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CHAPTER 5

Implantation and
Placental Development
(part 1)

By : Tgk. Chairannisa

The Ovarian-Endometrial Cycle


The Decidua
Implantation And Early Trophoblast
Formation
Placenta And Chorion Development
The Amnion
The Umbilical Cord
Placental Hormones
Fetal Adrenal Gland-Placental
Interactions

THE OVARIANENDOMETRIAL
The Ovarian Cycle
CYCLE
Follicular or Preovulatory Ovarian Phase
Ovulation
Luteal or Postovulatory Ovarian Phase

The Endometrial Cycle


Proliferative or Preovulatory Endometrial
Phase
Secretory or Postovulatory Endometrial
Phase

The Ovarian
Cycle

Follicular or Preovulatory Ovarian


Phase

Follicular development consists of several stages, which


include the gonadotropin-independent recruitment of
primordial follicles to the antral stage.
transforming growth GDF9 BMP-15 :
regulate granulosa cell proliferation and differentiation
as primary follicles grow,
stabilize and expand the cumulus oocyte complex in the
oviduct.

As antral follicles develop, surrounding stromal cells are


recruited, by a yet-to-be-defined mechanism, to
become thecal cells.
During the follicular phase, estrogen levels rise in
parallel to growth of a dominant follicle and to the
increase in its number of granulosa cells.

Ovulation
FERTILISASI

OOSIT

ENZIM

OTOT POLOS

EKSPANSI
KUMULUS
PROSTAGLANDIN

MATURASI

LONJAKAN
LH

KORPUS LUTEUM

Luteal or Postovulatory Ovarian Phase

The Endometrial Cycle


Proliferative or Preovulatory
Endometrial Phase
The preovulatory endometrium is characterized by
proliferation of glandular, stromal, and vascular endothelial
cells.
The early part of the proliferative phase, the endometrium is
usually less than 2 mm thick.
the late proliferative phase, the endometrium thickens from
both glandular hyperplasia and increased stromal ground
substance, which is edema and proteinaceous material.
midcycle, as ovulation nears, glandular epithelium becomes
taller and pseudostratified.

Secretory or Postovulatory Endometrial


Phase
predecidual transformation of the upper two thirds of the
functionalis layer.
growth and development of the spiral arteries continued.
During endometrial growth, spiral arteries lengthen at a
rate appreciably greater than the rate of endometrial
tissue thickening discordance obliges even greater
coiling of the already spiraling vessels.

Menstruation
With corpus luteum rescue and continued progesterone
secretion, the decidualization process continues.
Anatomical Events During Menstruation
With endometrial regression, spiral artery coiling
becomes sufficiently severe that resistance to blood
flow increases strikingly, causing endometrial
hypoxia.
endometrial ischemia and tissue degeneration.

Vasoconstriction precedes menstruation and is the most


striking and constant event observed in the cycle.
Intense spiral artery vasoconstriction also serves to limit
menstrual blood loss.
Leukocyte infiltration is considered key to both
endometrial extracellular matrix breakdown and repair of
the functionalis layer.
Invading leukocytes secrete enzymes the matrix
metalloprotease (MMP) add to the proteases already
produced initiate matrix degradation.

Prostaglandins and Menstruation.


Progesterone withdrawal increases expression of
cyclooxygenase 2 (COX-2) synthesize prostaglandins.
role for prostaglandinsespecially vasoconstricting
PGF2in menstruation initiation has been suggested
Prostaglandins serve an important function in the event
cascade leading to menstruation that includes
vasoconstriction, myometrial contractions, and
upregulation of proinflammatory responses.

Origin of Menstrual Blood


Endometrial bleeding appears to follow rupture of a
spiral arteriole and consequent hematoma formation.
With a hematoma, the superficial endometrium is
distended and ruptures.
fissures develop in the adjacent functionalis layer,
and blood and tissue fragments are sloughed.
Hemorrhage stops with arteriolar constriction.
Changes that accompany partial tissue necrosis also
serve to seal vessel tips.

THE DECIDUA
DECIDUAL STRUCTURE
DECIDUA BASALIS

Decidua directly beneath blastocyst implantation that


is modified by trophoblast invasion

DECIDUA CAPSULARIS

the enlarging blastocyst and initially separates the


conceptus from the rest of the uter- ine cavity

DECIDUA PARIETALIS
Lining the remainder of the uterus

IMPLANTATION AND EARLY TROPHOBLAS


FORMATION
Fertilization and Implantation
With ovulation, the secondary oocyte and adhered
cells of the cumulus-oocyte complex are freed from
the ovary.
the oocyte is quickly engulfed by the fallopian tube
infundibulum.
by directional movement of cilia and tubal peristalsis.
Fertilization, which normally occurs in the oviduct.

Molecular mechanisms allow spermatozoa to pass


between follicular cells.
through the zona pellucida, which is a thick
glycoprotein layer surrounding the oocyte cell
membrane into the oocyte cytoplasm.
Fusion of the two nuclei and intermingling of maternal
and paternal chromosomes creates the zygote.

IMPLANTATION AND EARLY TROPHOBLAST FORMATION

The Zygote

The Blastocyst
3 phases of the
embryo
implantation into
the uterine wall :

Appositio
n

Adhesion

initial contact of the blastocyst to the uterine wall;

increased physical contact between the blastocyst


and uterine epithelium

penetration and invasion of syncytiotrophoblast


and cytotrophoblasts into the endometrium, inner
third of the myometrium, and uterine vasculature.
Invasion

The Trophoblast

At 10 days

At 12 days

Placental Organization
Although maternal venous sinuses are tapped early in
implantation, maternal arterial blood does not enter the
intervillous space until around day 15.
By approximately the 17th day, however, fetal blood
vessels are functional, and a placental circulation is
established.
The fetalplacental circulation is completed when the
blood vessels of the embryo are connected with chorionic
vessels.

PLACENTA AND CHORION DEVELOPMENT


Chorionic villi in contact with the decidua basalis
proliferate to form the chorion frondosumor leafy
chorionwhich is the fetal component of the
placenta.
As growth of embryonic and extraembryonic tissues
continues, the blood supply to the chorion facing the
endometrial cavity is restricted.

villi in contact with the decidua capsularis cease to


grow and then degenerate chorion becomes the
avascular fetal mem- brane that abuts the decidua
parietalis, that is, the chorion laeveor smooth chorion.

Maternal Regulation of Trophoblast Invasion and


Vascular Growth
Decidual natural killer cells (dNK) accumulate in the decidua
and are found in direct contact with trophoblasts.
express both IL-8 and interferon-inducible protein-10, which
bind to receptors on invasive trophoblast cells.
produce proangiogenic factors, including Vascular endothelial
growth factor (VEGF) and placental growth factor (PlGF)
to attract and promote trophoblast invasion into the decidua and promote
vascular(spiral arteries) growth
trophoblasts secrete specific chemokines that attract the dNK cells to the
maternal-fetal interface.
Both cell types simultaneously attract each other.

Trophoblast Invasion of the Endometrium


Extravillous trophoblasts of the first-trimester placenta are
highly invasive. They form cell columns that extend from
the endometrium to the inner third of the myometrium.
Invasive trophoblasts secrete numerous proeolytic
enzymes that digest extracellular matrix and activate
proteinases already present in the endometrium

Invasion of Spiral Arteries


Spiral artery modifications are carried out by two
populations of extravillous trophoblastinterstitial
trophoblasts and endovascular trophoblasts.
uteroplacental vessel development as proceeding in two
waves or stages
occurs before 12 weeks postfertilization : invasion and
modification of spiral arteries up to the border between the
decidua and myometrium.

between 12 and 16 weeks and involves some invasion of


the intramyometrial segments of spiral arteries.

Establishment of Maternal Blood Flow

Approximately 1 month after conception, maternal blood


enters the intervillous space in fountain-like bursts from the
spiral arteries sweeps over and directly bathes the
syncytiotrophoblast.
Placental Growth and Maturation

In the first trimester, placental growth is more rapid than


that of the fetus. But by approximately 17 postmenstrual
weeks, placental and fetal weights are approximately
equal.
By term, placental weight is approximately one sixth of

Fetal and Maternal Blood Circulation in


the Mature Placenta
Fetal Circulation

Deoxygenated venous-like fetal blood flows to the placenta


through the two umbilical arteries.
Blood with significantly higher oxygen content returns from
the placenta via a single umbilical vein to the fetus.

Maternal Circulation