L17 Part 1 Placenta Flashcards

1
Q

Fertilisation process

A

Sperm and ovum meet in fallopian tube 12-24 hours after ovulation

Fusion occurs and 2nd meiotic division occurs

Acrosome reaction makes ovum impermeable to other sperm

End - zygote - has diploid (46 chromosomes)

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2
Q

Zygote to blastomere

A

Zygote

2 cell stage

4 cell stage

8 cell stage

Morula (72 hours)

Blastocyst (4 days)

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3
Q

Days 4-5

Morula develops..? becomes .x.?

what happens to x?

rest of the cells.. creates..

blastocyst reaches .. ready for..

A

The morula develops a cavity and becomes known as a blastocyst

Blastocyst thins out and becomes the trophoblast - start of the placenta

The rest of the cells move (are pushed up) to form the inner cell mass. This creates an embryonic pole

The blastocyst has now reached the uterine lumen and is ready for implantation

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4
Q

Days 6-7 Bilaminar disc of the embryo

what forms epiblast + hypoblast?

2 layers are =

hypoblast forms (2)

epiblast forms

what develops within epiblast mass?

A

Inner cell mass: differentiates into two layers: epiblast and hypoblast

These two layers are in contact

Hypoblast forms extra embryonic membranes and the primary yolk sac

Epiblast forms embryo

Amniotic cavity develops within the epiblast mass

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5
Q

Days 16+

how does the bilaminar disc develop further? aka =

initiated by =

epiblast =

what happens to hypoblast ?

epiblast

A

Bilaminar disc develops further by forming 3 distance layers (this process is known as gastrulation)

Initiated but he primitive streak

The epiblast becomes known as ectoderm

The hypoblast is replaced by cells from the epiblast and becomes endoderm

The epiblast gives rise to the third layer, the mesoderm

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6
Q

Embryo - the 3 germ layers

A

The hypoblast degenerates

The epiblast gives rise to all 3 germ layers

The embryo folds to create the adult pattern

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7
Q

The development of the placenta

A

Syncytiotrophoblast burrows into the myometrium of the uterus - the syncytiotrophoblasts invading the maternal spiral arteries and starting the formation of the primary/secondary and tertiary villi

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8
Q

Formation of the placenta (5)

A

Synctiotrophoblast invades decidua (endometrium)

Cytotrophoblast cells erodes maternal spiral arteries and veins

Spaces (lacunae) between them fill up with maternal blood

Followed by mesoderm that develops into foetal vessels

Aiding the transfer of nutrients, O2, across a simple cellular barrier

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9
Q

Cytotrophoblast cells (CTB) (4)

A

Undifferentiated stem cells

Invade the maternal blood vessels and destroy the epithelium

Give rise to the syncytiotrophoblast cells (STB)

Reduce in number as pregnancy advances

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10
Q

Syncytiotrophoblast cells (STB) (3)

A

Fully differentiated cells

Direct contact with maternal blood

Produce placental hormones

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11
Q

The placenta as an endocrine organ (2)

A

Human chorionic gonadotrophin (HCG)

  • maintenance of corpus luteum of pregnancy
  • progesterone and oestrogen

Human placental lactogen HPL

  • growth, lactation
  • carbohydrate and lipid
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12
Q

Placental barrier (4)

A

Maternal blood in the lacunae in direct contact with syncytiotrophoblasts

Mono layer of syncytiotrophoblast/cytotrophoblast/foetal capillary epithelium is all that separated the foetal and maternal blood

Cytotrophoblasts decrease as the pregnancy advances (not needed)

The barrier thins as pregnancy advances leading to a greater surface area for exchange (one 10m^2)

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13
Q

Transfer across the placenta (5)

A

Gases - oxygen and carbon dioxide by simple diffusion

Water and electrolytes

Steroid hormones

Proteins poor - only by pinocytosis

Transfer of maternal antibodies IgG - starts at 12 weeks - mainly after 34 weeks therefore lack of protection for premature infants

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14
Q

Names parts of the decidua (3)

A

Capsularis - overlying embryo and chorionic cavity

Parietalis - side uterus not occupied by embryo

Basalis - between uterine wall and chorionic villae

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15
Q

Vasa praevia

A

Velomentous cord insertion that runs across the cervical os

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16
Q

Vasa praaevia: What can happen if the foetal vessels within the umbilical cord rupture? (4)

A

The foetal vessels within the umbilical cord pass over the internal os

As the internal os dilates in labour the vessels are stretched and exposed and can rupture leading to massive foetal blood loss and death

Diagnosed on ultrasound using colour dopplers

Management deliver by C section when the foetus is above 34 weeks

17
Q

Clinical aspects of the placenta (3 in relation to where placenta is in uterus)

A

Position of the placenta within the uterus

  • mainly fundal (at the top)
  • anterior or posterior (front wall or back wall)
  • low lying or placenta praevia (near to cervical os)
18
Q

Placenta praaevia (4)

A

Massive bleeding in pregnancy

Painless bleeding

Foetal death

Maternal death

19
Q

Failure of trophoblastic invasion into maternal circulation at 12 and 18 weeks (4)

A

Poor maternal foetal mixing of blood

Lack of oxygen and nutrients to the foetus

Leads to foetal growth restriction

Pre-eclampsia (raised BP)

20
Q

Placenta Accrete (2)

A

The placenta has invaded too deep into the myometrium and thus after birth the placenta cannot separate and stays within the uterus

As a consequence the uterus cannot contact down and massive bleeding can occur leading to the requirement to do a hysterectomy

21
Q

Placental abruption (4)

A

Massive bleeding in pregnancy (often concealed)

Extremely painful

Foetal death

Maternal death

22
Q

How is placental abruption different to placenta praevia?

A

Bleeding can be concealed in placental abrasion i.e. not seen vie the vagina but the uterus fills up with blood

Different to placenta praevia where the blood is seen from he vagina

23
Q

Placenta in multiple pregnancies

A

Can lead to conjoined twins - see slide (MCMA)