Foetal membranes

A/P Dr San San Thwin

Foetal membranes

Placenta Amnion Connecting stalk with Umbilical cord, allantois and umb: vess: Yolk stalk ( vitelline duct) Yolk sac

Early developmental stage(1st Week)

After

fertilization Zygote Cleavage ( cell division) Morula(16 cell stage) -Blastocyst ( Outer cell mass, inner cell mass with blastocyst cavity)

Placenta

At the 8th day (2nd week) of intrauterine life, blastocyst is partially embedded in the endometrial stroma. Blastocyst consists of Inner cell mass or Embryoblast Outer cell mass or Trophoblast Trophoblast consists of Cytotrophoblast- inner, mononucleated cells -Syncytiotrophoblastouter, multinucleated cells without cell boundaries

Placenta

As the blastocyst penetrates deeper into the endometrium in the embryonic pole, vacuoles appear in the syncitium. These vacuoles fuse to form large lacunae. This stage is known as Lacunar stage

Placenta

Subsequently maternal sinusoids in the endometrium are eroded by syncitiotrophoblast & as a result, maternal blood enters the lacunar spaces, thus establishing uteroplacental circulation.

Placenta
CS

Chorionic Villi Formation of Chorionic Villi

By 3rd week, Trophoblast forms

A .Primary villus( 2 layers -cytotrophoblast & syncitiotrophoblast), B. then 2ndary villus ( with mesoderm core) and C. finally Tertiary villus( capp: formed in the core)

Placenta

Cappillaries in the tertiary villi make contact with the mesoderm of chorionic plate & connecting stalk. These vessels in turn establish contact with the intra- embryonic circulatory system, there by connecting the placenta and the embryo( via the connecting stalk)

Conn: stalk

Placenta

The cytotrophoblastic cells in the villi penetrate progressively into the overlying syncitium until they reach the endometrium. They establish contacts with the similar extensions of the neighbouring villi, thus forming an Outer trophoblastic shell. Villi that extend from chorionic plate to decidual plate are called Anchoring villi.

Placenta

The chorionic cavity becomes larger and the embryo is attached to the trophoblastic shell by a narrow connecting stalk, which later forms the Umbilical cord.

Umb: cord

Placenta

During the following months, small extensions sprout from the existing villous stems into the surrounding lacunar or inter- villous space.

Placenta
Placental Membrane or Placental Barrier initially consists of endothelial lining of foetal vessels the connective tissue in the villous core the cytotrophoblast the syncitiotrophoblast

Placenta

By 4th month cytotrophoblastic cells & some connective tissue cells ( C& C) disappear. The syncitium & endothelial wall of blood vessel are the only layers that separate the maternal & foetal circulation forming the Placental Barrier.

Placenta

Since the maternal blood in the intervillous space is separated from foetal blood by a chorionic derivative, the human placenta is considered as Hemochorial type.

Chorion Frondosum and Decidua Basalis

In the early week of development, villi cover the entire surface of chorion. Villi on the embryonic pole grow & expand to form Chorion Frondosum or Bushy Chorion. Villi on abembryonic pole degenerate & become smooth and is known as Chorion Laevae or Smooth Chorion. Decidua Basalis is derived from maternal endometrium

D. Basalis

Chorion Frondosum and Decidua Basalis

D. Bas

Decidual Reaction Changes occur in the decidua, which is the functional layer of endometrium and it is shed during parturition. Decidua that is in contact with chorion frondosum is Decidua Basalis Decidua over the abembryonic pole- Decidua Capsularis Decidua over the uterine wall Decidua Parietalis

D. Capsu D. Pariet

Placenta
With the increase in size of the chorionic cavity, the chorion laeve comes into contact with the decidua parietalis Formation of placenta is from 2 parts
1.Chorionic Plate or

Chorion Frondosum 2.Decidual Plate or Decidua basalis

Foetal Membranes

Similarly fusion of amnion and chorion form Amniochorionic Membrane. This membrane ruptures during delivery of the baby known as Breaking of Water.

Placenta
Cotyledons

Structure of placenta By the beginning of 4th month, placenta has 2 components Maternal portion- decidua basalis or decidual plate Foetal portion chorionic plate or chorion frondosum In the junctional zone decidual and syncitial cells intermingle. During 4th and 5th month, decidua forms a number of septa, the decidual septa project into intervillous spaces but do not reach the chorionic plate. As a result, the placenta is divided into a number of compartments or cotyledons.

Placenta
Functions Exchange of gases- like O2, Co2, Co Exchange of nutrients and electrolytes like amino acid, fatty acid, carbohydrate, vitamins Transmission of maternal antibodies- like immunoglobulin G Hormones production- like progesteron, oestrogen, human chorionic gonadotropin ( HCG), somato-mammotropin

Placenta
Full term placenta Discoid shape, diameter of 1525 cm, 3 cm thick, and weight is 500-600 gm. It comes out 30 minutes after the birth of the child. On the maternal side, it has 1520 cotyledons covered by a thin layer of decidua basalis and grooves between the cotyledons are formed by decidual septa ..
Cotyle :

Placenta
. The fetal surface of placenta
is covered by chorionic plate with chorionic vessels & umbilical cord, chorion and amnion Attachment of umbilical cord is usually eccentric and occasionally marginal Placenta with a marginal attachment of umbilical cord is called a battledore placenta

Placenta

Velamentous type where umbilical cord is attached to the chorionic membranes and not to the placenta

Placental abnomalities

Placenta accretachorionic villi penentrate the myometrium Placenta percretachorionic villi penentrate myometrium and perimetrium ( peritoneal lining) Placenta previablastocyst implants close to or overlying the internal os ( opening near cervix)

Foetal Membranes
Other foetal membranes are:

1.The connecting stalk( umbilical cord)containing the allantois and umbilical vessels (2 arteries and 1 vein) Wharton jelly a loose connective tissue in the umbilical cord forms a protective layer for the umbilical vessels.

Foetal Membranes
2.Yolk stalk or vitelline duct or vitello-intestinal duct Canal connecting the intraembryonic and extraembryonic cavities Yolk Sac- is present in the chorionic cavity. Later with the enlargement of amniontic cavity, the amnion comes in contact with chorion there by obliterating the chorionic cavity. Yolk sac shrink and is later obliterated.

Foetal Membranes

3.Allantois is an endodermal diverticulum from the hind gut It extends from urinary bladder to umbilicus and involutes to form urachus and after birth becomes median umbilical ligament birth

Foetal Membranes

4.Amnion, Amniotic fluid clear, watery fluid produced by amniotic cells and primarily from maternal blood. It is about 800-1000 ml at 37th week. Functions protective cushion, absorbs shock prevent adherence of embryo to the amnion allow foetal movements exchange of metabolic wastes during child birth, it forms a hydrostatic wedge that helps to dilate the cervical canal.

Foetal Membranes

Clinical correlations Hydramnios or polyhydramnios where there is excess of amniotic fluid( 1500 2000ml) Oligohydramnios refers to a decreased amount of amn: fluid ( 400 ml) Premature rupture of amnion is the most common cause of preterm labor and occurs in 10% of pregnancies

Clinical correlations

An extremely long umbilical cord may encircle the neck or any part of the body or a short cord may cause difficulty in delivery by pulling the placenta.

Clinical correlations

Ocassionally tear in amnion result in amniotic bands that may encircle part of foetus forming ring constrictions, amputations or other abnomalities.