayfetal.Sin
embargo,unpequeonmerodeclulas
sanguneasfetalesdevezencuandoescapara
travsdefectosmicroscpicosenla
membranaplacenatal.