Definition: Penetration of the blastocyst into the superficial (compact) layer of the endometrium.

Time: Implantation occurs at the 6th day after fertilization and is completed about the 11th day.

- The blastocyst at the inner cell mass side (embryonic pole) attaches to the endometrium. - The trophoblast proliferates rapidly and becomes differentiated into two layers: A. an inner cellular layer ----------- cytotrophoblast. B. an outer multinucleated protoplasmic mass with no cell boundaries ------------ syncytiotrophoblast-. The syncytiotrophoblast erodes the maternal tissue and becomes surrounded by lacunae filled with maternal blood so forming the primary villi.

Site: The normal site is the endometrium of the posterior wall of the fundus of the uterus in or near the middle line. The endometrium after implantation is called decidua.

1. Uterine ectopic pregnancy: a. At the cornu of the uterus (the site of attachment of the uterine tube) leading to early abortion. b. At the lower uterine segment leading to placenta previa. c. Cervix, leading to cervical pregnancy and early abortion.

mesentry tube

Internal os

ovary

2. Extra uterine ectopic pregnancy: a. The commonest site is in the Fallopian tube leading to tubal pregnancy that leads to early abortion or tubal rupture with severe internal haemorrhage. b. Ovary (ovarian pregnancy), broad ligament or omentum (rare). It is also called ectopic pregnancy. c. Peritoneum of It might result in death of the Douglas pouch (abdominal pregnancy). embryo or early abortion with severe internal haemorrhage.

Midline section of bladder, uterus, and rectum to show an abdominal pregnancy in the rectouterine (Douglas) pouch.

Decidua basalis (part of endometrium between the blastocyst & the myometrium ). Decidua paritalis (endometrium covers the wall of the uterus). Decidua capsularis (endometrium between the blastocyst & uterine cavity). Decidua marginalis (endometrium lying at the junction between the capsularis and parietalis).

The trophoblast differentiates into cytotrophoblast & syncytiotrophoblast. Cells of the cytotrophoblast divide and migrate externally. They lose their cell membranes to form the syncytiotrophoblast. The syncytiotrophoblast erodes the maternal tissues, so lacunae filled with maternal blood surround columns of syncytiotrophoblast. These columns of syncytiotrophoblast will form primary villi.

syncytiophoblast cytotrophoblast

The inner cell mass is differentiated into: Epiblast and hypoblast. Both layers will form the bilaminar germ disc. Clefts develop within the epiblast and coalesce to form the amniotic cavity.
The epiblast (future ectoderm) will

surround the amniotic cavity so forming the amniotic membrane. The hypoblast cells migrate and line the inner surface of the cytotrophoblast so forming the exocoelomic membrane which limits a space called the exocoelomic cavity (primary or primitive yolk sac).

 A new layer develops

consisting of loosely arranged cells derived from the epiblast. This layer fills the space between the exocoelomic membrane and the cytotrophoblast. Large spaces develop in the extraembryonic mesoderm and coalesce to form the extraembryonic coelom.

 The extraembryonic

coelom divides the extraembryonic mesoderm into the extraembryonic somatic mesoderm (lines the trophoblast, and covers the amnion) and extraembryonic visceral mesoderm (covers the yolk sac). Extraembryonic somatic mesoderm, cytotrophoblast, and syncytiotrophoblast constitute the chorion.

Clinical application:
The

syncytiotrophoblast secretes human chorionic gonadotrophin hormone which prevents the degeneration of the corpus luteum. It also stimulates the production of progesterone which in turn is important in sustaining the placenta. By the end of the 2nd week, the amount of this hormone will be sufficient to be detected in the maternal blood and urine. This is the basis of pregnancy test.

The

trophoblast differentiates into 2 layers, cytotrophoblast & syncytiotrophoblast The inner cell mass differentiates into 2 layers, epiblast & hypoblast. The primary mesoderm splits into somatopleuric primary mesoderm & splanchnopleuric primary mesoderm.