Anatomy Placenta

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ANATOMY AND PHYSIOLOGY

UTERUS

The uterus, also called the womb, is the hollow, pear-shaped organ in the female
reproductive system in which responsible for the fertilization of an egg cell, implantation, and
development of a fetus. It is a muscular organ that both stretches to be able to accommodate a
developing fetus and contracts in order to push out the baby during childbirth. The lining of the
uterus, the endometrium, is the source of the blood and tissue shed during menses phase or
menstruation.

The layers of uterus:

• Perimetrium – is the outer layer of the uterus and it is made up of serous membrane.
Provides support to the uterus located within the pelvis. Also known as the parietal peritoneum.

• Myometrium – is the middle layer made up of smooth muscle. It is responsible for the
uterus to stretch and the muscular layer permits this to occur. The muscle will contract during
labor and post nasally this muscular layer contracts forcefully to force out the baby and placenta.

• Endometrium – is the inner layer of the uterus which is made up of a simple columnar
epithelium. It is responsible of the shedding during menstruation, sloughing away from the inner
layer, this is the menstrual period occurring as a result of hormonal changes in the reproductive
system. The endometrium thickens during the menstrual period becoming rich with blood vessels
and glandular tissue until the next period occurs and the cycle begins again.

Four main sections:

• Fundus – the broad curved which is situated in the upper portion and it is the widest
portion of the organ that attaches to the uterine tubes.

• Corpus – the main part of uterus that starts directly below the level of uterine tubes and
continues downward, becoming increasingly narrower.

• Isthmus – the lower narrow part of the uterus.

• Cervix – the lowest two inches of the uterus. Tubular in shape, the cervix opens into the
vagina and dilates (widens) to allow. It is the passageway of the baby during delivery.

UTERINE TUBES

Uterine tubes are a pair of tubes one in each side of the uterus. The uterine tube (fallopian
tube) conveys the oocyte to the uterus. One of the paired tubes receives the oocyte from the
ovary to take to the uterus. The tubes are not directly connected to ovary. But it opens in
abdominal cavity very close to ovary. It has 3 distinct portions:
• Isthmus – narrow section of the uterine tubes connecting the ampulla to the uterine
cavity.

• Ampulla – widest section of the uterine tubes. The fertilization process usually occurs.

• Infundibulum – funnel-shaped opening near the ovary to which fimbriae are attached.

OVARIES

The ovaries are a set of paired glands resembling unshelled almonds set in the pelvic
cavity below and to either side of the umbilicus. They are usually pearl-colored and oblong.
They are homologous to the testes. Each ovary weighs from 2 to 5 grams and is about 4 cm long,
2 cm wide, and 1 cm thick. It provides a space for storage of the female egg cells and produce
the female hormones estrogen and progesterone. During the pregnancy, ovulation is suppressed,
and new dominant follicles do not develop. The ovaries are not attached to the fallopian tubes
but are suspended nearby from several ligaments, which help hold them in position.

Three main histological features:

• Surface – formed by simple cuboidal epithelium (known as germinal epithelium).


Underlying this layer is a dense connective tissue capsule.

• Cortex – comprised of a connective tissue stroma and numerous ovarian follicles. Each
follicle contains an oocyte, surrounded by a single layer of follicular cells.

• Medulla - formed by loose connective tissue and a rich neurovascular network, which
enters via hilum of the ovary

THE STRUCTURE OF PREGNANCY

PLACENTA

The placenta, is an important linking organ between the mother's uterus and the fetus. It
supports the developing fetus in uterus, by providing nutrients, removing waste products from
the fetus and allowing gas exchange through the mother's blood supply. The placenta weighs
about 500-600 grams and is 18 to 22 centimeters in diameter and about 2 to 2.5 centimeters
thick.

PLACENTAL DEVELOPMENT

• Pre implantation – the development of the placenta begins with the implantation of the
blastocyst. The blastocyst consists of 32-64 cells containing two different types of differentiated
embryonic cells: the outer trophoblast cells and the inner cell mass. Stem cells form the placenta.
The inner cell mass forms the fetus and the fetal membrane.
• Implantation – on day 6, the zona pellucida disintegrates, the implantation begins as the
blastocyst “hatches”. Later on, trophoblast cells and endometrial decidual epithelial interacts to
begin invading the maternal uterine cells. The embryo then secretes proteases to allow deep
penetration

into the uterine lining. The implant is interstitial. Normal implantation occurs on the anterior or
posterior wall of the uterine body. On day 8, the differentiation of the trophoblast into the outer
multinucleated syncytiotrophoblast. The job of the syncytiotrophoblast is to produce hormones
such like Human Chorionic Gonadotropin (HCG) in the week 2 of the pregnancy.

• Post implantation – during day 9, the early uteroplacental circulation take place by the
end of second week. This happens when syncytiotrophoblast erodes maternal tissues making
maternal blood from uterine spiral arteries enters in the lacunar network. The formation of the
primary chorionic villi (finger-like projections) wherein implanted and expanded in the
surrounding syncytiotrophoblast. Moreover, an extra-embryonic mesoderm develops in these
villi, creating a core of loose connective tissue, which is called secondary chorionic villi, this
happens during the third week of pregnancy. Afterwards, the tertiary chorionic villi are formed
by the end of the third week in the embryonic mesoderm of the secondary chorionic villi making
the tertiary chorionic villi. In the tertiary chorionic villi, the cytotrophoblast cells develops
towards the decidua basalis of the uterus and spread across it forming called cytotrophoblastic
cell.

• Establishment of fetal circulation – as the fetus high demands for blood supply the
maternal spiral arteries undergoes remodeling to produce low resistance to meet the needs of the
fetus. The maternal spiral arteries will invade by the cytotrophoblast and replace maternal
endothelium. They undergo an epithelial to endothelial differentiation, which increases the
diameter and reduces the resistance of the vessels. Pre-eclampsia is a trophoblastic disorder
related to failed or incomplete differentiation of cytotrophoblastic cells during the epithelial to
endothelial transformation.

• Full term placenta – at term, the placenta is disc-shaped with a diameter of 15-25 cm, a
thickness of about 3 cm and a weight of about 500-600 grams. At birth, it is torn from the wall of
the uterus, and about 30 minutes after the baby is born, it is expelled from the uterine cavity. The
mother side will have 15-20 bulging areas of cotyledons, covered by a thin layer of decidua
basalis. The fully developed placenta contains intervillous space. These structures will contain
approximately 150 mL of maternal blood. This is changing 34 times per minute. A chorionic
plate covers the fetal surface. The chorionic vessels converge toward the umbilical cord. These
are a number of large arteries and veins. The amnion covers the layer of chorion. The umbilical
cord usually attaches in the middle of the placenta, perpendicular to it. A velamentous insertion
may occur if the umbilical cord inserts outside of the placenta, but this is rare.

Anatomical Variations:
 Bilobed placenta – also known as a "double duplex," this is where the placenta is made
up of two roughly equal-sized lobes. The umbilical cord can insert into either lobe, pass through
both, or lie between them. Although this condition does not increase the risk of fetal harm, it can
cause first-trimester bleeding, excess amniotic fluid in the gestational sac, placental abruption
(premature separation of the placenta from the uterus), or retained placenta (when the placenta is
still intact). remaining in the body after birth).

 Succenturiate placenta – a lobe of placenta forms separately from a main body that is
linked via the umbilical cord to the fetus. Essentially, it’s a variation of a bilobed placenta that
occurs more commonly in women who are of advanced maternal age or in those who have had in
vitro fertilization.

 Circumvallate placenta – this is when the membranes of the placenta tuck back around
its edges to form a ring-like (annular) shape.

 Battledore placenta – also known as “marginal cord insertion,” this is when the
umbilical cord runs through the margin of the placenta rather than the center.

Associated Conditions:

Placenta previa - this condition occurs when the placenta forms partially or totally
toward the lower end of the uterus, including the cervix, rather than closer to its upper part.

There are three types of placenta previa:

1. Partial placenta previa - placenta partially covers the cervical opening (not fully covered).

2. Marginal placenta previa - placenta is near the edge of the cervical opening.

3. Complete placenta previa - placenta completely covers the cervical opening.

Placenta Acreta - when the placenta implanted too deep within the uterine wall without
penetrating the uterine muscle (myometrium).

Abruptio Placenta - a condition wherein the placenta separates prematurely from the uterine
wall. When this happens the supply of oxygen, blood, anf nutrients will stop.

UMBILICAL CORD

The umbilical cord is consisting of two arteries and one vein, it is also known as the
“suypply line” of the fetus from receiving blood, oxygen, and nutrients from the mother to the
placenta. The approximately lenght of the cord is 55 to 60 centimeters.
AMNIOTIC MEMBRANE AND AMNIOTIC FLUID

The amniotic membrane is the thin-walled sac that envelopes the fetus inside the womb
(uterus). The primary function of the amniotic membrane is to prevent the fetus from injury.
Inside the membrane is called the amniotic fluid and its function is to protects the fetus, keeps a
steady temperature to prevent hyperthermia and hypothermia.

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