AUTONOMIC NERVOUS SYSTEM

 Provides the efferent (motor) pathway linking areas of the brain concerned with the
regulation of the internal environment to specific effectors such as blood vessels, glands
and the heart

SYMPATHETIC DIVISION *****

 EFFERENT fibres originate in cells in the inter-mediolateral column of T1 - L2/3 segments

of the spinal cord - pre-ganglionic neurons *

 Axons of pre-ganglionic fibres emerge via the ventral root of the spinal cord together with
somatic motor fibres *
 Shortly after the dorsal and ventral roots of the spinal cord fuse, sympathetic pre-ganglionic
fibres leave the spinal nerve trunk and travel to sympathetic ganglia via white rami
communicantes *
 Sympathetic pre-ganglionic fibres synapse with post-ganglionic neurons in the sympathetic
ganglia *
 Fibres entering the sympathetic ganglia high up in the thorax may travel up the sympathetic
trunk to cervical ganglia where they synapse with post-ganglionic neurons
 Pre-ganglionic fibres may pass through the sympathetic ganglia without synapsing - these
myelinated fibres form splanchnic nerves of which there are three - greater splanchnic
nerve (5th - 9th thoracic ganglia - pierce the diaphragm and synapse in the celiac ganglion),
lesser splanchnic nerve (10thand 11th thoracic ganglia, pierce the diaphragm and synapse
with cells in the lower part of the celiac plexus) and lowest splanchnic nerve (12 th thoracic
ganglion, may be absent, pierces the diaphragm and synapses with cells in the renal
plexus) *
 A few pre-ganglionic fibres travelling in the greater splanchnic nerve synapse directly with
cells in the adrenal medulla *

 Sympathetic post-ganglionic fibres travel to target organs via grey rami communicantes and
segmental spinal nerves *
 Sympathetic pre-ganglionic fibres may therefore terminate in the ganglion of the same
segment or pass to another ganglion in the sympathetic chain or to pre-vertebral ganglia
such as the celiac ganglion *

 Sympathetic pre-ganglionic fibres are myelinated (white) while post-ganglionic fibres are
non-myelinated (grey) *

 With the exception of the cervical region, sympathetic ganglia are distributed segmentally as
far as the coccyx *

 The cervical sympathetic chain is represented by the superior, middle and inferior cervical
ganglia which supply the eyes, lacrimal, salivary glands (superior), heart and respiratory
tract (middle & inferior plus upper 3-4 thoracic ganglia) *
 Sympathetic pre-ganglionic fibres to the abdominal organs form the splanchnic nerves
which are distributed to the celiac, superior and inferior mesenteric plexuses *
 All pre-ganglionic fibres secrete acetylcholine *

1
  AFFERENT myelinated fibres travel from the viscera through the sympathetic ganglia
without synapsing, enter the spinal nerve via the white rami communicantes and reach their
cell bodies in the posterior (dorsal) root ganglion of the corresponding spinal nerve. The
central axon then enters the spinal cord and may form the afferent component of a local
reflex arc or pass to higher autonomic centres in the brain *

CHROMAFFIN CELLS *****

 Derived embryologically from the neuro-ectoderm (neural crest). During development, chromaffin
cells are widely scattered within the embryo but in the adult can only be found in the adrenal medulla*

 Innervated by pre-ganglionic fibres from the thoracic spinal cord via the splanchnic nerves. These
fibres synapse directly with the chromaffin cells which are homologous to sympathetic post-ganglionic
neurons and can generate action potential *

 Sympathetic pre-ganglionic fibres are myelinated while post-ganglionic fibres are non-myelinated. All
pre-ganglionic fibres secrete acetylcholine *

Synthesis of adrenaline in adrenal medulla *****

 Tyrosine converted to dihydrophenylalanine (DOPA) by tyrosine hydroxylase *

 DOPA converted to dopamine by DOPA decarboxylase *
 Dopamine converted to noradrenaline by dopamine-beta-hydroxylase *

 Noradrenaline converted to adrenaline by phenylethanolamine-N-methyltransferase

ORGAN SYMPATHETIC PARASYMPATHETIC

Eyes - pupils Dilatation Constriction / accomodation

Lachrymal glands No effect / vasoconstriction Secretion

Heart Tachycardia & increased Bradicardia, no effect on force of

force of contraction contraction

Salivary gland Secretion of viscous fluid, Copious secretion of saliva,

vasoconstriction vasodilatation

Blood vessels Vasoconstriction. Vasodilatation in some exocrine

Vasodilatation in skeletal glands and external genitalia
muscle

Lungs Bronchodilatation Bronchoconstriction & increased

secretion

2
Adrenal medulla Secretion of adrenaline & No innervation
noradrenaline

GI Tract Vasoconstriction, Increased motility and secretion;

constriction of sphincters, relaxation of sphincters
decreased motility and
secretion
Kidneys Vasoconstriction & No effect
decreased urine out-put

Bladder Inhibit micturiction Initiate micturiction

Sweat glands Secretion by eccrine glands No innervation

Hair follicle Piloerection No innervation

Genitalia Ejaculation Erection

PELVIC SPLANCHNIC NERVES

 There are thoracic, lumbar, sacral, and pelvic splanchnic nerves. "Splanchnic" refers to
nerves that supply viscera. *
 Thoracic, lumbar and sacral splanchnic nerves emerge from sympathetic ganglia and
carry sympathetic fibers*

 Pelvic splanchnic nerves arise from the ventral (anterior) primary rami of S2, 3, 4. *

 These are the ways in which parasympathetic neurons reach the hypogastric plexus,
and therefore the pelvic viscera and distal colon.*

 The parasympathetic part of the autonomic nervous system is the "craniosacral" part.
Parasympathetic innervation to most of the gut comes from the "cranio-" half of that, i.e., the
vagus nerve. The rest, to colon distal to the splenic flexure and to pelvic viscera, is from the
"-sacral" half, via the pelvic splanchnic nerves.

 Intermingle with sympathetic nerves in the hypogastric plexus

 Pelvic splanchnic nerves innervate the kidneys, urinary bladder, distal portions of the
large intestine and the sex organs. Contain EFFERENT fibres
 Stimulate smooth muscle activity in the distal large bowel
 Contract the detrusor and relax the urethral sphincter

 Vasodilatation of genital / reproductive organs

3
 AFFERENT / EFFERENT FIBRES *****

 Each spinal nerve is connected to the spinal cord by two roots - anterior (ventral) and
posterior (dorsal) roots
 The anterior root contains nerves carrying impulses AWAY FROM the CNS - EFFERENT
fibres. Efferent fibres to skeletal muscles are called motor fibres - cell bodies located in the
anterior grey horn of the spinal cord *
 Posterior roots contain fibres carrying impulses TO the CNS - AFFERENT fibres -
conveying information about sensation of touch, pain, temperature, vibration - SENSORY
fibres. Cell bodies are located in the posterior / dorsal root ganglion with a peripheral axon
to the viscera and a central axon to the CNS *
 At each intervertebral foramen, the anterior and posterior roots unite to form a spinal nerve *
 On emerging from the foramen, each spinal nerve divides into a large anterior ramus and a
smaller posterior ramus which passes posteriorly to supply the skin and muscle of the back.
The anterior ramus supplies the antero-lateral body wall and limbs *
 At the root of the limbs, the anterior rami come together to form complex nerve plexuses

REGULATION OF CATECHOLAMINE RELEASE *****

Basal secretion is very small

 Secretion mediated directly by the activity of the splanchnic nerves and the gland
becomes non-functional if these nerves are cut
 Secretion increased in stressful situations: *

1) Exercise

2) Hypoglycaemia

3) Cold

4) Haemorrhage

5) Hypotension

6) Emotional situations such as fear, anger, pain, sexual arousal

7) Glucocorticoids via cortical sinusoids stimulate conversion of noadrenaline to adrenaline

8) Fetal adrenal responds directly to hypoxia

 Phaeochromocytoma - tumour of the chromaffin cells is characterised by increased catecholamine

production*

 Results in episodic or sustained hypertension, tremor, hyperglycaemia, anxiety, arrhythmias,

sweating and a raised metabolic rate *

Question 1: The parasympathetic nervous system supplies

a. Dilator fibres to the bronchioles

True False
b. Inhibitory fibres to the myocardium

4
 True False
c. Dilator fibres to the sphincter pupillae
True False
d. Constrictor fibres to the small intestine
True False

Question 2: The pelvic splanchnic nerves

a. Are derived from posterior rami of sacral spinal nerves

True False
b. Supply the ascending colon with motor fibres
True False
c. Supply the uterus with parasympathetic fibres
True False
d. Contain parasympathetic fibres
True False

Question 3: The pelvic splanchnic nerves

a. Supply afferent fibres

True False
b. Intermingle with branches of the sympathetic pelvic plexus
True False
c. Are pre-ganglionic fibres
True False
d. Supply the bladder sphincter with motor fibres
True False

Question 4: Chromaffin cells

a. Are present in the celiac ganglion

True False
b. Are derived from neuro-ectoderm
True False
c. Are present in the adrenal cortex
True False
d. Are present in the adrenal medulla
True False

Question 5: The sympathetic ganglia

a. Are arranged segmentally in the cervical sympathetic chain

True False
b. Contain cholinergic pre-ganglionic nerve terminals
True False

5
 c. Contain adrenergic pre-ganglionic nerve terminals
True False
d. Receive non-myelinated pre-ganglionic fibres through the grey rami communicantes
True False

Question 6: The sympathetic nervous system supplies

a. Inhibitory fibres to the detrusor muscle

True False
b. Constrictor fibres to blood vessels in skeletal muscle
True False
c. Constrictor fibres to the sphincter of Oddi
True False
d. Dilator fibres to blood vessels of the external genitalia
True False

Question 7: The sympathetic nervous system supplies

a. Dilator fibres to the bronchial tree

True False
b. Constrictor fibres to the muscle of the small intestine
True False
c. Inhibitory fibres to the detrusor muscle
True False
d. Inhibitory fibres to the detrusor muscle
True False

Question 8: The pelvic splanchnic nerves

a. Are motor to the internal sphincter of the bladder

True False
b. Contain afferent fibres for the ovary
True False
c. Conduct pain from the body of the uterus
True False
d. Have noradrenaline as the neurotransmitter
True False

Question 9: The release of catecholamines from the adrenal medulla

a. Increases during sleep in healthy individuals

True False
b. Increases when the nerves to the adrenal gland are stimulated
True False
c. Increases following an increase in blood sugar

6
 True False
d. Increases during acute haemorrhage
True False

Question 10: The pelvic splanchnic nerves

a. Supply the uterus with vasodilator fibres

True False
b. Contain sympathetic fibres
True False
c. Contribute to the inferior hypogastric plexus
True False
d. Contribute to the inferior mesenteric plexus
True False

Question 11: With respect to the nervous system

a. Efferent fibres transmit impulses away from the CNS

True False
b. Each spinal nerve has a larger posterior and a smaller anterior ramus
True False
c. The anterior (ventral) root of the spinal cord contains efferent fibres
True False
d. The posterior (dorsal) root of the spinal cord contains sensory fibres
True False

Question 12: Chromaffin cells

a. Can decarboxylate amino acids

True False
b. Are innervated by pre-ganglionic sympathetic fibres
True False
c. Can generate action potential
True False
d. Are innervated by non-myelinated nerve fibres
True False

Question 13: The sympathetic nervous system supplies

a. Dilator fibres to the bronchial tree

True False
b. Constrictor fibres to the muscle of the small intestine
True False
c. Inhibitory fibres to the detrusor muscle
True False

7
 d. Constrictor fibres to the coronary arteries
True False

Question 14: The sympathetic ganglia

a. Are located within the walls of abdominal viscera

True False
b. Contain afferent myelinated fibres
True False
c. Contain the cell bodies of pre-ganglionic neurons
True False
d. Contain the cell bodies of post-ganglionic neurons
True False

Question 15: Parasympathetic stimulation results in

a. Ejaculation
True False
b. Increased secretion by eccrine sweat glands
True False
c. Viscous secretion by the salivary glands
True False
d. Renal vasoconstriction and decreased urine out-put
True False

PRE-IMPLANTATION DEVELOPMENT *****

 The Zygote begins a series of mitotic divisions within 24h of fertilization - cleavage. The
number of cells increases but the size of the embryo remains constant within the zona
pellucida - results in a decrease in mean cell volume. By the 32 cell stage, the embryo is
called a morula *
 The cells (blastomeres) become segregated into the inner cell mass which forms the
embryo proper and the outer cell mass which forms the placenta and membranes *
 Fluid collects between the cells of the inner cell mass, forming a blastocyst cavity - day 4 of
development

The blastocyst enters the uterine cavity ~day 4, hatches from the zona Pellucida *

PRIMITIVE STREAK *****

 Appears during the third week and is clearly visible by day 15-16
 Narrow groove on the epiblast with slightly bulging sides
 Cephalic end forms primitive node - elevated area surrounding a small pit, the primitive pit

8
  ells from the epiblast migrate towards the primitive streak, detach from and slip underneath
the epiblast to form a third layer between the epiblast and hypoblast - the intra-embryonic
mesoderm
 These cells also form most, or all of the intra-embryonic endoderm
 This process is known as gastrulation, at the end of which the remaining epiblast forms the
ectoderm
 The ectoderm and endoderm remain in contact, without intervening mesoderm in two
regions - the buccopharyngeal membrane and the cloacal membrane

NERVOUS SYSTEM *****

 Development begins during the third week *

 A thickening of the ectoderm forms the neural plate with elevated lateral edges forming the
neural folds and the depressed mid-region forming the neural groove *
 Fusion of the neural folds begins in the region of the future neck (4th somite) and proceeds
in ceplalic and caudal directions, forming the neural tube
 The neural tube remains temporarily open to the amniotic cavity at the anterior and
posterior neuropores *
 The anterior neuropore closes on day 25 and the posterior on day 27 *
 Abnormal fusion of the neural tube results in neural tube defects - spina bifide /
anencephaly. Risk reduced by use of folic acid 12 weeks before to 12 weeks after
fertilisation *

NEURAL CREST *****

 Ectodermal cells at the edge of the neural grove, become detached and located initially
between the closed neural tube and the overlying ectoderm *
 Contribute to several important structures including

1) The truncoconal septum of the heart - migrate via pharyngeal arches. Form the connective
tissue , muscle and parasympathetic ganglia *

2) Dorsal root ganglia of spinal nerves *

3) Sensory ganglia of 5th, 7th, 9th and 10th cranial nerves *

4) Aortic sympathetic ganglia *

5) Sympathetic chain *

6) Parasympathetic ganglia *

7) Melanocytes *

8) Cartilage of pharyngeal arches *

9) Odontoblasts *

10) Schwann cells and meninges *

9
SPERMATOGENESIS

 Begins at puberty under the influence of testosterone *

 Sertoli cells differentiate and the sex cords become canalised and converted into
seminiferous tubules *
 The dormant primordial germ cells divide by mitosis and then differentiate into
spermatogonia located immediately beneath the basement membrane of the
seminiferous tubules *
 Germ cells are translocated from the basement membrane to the lumen of the
seminiferous tubule as spermatogenesis progresses

 Spermatogonium - (mitotic division) -primary spermatocyte - (first meiotic

division) - secondary spermatocyte - (second meiotic division) - spermatid -
(spermiogenesis) - spermatozoon *
 Spermatozoon obtain full motility in the epididymis *
 Spermatogenesis takes 64 days *
 Primordial germ cells - diploid (2N) *
 Spermatogonia - diploid (2N) *
 Primary spermatocytes - diploid (4N) *
 Secondary spermatocytes - haploid (2N) *
 Spermatides - haploid (N) *

SPERMATOZOON *****

 Head - contains a condensed nucleus capped by the acrosome which contains

hydrolytic enzymes
 Middle-piece - contains large helical mitochondria which generate the power for
swimming
 Tail - contain microtubules forming part of the propulsion system
 Sperm morphology is not important in determining fertility and abnormal spermatozoa
are commonly present in fertile semen *
 Capacitation - changes in the acrosome in preparation for release of hydrolytic
enzymes required to penetrate the zona pellucida - occurs in the female genital
tract

OOGENESIS *****

 Begins during intra-uterine life. The primordial germ cells undergo mitosis and then
differentiate into oogonia *
 By the 5th month in-utero, the number of oogonia is at a maximum - 7 million *
 Oogonia enlarge into primary oocytes. These are surrounded by flattened follicular
cells forming primordial follicles
 Primary oocyte enters prophase of meiosis I and becomes arrested at the dictyotene
stage. Meiosis I is not completed until puberty *

10
 Primordial follicles begin to degenerate such that at birth, there are 700,000 - 2
million, and at puberty there are 40,000 *
 Several primordial follicles (10-12) begin to mature with each menstrual cycle and one
dominant follicle becomes selected by mechanisms which are not fully
understood *
 Follicular cells become cuboidal, forming the primary follicle. A layer of acellular
mucopolysaccharide becomes deposited between the developing oocyte and the
follicular cells, forming the zona pellucida
 Resumption of meiosis is triggered by the ovulatory LH / FSH surge with formation of
the secondary oocyte with most of the cytoplasm and the first polar body *
 Ovulation occurs the moment the secondary oocyte shows spindle formation and the
second meiotic division is only completed if fertilisation occurs *
 The polar body also completes meiosis II, resulting in one definitive oocyte and three
polar bodies *

FERTILIZATION *****

 Occurs in the ampulla of the fallopian tube *

 The second meiotic division in the oocyte is only completed if fertilization occurs *
 The spermatozoan undergo capacitation within the female genital tract, during which
seminal plasma proteins and a glycoprotein coat are removed from the plasma
membrane overlying the acrosome
 The spermatozoan force their way through the cumulus oophorus to reach the zona
pellucida to which they are attached aided by sperm receptors
 The acrosome reaction results in the release of hydrolytic enzymes and one
spermatozoan enters the oocyte. This causes immediate release of cortical
granules into the perivitelline space (between the oocyte cell membrane and the
zona pellucida, preventing penetration by other sperm *

DEVELOPMENT OF THE TESTIS *****

 The gonads do not develop male / female differentiation until the end of the 6th week *
 Primordial germ cells develop from the yolk sac endoderm and migrate via the dorsal
mesentery of the hindgut to reach the gonadal ridge in the 6th week *
 Failure of migration results in gonadal agenesis
 The gonadal ridge develops medial to the mesonephros by proliferation of the coelomic
epithelium and condensation of the underlying mesenchyme, forming the primitive
sex cords
 The sex-determining region of the Y chromosome has a testis determining factor,
transcription of which triggers male development *
 Primitive sex cords proliferate into medullary cords with Sertoli cells which produce
Mullerian Inhibiting Factor which acts on the ipsilateral Mullerian tube only, causing

11
 degeneration. Mullerian remnants in the male include the appendix testis and the
Utriculus prostaticus *
 Leydig (Interstitial) cells develop from the mesenchyme and produce testosterone,
influencing development of the duct system and external genitalia. The enzyme 5-
alpha reductase is essential for the development of the external genitalia but not for
the development of the duct system *
 The distal excretory tubules of the mesonephros persist, forming the ductuli efferentes while
the mesonephric duct elongates and forms the eipdidymis and vas deferens *
 The medullary cords remain solid until puberty when they become canalised, forming the
seminiferous tubules *
 The first meiotic division and spermatogenesis do not commence until puberty *
 The seminal vesicles develop as outgrowth of the mesonephric duct while the prostate and
bulbo-urethral glands develop from the prostatic urethra

DESCENT OF THE TESTIS *****

 During the 7th week, the testis begins to detach from the surrounding mesenchyme and
develops a tough connective tissue coat - tunica albuginae
 A thickening of mesenchyme, the Gubernaculum testis runs from the testis to the genital
swellings
 As a result of the growth of the body relative to the gubernaculums, the testis descends to
lie in the inguinal region during the 12th week *
 During this process, an evagination of the coelomic epithelium forms the processus
vaginalis which follows the descent of the testis
 The final descent of the testis into the scrotum occurs in the 7th-9th months*
 The processus vaginalis is obliterated during the first year of life, forming the tunica
vaginalis

DEVELOPMENT OF THE OVARY *****

 The primitive sex cords disintegrate and the centre of the developing ovary becomes
replaced by a vascular stroma, forming the ovarian medulla *
 The surface epithelium continues to proliferate, producing cortical cords which split into
isolated cell clusters surrounding the primitive germ cells
 The primitive germ cells differentiate into oogonia which undergo several mitotic divisions.
The number of oogonia reaches its maximum (~7 million) during the 5th month after
which degeneration begins *
 The oogonia become surrounded by a layer of follicular cells from the surface epithelium
and develop into primary oocytes. Primary oocytes surrounded by follicular cells form
primordial follicles
 The primary oocytes duplicate their DNA and enter the first meiotic division and become
arrested during Prophase I until puberty

 There are 700,000 - 2 million primary oocytes at birth and 40,000 at puberty*
 The descent of the ovary is less extensive, coming to lie within the pelvis. The round
ligaments of the ovary and uterus are the equivalent of the gubernaculums testis *

12
PHARYNGEAL ARCHES

 First arch - cartilage forms incus and malleus, mesenchyme gives rise to the maxilla,
mandible, zygomatic bone and part of the temporal bone

 Second arch - cartilage forms the stapes and styloid process of the temporal bone and part
of the hyoid bone

 Third arch - part of the hyoid bone

 Fourth to sixth arches - thyroid, cricoid, arytenoids and cuneiform cartilages

 Pharyngeal arches develop during the 4th-5th weeks. The arches receive neural crest cells
which form the skeletal components while the mesenchyme forms the muscle.

NERVE SUPPLY TO PHARYNGEAL ARCHES

 First arch - mandibular branch of the trigerminal nerve

 Second arch - facial nerve

 Third arch - glossopharyngeal nerve

 Fourth arch - superior laryngeal branch of the vagus

 Sixth arch - recurrent laryngeal branch of the vagus

PHARYNGEAL POUCHES

 First pouch - tympanic cavity and pharyngo-tympanic tube

 Second pharyngeal pouch - palatine tonsil

 Third pharyngeal pouch - inferior parathyroid gland and the thymus gland

 Fourth pharyngeal pouch - superior parathyroid gland

 Fifth pharyngeal pouch - parafollicular or C cells of the thyroid gland

 The thyroid gland develops from an epithelial proliferation in the floor of the pharynx
(represented by the foramen cecum) and subsequently descends in front of the
pharyngeal gut, hyoid bone and laryngeal cartilages to reach its final position in the
7th week.

 Thyroxine is produced from the 12th week.

 The first pharyngeal cleft forms the external auditory meatus. The others do not form any
definitive structures.

FETAL ARTERIAL SYSTEM *****

13
  Each branchial arch receives its own artery during the 4-5th week - aortic arches

 The first aortic arch disappears apart from a small part - maxillary artery

 Second arch disappears - small hyoid artery

 Third arch - common carotid artery and first part of internal carotid artery

 The forth arch on the left forms part of the arch of the aorta. Right - proximal part of right
subclavian artery

 Fifth arch is transient

 Sixth arch - pulmonary arch

FETAL VENOUS SYSTEM *****

 Three pairs of major veins develop in the 5 th week:

 Vitelline veins - carry blood from the yolk sac to the sinus venosus - develops into the post-
hepatic portion of the inferior vena cava, the portal vein and superior mesenteric vein

 Umbilical veins - the proximal part of both umbilical veins and the remainder of the right vein
later disappear so that the left vein is the only one to carry blood from the placenta to the
liver

 Cardinal veins: anterior cardinal veins anastomose to form the brachiocephalic vein. The
superior vena cava is formed from the right common cardinal vein and the proximal portion
of the right anterior cardinal vein. Anastomosis of the sacrocardinal veins forms the
common iliac veins. *

The developing umbilical cord contains the following *

 Yolk sac stalk

 Two umbilical arteries and one umbilical vein

 The remnant of the allantois

 Small intestinal loops

 Extra-embryonic mesoderm

FETAL CIRCULATION *****

 Two umbilical arteries and one umbilical vein with in the umbilical cord *
 The umbilical vein carries oxygenated blood from the placenta to the fetus *
 Oxygenated blood in the umbilical vein bypasses the liver, draining into the inferior vena
cava via the ductus venosus *
14
  The obliterated umbilical vein forms the ligamentum teres while the obliterated ductus
venosus forms the ligamentum venosum. The ductus venosus is formed when a direct
communication develops between the left umbilical vein and the hepatocardiac channel *
 Oxygenated blood entering the right atrium from the inferior vena cava is directed into the
left atrium through the foramen ovale *
 Desaturated blood from the superior vena cava flows via the right ventricle to the pulmonary
artery *
 Oxygenated blood then enters the aorta via the left ventricle
 Some blood from the right atrium leaves via the pulmonary artery - mainly return from the
superior vena cava. As the pulmonary circulation has high resistance, the blood enters the
descending aorta through the ductus arteriosus which connects the pulmonary artery to the
aorta *
 From the aorta, blood is supplied to the fetus, deoxygenated blood returns to the placenta
via two umbilical arteries - oxygen saturation here is ~58% *
 The proximal part of the umbilical arteries form the superior vesical arteries. The obliterated
distal part form the medial umbilical ligaments *
 Oxygenated and deoxygenated blood become mixed at the following points *

1) The liver, mixing with blood returning via the portal system

2) The inferior vena cava, mixing with venous blood from the lower extremities

3) The right atrium, mixing with venous blood from the superior vena cava

4) The descending aorta, mixing with blood from the ductus arteriosus

 Blood in the ascending aorta has the highest oxygen saturation and supplies the heart and
brain *
 Blood in the right ventricle is therefore mostly de-oxygenated blood from the superior vena
cava. Oxygenated blood passes directly into the left atrium via the foramen ovale and does
not enter the right ventricle *

CIRCULATORY CHANGES AT BIRTH *****

 Placental blood flow ceases

 Respiration begins
 Pulmonary artery vasodilatation in response to falling PaCO2 and rising PaO2 - rapid fall in
pulmonary vascular resistance in the first few days of life *
 Closure of the umbilical arteries - functionally closed within a few minutes of birth,
obliteration takes 2-3 months. Distal part forms the Medial umbilical ligaments while the
proximal portion remains open as the superior vesical arteries *

 Closure of the umbilical vein and ductus venosus - occurs shortly after closure of the
umbilical arteries. The umbilical vein forms the Ligamentum teres hepatis in the falciform
ligament while the ductus venosus forms the ligamentum venosum *
 Loss of umbilical blood supply reduces venous return via the inferior vena cava - fall in
pressure *
 Closure of the Ductus arteriosus - dependent on a rise in PaO2. Prostaglandin F, low
calcium, low glucose and high pulmonary pressure keep ductus arteriosus open in utero.
Hypoxia can cause ductus to become patent *

15
  Closure of the foramen ovale - caused by decreased right atrial pressure and increased left
atrial pressure. Held shut by haemodynamic forces only for the first few weeks. Remains
potentially patent in 25-30% of normal adults *

GENITAL DUCTS IN THE FEMALE *****

 The Mullerian ducts persist in the female while the Mesonephric ducts degenerate. The
Mullerian duct gives rise to the Fallopian tube, body of the uterus, cervix and
upper third of the vagina *
 The Mullerian ducts fuse and grow into the urogenital sinus, forming the sinovaginal
bulb which proliferates to form a solid plate of tissue between the uterus and
the urogenital sinus. This becomes canalised at the end of the 5th month to
form the vagina *
 The epoophron and paroophron and Gartner?s cyst are remnants of the Mesonephric
duct *

 BLADDER & URETHRA*****

 Development occurs in the 4th to 7th week

 Urogenital septum divides the cloaca into the anorectal canal and the
primitive urogenital sinus - endodermal in origin *

 Cloacal membrane divided into urogenital membrane and anal membrane *

 The upper part of the urogenital sinus forms the bladder (except the trigone)
which is initially continuous with the allantois (obliterated to form the
urachus) *

 The trogone is formed from the mesoderm of the mesonephric ducts *

 The narrow pelvic part of the urogenital sinus forms the prostatic and
membranous urethra in the male *

 The definitive urogenital sinus which forms the external genitalia

EXTERNAL GENITALIA *****

 Cloacal folds develop on either side of the cloacal ggmembrane during the
3rd week and fuse to form the genital tubercle cranial to the cloaca

 With partitioning of the cloaca, the folds form the urethral folds anteriorly and
the anal folds posteriorly

 The male / female genitalia are indistinguishable at the end of the 6th week *

 Under the influence of testosterone (and 5-alpha reductase), the genital

tubercle elongates rapidly in the male, forming the penis, pulling the urethral folds
forward forming the urethral groove

16
  The urethral groove closes over at the end of the 12th week, forming the penile
urethra. The lining is endodermal in origin. The external urethral meatus is formed
from ectodermal cells from the tip of the glans which penetrate inwards, forming a
cord which is later canalised *

 The genital swellings, which form on either side of the urethral swellings form
the scrotum in the male and the labia majora in the female

 In the female, there is only slight elongation of the genital tubercle, forming the
clitoris. The urethral folds do not fuse and form the labia minora. The urogenital
groove is open to the surface and forms the vestibule *

 The epithelium of the male and female urethra is endodermal (urogenital sinus)
in origin apart from the most distal tip in the male which is ectodermal in origin.
The proximal part of the urethra in the female forms the urethral and paraurethral
glands and greater vestibular (Bartholin's) glands *

DEVELOPMENT OF THE GUT *****

FOREGUT

 The pharynx extends from the buccopharyngeal membrane to the tracheo-bronchial

diverticulum

 The tracheo-bronchial diverticulum develops on the ventral wall of the foregut during the 4th
week and then becomes separated from it by the tracheo-oesophageal septum. The
respiratory primordium is therefore developed from the foregut

 The stomach develops as a dilatation and rotates 90 degrees clockwise along its
longitudinal axis. The left side comes to lie anteriorly such that the left vagus nerve forms
the anterior vagal trunk

 Rotation of the stomach leads to the formation of the lesser sac

 The liver develops as an outgrowth of the endoderm of the distal foregut, as does the gall
bladder, bile and cystic ducts. The haemopoietic cells, Kupffer cells and connective tissue
are derived from the mesoderm of the septum transversum

 The pancreas develops from a dorsal and a ventral pancreatic bud from the distal foregut.
With rotation of the duodenum, the ventral pancreatic bud migrates dorsally.

 The dorsal bud forms the head, body and tail while the ventral bud forms the uncinate
process of the pancreas.

 The main pancreatic duct is formed from the distal part of the dorsal pancreatic duct and
the entire ventral duct. Exocrine pancreatic glands are derived from the foregut endoderm.

 Insulin secretion begins in the fifth month. The origin of the Islets is controversial.

MIDGUT
 Begins distal to the entrance of the bile duct into the duodenum and ends at the junction
between the proximal 2/3 and distal 1/3 of the transverse colon

17
  During the 6th week, the midgut herniated into the extra-embryonic coelom in the umbilical
cord and rotates 90 degrees counter clockwise along the axis of the superior mesenteric
artery when viewed from in front
 The apex of the intestinal loop remains in open connection with the yolk sac through the
vitelline duct, remnants of which form the Meckel?s diverticulum
 During the 10th week, the midgut retracts into the abdomen, undergoing a further 180
degrees rotation

HINDGUT
 Extends to the upper two thirds of the anal canal. The distal third of the anal canal is
formed from the ectoderm of the cloaca and the junction is marked by the pectinate line
 The urogenital septum divides the cloaca into an anterior urogenital sinus (forming the
bladder, pelvic urethra and external genitalia) and the anorectal canal
 The gut forms a solid cord during the 6th week with re-canalisation during the 7th - 8th
weeks
 The smooth muscle and mesentery of the gut is derived from mesoderm

KIDNEY AND URETER *****

 Three overlapping systems

Pronephros

 Vestigial - develops from cervical nephrotomes, disappears by the end of the 4th
week

Mesonephros *****

 Develops from the intermediate mesoderm on either side of the upper thoracic
and lumbar vertebrae during the 4th week *

 The mesonephric duct appears ~day 24 on the dorso-lateral aspect of the

mesonephros and grows caudally to fuse with the cloaca on ~day 26 *

 The mesonephros is functional between the 6th - 10th week, producing urine.
The mesonephros regresses after 10 weeks in the female *

 In the male, the mesonephric duct and a few modified mesonephric tubules
persist forming the ductus deferens and ductuli efferentes of the testis. In the
female, Gartner?s duct cysts, epoophron and paroophron are mesonephric
remnants *

 Mullerian remnants in the male include the appendix testis and the Utriculus
prostaticus *

 The developing gonad lies medial to the mesonephros *

 The mesonephric ducts are derived from mesoderm

18
Metanephros - permanent kidney *****

 Develops in the 5th-15th week from the metanephric mesoderm in the sacral
region *

 Ureters - develop from the ureteric bud, an outgrowth of the mesonephric duct
close to its opening into the cloaca. Grows into the metanephric mesoderm,
successive divisions forming the renal pelvis, major and minor calyces and
collecting tubules *

 The metanephric mesoderm develops into the excretory units under inductive
influence of the ureteric bud, forming the Bowman’s capsule and excretory tubules.
If the ureteric bud is missing, the kidney does not develop *

 The metanephros is functional from the 10th week *

Metanephric development occurs in the pelvis and the kidney later ascends to its location
in the abdomen by the 10th week. Failure of this ascent leads to a pelvic kidney *

LOWER URINARY TRACT *****

 The cloaca becomes divided into the anorectal canal and the primitive urogenital
sinus during the 4th - 7th week by the urorectal septum *

 The cloacal membrane is divided into the anal and urogenital membranes

 The upper part of the primitive urogenital sinus forms the urinary bladder which
is initially continuous with the allantois *

 The obliterated allantois forms the urachus or median umbilical ligament *

 The distal portions of the mesonephric ducts are absorbed into the urinary
bladder such that the ureters come to open directly into the bladder. With the
ascent of the kidneys, the mesonephric ducts come to open into the prostatic
urethra as the ejaculatory ducts *

 The part of the mucosa of the bladder derived from the incorporation of the
mesonephric ducts is mesodermal in origin and forms the TRIGONE. The
mesodermal lining of the trigone is later replaced by cells of endodermal origin
such that at birth, the bladder is completely lined by cells of endodermal origin *

 The narrow pelvic part of the urogenital sinus forms the prostatic and
membranous part of the urethra in the male (membranous urethra in the female).
Outgrowths of the endoderm of the prostatic urethra into the surrounding
mesoderm form the prostate gland (urethral and para-urethral glands in the
female)*

 The definitive urogenital sinus develops into the distal urethra and external
genitalia *

Question 1: The following are derived from the mesonephros

19
 a. Appendix of the testis
True False
b. Efferent ductules of the testis
True False
c. Gartnet?s duct cyst
True False
d. Prostatic utricle
True False

Question 2: During the development of the gastro-intestinal system

a. The liver is derived from mid-gut endoderm

True False
b. The haemopoietic cells of the liver are derived from foregut endoderm
True False
c. The pancreas is derived from the endoderm of the midgut
True False
d. The pancreas develops from a dorsal and a ventral pancreatic buds
True False

Question 3: With respect to the circulatory system in the fetus

a. Blood flows from the left atrium into the right atrium through the foramen ovale
True False
b. The resistance within the pulmonary vessels is high
True False
c. Oxygenated blood from the placenta is mixed with deoxygenated blood within the
right atrium
True False
d. Oxygenated blood from the placenta is mixed with deoxygenated blood in the inferior
vena cava
True False

Question 4: During the development of the genital system in the male

a. The male gonad is distinguishable from the female gonad by 4 weeks of

development
True False
b. Germ cells are present in the developing gonad by 5 weeks
True False
c. Gonadal development may proceed in the absence of germ cells
True False
d. Germ cells originate in the endoderm of the yolk sac
True False

20
Question 5: In the fetal circulatrion

a. Blood from the inferior vena cava is largely directed through the foramen ovale
True False
b. Most blood from the superior vena cava passes directly from the right to the left
atrium
True False
c. Out-put of the right ventricle is greater than that of the left ventricle
True False
d. Blood in the descending aorta is more oxygenated than that in the ascending aorta
True False

Question 6: With respect to the development of the urinary tract

a. The mesonephric duct disappears completely in the male

True False
b. The mesonephric duct persists in the female to form the fallopian tubes
True False
c. The metanephros forms the permanent kidney
True False
d. The metanephros appears during the third week
True False

Question 7: With respect to the circulatory system in the fetus

a. The obliterated umbilical vein forms the ligamentum venosum

True False
b. The obliterated ductus venosus forms the ligamentum venosum
True False
c. The ductus venosus connects the umbilical vein to the inferior vena cava
True False
d. The ductus arteriosus connects the pulmonary vein to the aorta
True False

Question 8: The following are derived from the pharyngeal arches

a. First pharyngeal arch ? the mandible

True False
b. First pharyngeal arch ? the maxilla
True False
c. First pharyngeal arch ? the thyroid gland
True False
d. Fourth and sixth pharyngeal arches ? thyroid and cricoid cartilages
True False

21
Question 9: With respect to the development of the external genitalia

a. The lining of the male external urethral meatus is ectodermal in origin

True False
b. The genital swellings give rise to the penis
True False
c. The genital tubercle gives rise to the clitoris in the female
True False
d. In the female, the urogenital groove is open to the surface and forms the vestibule
True False

Question 10: With respect to the development of the female gonadal system

a. The primitive sex cords disintergrate

True False
b. The surface epithelium of the ovary continues to proliferate, producing cortical cords
True False
c. The germ cells develop into oogonia
True False
d. The follicular cels are derived from the mesenchyme of the gonadal ridge
True False

Question 11: In the fetal circulatrion

a. The ductus venosus delivers blood directly into the superior vena cava
True False
b. The umbilical artery returns blood from the placenta
True False
c. The ductus arteriosus carries blood to the lungs
True False
d. Blood returning from the lungs is 90% saturated with oxygen
True False

Question 12: The following are derived from the urogenital sinus

a. Paraurethral glands
True False
b. The greater vestibular glands
True False
c. Gartner?s duct
True False
d. Urachus
True False

Question 13: With respect to the development of the urinary tract

22
 a. There is an increase in the number of nephrons in each kidney after birth
True False
b. The mesonephric kidney develops in the pelvis
True False
c. The metanephric kidney develops in the pelvis and ascends into the abdomen
True False
d. The ureters are endonermal in origin
True False

Question 14: With respect to the development of the urinary tract

a. The ureter develops as an outgrowth of the mesonephric duct close to its entrance
into the cloaca
True False
b. The ureter develops as an outgrowth of the paramesonephric duct close to its
entrance into the cloaca
True False
c. The ureteric bud gives rise to the renal collecting tubules
True False
d. The metanephric mesoderm gives rise to the excretory units of the kidney
True False

Question 15: With respect to the development of the female gonadal system

a. The paramesonephric duct opens into the intra-embryonic coelom

True False
b. The mesonephric duct disintergrates under influence of oestrogen produced by the
developing ovaries
True False
c. Mullerian inhibiting factor is produced by the developing ovary
True False
d. The infundibulo-pelvic ligament is the female equivalent of the gubernaculum testis
True False

AMNIOTIC FLUID *****

· Initially produced by primitive cells around the amniotic vesicle

· Later formed from transudate from fetal skin and umbilical cord and diffusion across
the amniotic membrane *

23
· Fetal skin becomes keratinised in the second trimester and amniotic fluid is mainly
formed from fetal urine and lung secretions. The term fetus passes 500-700ml urine
per day *

· Fetal swallowing is a major route of amniotic fluid re-circulation and begins at 12

weeks. At term. ~500ml amniotic fluid is exchanged / 24h *

· Amniotic fluid volume = 50ml at 12 weeks, 150ml at 16 weeks gestation and

~1000ml at term. Peak volume is at 32-36 weeks *

· Osmolarity: 275 mOsmol/l (lower than maternal or fetal), decreases as pregnancy

progresses *

· Cells: at term, contains fetal epithelial cells, amniocytes and dermal fibroblasts.
Epithelial cells and amniocytes grow poorly in culture. Glial cells present if neural
tube defect *

· Protein: concentration increases with gestation but plateaus after 30 weeks. Mainly
albumin and globulins. Also contains AFP (1/10TH concentration in fetal blood -
rises until 12 weeks then declines). Virtually no fibrinogen. *

· Urea, creatinine and urateconcentration increases with gestation

· Amino acids: concentration similar to that in maternal plasma

· Lipids: mainly free fatty acids. Also contains phospholipids, cholesterol and lecithin
(secreted by lungs during maturation) *

· Carbohydrates: mainly glucose; concentration ~ half that of maternal serum

· PO2 = 2-15mmHg while PCO2 = 50-60mmHg

· pH = 7.0 (acidic relative to fetal blood)

· Bilirubin concentration falls in the third trimester (except in haemolytic disease)*

DEVELOPMENT OF THE PLACENTA *****

 Fetal weight is related to placental weight. The fetal:placental weight ratio increases with
gestation age. At term, fetal weight is 5-6x placental weight. At 32 weeks gestation, fetal
weight ~ 4x placental weight
 During implantation, the outer layer of the blastocyst proliferates to form the outer cell mass
from which the trophoblast and the placenta develop
 The trophoblast differentiate into an inner layer of large clear mononuclear cells, the
cytotrophoblast and an outer layer of multi-nucleated cells, the syncytiotrophoblast which
forms a true syncytium

24
  DNA synthesis and mitosis occurs only in the cytotrophoblast layer. The
syncytiotrophoblast is formed by fusion of cells from the cytotrophoblast layer *
 Lacunae appear within the syncytiotrophoblast between days 10 - 13 post-ovulation and are
the precursors of the intervillous space. The lacunae are separated by columns of
syncytiotrophoblast called primary villous stems (These are not villi)

DEVELOPMENT OF THE VILLOUS TREE

 Primary villous stems become infiltrated by cytotrophoblasts between days 13-21 post-
ovulation
 Villous stems are subsequently infiltrated by extra-embryonic mysenchyme which
differentiates into fetal blood vessels
 The distal parts of the villous stems are not vascularised. Here, cytotrophoblasts proliferate
and spread laterally to form a cytotrophoblastic shell, splitting the syncytiotrophoblast into a
definitive syncytiotrophoblast on the fetal side and the peripheral syncytium on the decidual
side which degenerates and is replaced by fibrinoid material (Nitabuch's layer)
 Sprouts extend from primary villous stems, initially made up of syncytiotrophoblast and
then infiltrated by cytotrophoblast and mesenchyme - these are primary stem villi and the
placenta is a true villous structure by day 21 of gestation. These villi grow and divide into
secondary, tertiary and terminal villi
 The villi oriented towards the uterine cavity degenerate between day 21 and the 4th month
to form the chorion laeve. The overlying decidua degenerates and the chorion laeve comes
in contact with the deciduas of the opposite uterine wall
 The rest of the villi form the chorion frondosum which develops into the definitive placenta
 Division and modification of the villous tree continues until term. First trimester villi are
larger, have a complete layer of cytotrophoblasts and have a loose mysenchymal core
which is vascularised towards the end of the first trimester
 At term, the villi are smaller, cytotrophoblasts are few in number, the syncytiotrophoblast is
irregularly thinned. Fetal vessels are sinusoidal and occupy most of the villous core and lie
close to the syncytiotrophoblast, forming vasculusyncytial membranes which maximise
materno-fetal transfer.
 Sometimes, the syncytiotrophoblast nuclei appear in clusters called syncytial knots - more
common in placentas from IUGR / pre-eclamptic pregnancies *
 Maternal blood is separated from fetal blood by the syncytiotrophoblast and the fetal
capillary endothelium *

TROPHOBLAST INVASION *****

 Extra-villous cytotrophoblast from the trophoblastic shell break through the outer
syncytiotrophoblast layer and invade the decidua
 Some of these cells invade the decidua (interstitial trophoblasts) and fuse to form
multinucleat giant cells
 Endovascular trophoblasts invade the lumen of spiral arteries, destroying the muscular and
elastic layers of the vessels, replacing these with fibrinoid and replacing the vascular
endothelium. The vessels are converted into wide, low resistance vascular channels *
 This invasion is initially restricted to the intra-decidual portion of the vessels and starts at 8-
12 weeks. During the 4th month (16-18 weeks), a second wave of invasion occurs,
extending to involve the intra-myometrial segments of the spiral arterioles *
25
  Extravillous trophoblasts invade through the decidua, followed by a second wave of
migration ~18 weeks gestation to invade the myometrium. Some differentiate and fuse into
multinucleated giant cells within the decidua and myometrium *
 Trophoblast cells stain positively for cytokeratin while decidual stromal cells are negative
 The basic structure of the placenta is formed by day 20 of pregnancy

PLACENTAL LOBES AND LOBULES

 LOBES: Placental septae develop during thr 3rd month as protrusions of the basal plate into
the intervillous space, dividing the maternal surface of the placenta into 15-20 lobes
 Lobes are not structural or functional units
 LOBULES: Each placental lobule is derived from a single secondary stem villus. A
cotyledon is that part of the villous tree which has arisen from a single primary stem villus
and contains 2-5 lobules
 Each placental lobule is supplied by a single utero-placental artery

THE PLACENTAL BED

 Refers to the deciduas and myometrium directly underlying the placenta
 The fetal component is made up of extra-villous trophoblasts
 The maternal component is made up of decidualised endometrial stromal cells,
macrophages and granular lymphocytes. Residual endometrial glands are also present.

PLACENTAL HORMONE PRODUCTION *****

OESTROGENS *

 Mainly oestriol, but also oestradiol and oestrone in smaller amounts. Oestriol is
produces from DHES-sulphate from fetal zone of the fetal adrenal gland and also
from the maternal adrenals. Fetal DHEA-S is initially hydroxylated by the fetal liver

PROGESTERONE *

 Produced from maternal cholesterol. Pregnenolone is also produced and is

converted by the fetal adrenals into androgens which are then converted by the
placenta into oestrogens.

HCG

 Produced by the syncytiotrophoblast. Cytotrophoblasts produce HCG in-vitro

Human Placental Lactogen - has growth-hormone -like effects and decreases insulin-
sensitivity. *

Human chorionic thyrotropin and virtually all of the hypothalamic releasing hormones

INHIBIN & ACTIVIN *

 Produced by the feto-placental unit (mainly by the ovary in non-pregnant state)

26
  Inhibin-A levels peak in early pregnancy and rise again at term and are increased
in pre-eclampsia

 Activin levels increase with gestation age and a marked increase occurs with the
onset of labour and in pre-eclampsia

PLACENTAL TRANSFER

FACTORS AFFECTING PLACENTAL TRANSFER:

 Utero-placental blood flow - particularly important in the exchange of lipid soluble

solutes such as O2, CO2

 Feto-placental blood-flow

 Surface area of placenta

 Activity of placental transport systems in the microvillous and basal plasma

membranes of the syncytiotrophoblast

 Molecular weight and lipid solubility of solute

 Charge of solute

 Protein binding

 Placental metabolism of solute

 Concentration of solute in maternal and fetal plasma

PLACENTAL GAS TRANSFER

O2 / CO2 *****

 Small lipid soluble molecules - transfer is by simple diffusion and rate of transfer
is dependent on maternal / fetal concentrations (partial pressure), rate of blood flow
and surface area

 The fetal O2 - Hb dissociation curve lies to the left of the maternal curve - fetal
red cells have greater affinity for O2 - see respiratory physiology

 A hypoxic fetus develops both respiratory and metabolic acidosis ? CO2 excretion
is impaired and anaerobic glucose metabolism results in lactate production

 During acidosis, the fetal O2 - Hb dissociation curve is shifted to the right,

decreasing oxygen binding for a given partial pressure and releasing more O2 in
fetal tissues. De-oxygenated Hb becomes available and acts as a better buffer than
oxygenated Hb.

WATER TRANSFER

27
  3-4L of water is exchanged per hour between the mother and the fetus, placenta
and amniotic fluid

 Net water accumulation by the fetus continues until delivery

 Water exchange is by perfusion transfer and osmosis

 Maternal dehydration / over-hydration will affect fetal water accumulation,

although there is a time lag

CARBOHYDRATES & AMINO ACIDS *****

 Glucose transport across the microvillous and basal plasma membranes is by

facilitated diffusion. *

 This is dependent on glucose concentration gradient and the activity of transport

proteins within the placenta. In theory, facilitated diffusion can be saturated.

 In practice, the glucose transfer capacity (especially of the microvillous plasma

membrane) is so large that it would not approach saturation under in-vivo conditions

 Fetal amino acid concentrations are generally higher than maternal levels *

 Transfer of amino acids from the mother to the fetus is therefore against a
concentration gradient and energy (ATP) is required for this process *

 This energy is provided by coupling the transfer of amino acids (up a

concentration gradient) to the transfer of sodium ions (down a concentration
gradient) - secondary active transport. These are called Na+-dependent
transporters. The sodium concentration gradient is maintained by Na+K+ATPase.
 Other amino acid transport systems are, however, Na+-independent.

ELECTROLYTE TRANSFER *****

 Na+ concentration is low while K+ is high within the syncytiotrophoblast

 These concentrations are maintained by Na+K+ATPase which transfers 3Na+ out

for 2K+ into the syncytiotrophoblast across the microvillous plasma membrane *

 Total and ionised calcium concentration - higher in fetal than maternal plasma.
Calcium transfer across the microvillous plasma membrane is magnesium
dependent and dependent on 1,25-dihydroxycholecalciferol *

 Phosphate transfer is Na+-dependent

Molecule Placental transfer

Testosterone Minimal transfer - androgens aromatised by placenta. Very

high maternal androgen concentration may virilise female
fetus
Ca2+, Mg2+ Active transfer against concentration gradient

28
PTH, Calcitonin Not transferred

Vitamin D Good transfer

IgA Minimal passive transfer

IgG Good active and active transfer from 7 weeks gestation

IgM No transfer

Glucose Fascilitated diffusion - excellent transfer

Amino acids Active transport - excellent transfer

Free fatty acids Very limited transfer - essential fatty acids only

Ketone bodies Excellent transfer - diffusion

Insulin, glucagons No transfer

Thyroid hormone Poor transfer - diffusion

TRH Excellent transfer

Iodine and thioamides Excellent transfer

Cortisol & aldosterone Excellent transfer

ACTH No transfer

29
Question 1: With respect to the transfer of solutes across the placenta

a. Glucose transfer is by simple diffusion

True False
b. Amnio-acid transfer is by active transport
True False
c. Amino acid concentrations are lower in the fetal than in the maternal plasma
True False
d. Glucose concentration is lower in the fetal than in maternal plasma
True False

Question 2: With respect to the structure of the placenta

a. Each placental lobule is formed from a single primary stem villus

True False
b. Each placental lobe is supplied by a single utero-placental artery
True False
c. Each cotyledon has 2-5 lobules
True False
d. Each placenta is divided into 15-20 lobes by septae which originate from the
chorionic plate
True False

Question 3: With respect to the transfer of water between the mother and the fetus

a. 3-4L of water are exchanged between the maternal and fetal compartments per 24h
True False
b. Water crosses the placenta by osmosis
True False
c. Net water accumulation by the fetus stops at 37 weeks gestation
True False
d. Maternal dehydration has no impact on net fetal water accumulation
True False

Question 4: With respect to the development of the placenta

a. Trophoblasts initially invade the uterine spiral arterioles at 16-18 weeks gestation
True False
b. Villous cytotrophoblasts form a layer beneath the syncytiotrophoblast in early
pregnancy
True False
c. The syncytiotrophoblast is the only cellular layer between maternal and fetal blood
True False
d. Syncytial knots in the placenta are composed of aggregates of cytotrophoblasts
True False

30
Question 5: The placenta

a. Produces oestriol from cholesterol

True False
b. Produces progesterone from cholesterol
True False
c. Produces more oestradiol than oestriol
True False
d. Produces Inhibin-A and Activin
True False

Question 6: The composition of amniotic fluid varies as normal pregnancy advances in the
following way

a. Glucose concentration falls

True False
b. Uric acid concentration rises
True False
c. Oestriol concentration falls
True False
d. Osmolality falls
True False

Question 7: The human placenta

a. Has negligible oxygen requirement

True False
b. Has syncytiotrophoblast as the major component of trophoblast at term
True False
c. Is haemochorial
True False
d. Has anastomoses between villous vessels
True False

Question 8: During the development of the placenta

a. Interstitial trophoblasts invade the spiral arteries

True False
b. Only the intra-decidual segment of spiral arteries are converted by trophoblast
invasion
True False
c. The endothelial lining of spiral arteries is replaced by fibrinoid material
True False
d. The elastic layer of spiral arteries remains intact after trophoblast invasion
True False

31
Question 9: Amniotic fluid

a. Contains cells of maternal origin

True False
b. At term, is hyperosmolar compared to fetal plasma
True False
c. Contains bilirubin
True False
d. Contains phospholipids
True False

Question 10: Trophoblast

a. Develops from the blastocyst

True False
b. Secrete gonardotrophins
True False
c. Is physiologically invasive
True False
d. Forms part of the chorion
True False

Question 11: With respect to the transfer of electrolytes across the placenta

a. Na+ is taken up across the microvillous plasma membrane through the action of
Na+K+ ATPase
True False
b. The concentration of Na+ is higher within the syncytiotrophoblast than in maternal
plasma
True False
c. The concentration of K+ is lower in maternal plasma than in the syncytiotrophoblast
True False
d. Total calcium concentration is higher in fetal than in maternal plasma
True False

Question 12: Amniotic fluid

a. Has a protein content similar to maternal plasma

True False
b. Is mainly a filtrate of maternal plasma during the second half of pregnancy
True False
c. Has the highest bilirubin concentration during the last trimester
True False
d. Concentration of alpha-fetoprotein increases with increasing gestation age
True False

32
Question 13: In the human placenta

a. Intervillous spaces communicate directly with the uterine arteries

True False
b. Decidual cells are derived from endometrial stromal cells
True False
c. At term, each lobe represents a single primary stem villus
True False
d. Cytotrophoblasts are in direct contact with maternal blood
True False

Question 14: With respect to the transfer of electrolytes across the placenta

a. Ionised calcium concentration is lower in fetal than in maternal plasma

True False
b. Uptake of calcium by the microvillous plasma membrane is magnesium dependent
True False
c. Uptake of calcium by the microvillous plasma membrane is independent of 1,25-
dihydroxycholecalciferol
True False
d. Placental ion uptake is by facilitated diffusion
True False

Question 15: During fetal acidosis

a. The O2- Hb dissociation curve is shifted to the left

True False
b. More O2 becomes bound to Hb for a given partial pressure
True False
c. The buffering capacity of oxygenated Hb is better than that of deoxygenated Hb
True False
d. Decreased oxygen supply from the utero-placental circulation results in respiratory,
but not metabolic acidosis
True False

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