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Structure:

Placenta is a structure that establishes firm connection between the


foetus and the mother.

From the outer surface of the chorion a number of finger like


projections known as chorionic villi grow into the tissue of the uterus.
These villi penetrate the tissue of the uterine wall of the mother and
form placenta.

The placenta is a connection between foetal membrane and the inner


uterine wall. Thus, placenta is partly maternal and partly embryonic.
By means of placenta the developing embryo obtains nutrients and
oxygen from the mother and gives off carbon dioxide and nitrogenous
waste.
In the placenta, the foetal blood comes very close to the maternal
blood, and this permits the exchange of materials between the two.
Food (glucose, amino acids, lipids), water, mineral salts, vitamins,
hormones, antibodies and oxygen pass from the maternal blood into
the foetal blood, and foetal metabolic wastes, such as carbon dioxide,
urea and warn pass into the maternal blood.

The placenta, thus, serves as the nutritive, respiratory and excretory


organ of the foetus. The blood of the mother and foetus do not mix at
all in the placenta or at any other place. The blood of the foetus in the
capillaries of the chorionic villi comes in close contact with the
mothers blood in the tissue between the villi, Inn they are always
separated by a membrane, through which substances must diffuse or
lie transported by some active, energy requiring process.

The type of placenta in man is of described as deciduate (intimate


contact between loetal and maternal tissue), discoidal (villi occur in
the form of disc), haemo-chorial (chorionic epithelium in direct
contact with maternal blood).

Functions of Placenta:
The placenta performs the following functions:

1. Nutrition:

Food materials pass from the mothers blood into the foetal blood
through the placenta.

2. Digestion:

The trophoblast ol the placenta digest protein before passing them


into foetal blood.

3. Respiration:

Through the placenta oxygen passes from the maternal blood to the
foetal blood, and carbon dioxide passes from foetal blood to maternal
blood.

4. Excretion:

Nitrogenous wastes such as urea pass from foetal blood into maternal
blood through placenta and are filtered out by the kidneys of the
mother.

5. Storage:
The placenta stores glycogen, fat etc. for the foetus before liver is
formed.

6. Barrier:
Placenta functions as an efficient barrier (defensive wall) and allows
useful: aerials to pass into the Social blood. Harmful substances such
as nicotine from cigarette and addictive drugs such as heroin can pass
through placenta. Therefore, pregnant women should avoid cigarette
and drugs. Viruses and bacteria can pass through placenta.
7. Endocrine function:
Placenta functions as an endocrine gland it secretes hormones such as
oestrogen, progesterone and human chorionic gonadotropin (HCG).

Parturition (Birth):
These steroid hormones stimulate placenta to produce Prostaglandins.
Hormone oxytocin is secreted from pituitary. These two hormones
cause uterus to begin powerful muscular contractions which becomes
stronger and stronger over a period of 2 to 18 hours. During that time,
the cervix becomes fully dilated and amniotic sac ruptures.

The baby is expelled out of the uterus through the birth canal. Soon
after, the placenta is also expelled out of the uterus. Labour pain can
be induced artificially by injection of oxytocin or insertion of
prostaglandin into the vagina. When the woman is incapable of taking
the labour pain, she can have a surgical procedure for child birth
called caesarean.

Lactation:
The production and release of milk is called lactation .Prolactin, a
hormone of anterior pituitary stimulates lactation after parturition.
High levels of estrogen act directly on mammary glands and can block
the stimulation by prolactin. The mother produces thick, yellowish,
high protein fluid called colostrum for 2-3 days after parturition.

Colostrum contains a great amount of maternal antibodies and helps


in strengthening the babys immune system. Colostrum also acts as a
laxative, removing foetal wastes, called meconium, retained in the
intestine. The newborns suckling stimulates the pituitary to release
oxytocin as well as prolactin. Oxytocin triggers milk release from the
mammary glands. Breast feeding during the period of infant growth is
always recommended for bringing up a healthy baby.

Placenta

placenta

Placenta

Human placenta from just after birth with the umbilical cord in place

The placenta (also known as afterbirth) is an organ that connects the developing fetus to
the uterine wall to allow nutrient uptake, provide thermo-regulation to the fetus, waste elimination,
and gas exchange via the mother's blood supply, fight against internal infection and produce
hormones to support pregnancy. The placenta provides oxygen and nutrients to growing babies and
removes waste products from the baby's blood. The placenta attaches to the wall of the uterus, and
the baby's umbilical cord develops from the placenta. The umbilical cord is what connects the
mother and the baby. Placentas are a defining characteristic of placental mammals, but are also
found in some non-mammals with varying levels of development.[1] The homology of such structures
in various viviparous organisms is debatable and, in invertebrates such as Arthropoda,
is analogous at best.
The word placenta comes from the Latin word for cake,
from Greek / plakenta/plakonta, accusative of
/ plakeis/plakos, "flat, slab-like",[2][3] in reference to its round, flat appearance in
humans. The classical plural is placentae, but the form placentas is common in modern English and
probably has the wider currency at present.
Prototherial (egg-laying) and metatherial (marsupial) mammals produce a choriovitelline
placenta that, while connected to the uterine wall, provides nutrients mainly derived from the egg
sac.
The placenta functions as a fetomaternal organ with two components: the fetal placenta (Chorion
frondosum), which develops from the same blastocyst that forms the fetus, and the maternal
placenta (Decidua basalis), which develops from the maternal uterine tissue. [4]

Structure
In humans, the placenta averages 22 cm (9 inch) in length and 22.5 cm (0.81 inch) in thickness,
with the center being the thickest, and the edges being the thinnest. It typically weighs approximately
500 grams (just over 1 lb). It has a dark reddish-blue or crimson color. It connects to the fetus by
an umbilical cord of approximately 5560 cm (2224 inch) in length, which contains two umbilical
arteries and one umbilical vein.[5] The umbilical cord inserts into the chorionic plate (has an eccentric
attachment). Vessels branch out over the surface of the placenta and further divide to form a
network covered by a thin layer of cells. This results in the formation of villous tree structures. On the
maternal side, these villous tree structures are grouped into lobules called cotyledons. In humans,
the placenta usually has a disc shape, but size varies vastly between different mammalian species. [6]

Microbiota[edit]
Main article: Placental microbiome
The healthy placenta was considered to be a sterile organ but studies published in 2013 and 2014
showed that the placenta is a niche of the human microbiome, and those studies provided initial
characterization of the placental flora;[7][8] these microorganisms are distinct from viruses, fungi, and
bacteria that cause infection and preterm birth in chorioamnionitis and other pregnancy
complications.[7] While biofilms are often found in the amniotic fluid of failed pregnancies, they are
found in particulate matter that is found in about 1% of health pregnancies; as of 2015 it was not
known whether these biofilms are part of the normal placental flora. [8]
The placental flora more closely resembles that of the oral microbiome than either the vaginal or
rectal microbiome; the reason why was not known as of 2015. [7]
In non-human animals, part of the microbiome is passed onto offspring even before the offspring are
born. Bacteriologists assume that the same probably holds true for humans. [8]

Physiology

Development

Placenta

Placentation

The placenta begins to develop upon implantation of the blastocyst into the maternal endometrium.
The outer layer of the blastocyst becomes the trophoblast, which forms the outer layer of the
placenta. This outer layer is divided into two further layers: the underlying cytotrophoblast layer and
the overlying syncytiotrophoblast layer. The syncytiotrophoblast is a multinucleated continuous cell
layer that covers the surface of the placenta. It forms as a result of differentiation and fusion of the
underlying cytotrophoblast cells, a process that continues throughout placental development. The
syncytiotrophoblast (otherwise known as syncytium), thereby contributes to the barrier function of
the placenta.
The placenta grows throughout pregnancy. Development of the maternal blood supply to the
placenta is complete by the end of the first trimester of pregnancy (approximately 1213 weeks).
Placental circulation

.
Maternal blood fills the intervillous space, nutrients, water, and gases are actively and passively
exchanged, then deoxygenated blood is displaced by the next maternal pulse

Maternal placental circulation


In preparation for implantation of the blastocyst, the uterine endometrium
undergoes "decidualisation". Spiral arteries in decidua are remodeled so
that they become less convoluted and their diameter is increased. The
increased diameter and straighter flow path both act to increase maternal
blood flow to the placenta. The relatively high pressure as the maternal
blood fills intervillous space through these spiral arteries bathes the
fetal villi in blood, allowing an exchange of gases to take place. In humans
and other hemochorial placentals, the maternal blood comes into direct
contact with the fetal chorion, though no fluid is exchanged. As the
pressure decreases between pulses, the deoxygenated blood flows back
through the endometrial veins.
Maternal blood flow is approximately 600700 ml/min at term.

Fetoplacental circulation
Fetal circulation

Deoxygenated fetal blood passes through umbilical arteries to the placenta.


At the junction of umbilical cord and placenta, the umbilical arteries branch
radially to form chorionic arteries. Chorionic arteries, in turn, branch
into cotyledon arteries. In the villi, these vessels eventually branch to form
an extensive arterio-capillary-venous system, bringing the fetal blood
extremely close to the maternal blood; but no intermingling of fetal and
maternal blood occurs ("placental barrier").[9]
Endothelin and prostanoids cause vasoconstriction in placental arteries,
while nitric oxide causes vasodilation.[10] On the other hand, there is no
neural vascular regulation, and catecholamines have only little effect. [10]
The fetoplacental circulation is vulnerable to persistent hypoxia or
intermittent hypoxia and reoxygenation, which can lead to generation of
excessive free radicals. This may contribute to pre-eclampsia and
other pregnancy complications.[11] It is proposed that melatonin plays a role
as an antioxidant in the placenta.[11]

Birth
Placental expulsion begins as a physiological separation from the wall of
the uterus. The period from just after the child is born until just after the
placenta is expelled is called the "third stage of labor". The placenta is
usually expelled within 1530 minutes of birth.
Placental expulsion can be managed actively, for example by
giving oxytocin via intramuscular injection followed by cord traction to assist
in delivering the placenta. Alternatively, it can be managed expectantly,
allowing the placenta to be expelled without medical assistance.
A Cochrane study suggests that blood loss and the risk of postpartum
bleedingwill be reduced in women offered active management of the third
stage of labour.[12]
The habit is to cut the cord immediately after birth, but allegedly there is no
medical reason to do that; on the contrary, it is theorized that not cutting the
cord helps the baby in its adaptation to extrauterine life, especially in
preterm infants.[13]
Functions

Nutrition

Maternal side of a placenta shortly after birth.

The perfusion of the intervillous spaces of the placenta with maternal blood
allows the transfer of nutrients and oxygen from the mother to the fetus and
the transfer of waste products and carbon dioxide back from the fetus to
the maternal blood supply. Nutrient transfer to the fetus occurs via
both active and passive transport. Active transport systems allow
significantly different plasma concentrations of various large molecules to
be maintained on the maternal and fetal sides of the placental barrier.
[14]
Adverse pregnancy situations, such as those involving
maternal diabetes or obesity, can increase or decrease levels of nutrient
transporters in the placenta resulting in overgrowth or restricted growth of
the fetus.[15]

Excretion
Waste products excreted from the fetus such as urea, uric acid,
and creatinine are transferred to the maternal blood by diffusion across the
placenta.

Immunity
Antibodies can pass through the human placenta, thereby providing
protection to the fetus in utero.[16] This transfer of antibodies begins as early
as the 20th week of gestational age, and certainly by the 24th week. [17] This
passive immunity lingers for several months after birth, thus providing the
newborn with a carbon copy of the mother's long-term humoral immunity to
see the infant through the crucial first months of extrauterine life. IgM,
however, cannot cross the placenta, which is why some infections
acquired during pregnancy can be hazardous for the fetus.
Furthermore, the placenta functions as a selective maternal-fetal barrier
against transmission of microbes. However, insufficiency in this function
may still cause mother-to-child transmission of infectious diseases.
Endocrine function
The first hormone released by the placenta is called the human
chorionic gonadotropin hormone. This is responsible for stopping the
process at the end of menses when the Corpus luteum ceases activity
and atrophies. If hCG did not interrupt this process, it would lead to
spontaneous abortion of the fetus. The corpus luteum also produces
and releases progesterone and estrogen, and hCG stimulates it to
increase the amount that it releases. hCG is also what is the indicator of
pregnancy, and the hormone that pregnancy tests look for. These tests
will work when menses has not occurred or after implantation has
happened on days seven to ten. hCG may also have an anti-antibody
effect, protecting it from being rejected by the mothers body. hCG also
assists the male fetus by stimulating the testes to produce testosterone,
which is the hormone needed to allow the sex organs of the male to
grow.

Progesterone helps the embryo implant by assisting passage through


the fallopian tubes. It also affects the fallopian tubes and the uterus by
stimulating an increase in secretions necessary for fetal nutrition.
Progesterone, like hCG, is necessary to prevent spontaneous abortion
because it prevents contractions of the uterus, and is necessary for
implantation.

Estrogen is a crucial hormone in the process of proliferation. This


involves the enlargement of the breasts and uterus, allowing for growth
of the fetus and production of milk. Estrogen is also responsible for
increased blood supply towards the end of pregnancy
through vasodilation. The levels of estrogen during pregnancy can
increase so that they are thirty times what a non-pregnant woman mid-
cycles estrogen level would be.

Human placental lactogen is a hormone used in pregnancy to


develop fetal metabolism and general growth and development. Human
placental lactogen works with Growth hormone to stimulate Insulin-like
growth factor production and regulating intermediary metabolism. In the
fetus, hPL acts on lactogenic receptors to modulate embryonic
development, metabolism and stimulate production of IGF, insulin,
surfactant and adrenocortical hormones. hPL values increase with
multiple pregnancies, intact molar pregnancy, diabetes and Rh
incompatibility. They are decreased with toxemia, choriocarcinoma,
and Placental insufficiency.[18][19]
Cloaking from immune system of mother
Immune tolerance in pregnancy

The placenta and fetus may be regarded as a foreign allograft inside the
mother, and thus must evade from attack by the mother's immune system.
For this purpose, the placenta uses several mechanisms:

It secretes Neurokinin B-containing phosphocholine molecules. This


is the same mechanism used by parasitic nematodes to avoid detection
by the immune system of their host.[20]

There is presence of small lymphocytic suppressor cells in the fetus


that inhibit maternal cytotoxic T cells by inhibiting the response
to interleukin 2.[21]
However, the Placental barrier is not the sole means to evade the immune
system, as foreign fetal cells also persist in the maternal circulation, on the
other side of the placental barrier.[22]

Other functions
The placenta also provides a reservoir of blood for the fetus, delivering
blood to it in case of hypotension and vice versa, comparable to
a capacitor.

Ultrasound image of human placenta and umbilical cord (color Doppler


rendering) with central cord insertion and three umbilical vessels, at 20
weeks of pregnancy
Clinical significance

Micrograph of a cytomegalovirus (CMV)infection of the placenta (CMV placentitis). The characteristic


large nucleusof a CMV-infected cell is seen off-centre at the bottom-right of the image. H&E stain.

Numerous pathologies can affect the placenta.

Placenta accreta, when the placenta implants too deeply, all the way to the actual muscle of
uterine wall (without penetrating it)

Placenta praevia, when the placement of the placenta is too close to or blocks the cervix

Placental abruption/abruptio placentae


Infections involving the placenta:

Placentitis, such as the TORCH infections.

Chorioamnionitis.

Society and culture[edit]


The placenta often plays an important role in various cultures, with many societies conducting rituals
regarding its disposal. In the Western world, the placenta is most often incinerated.[24]
Some cultures bury the placenta for various reasons. The Mori of New Zealand traditionally bury
the placenta from a newborn child to emphasize the relationship between humans and the earth.
[25]
Likewise, the Navajo bury the placenta and umbilical cord at a specially chosen site,[26]particularly
if the baby dies during birth.[27] In Cambodia and Costa Rica, burial of the placenta is believed to
protect and ensure the health of the baby and the mother.[28] If a mother dies in childbirth,
the Aymara of Bolivia bury the placenta in a secret place so that the mother's spirit will not return to
claim her baby's life.[29]
The placenta is believed by some communities to have power over the lives of the baby or its
parents. The Kwakiutl of British Columbia bury girls' placentas to give the girl skill in digging clams,
and expose boys' placentas to ravens to encourage future prophetic visions. In Turkey, the proper
disposal of the placenta and umbilical cord is believed to promote devoutness in the child later in life.
In Ukraine, Transylvania, and Japan, interaction with a disposed placenta is thought to influence the
parents' future fertility.
Several cultures believe the placenta to be or have been alive, often a relative of the
baby. Nepalese think of the placenta as a friend of the baby; Malaysian Orang Asli regard it as the
baby's older sibling. The Igbo of Nigeria consider the placenta the deceased twin of the baby, and
conduct full funeral rites for it.[28] Native Hawaiians believe that the placenta is a part of the baby, and
traditionally plant it with a tree that can then grow alongside the child. [24] Various cultures
in Indonesia, such as Javanese, believe that the placenta has a spirit and needs to be buried outside
the family house.
In some cultures, the placenta is eaten, a practice known as placentophagy. In some eastern
cultures, such as China, the dried placenta (ziheche , literally "purple river cart") is thought to
be a healthful restorative and is sometimes used in preparations of traditional Chinese medicine and
various health products.[30] The practice of human placentophagy has become a more recent trend in
western cultures and is not without controversy; its practice being considered cannibalism is
debated.
Some cultures have alternative uses for placenta that include the manufacturing of cosmetics,
pharmaceuticals and food.

Function of Amnion
The amnion is a membranous sac which surrounds and protects the embryo.
When first formed, the amnion is in direct contact with the body of the
embryo, but about the fourth or fifth week, amniotic fluid begins to
accumulate within it. As the volume of the fluid increases, the amnion
expands and ultimately adheres to the inner surface of the chorion.
Increasing amnion quantities allow free movements of the fetus during the
later stages of pregnancy, and also protect it by diminishing the risk of injury.

Function of Amnion
The human embryo develops in the mother's uterus within a fluid-filled sac
called the amnion. The primary function of the amnion is to create a
roomy, weightless, protective chamber in which the fetus can grow freely.
Thus, as the embryo grows, the amnion expands as well. The amount of fluid
contained in the amnion (known as amniotic fluid) is important for
maintaining the size of the cavity. If there is an inadequate supply of
amniotic fluid (a condition given the fancy term, oligohydramnios), and
consequently an unusually small amniotic sac, the growth of the fetus will
be constrained. This can result in severe malformations. The lungs, for
instance, seem to be very sensitive to the amount of space available in the
amnion. If there is insufficient amniotic fluid, the wall of the mother's
uterus will compress the chest of the fetus, restricting the development of
the lungs. Aside from cushioning the fetus and providing a medium in which
he/she can move easily, amniotic fluid serves other important functions.
For instance, it may be a source of fetal nutrients and, as we have already
learned, is vital for fetal lung development.

Function of the Amnion


Amnion