Fetal membranes , placenta and twins
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Fetalmembranes,placenta&twins
Dr.MohamedElfikyProfessorofanatomyandembryology
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Early Human Development
Mohamed el fiky
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Early Human Development
Mohamed el fiky
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Early Human Development
Mohamed el fiky
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Early Human Development
Mohamed el fiky
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Embryo after foldingHead swelling
Cardiac swelling
Umbilical cord
Y.S
GUT
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• Thetermfetalmembraneisappliedtothosestructuresderivedfrom
theblastocystwhichdonotcontributetotheembryo.
ØTheamnion,
Øthechorion,
Øtheyolksac
ØAllantois
ØUmbilicalcord
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Amnion•Amniotic membrane : amniotic epi. + extraembryonic mesoderm
•Amniotic fluid:Produce:1)amniotic cells
2) infusion of fluid from maternal blood
3) urine output from the fetus4) pulmonary secretions
Output: 1) absorbed by amniotic cells2) fetus swallow
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AmnioticFluid
• Playsamajorroleinfetalgrowthanddevelopment.
• Dailycontributionoffluidfromrespiratorytractis300-400ml.
• 500mlofurineisaddeddailyduringthelatepregnancy.
• Amnioticfluidvolumeis30mlat10weeks,350mlat20weeks,
700-1000mlat37weeks.
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CompositionofAmnioticFluid• 99%iswater• Desquamatedfetalepithelialcells• Organic&inorganicsalts• Protein,carbohydrates,fats,enzymes,hormones• Meconium&urineinthelatestage
Abnormalitiesofamnioticfluid• Oligo-hydramnios: thevolumeoftheamnioticfluidislessthan½litre.Thismayleadtoadhesionsbetweentheembryoandtheamnion.
• Poly-hydramnios: thevolumeoftheamnioticfluidismorethan2litres.Thismayleadtoprematureruptureoftheamnion.
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Significance of Amniotic Fluid• Permitssymmetricalexternalgrowthoftheembryoandfetus
• Actsasabarriertoinfection
• DuringlaborithelpdilatationofthecervixoftheuterusandItwashbirthcanaland
protectthefetusagainstinfections
• Preventsadherenceofamniontofetus
• Cushions&protectstheembryoandfetus
• Helpsmaintainthebodytemperature
• EnablesthefetustomovefreelyMohamed el fiky
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Yolk Sac• Itislargeat32days
• Shrinksto5mmpearshaped
remnantby10th week&
connectedtothemidgutbya
narrowyolkstalk
• Becomesverysmallat20
weeks
• Usuallynotvisiblethereafter
Primaryyolksac
secondaryyolksacMohamed el fiky
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Significance of Yolk Sac
• Hasaroleintransferofnutrients duringthe2nd and3rd weeks
• Blooddevelopmentfirstoccurshere• Incorporateintotheendodermofembryoasaprimordialgut
• Primordialgermcellsappearintheendodermalliningofthewalloftheyolksacinthe3rd week
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Fate of Yolk Sac• At10weeksliesinthechorioniccavitybetweenchorionicandamnioticsac• Atrophiesaspregnancyadvances• Sometimesitpersiststhroughoutthepregnancybutofnosignificance• Inabout2%ofadultstheproximalintra-abdominalpartofyolkstalkpersistsasanileal diverticulumorMeckeldiverticulum
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Allantois• Inthe3rd weekitappearsasa
sausagelike diverticulumfromthe
caudalwallofyolksacthatextends
intotheconnectingstalk
•Duringthe2nd month,the
extraembryonicpartoftheallantois
degenerates Mohamed el fiky
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Functions of Allantois• Bloodformationoccursinthewallduringthe3rd to5th
week
• Itsbloodvesselspersistastheumbilicalveinand
arteries
• BecomesUrachus andafterbirthistransformedinto
medianumbilicalligamentextendsfromtheapexof
thebladdertotheumbilicus
Anomaliesofallantois:• Urachalfistula:Theurachus remainspatent,urinedischargesfromtheumbilicus.
• Urachalsinus:Theupperendoftheurachus remainspatent.
• Urachalcyst:Themiddlepartoftheurachus remainspatent.
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TheUmbilicalCordAnatomy
•Origin: Itdevelopsfromtheconnectingstalk.•Length:
Atterm,itmeasuresabout50cm.•Diameter: 2cm.
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Structure: It consists of mesodermalconnective tissue called Wharton's jelly, covered by amnion.
It contains:1. One umbilical vein carries
oxygenated blood from the placenta to the foetus
2. Two umbilical arteries carry deoxygenated blood from the foetusto the placenta,
3. Remnants of the yolk sac and allantois.
TheUmbilicalCord
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Insertion:•The cord is inserted in the foetal surface of the placenta near the center "eccentric insertion" (70%)
• Or at the center "central insertion" (30%).
TheUmbilicalCord
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AbnormalitiesOfTheUmbilicalCord
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(A)Abnormalcordinsertion1. Marginal insertion : in the placenta ( battledore insertion).2. Velamentous insertion: in the membranes and vessels
connect the cord to the edge of the placenta. • If these vessels pass at the region of the internal os , the
condition is called " Vasa praevia".
1. Short cord which may lead to :i-Intrapartum haemorrhage due to premature separation of the
placenta,ii-Delayed descent of the foetus druing labour,iii-Inversion of the uterus.2. Long cord which may lead toi-Cord presentation and cord prolapse,ii-Coiling of the cord around the neck,iii-True knots of the cord. Mohamed el fiky
Velamentous insertion(B)Abnormalcordlength
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Chorion
Chorion1- extraembryonicmesoderm2- cytotrophoblast3- Syncytiotrophoblast
Chorion• Definition: Chorionisthenamegiventothetrophoblastaftertheformationoftheextraembryonicmesodermfromitsinnersurface.
• Thechorioniscomposedof:• Syncito-trophoblast (outer layer).• Cytotrophoblast (middlelayer).• Extra-embryonicmesoderm(innerlayer).
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CHORIONFRONDOSUMANDDECIDUABASALIS
• Intheearlyweeksofdevelopment,villi
covertheentiresurfaceofthechorion.
Aspregnancyadvances,villionthe
embryonicpolecontinuetogrowand
expand,givingrisetothechorion
frondosum(bushychorion).Villionthe
abembryonic poledegenerateandbythe
thirdmonththissideofthechorion,now
knownasthechorionlaeve,issmoothMohamed el fiky
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Chorion• Chorionicvillicovertheentirechorionicsacuntilthebeginningof8th week
• Asthissacgrows,thevilliassociatedwithdeciduacapsularis arecompressed,reducingthe
bloodsupplytothem
• Thesevillisoondegeneratesproducinganavascularbareareasmoothchorion(chorion
laeve)
• Asthevillidisappear,thoseassociatedwiththedeciduabasalisrapidlyincreaseinnumber
• Branchprofuselyandenlarge
• Thisbushypartofthechorionicsacisvillouschorion
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CHORIONICVELLI• Bythebeginningofthethirdweek, thetrophoblastischaracterizedby
primaryvillithatconsistofacytotrophoblastic corecoveredbyasyncytial
layer.Duringfurtherdevelopment,mesodermalcellspenetratethecoreof
primaryvilliandgrowtowardthedecidua.Thenewlyformedstructureis
knownasasecondaryvillus.
• Bytheendofthethirdweek,mesodermalcellsinthecoreofthevillusbegin
todifferentiateintobloodcellsandsmallbloodvessels,formingthevillous
capillarysystem.Thevillusisnowknownasatertiaryvillusordefinitive
placentalvillus. Mohamed el fiky
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PRIMARY villous
•Growthoftheseextensionsarecausedbyunderlyingextraembryonicsomaticmesoderm
• Thecellularprojectionsformprimarychorionicvilli Mohamed el fiky
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SECONDARY CHORIONIC VILLI
Earlyin3rdweek,extraembryonicmesodermextendsinsidethevilli
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Tertiary villus
During3rd week,arterioles,venules &capillariesdevelopinthemesenchymeofvilli&joinumbilicalvesselsBytheendof3rd week,
embryonicbloodbeginsto
flowslowlythrough
capillariesinchorionicvilliMohamed el fiky
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Decidua• Thegravidendometriumisknownas
decidua
• Itisthefunctionallayerofendometriumin
apregnantwoman
• Thispartoftheendometriumseparates
fromtherestoftheuterusafter
parturition
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Parts of decidua• Deciduabasalis: Itisthepartofdecidua
betweenblastocystandmyometrium.It
formsthefetalpartofplacenta.
• Deciduacapsularis: Itcoversthe
blastocystexceptembryonicpoleand
separatesitfromuterinecavity.
• Deciduaparietalis: Itistherestof
endometriumthatlinestherestof
uterinecavity.Mohamed el fiky
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Fateofdecidua• Deciduabasalissharesinthe
formationofplacenta.
• Deciduacapsularisand
parietalisfusetogetherand
sheddedwithplacentaafter
delivery.
Deciduabasalis
Amnioticcavity
Fuseddeciduaparitalis,chorionlaeveandamnion
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32
PLACENTA
• Thisisafetomaternal organ.
• Ithastwocomponents:
• Fetalpart – developsfromthechorion
frondosum)
• Maternalpart – derivedfromthedecidua
basalis)
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• Duringthe4th and5th month,thedeciduaformsanumberofdecidual septa,whichprojectintotheintervillous space.
• Asaresultofthisseptumformation,theplacentaisdividedintoanumberofcompartments(cotyledons).
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PLACENTALMEMBRANE(placentalbarrier)
• Thisisacompositestructurethat separatingthefetalbloodfromthe
maternalblood.
• Earlyplacentalbarrier:(Ithasfourlayers):
• Syncytiotrophoblast
• Cytotrophoblast
• Connectivetissueofvillus
• Endotheliumoffetalcapillaries
• Lateplacentalbarrier:Afterthe20th week,thecytotrophoblastic cells
disappearandtheplacentalmembraneconsistsonlyof 2layer:• Syncytiotrophoblast
• Endotheliumoffetalcapillaries 35Mohamed el fiky
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It separates fetal from maternal blood.It prevents mixing of them.
It is an incomplete barrier as it only prevents large molecules to pass ( heparin & bacteria)
But cannot prevents passage of viruses(e.g. rubella), micro-organisms(toxoplama, treponemapallidum) drugs and hormones.
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isdiscoidinshape.
n Diameter=15-25cm,
n 2-3cmthick,
nWeight=0.5kg.
n Umbilicalcordisattachedtoitscenter.
nPosition : in the upper uterine
segment (99.5%), either in the posterior
surface (2/3) or the anterior surface (1/3).
Thefulltermplacenta
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1- Fetalsurface:whichissmoothandshinnybecauseitiscoveredbyanamnioticmembrane.Theumbilicalcordisattachedcentrallytothissurface.
2- Maternalsurface:whichisrough,reddish,andhas15– 20elevatedareascalledcotyledonswithdeepgroovesinbetweenmadebythedecidual septa.
Surfaces
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Functionofplacenta:-1. Respiratoryfunction2. Excretoryfunction3. Nutritionalfunction4. Endocrinefunction:- placentaactsasendocrine
gland5. Barrierfunction:- preventstransferofmaternal
infection.6. Enzymaticaction-7. Immunologicalfunction:- igG.
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AbnormalitiesOfThePlacenta
(A) Abnormal Shape
(B) Abnormal Diameter
(C) Abnormal Weight
(D) Abnormal Position
(E) Abnormal AdhesionMohamed el fiky
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Abnormalitiesofplacenta1- Abnormalposition:PlacentaPreviatheplacentaisattachedtotheloweruterinesegment(duetolowlevelofimplantationoftheblastocyst).Itcausessevereantepartumhaemorrhage.Therearethreetypes:
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MarginalisLateralis(parietalis)
Centralis
the placenta does not reach the
internal os of the cervix.
the margin of the placenta overlies the internal os of the cervix.
the center of the placenta overlies the internal os
of the cervix .
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2- Abnormaladhesion:1- Placentaaccreta:duetoabnormal
adhesionbetweenthechorionicvilliand
theuterinewall.
2- Placentapercreta:Thechorionicvilli
penetratethemyometriumallthewayto
theperimetrium.
- theplacentafailstoseparatefromthe
uterusafterbirthandmaycausesevere
postpartumhemorrhage.Mohamed el fiky
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3- Abnormalattachmentofumbilicalcord:a- Velamentous attachment:Thecorddoesnotreachtheplacentaitselfbutisattachedtoamnioticmembraneoverthefetalsurfaceofplacenta.Theumbilicalvesselspassinthemembranetoreachtheplacenta.Itiseasly torn.
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(4)AbnormalShapeA- Accessoryplacenta: oneortwolobesarecompletelyseparatedfromthemain
placenta.Bilobate , Bipartite B- Placenta Fenestrate
(5)AbnormalDiameter:Placentamembranacea :Theplacentaislarge,thinandmaymeasure30-40cmindiameter.mayencroachontheloweruterinesegment
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Twins
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Twins• Di-zygotictwins
• Incidece :morecommon(70%).
• Mechanismofdevelopment: resultsfromfertilizationof2ova(from2
ovaries)duringanoverian cycleby2separatesperms.
• Placenta: 2separateplacentae.
• Chorion: 2separatechorionicsacs.
• Sex:maybeofthesameordifferentsex.
• Features:differentfetures. Mohamed el fiky
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Twins•zygotic-Mono
• Incidece :lesscommon. resultsfromfertilizationofoneovabyonesperms.• Mechanismofdevelopment:resultsfromdivisionofasinglefertilizedovumduringoneofthefollowingstagesofdevelopment:
• Twocellstage.• Stageofblastocyst,wheretheinnercellmassdividesinto2masses.• Placenta:singlecommonplacenta.• Chorion:singlecommonchorionicsac.• Sex:alwaysofthesamesex.• Features:exactlyidentical.
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