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FUNCTION
OF PLACENTA INCLUDING
PLACENTAL
INSUFFICIENCY
DEFINITION:
Placenta is a fleshy structure that develops
mostly from fetal chorionic tissue and
maternal decidua during pregnancy. It lies
implanted on the uterine wall. It is
connected with fetus through umbilical
cord in the amniotic cavity .It maintains
pregnancy and carries vital fetal functions.
The human placenta is discoid because of
its shape; hemochorial, because of direct
contact of chorion with the maternal blood
DEVELOPMENT OF THE
HUMAN PLACENTA
Decidua : It is the name given to
endometrium during pregnancy.
Decidua basalis
Decidua capsularis
Decidua parietalis
Early Trophoblast
Syncitio trophoblast / Plasmodia
trophoblast
Cytotrophoblast / Langhans
layer
Extra embryonic mesoderm
Stages in formation of
chorionic villi
Primary villi: consist of a central
core of cytotrophoblast covered by a
layer of syncitio trophoblast.
Adjoining villi are separated by an
intervillous space.
Placental ageing
Villi changes:
Decreasing thickness of the syncitium and
appearance of syncitial knots.
Partial disappearance of Langhans cells.
Decrease in the stromal tissue including
Hofbauer cells.
Obliteration of some vessels and marked
dilatation of the capillaries.
Thickening of the basement layer of the fetal
endothelium and the cytotrophoblast.
Deposition of fibrin on the surface of the villi.
STRUCTURE OF PLACENTA
AT FULLTIME PREGNANCY
Naked Eye Anatomy:
Micro anatomy
At term 4/5th of placenta is of
fetal origin. Decidual plate and
maternal sinus blood belong to
mother. Structure of placenta
from fetal to maternal are:
Stem villi:
These arise from the chorionic plate and extends
to the basal plate. Functional unit of the placenta
is called a fetal cotyledon or placentome,
which is derived from a major primary stem
villus. Functional subunit is called a lobule which
is derived from a tertiary stem villi. About 60
stem villi persist in human placenta. Thus each
cotyledon (totalling 15-29) contains 3-4
major stem villi. The fetal capillary system
within the villi is almost 50 km long. Thus, while
some of the villi are anchoring the placenta to
the deciduas, the majority are free within the
intervillous space and are called nutritive villi
PLACENTAL CIRCULATION
The fetal circulation system
1 Umbilical arteries
2 Umbilical vein
3 Fetal capillaries
1 Spiral arteries
2 Uterine veins
3 Intervillous spaces
A Basal plate
The placental
membrane(barrier)
In the first trimester it consists of the syncytiotrophoblast, the
cytotrophoblast (Langhans' cells), the villus mesenchyma (in which
numerous ovoid Hofbauer cells that exhibit macrophage properties are
found) and the fetal capillary walls.
1
2
3
4
5
6
Intervillous space
syncitiotrophoblast
cytotrophoblast
villus mesenchyma
fetal capillaries
Hofbauer macrophage
1
2
3
4
5
6
Intervillous space
Syncytiotrophoblast
Cytotrophoblast
Villus mesenchyma
Fetal capillaries
Hofbauer macrophages
PLACENTAL FUNCTIONS
Respiratory function
Excretory function
Nutritive function
Glucose
Lipids
Amino Acids
Water and electrolytes
Hormones
ENZYMATIC FUNCTION
STORAGE FUNCTION
BARRIER FUNCTION
IMMUNOLOGICAL FUNCTION
ENDOCRINE FUNCTIONS: The placenta
produces hormones that are vital to the survival
of fetus. It includes following.
Protein hormones: hCG, hPL PS -1G
Steroid hormones: Estrogen
(estriol,estradiol,estrone) , Progesterone.
Functions:
Proteolysis and lipolysis in mother and
promotes transfer of glucose and amino
acids to the fetus.
It antagonizes insulin action, high level of
maternal insulin promotes protein synthesis.
Stimulates breast development to prepare
for lactation.
PLACENTAL GRADING
Grade
Grade
Grade
Grade
0:
1:
2:
3:
placental
placental
placental
placental
age
age
age
age
12-24 weeks
30-32 weeks
36 weeks
38 weeks
ABNORMALITIES OF
PLACENTA AND CORD
PLACENTA SUCCENTURIATA
PLACENTA EXTRACHORIALIS:
Circumvallate Placenta
Placenta marginata
PLACENTA MEMBRANECAE
BIPARTITE PLACENTA
TRIPARTITE PLACENTA
Placenta in multiple pregnancy
CORD ABNORMALITIES
BATTLEDORE PLACENTA
VELAMENTOUS PLACENTA
PLACENTAL INSUFFICIENCY
Definition: Placental insufficiency is
a complication of pregnancy in which
the placenta cannot bring enough
oxygen and nutrients to a baby
growing in the womb.
Etiology
Effects
Treatment
Side effects of the treatment
Monitoring the condition
Preventing the condition
BIBLIOGRAPHY
Pritchard JA, Grant NF. Williams obstetrics. 17th edition.
Connecticut: Appleton century crafts;1985
Dawn CS. Textbook of obstetrics and neonatolgy. 16th
edition. Kolkata: Dawn book publishers; 2004
Dutta DC. Textbook of obstetrics. 6th edition. Kolkata: New
Central Book Agency; 2004
Orshan SA. Maternity, Newborn and Womens health
nursing. Philadelphia: Lippincott Williams and Wilkins ;
2008
Ladewig PW, London ML, Olds SB. Maternal newborn
nursing. California: Addison Wesley nursing; 1994
Lowdermilk DL, Perry SC. Maternity and womens health
care. 8th edition Missouri: Mosby; 2004