L12: Placenta Flashcards

(96 cards)

1
Q

What weeks are for normal term pregnancy

A

37-42 weeks

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2
Q

At week 9 what is the embryo considered to be

A

A foetus

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3
Q

What is pregnancy considered to be from in terms of the date

A

1st of the last period

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4
Q

For implantation to take place what type of endometrium do we need

A

Receptive endometrium

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5
Q

When can implantation occur

A

Within the implantation window

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6
Q

Approximately when is the implantation window

A

In mid secretory phase

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7
Q

What are the 2 phases in the uterus cycle

A

Proliferative phase

Secretory phase

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8
Q

What is the proliferative phase about

A

Growing the endometrium

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9
Q

Under what hormone is the proliferative phase under the control of

A

Oestrogen

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10
Q

In the secretory phase what is the dominant hormone

A

Progesterone

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11
Q

What occurs in the secretory phases

A

1) oestrogen and progesterone are secreted from the corpus luteum
2) oestrogen and progesterone in moderate levels cause a negative feedback to the HPG and LH/FSH levels are suppressed
3) the progesterone matures the endometrium lining so it is receptive
4) as the corpus luteum degrades the oestrogen and progesterone levels decrease and the endometrium undergoes apoptosis so you get a period if implantation doesn’t occur

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12
Q

What occurs to the endometrium when it becomes receptive

A

Glands increase in secretions

Epithelium surface microvilli swell up (pinopodes) so they absorb the uterine fluid to help catch the blastocytes

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13
Q

Where does fertilisation occur

A

Ampulla of the uterine tube

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14
Q

Where does cleavage begin

A

In the uterine tube

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15
Q

At day 5 what forms

A

Blastocytst

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16
Q

At day 6 what happens to the blastocytes

A

Hatches from the zona pellucida

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17
Q

Between day8-9 what happens to the blastocytes that hatches

A

Implants to endometrium

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18
Q

What are the 3 phases of implantation

A

1) apposition
2) attachment
3) invasion

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19
Q

What occurs in apposition

A

Blastocyst loosely associates with the uterine wall (therefore is at risk of being washed off here)

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20
Q

What occurs in during attachment

A

Blastocyst firmly adheres to the endometrium by adhesion molecules and integrin

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21
Q

What happens during invasion

A

Blastocyst attaches to the uterine wall and triggers enzyme production which degrades and invades the glycogen rich endometrial stroma for nutrients

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22
Q

What is the decidua

A

A modified mucosal lining of the uterus the forms in preparation to pregnancy

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23
Q

Which hormone initiates decidualisation of the endometrium

A

Progesterone

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24
Q

What are the changes that occur in decidualisation

A
Oedema 
Blood vessels leaky
Changes to extracellular matrix 
Angiogenesis 
Infiltration of uterine natural killer cells for immune tolerance for embryo 
Fibroblast 
Store glycogen and lipids 
Secrete proteins
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25
At what day does the decidua surround the implanted blastocyst
Day 10
26
What are the 2 sides of a placenta
Embryo side | Maternal side
27
What are the structures in the maternal side
Chorion Endometrial veins Spiral arteries
28
How many types of placenta are there
3
29
What is the types of placenta based on
Structural organisation and separation of fetal and maternal blood
30
What are the 3 main types of placenta
1) haemochorial 2) endotheliochorial 3) epitheliochorial
31
Which type of placenta is found in humans
Haemochorial
32
What is the haemochorial
When the chorion is indirect contact with the maternal blood
33
As the blastocyst implants into the endometrium what happen to it
Differentiates
34
When the blastocyst undergoes differentiation what are the 3 main structures that form
Amniotic cavity Bilaminar disc Trophoectoderm (outer cell)
35
What is the bilmaninar disc composed of
Epiblast | Hypoblast
36
What are the 3 cell types the trophoectoderm gives rise to
Cytotrophoblast Syncitiotrophoblast Extravillous cytotrophoblast
37
What are the synctiotrophoblast and extravillous cytotrophast from
Cytotrophoblast
38
What happens to the syncitiotrophoblast
Gradually degrades its way into the endometrium tissue
39
What does the embryo gets its nutrients from
Products of glandular sections | Blood supply via spiral arteries
40
What structures then begin to form in the syncitiotrophoblast
Lucunae (spaces)
41
What does lucaneae store
Digested products of the cell and glands
42
As the syncitiotrophoblast grows into the endometrium what structure does it hit
The maternal spiral arteries
43
What does maternal vessel anastomose with
Lucunae
44
What does anastomoses of lucunae and maternal vessels from
Sinusoids
45
What begins the primary villi formation
When the cytotrophoblast begin to poke way down the syncitiotrophoblast between the sinusoids
46
What forms the primary vili
Cytotrophoblasts extend into the syncitiotrophoblast to form finger like projections into the decidua
47
After the primary vili what other villi begins to form/develop
Secondary villi
48
What occurs to from the secondary villi
Extra-embryonic mesoderm behind the cytotrophoblast begins to push the structures in between the cytotrophoblast and syncitiotrophoblast
49
After the secondary villi formation what villi begins to develop/form
Tertiary vili
50
What occurs to from the tertiary villi
1) The extra embryonic mesoderm begins to differentiate 2) formation of blood vessels from the endothelial cells 3) these blood vessel fuse with the developing vessels to link the fetal blood via invading vessels from the umbilical cord 4) sinosoidal spaces also expand so you get the formation of intervillous space
51
After the tertiary villi what happens to it
Matures to from the mature villi
52
What happens to form the mature villi
1) Stem villi form which is attached to the choronic plate 2) from the stem villi, branch vili project 3) from the branch villi, terminal villi from
53
Which villus is the main exchange with the maternal and fetal blood
Terminal villus
54
When the mature villi has developed what villus do we get
Choronic villus
55
What is the placental membrane
The distance of diffusion between the maternal blood and the fetal blood
56
What is the placental membrane like in 10 weeks of gestation
Large
57
What is the placental membrane large at 10weeks
The fetal blood is central placed and therefore further away from the maternal blood
58
When does the placental membrane decreases/shorter
At term
59
What allows the placental membrane to become shorter at term
More branches from Syncitiotrophoblast thins down Cytotrophoblast thins
60
Which arteries from the mother bring in maternal blood around the choronic villi
The maternal spiral arteries
61
Where does the maternal blood come into
The intervilous space (formed from the sinusoidal spaces)
62
What happens to the maternal spiral arteries to allow for low resistance and high blood flow
Remodelling to increase the diameter
63
Where does extravillous trophoblast form from
Cytotrophoblast at the tip of the anchoring villi
64
When are extravillous cytotrophoblast form
When the anchoring villi form
65
What happens to the extravillous cytotrophoblast when they form
- Migrate into the decidua and block the spiral arteries | - remove smooth muscle and replace endothelium to from the endovascular trophoblast layer
66
Why does the extravillous trophoblast cells block the spiral arteries
To create a low oxygen environment for the early foetus because it doesn’t have the mechanism to deal with oxidative stress yet
67
At the end of which week does the extravillous trophoblast break down the plug in the spiral arteries to allow blood flow into the intervillous space
14
68
Describe how remodelling of the spiral arteries occurs via extravillous trophoblast cells
1) interstitial EVT communicates with smooth muscles cells so they undergo apoptosis 2) interstitial EVT remodels the matrix and lays down material to from the scaffold support 3) endovascular EVT comes down inside the blood vessel to allows endothelial cells to undergo apoptosis 4) endovascular and interstitial EVT then replaces the endothelial cells.
69
Overall what does the remodelling allow
Blood vessels that are larger in diameter, low resistance and high blood flow
70
What are the 2 phases of nutrition for the embryo/foetus
1) histiotrophic phase | 2) haemotrophic phase
71
What is the histiotrophic phase
Fetus gets nutrients form the glandular secretion of endometrium and breakdown of products of decidua
72
What is the haemotrophic phase
EVT plugs off the spiral arteries and blood flows into the placenta
73
How does deoxygenated blood flow from the fetus to the placenta for exchange
1) umbilical arteries 2) fetal capilaries 3) choronic villus 4) stem villus 5) intermediate villi 6) terminal villi
74
Which molecules can pass by diffusion across the placenta
``` Oxygen Carbon dioxide Sodium Urea Fatty acids Sugars ```
75
Which molecules need active transport across the placenta
Amino acids Iron Calcium
76
Which substances are not transport across the placenta
Conjugated steroids | Most bacteria
77
What are the harmful substances that can cross the placenta
Drugs Caffeine Alcohol Cocaine
78
What allows the fetus to pick up the oxygen from the mother with a higher affinity
Fetal haemoglobin
79
What effects occurs to allow the gas exchange
Double Barr effect
80
What is the double Barr effect
Carbon Dioxide from fetus is dumped to maternal blood so oxygen dissociates from mother
81
What channels allow the diffusion of glucose across the placenta
GLUT1 | GLUT3
82
How are protein tranported to the fetus
1) proteins are broken into amino acids | 2) amino acids transported take it up
83
What does amino acids transporters require
ATP
84
What hormone is amino acids transporter on fetus regulated by
Progesterone
85
Which maternal antibodies can be transported to the fetus
IgG
86
What is early onset pre-eclampsia
Insufficient penetration of EVT and lack of remodelling of the spiral arteries so spiral arteries have small diameter and therefore low blood flow when the spiral arteries unplug
87
What can premature loss of EVT in spiral arteries lead to
Early initiation of blood flow that leads to miscarriage
88
What is the treatment of pre-eclampsia
Delivery of placenta and baby
89
What is intra-uterine growth restriction
When the baby does not grow as much as expected
90
Why does intra uterine growth restriction occur
Due to blood flow on both sides of the placenta reduced
91
What can intra uterine growth restriction be associated with
Pre-eclampsia
92
What is the normal location of implantation
High up on the posterior wall of uterus
93
Where else can the embryo implant that can be problematic
Marginal Complete Low lying
94
What does the marginal, complete and low lying implantation cause
Barrier to escape of uterus in parturition | Risk of placental abruption leading to haemorrhage and death of fetus
95
What is placenta accreta
The placenta attaches to the myometrium (deep layer) due to excessive trophoblast invasion instead of attaching to the endometrium (superficial layer)
96
What is the treatment for placenta accreta
- C-section of placenta | - Hysterectomy (if severe)