THE PLACENTA AT TERM

PRESETED BY: Ndhlovu

Chinama
 GENERAL OBJECTIVES
• At the end of the lecture student
nurses should be able to acquire
knowledge and understanding of
placenta
 SPECIFIC OBJECTIVES
• At the end of the lecture student
nurses should be able to:
1. Define placenta
2. Describe the placenta at term
3. Describe the membranes of the
placenta
4. Describe the umbilical cord
5. State malformation of the placenta,
membranes and cord development
 DEFINITION:
• The placenta is a flat roughly circular
or disc shaped structure or temporal
organ with the chorionic membranes
extending outwards from it’s edges.
Position
• It is normally situated in the upper
uterine segment.
• It is confirmed by sending the woman
for scanning.
 SIZE
• The placenta is 20-22cm in
diameter and it is about 2.5cm
thick in the centre but it gets
thinner towards the circumference.
• It weighs about 0.5kg or 500g or
1/6 of the baby’s weight at term.
• It is made up of two surfaces which
are maternal and foetal surfaces.
 MATERNAL SURFACES
• In utero maternal surface of the
placenta lies next to the uterus and
it’s deeply embedded in the decidua.
• On inspection following delivery the
chorionic villi are arranged in lobes
or cotyledons.
• The maternal surface is divided into
16-20 lobes or cotyledons which are
separated by deep groove or furrow
or sulci.
 FOETAL SURFACES
• This surface faces the foetal
during pregnancy and has the
umbilical cord inserted into it.
• It is covered with amniotic
membrane (Amnion) which
gives it a smooth shinny
appearance.
 FOETAL SURFACES
CONT’D
• The amnion can be stripped
away from the foetal surface
up to the insertion of the cord.
• Foetal blood vessels can be
seen radiating from the
insertion of the umbilical cord
out wards the edge of the
placenta.
 FOETAL SURFACES
CONT’D
• These blood vessels are the branches
of the umbilical vein and the two
umbilical arteries as they branch
they deep into the placental tissue
and become smaller as they
approach the placental edge.
• The two membranes attached to the
placenta are the Chorion and the
Amnion.
PLACENTA
 MEMBRANES
CHORION – is continous with the
edge of the placenta because
both develop from the
trophoblast.
• The Chorion is an opaque fliable
membrane and the outer
membrane of the foetal sac
which lines the decidua villi
during pregnancy.
 MEMBRANES CONT’D
• The hole in the Chorion
through which the baby has
been born will be seen after
delivery called Fenestrum.
• The Chorion should have no
blood vessels running through
it.
 MEMBRANES CONT’D
AMNION – it is the inner
membrane of the foetal sac
lining the amniotic cavity and
contains the liquor amni.
• The amnion can be stripped off
the Chorion and off the foetal
surface and the placenta up to
the insertion of the umbilical
cord.
 MEMBRANES CONT’D
• It is a transparent membrane
which is strong and pliable.
• After delivery the amnion also
has a hole in it through which
the baby has been born which
is the fenestrum.
• The amnion has no blood
vessels as well.
 UMBILICAL CORD
Situation
• The umbilical cord is derived from the
duct which forms between the amniotic
sac and the York sac.
• The umbilical cord extends from the
foetal surface of the placenta to the
umbilical area which is continous with
the skin of the foetus at the junction.
• It is normally inserted into the centre of
the placenta about 5-10cm from the
placental edge.
UMBILICAL CORD CONT’D
Size
• At full term the umbilical cord
measures 40-56cm in length and is
1-2cm thick and it carries three blood
vessels which are 2 arteries
containing impure foetal blood going
to the placenta and 1 vein containing
oxygenated blood going back to the
foetus.
UMBILICAL CORD CONT’D
Shape
• The shape is like a cord and has 40 spiral
twists in it.
Structure
• Amnion covers the cord a continuation
covering of the foetal surface of the
placenta.
• The foetal end of the cord is continous
with the skin which covers the abdomen.
• Both skin and amnion are derived from
ectoderm.
THE THREE BLOOD VESSELS OF
THE CORD
• The three blood vessels coil around each
other within the cord and are continous with
the tinny vessels in the chorionic villi of the
placenta.
• One (1) umbilical vein transports oxygen and
food nutrients to the foetal circulation
system from the maternal blood which lies in
the decidua spaces.
• Two (2) umbilical arteries return waste
products from the foetus to the placenta
where they are assimilated to the maternal
blood where they are secreted.
 WHARTON’S JELLY
• Wharton’s jelly surrounds blood
vessels; it is a jelly like substance
which like the blood vessels is
derived from mesoderm.
• Wharton’s jelly sometimes collects in
small clusters and forms a false
Knot on the cord.
• It is the amount of jelly which makes
the cord thick or thin and there are
no blood vessels in the jelly.
FUNCTIONS OF THE PLACENTA

• The placenta’s integrity is very

crucial.
• The following are the functions of the
placenta:
1. Respiration – exchange of gases
i.e oxygen from the maternal
circulation is passed onto the foetus
while carbon dioxide from the foetal
circulation is passed to the maternal
circulation.
FUNCTIONS OF THE PLACENTA
CONT’D
2. Nutrition – nutrients
necessary for normal foetal
development, growth and
survival such as glucose, amino
acids, vitamins, mineral salts
are transferred from the
mother’s circulation across the
placenta membranes to the
foetus.
FUNCTIONS OF THE PLACENTA
CONT’D
• The placenta selects
substances which can pass
direct to the foetus.
• It also has enzymes that can
break proteins, fats, and
carbohydrates suitable for the
foetus.
FUNCTIONS OF THE PLACENTA
CONT’D
3. Excretion – waste products such
as creatinine, urea, uric acid,
birilubin, carbon dioxide etc
occurring as a result of metabolism
taking place in the body of the
foetus are returned to the maternal
circulation via the placenta.
• There is little foetal tissue break
down.
FUNCTIONS OF THE PLACENTA
CONT’D
4. Protection or barrier – the
placenta provides limited barrier
to infection.
• Few bacteria can cross the
placenta barrier and such
organisms are Treponema
pallidum, tubercle bacilli, viruses
like German measles can free
cross the placenta barrier.
FUNCTIONS OF THE PLACENTA
CONT’D
• Antibodies (Immunoglobulin-
G) (IgG) cross the placenta to
the foetus conveying
immunity to the baby for the
first 3 months of life after
birth.
FUNCTIONS OF THE PLACENTA
CONT’D
5. Endocrine – placenta is a temporal
endocrine organ.
• The Human Chorionic Gonadotrophin
Hormone (HCGH), oestrogen levels
gives an index of foetal well being.
• Foetus provides precursors for
production of oestrogen throughout
pregnancy after the activities of
corpus luteum declines.
FUNCTIONS OF THE PLACENTA
CONT’D
• Progesterone maintains the
integrity of the decidua through
out pregnancy.
• Human Placental Lactogen
Hormone action is connected
with the activities of human
growth hormone but does not
promote growth itself.
FUNCTIONS OF THE PLACENTA
CONT’D
• It is involved in glucose
metabolism in pregnancy.
• As the levels of HCGH decreases
the levels of Human Placental
Lactogen increases and continue
throughout pregnancy.
FUNCTIONS OF THE PLACENTA
CONT’D
6. Storage – glucose is stored
in the form of glycogen which
is reconverted to glucose
when needed, iron, fat
soluble vitamins (ADEK) are
also stored in the placenta.
FUNCTIONS OF THE PLACENTA
CONT’D
7. Enzymal – every enzyme
known exists in the human body
has been found in the placenta.
• The enzymes are necessary for
synthesis of proteins,
functioning of foetal tissue,
steroid convention to produce
progesterone and oestrogen.
FUNCTIONS OF THE PLACENTA
CONT’D
• 8. Stabilization – the
placenta anchors the growing
foetus, amniotic sac, liquor
amni to hold within the
uterine cavity
 LIQUOR AMNI (AMNIOTIC
FLUID)
• Liquor amni fills the amniotic sac.
• It is normally a clear pale straw
coloured fluid alkaline in reaction with
a Ph 7.21.
• Its origin is not clearly understood but
it is thought to be formed mainly by
fluid diffusion through the chorionic
and amniotic membranes
(Trophoblastic cells) from the maternal
blood in the decidua of the uterus.
 LIQUOR AMNI (AMNIOTIC
FLUID) CONT’D
• When foetal kidneys are functioning the
foetus passes urine in the liquor amni.
• The foetus also swallows liquor amni
which is then absorbed from the foetal
intestines and passed into the foetal
circulation and so back to the placenta
and the maternal circulation.
• The whole volume of the fluid in the sac
is changed every 3 hours like water
being changed by the filter in the
swimming pool.
 Increased rate of liquor amni
from last menstrual period
• At 10 weeks it will be 35ml
• At 10-20 weeks a rapid increase in
volume to about 300ml
• At 20-30 weeks double to about 600ml
• At 30-38weeks increases slowly to a
litre or 1000ml
• After 38 weeks decrease to about
600ml at term (40weeks)
FUNCTIONS OF LIQUOR AMNI

During pregnancy (its mainly to

form a buffer between the foetus
and uterus).
• To permit symmetrical growth of
the embryo by equalizing
pressures
• Prevents the amnion from
adhering to the embryo and later
the foetus
 FUNCTIONS OF LIQUOR AMNI
CONT’D
• Cushions the foetus from impacts to
the maternal abdomen
• To maintain the embryo (foetus) at a
constant temperature
• To allow the foetus to move freely for
the development of the muscles
• To protect the foetus from infection
 FUNCTIONS OF LIQUOR AMNI
CONT’D
During labour
• To equalize the compression or
pressure on the foetus
• When the membranes rupture
the fluid flashes through the
birth canal and so helps to
reduce the likelihood of the
foetus to become infected
during birth
 MALFORMATION OF THE
PLACENTA, MEMBRANES AND
CORD DEVELOPMENT

1. PLACENTA SUCCENTURIATA
• Accessory lobe of the placenta or
cotyledon develops away of the
main placenta structure.
• Blood vessels travel across the
membranes connecting the
succenturiata lobe with the main
placenta.
PLACENTA SUCCENTURIATA
 MALFORMATION OF THE
PLACENTA, MEMBRANES AND
CORD DEVELOPMENT CONT’D

• The complications of this

abnormality are that the
accessory lobe might be retained
in utero when placenta is
expelled causing postpartum
haemorrhage (PPH).
 MALFORMATION OF THE
PLACENTA, MEMBRANES AND
CORD DEVELOPMENT CONT’D

2. PLACENTA BIPARTITA
• Two separate areas of placenta tissue
development but there are no
connecting blood vessels between
them.
• The characteristic is that there is one
umbilical cord which divides sending a
branch to each lobe distinguished from
2 placentae with two cords in twin
pregnancy.
 MALFORMATION OF THE
PLACENTA, MEMBRANES AND
CORD DEVELOPMENT CONT’D
3. PLACENTA CIRCUMVALLATA
• During development the amnion and
Chorion double bag around the
circumference of the placenta giving a
collar appearance attachment of the
Chorion is folded back on foetal surface
causing easy detachment from uterine wall
which may result in Antepartum
haemorrhage (APH).
• This can be seen post delivery of the
placenta and during examination.
 MALFORMATION OF THE
PLACENTA, MEMBRANES AND
CORD DEVELOPMENT CONT’D

4. PLACENTA INFARCTS
• True infarcts of the placenta are areas
of necrosis where chorionic villi have
been damaged usually due to
vasospasm of the maternal circulation
and areas become calcified.
• The affected parts of the placenta are
rendered incompetent and if severe
can cause placental insufficiency.
 MALFORMATION OF THE
PLACENTA, MEMBRANES AND
CORD DEVELOPMENT CONT’D

• The placenta is small and

thin instead of the usual
deep red colour.
• Large parts of the placenta
have a whitish anaemic
appearance.
 MALFORMATION OF THE
PLACENTA, MEMBRANES AND
CORD DEVELOPMENT CONT’D
• Fibrin deposits on the maternal
surface are seen as tinny, grayish,
light, grit deposits while on the foetal
surface appearance as white
patches.
• A bruised area after the removal of a
very dark red blood clot indicates
early placental bleed which could
have been caused by placenta
abruptio or placenta praevia.
 MALFORMATION OF THE
PLACENTA, MEMBRANES AND
CORD DEVELOPMENT CONT’D
5. PLACENTA OEDEMA
• A large pale placenta may indicate that
the mother has diabetes mellitus.
• Meconeum stained (yellow) is caused by
meconeum being passed in utero e.g in
intrauterine growth retardation (IUGR).
• Yellow staining can be due to high level
of birilubin in liquor amni caused by
Rhesus Iso Immunization.
 MALFORMATION OF THE
PLACENTA, MEMBRANES AND
CORD DEVELOPMENT CONT’D
6. PLACENTA ACCRETA
• The trophoblastic villi penetrate
through the basal layer of the
decidua and become attached to the
myometrium cells through the basal
layer.
7. PLACENTA INCRETA
• The trophoblastic villi have
penetrated the myometrial cells and
 MALFORMATION OF THE
PLACENTA, MEMBRANES AND
CORD DEVELOPMENT CONT’D
8. PLACENTA PECRETA
• The trophoblastic villi have
penetrated through to the serosal
surface of the uterus (perimetrium).
• NB: these conditions results in
retention of the placenta and will
necessitate surgical intervention.
 MALFORMATION OF THE PLACENTA,
MEMBRANES AND CORD DEVELOPMENT
CONT’D

9. HAEMAGEOMATA OF PLACENTA
• It is the only common
untrophoblastic tumour of the
placenta and occurs in about 1% of
all placentae which is rare.
• Haemageomas are usually small and
single but may occassionary be large
and multiple.
 MALFORMATION OF THE
PLACENTA, MEMBRANES AND
CORD DEVELOPMENT CONT’D
• Small ones are not visible on external
examination.
• Large ones are seen as bulging
protuberances on the foetal surface
of the placenta.
• On maternal surface they may
replace an entire lobe.
 MALFORMATION OF THE
PLACENTA, MEMBRANES AND
CORD DEVELOPMENT CONT’D
• Most of the haemageomata are
of no clinical importance but
those measuring more than
5cm in diameter may be
associated with maternal and
foetal conditions like
polyhydramnios, foetal hypoxia,
IUGR and even uterine death.
 MEMBRANES AND THE
CORD
BATTLEDORE
• The insertion of the cord is
at the very edge of the
placenta.
• This is very rare but should
it occur may cause loss of
foetal blood.
 MEMBRANES AND THE CORD
CONT’D
PLACENTA VELAMENTOSA
• Insertion of the cord is into
the membranes insteady of
the foetal surface of the
placenta.
• It is called velamentosa
insertion of the cord.
 MEMBRANES AND THE CORD
CONT’D
VASA PRAEVIA
• Is a condition with a placenta
velamentosa and the foetal blood
vessels from the umbilical cord lining
the presenting part during labour.
• The danger is that membranes will
rupture the vessels and may be torn
or severed.
 OLIGOHYDRAMNIOS
• Is the deficiency in the amount of
amniotic fluid or liquor amni can be
less than 300ml.
• It is associated with congenital
malformations eg renal agenesis
(absence of kidney) intra uterine
growth retardation (IUGR).
• Certain deformities like tallipes may
develop due to pressure on the
foetus.
 POLYHYDRAMNIOS
• This is excessive amniotic
fluid which is above normal
(quantity more than 1500ml).
• It is associated with multiple
pregnancy, foetal
abnormalities like encephaly,
oesphageal atresia (foetus
unable to swallow amniotic
 SHORT CORD
• Cord less than 40cm (normal is 40-56cm.
the dangers are:
• Delay or prevention of descent of the
foetus during labour.
• May cause early separation of the
placenta during labour leading to foetal
hypoxia, cord may snap resulting in
foetal anoxia, loss of foetal blood and
retained placenta.
• Short cord would be natural or wind
around the foetal head
CORD AROUND THE NECK
 LONG CORD
• Is a cord which is more than
60-70cm. dangers are:
• Cord wind the neck and body
2-3 times which will decrease
the amount of blood flow to
the foetus resulting in under
development or even foetal
death.
 TRUE KNOTS IN THE CORD

• This is when the foetus passes

through the loop of the cord
forming a knot.
• It is likely to occur with a long
cord during the period of
gestation when there is a great
ratio of liquor amni to that of the
foetus.
TRUE KNOT
 TRUE NOTES IN THE CORD
CONT’D
• This is from 16th -24th week when
there is a lot of liquor amni.
• Dangers are that:
• During delivery the knot could be
drawn tight as the foetus
descends causing anoxia and
even foetal death.
 QUOTE
“LIFE WILL BE MEANINGFUL
AND FULL OF HAPPINESS
WHEN WE LEARN TO DO THE
RIGHT BECAUSE IT IS RIGHT
AND NOT AS AN OBLIGATION”
THE END