Embryology Lecture 4 Placental and Fetal Membranes Flashcards

1
Q

What does the placenta do?

A

During that 9 month period it provides nutrition, gas exchange, waste removal and endocrine and immune support for the developing fetus

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2
Q

What are the 2 components to the placenta?

A

Maternal Component:

Derived from decidua basalis of uterine endometrium

¤At birth:

Dark red in color

Oozes blood due to torn vessels at the time of birth

Fetal Component:

¤Derived from trophoblast and extraembryonic mesoderm:

Chorion frondosum

At birth:

Smooth, shiny, light blue or blue pink color because amnion covers the surface

5-8 large chorionic blood vessels are present

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3
Q

What are the 3 types of decidua?

A

¤Portion of decidua where blastocyst is implanted:

decidua basalis

¤Part of decidua that separates embryo from uterine lumen:

decidua capsularis

¤Part lining rest of uterine cavity:

decidua parietalis (vera)

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4
Q

Desribe the chorion frondosum

A

Consists of tertiary chorionic villi derived from trophoblasts (cytotrphoblasts and syncytiotrophoblasts) and extraembryonic mesoderm which collectively known as villous chorion (Chorion frondosum)

¨Villi are the functional units of placenta

¨When first formed they are spread around the chorion

¨ Later villi in the region of decidua capsularis degenerate and the chorion becomes smooth:

¨ chorion laeve

¨ Villi in the region of decidua basalis proliferate and expand giving rise to a bushy chorion:

¨ chorion frondosum

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5
Q

Relationships between the embryo and maternal decidua (pink) from the early weeks of pregnancy through the fifth month and the formation of chorion frondosum and chorion laeve

A

8.5.6

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6
Q

Describe the stages of villi

8.5.6

A

¨Late 2nd week and beginning of 3rd week cytotrophoblasts have grown into syncytiotrophoblasts to form primary villi

¨Later, extraembryonic mesoderm grows into the primary villi and the villi are now known as secondary villi

¨By the end of 3rd week blood cells and vessels develop in the mesoderm core. The villi are now known as tertiary villi

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7
Q

Summary slide of villi

A

8.5.6

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8
Q

Formation of Cytotrophoblastic Shell

A

Cytotrophoblast cells in the villi penetrate the overlying syncytium until they reach the maternal decidua

¨Here they make contact with similar extensions of neighbouring villi to form the outer cytotrophoblastic shell:

¤Attaches fetal part of placenta to maternal part

¤Attaches the chorionic sac to the maternal endometrium

¨Anchoring Villi/Stem villi

¤Chorionic villi that attach firmly to the decidua basalis through the cytotrophoblastic shell

¤Extend from chorionic plate to decidua

¨Free Villi/Terminal Villi:

¤Branch from the sides of stem villi

¤Exchange of nutrients and gas occur through free villi

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9
Q

Overall view of a 5-week-old embryo illustrating the relationships of the chorionic plate, villi, and outer cytotrophoblastic shell

A

8.5.6

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10
Q

What is the function of the placental barrier and what is it made out of?

A

Separates maternal blood from fetal blood

Composition:

¤Syncytiotrophoblast, cytotrophoblast, connective tissue (extra-embryonic mesoderm), endothelium of fetal capillaries - early pregnancy

¤Syncytiotrophoblast, endothelium of fetal capillaries - late pregnancy

Acts as a selective barrier (some substances freely cross, whereas other substances don’t)

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11
Q

What are the partitions of a mature placenta called?

A

decidual/placental septa

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12
Q

What does the placenta look like? (maternal vs fetal)

A

Maternal Surface:

¨Rough and divided into 8-10 cotyledons

¨ Dark red in color and oozes blood due to torn maternal blood vessels

Fetal Surface:

¨ Smooth and shiny

covered by amnion

¨ The attachment of the umbilical cord is usually eccentric

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13
Q

Establishing the Uteroplacental Circulation

A

This is accomplished by MODIFICATION OF THE SPIRAL ARTERIES:

¤Specialized invasive cytotrophoblast cells, migrate out from the cytotrophoblast shell

¤I_nvade the spiral arteries_ (but not the veins) and displace the endothelial cells of the spiral arteries forming hybrid arteries. This leads to:

Widening of spiral arteries

Blood escaping from their open ends leaves easily at a much lower pressure than normal arterial pressure

As the embryo grows, these arteries provide an increasing flow of blood into the intervillous space

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14
Q

Functions of Placenta Summary

A

¨Exchange of Gases:

¤Transport oxygen, carbon dioxide and carbon monoxide by simple diffusion

Exchange of Nutrients and Electrolytes:

¤ Amino acids, carbohydrates, vitamins etc

Transmission of Maternal Antibodies:

¤IgG for passive immunity

Hormone Production:

¤Human chorionic gonadotropin (hCG), somatomammotropin / placental lactogen (provides fetus priority on maternal blood glucose), progesterone (maintains the endometrium during pregnancy) and estrogen for mammary gland development and uterine growth

Excretion:

¤Metabolic waste products produced by fetus

Barrier:

¤Prevents many bacteria and other harmful substances from reaching the fetus

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15
Q

______ is contain 2 -3 separate lobes

____ is a asmall part of placenta is separated from rest of it and sometimes retained inside uterus and cause postpartum hemorrhage

______ is peripheral edge of placenta is covered by decidua

A

¨Duplex or triplex placenta

¨Placenta succenturiata

¨Circumvallate placenta

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16
Q

What is placental accreta?

A

¤Abnormal adherence of chorionic villi to the myometrium

¤Most patients with placenta accreta have normal pregnancies and labors

17
Q

What is placental percreta?

A

¤chorionic villi penetrate the full thickness of the myometrium to or through the perimetrium

¨Third-trimester bleeding is the common presenting sign of these placental abnormalities

¨After birth, the placenta fails to separate from the uterine wall and attempts to remove it may cause hemorrhage that is difficult to control

18
Q

What is placental previa?

A

¤blastocyst implants close to or overlying the internal os of the uterus

19
Q

What is preeclampsia and eclampsia?

A

¤Sudden development of maternal hypertension and proteinuria after week 20-32 of gestation

¤Inadequate formation of the cytotrophoblastic shell is thought to be a leading cause of preeclampsia

¤A severe form of preeclampsia that leads to seizures in the mother

20
Q

Describe the definitive umbilcal cord

A

¨Contains right and left umbilical arteries, left umbilical vein, buried within mucous connective tissue (Wharton’s jelly)

21
Q

A light grey shiny sac indicating _______

Meconium discharge indicating _______

Urine discharge indicating an ______

A

omphalocele

vitelline fistula

urachal fistula

22
Q

_____ is when cord is attached to margin

_____ blood vessels divide before reaching the placenta

______ blood vessels are attached to amnion, where they ramify before reaching the placenta

(can cause vasa previa)

A

Battledore placenta

Furcate

Velamentous placenta

23
Q

Implantation and Placentation

A

The placenta is derived from the trophoblast cells that further differentiate and invade maternal tissues

–Cytotrophoblast: stem cell population

–Syncytiotrophoblast: invasive fused cells (syncytium) derived from cytotrophoblast

–Invasion process breaks into maternal capillaries, trophoblastic lacunae fill with maternal blood

24
Q

What is the amniotic fluid made up of

8.5.6

A

Polyhydramnios: > 1500 ml (often result of gut or swallowing defect, also secondary to maternal diabetes)

Oligohydramnios: < 400 ml failure to produce enough fluid (usu. Renal defects)

25
Q

What are amnitoic bands?

A

The amnion can ensnare parts of the fetus (usually limbs) and cause constriction or even amputation

26
Q

Difference between monozygotic twins (identical) and dizygotic twins (fraternal)

A

Fraternal: ¤Results from fertilization of two different secondary oocytes by two different sperms

Identical: ¤Results from fertilization of one secondary oocyte by one sperm

27
Q

How are conjoined twins formed

A

¤Form exactly like monozygotic twins except that the inner cell mass doesn’t completely split

28
Q

What is fetus papyraceus?

A

One partner usually dies in the first trimester, and is compressed and mummifies (fetus papyraceus)

29
Q

What is twin transfusion syndrome?

A

¨Usually occur in monozygotic twins which share common placenta

¨Placental vascular anastomoses produce unbalanced blood flow to the fetuses