Maternal Placental Foetal Unit

Specific Learning Outcomes

 Understand the structure of the placenta
 Internalize the functions of the placenta
 Describe possible abnormalities fo the placenta and the danger
The Intervillous Space
 Contains maternal blood
 Is derived from the lacunae that developed in the syncytiotrophoblast
during 2nd week of development
 Divided into compartments by placental septa but
 Free communication since septa do not reach chorionic plate
 Spiral endometrial arteries in decidua basalis
 Pass through cytotrophoblastic shell
 Pass blood into intervillous space then
 Blood drained by endometrial veins
 Numerous branch villi arise from stem chorionic villi and
 Continuously shower circulating maternal blood
The Amniochorionic Membrane
 Amniotic sac enlarges faster than chorionic sac so
 Amnion and smooth chorion soon fuse to
 Form amniochorionic membrane and fuses with
 Decidua capsularis which disappears and
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  Amniochorionic membranes adhere to decidua parietalis.
 Amniochorionic rupture leads to the
 Draining of amniotic fluid
 Branch villi arise from stem villi
 Branch chorionic villi of placenta
 Provide large surface area for exchange of material
 Material cross very thin placental membrane interposed
 Between foetal & maternal circulations
 Placental membrane consists of extra foetal tissues
a) Foetal placental circulation
 Umbilical arteries
 Drain into cord attachment to placenta then divide into
 A number of radially disposed chorionic arteries which
 Branch freely in chorionic plate before
o Entering the chorionic villi
 Blood vessels form an extensive
 Arterio – capillary – venous system in chorionic villi which
 Brings foetal blood extremely close to maternal blood &
o Forms a large exchange area between the two systems
 Normally no intermingling of foetal and maternal blood unless if
 Minute placental membrane defects when

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  Very small amounts of foetal blood may enter maternal
circulation
 Well oxygenated foetal blood gets into thin-walled veins
 That follow chorionic arteries to umbilical cord attachment
 Where they converge to form umbilical vein.
b) Maternal placental
 Blood in intervillous space is temporarily
 Outside maternal circulatory system.
 80 – 100 spiral endometrial arteries in decidua basalis
 Are pulsitile and propelled in jet – like fountains
 Through gaps in cytotrophoblastic shell in spurts
 Towards chorionic plate forming “roof” of intervillous space
 As pressure dissipates blood flows slowly around the blood villi
 Metabolic and gaseous exchange with foetus is facilitated
 Blood eventually returns through endometrial veins to maternal
circulation
 Welfare of embryo and foetus depends more on adequate bathing
 Of branch villi with maternal blood than on any other factor
 Intervillous space of mature placenta contains about 150ml of
 Blood that is replenished three or four times per minute.

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 NB: During intermittent contractions there is slight reduction in
uteroplacental blood flow
Placental Circulation

FIGURE 7-8

The Placental Membrane

 Composite membrane that consists of extra-foetal tissues separating
maternal and foetal blood.
 Until about 20 weeks consists of four layers
 syncytiotrophoblast
 cytotrophoblast

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  connective tissue of villus
 endothelium of foetal capillaries
 Cytotrophoblast disappears in most areas leaving membrane in 3
layers
 At these sites syncytiotrophoblast comes in direct contact with
 Endothelial of foetal capillaries to form
 Vasculosyncytial placental membrane
 Most drugs and other substances in maternal plasma pass through
 Placental membranes & enter foetal plasma
 Placental membrane becomes progressive thinner as pregnancy
advances.
 During 3rd trimester
 Numerous nuclei in syncytiotrophoblast aggregate to form
 Multinucleated protrusions or aggregations - syncytial knots
 Knots break off, enter intervillous space then into maternal
 Circulation Knots rapidly destroyed by local enzymes
 With aging fibrinoid material forms on surfaces of villi and
 Appear to reduce placental transfer
Functions of the Placenta
1. Metabolism
 Synthesizes glycogen, cholesterol and fatty acids for
 Nutrition and energy for embryo/foetus
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2. Placental transport of gases and nutrients
 Facilitated by great surface area of placental membrane
 Transfer mainly by:
 Simple diffusion
 Facilitated diffusion through electrical charges
 Active transport against concentration gradient using ATP
 Pinocytosis - material engulfed as a small sample of
extracellular fluids
 Very small defects or breaks in placental membranes may
o allow RBCs either way
 Infection of placenta by creating lesions & then cross
placental membranes
o Under their own power e.g. maternal leucocytes,
treponema pallidum
o Through defects created e.g. some bacteria and protozoa
such as Toxoplasma gondi.
Transfer of Gases
 Oxygen, carbon dioxide & carbon monoxide by simple diffusion
 Exchange of oxygen &carbon dioxide
 Limited more by blood flow than diffusion efficiency
 Hence foetal hypoxia more primarily from factors that

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  Diminish either uterine flow or foetal blood flow

Nutritional Substances
Water - Simple diffusion and in increasing amounts as pregnancy
advances
Glucose produced by mother and placenta & is diffused rapidly
Maternal cholesterol, triglycerides or phospholipids - transfer little
or none
Vitamins - water soluble cross faster than fat soluble.
Hormones
 Slow transfer of thyroxin or triiodothyronine and
 Other protein hormones in small amounts
 Unconjugated steroid hormones cross placenta membrane rather
freely
 Testosterone and certain synthetic progestins
 cross placental membrane hence
 May masculinize female foetus
Electrolytes
 Freely exchanged in significant quantities each at its own rate
Maternal Antibodies
 Cross by pinocytosis & provide foetal humoral immunity
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 Alpha & Beta globulins reach foetus in very small quantities
 Unlike delta globulins e.g. IgG
 Maternal protein, transferrin has receptors & carries iron to
embryo/foetus.
Waste Products
 Urea and uric acid by simple diffusion; bilirubin cleared quickly
Drugs and drug metabolites
 Most cross by simple diffusion except
 Those with structural abnormality to amino acids such as
 Methyl dopa and antimetabolites
 Some cause congenital anomalies
 Foetal drug addiction
 May occur after maternal use e.g. heroin
 50-75% of newborns experience withdrawal symptoms
 Since no psychic foetal dependence, problem over with full
withdrawal
 Muscle relaxants do not readily cross placenta.
 All sedative and analgesics cause respiratory depression in newborn
depending on dose and its timing in relation to delivery.
Infectious agents
 Viruses may cross and cause infection

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 Also organisms such treponema pallidum and toxoplasmosis gondii
 Enter foetal circulation & cause congenital anomalies and/or death.
Placental Endocrine Synthesis and Secretion
 Syncytiotrophoblasts of the placenta synthesizes protein and steroid
hormones.
Protein Hormones
 hCG - similar to LH;
 Secreted during 2nd week, maintains corpus luteum
 Rises in urine and maternal blood to maximum by 8th week then
declines
 Forms progesterone from maternal cholesterol and pregnenolone
 Syncytiotrophoblast produces oestrogens.
 human chorionic somatomammotropin (hCs) or human placental
lactogen(hPL)
 human chorionic thyrotropin (hCT)
 human chorionic corticotrophin (ACTH)
Variations in Placental Shape
 Chorionic villi usually persist only where
 Villous chorion is in contact with decidua basalis
 Placenta membranacea (diffuse or membranous placenta)
 Villi persist on entire surface of chorionic sac

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  Thin layer of placenta attaches to large area of uterus
 Several variations when villi persist elsewhere e.g
 Accessory, bidiscoid & horse-shoe placentae
 Variations of little physiological or clinical significance
Maternal Surface of Placenta
 Cobblestone appearance produced cotyledons separated by
 Formerly occupied by placental septa.
Foetal Surface of Placenta
 Umbilical cord usually attached to foetal surface and its epithelium
contours
 With the amnion adhering to foetal surface of placenta
 Chorionic vessels radiate to and from umbilical cord
 Through the transparent amnion
 Umbilical vessels branch on foetal surface to form chorionic vessels
which enter the chorionic villi

DR. D.K NGOTHO

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