The Placenta, Umbilical Cord, & Amniotic Cavity, changes of pregnancy Flashcards
The Placenta
general
Temporary fetal organ that begins developing shortly after implantation
Roles of the placenta:
Facilitating nutrient, and gas and waste exchange between maternal and fetal circulations
Serves as an endocrine organ producing hormones that regulate both maternal and fetal physiology during pregnancy
Placental cells (trophoblasts) invade and start to remodel the uterine vasculature within a few hours after implantation → starts to produce hCG
Placental Structure
Flat, discoid organ measuring 20-25 cm in diameter and 3 cm in thickness
Membranes (fuses into a single membrane by delivery):
Amnion
Chorion
2 sides:
Basal plate (maternal side):
Divided into lobes
Separated by septa
Chorionic plate (fetal side):
Contains branching chorionic villi, providing a massive surface for exchange
Umbilical cord emerges from the fetal side of the placenta
Umbilical cord:
2arteries
1 vein
Placental Circulation
Chorionic villi provide a large surface area for maternal–fetal exchange
Spiralarteries(maternal) fill the intervillous spaces in the decidua basalis layer of the endometrium:
-Bring in oxygenated blood for fetus
-Spiralarteries“rupture” and become large spaces called lacunae
2 umbilical arteries bring deoxygenated blood from fetus to placental chorionic villi
Gas and molecule exchange occurs between the fetal blood in the chorionic villi and the maternal blood in the lacunae, across the placental barrier
1umbilical veintransports oxygenated blood back to the fetus
Maternalveinstake deoxygenated blood back to the maternalcirculation
Maternal and fetal blood never come into direct contact
Functions of the Placenta
Gas exchange
O2-CO2exchange
Occurs via simplediffusion
Fetal hemoglobin has ↑ affinity for oxygen compared to maternal hemoglobin
Nutrient exchange
Provides materials needed for fetal development and growth
Mechanisms of exchange:
Water andsodiumby simplediffusion
Glucoseby facilitateddiffusion
Large molecules (LDLs, peptides,antibodies) by receptor-mediatedendocytosis
Amino acidsby secondaryactive transport
Metabolic functions
Glycogen synthesis
Cholesterolsynthesis
Protein metabolism
Waste product removal
Waste products (urea and CO2) are transported back to the mother
Occurs via simplediffusion
Hormonal secretion
Human chorionic gonadotropin(hCG): Maintains the activity of the corpus luteum required for continuation ofpregnancy
Human growth hormone(hGH)
Human placental lactogen: Stimulates maternal insulin production to ↑ glucose available to the fetus
Chorionic thyrotropin
Chorioniccorticotropin-releasing hormone(CRH)
Progesterone: Maintainspregnancy, preventsmenstruation
Estrogens
Glucocorticoids
Placenta previa
general, Dx, Tx
Abnormal attachment of the placenta in the lower uterine segment
Can obstruct (partially or completely) the internal cervical os
Maternal and fetal hemorrhage can result fromcervical dilation
Classically presents as painless bright red vaginal bleeding
Diagnosed by ultrasound
Treatment:
Pelvic rest (avoiding digital exams and intercourse)
Delivery via C-section prior to the onset oflabor(or emergently if there is clinical bleeding)
Abnormal implantation of the placenta into the uterine wall
dx, tx
Placenta accreta
Chorionic villi invade to the myometrium
Placenta increta
Chorionic villi penetrate deeper into the myometrium
Placenta percreta
Chorionic villi reach the uterine serosa and/or invade other organs
Diagnosed by ultrasound
Treatment:
Delivery via planned C-section, sometimes with concurrent hysterectomy (especially in cases of placenta increta and placenta percreta)
Placental abruption
general, dx, tx
Premature separation of the normally implanted placenta from the uterus
Clinical diagnosis based on a presentation with painful contractions with or without bleeding
Large abruptions may be seen on ultrasound
Treatment
Depends on thegestational ageand size of abruption
Significant abruptions require immediate delivery
The Umbilical Cord
general and length
Connects the fetus to the placenta
Extends from the fetal umbilicus to the fetal surface of the placenta
Cord length:
Depends on amniotic fluid volume and fetal mobility
Average length: 55 cm
≤ 40 cm is considered a short cord
Umbilical cord
structure
Vessels
Contains 2arteriesand 1 vein
Vessels are surrounded by a protective substance called Wharton’s jelly
Counted by sonographic evaluation, with the 3 vessels seen in the 1st trimester
Coiling: the vein andarteriesspiral around each other
Bloodflow
Umbilical vein supplies oxygenated blood to the fetus
Umbilicalarteriestake deoxygenated blood away from the fetus
Umbilical cord structure
Insertion into the placenta:
Normal: central insertion
Variants:
Eccentric: off center
Marginal: the cord inserts on the edge of the placenta
Velamentous: last portion of the umbilical cord lacks the protective Wharton’s jelly, leaving the umbilical vessels exposed
Abnormal insertion
Increases the risk of complications duringlaborand/or delivery
Umbilical cord rupture and/or prenatal hemorrhage
Amniotic Cavity
functions and amnioin
Fluid-filled cavity that encases the developingembryo/fetus
Functions of the amniotic cavity
Protects fetus against trauma
Protects umbilical cord against compression
Nutrientreservoirfor the fetus
Provides space for normal fetal growth and development
Amnion:
An avascular, tough but pliable membrane
1 of the 2 primary fetal membranes
Ultimately fuses with the chorion
Functions of the amnion:
Involved in solute and water transport required for amniotic fluidhomeostasis
Produces bioactive compounds
Amniotic cavity
Amniotic fluid
Normal fluid index/oligo/poly
Amniotic fluid:
Liquid that surrounds theembryoand fetus during its development
As the fetus grows, it “creates” amniotic fluid via urination, and continually “recycles” the fluid byswallowingit
Congenital defects inswallowingand/or the renal/urinary system can lead to abnormalities in amniotic fluid volume
Normal amniotic fluid index: 5-25 cm of fluid
Oligohydramnios: less than 5 cm
Polyhydramnios: greater than 25 cm is considered
Β-hCG
Peaks around week 9
Produced by the placenta
Maintains to activity of the corpus luteum until ~12 weeks
Estrogen (estriol)
Produced by the corpus luteum → placenta
Increases throughout pregnancy; drops drastically just before birth
Prepares the maternal body for delivery
Progesterone
Produced by the corpus luteum → placenta
Increases throughout pregnancy; drops drastically just before birth
Maintains the uterine lining
Smooth muscle relaxant