Download - Placenta and fetal membranes
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Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
Placenta & Fetal MembranesPlacenta & Fetal Membranes
Crisostomo S. O. Ordoño Jr. MDCrisostomo S. O. Ordoño Jr. MD
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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DeciduaDecidua
SpecializedSpecialized
Highly modifiedHighly modified
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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DeciduaDecidua
Dependent on:Dependent on:
EstrogenEstrogen
ProgesteroneProgesterone
Blastocyst ImplantationBlastocyst Implantation
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Decidua of PregnancyDecidua of Pregnancy
Structure based on anatomical location:Structure based on anatomical location:
Decidua BasalisDecidua Basalis
Decidua CapsularisDecidua Capsularis
Decidua ParietalisDecidua Parietalis
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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DeciduaDecidua
Decidua VeraDecidua Vera
14 – 16 weeks AOG14 – 16 weeks AOG
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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DeciduaDecidua
Layers of the Decidua Parietalis & BasalisLayers of the Decidua Parietalis & Basalis
Zona CompactaZona Compacta
Zona SpongiosaZona Spongiosa
Zona BasalisZona Basalis
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Decidua ReactionDecidua Reaction
Commences mid-luteal Commences mid-luteal phasephase
Completed with Completed with Blastocyst ImplantationBlastocyst Implantation
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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DecidualDecidual
Decidual ReactionDecidual Reaction
Endometrial Stromal Endometrial Stromal CellsCellsEnlarge, polygonalEnlarge, polygonalRound & vesicular nucleiRound & vesicular nucleiClear & basophilic cytoplasmClear & basophilic cytoplasmPericellular membranePericellular membrane
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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DeciduaDecidua
Pericellular Membrane provides:Pericellular Membrane provides:
Attachment for the Attachment for the TrophoblastTrophoblast
Protection against Protection against proteasesproteases
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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DeciduaDecidua
Blood Supply:Blood Supply:
Decidua ParietalisDecidua Parietalis
Decidua CapsularisDecidua Capsularis
Decidua BasalisDecidua Basalis
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Decidual HistologyDecidual Histology
True Decidual CellsTrue Decidual Cells
Endometrial StromaEndometrial Stroma
Bone Marrow Derived Bone Marrow Derived CellsCellsEndometrial large Endometrial large granular lymphocytesgranular lymphocytes
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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DeciduaDecidua
Zona SpongiosaZona Spongiosa
Large distended glands Large distended glands with hyperplasia minimal with hyperplasia minimal stromastroma
Becoming cuboidal to flat Becoming cuboidal to flat in later pregnancyin later pregnancy
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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DeciduaDecidua
Decidua BasalisDecidua Basalis
Spongy zone is mainly Spongy zone is mainly arteries & veinsarteries & veins
Invaded by interstitial Invaded by interstitial trophoblast & giant cellstrophoblast & giant cells
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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DeciduaDecidua
HistologyHistology
Nitabuch’s Layer/ Nitabuch’s Layer/ Fibrinoid DegenerationFibrinoid Degeneration
Rohr Stria found at the Rohr Stria found at the bottom of the intervillous bottom of the intervillous space & surrounding the space & surrounding the anchoring villianchoring villi
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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DeciduaDecidua
Prolactin productionProlactin production
Produced by the same Produced by the same gene in the pituitarygene in the pituitary
Identical amino acid Identical amino acid sequencesequence
Different promoter to Different promoter to initiate transcriptioninitiate transcription
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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DeciduaDecidua
Role of ProlactinRole of Prolactin
Maintenance of AF Maintenance of AF volumevolume
Regulate immune Regulate immune function in the deciduafunction in the decidua
Regulate angiogenesisRegulate angiogenesis
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Fertilization & ImplantationFertilization & Implantation
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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107 - cell Blastocyst107 - cell Blastocyst
Stage of release from the Stage of release from the zona pellucidazona pellucida
Due to proteases from Due to proteases from the secretory the secretory endometriumendometrium
Blastocyst directly Blastocyst directly influence the receptivity influence the receptivity of the endometriumof the endometrium
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Receptivity of the EndometriumReceptivity of the Endometrium
Cytokines from Cytokines from the Blastocystthe Blastocyst
EstrogenEstrogen
ProgesteroneProgesterone
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Endometrial ResponseEndometrial Response
Leukemia Inhibiting Leukemia Inhibiting FactorFactor
Colony Stimulating FactorColony Stimulating Factor
Effect: increase Protease secretion by Trophoblast Effect: increase Protease secretion by Trophoblast to degrade the extracellular matrixto degrade the extracellular matrix
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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ImplantationImplantation
Occurs within 6 – 7 days Occurs within 6 – 7 days post fertilizationpost fertilization
Must be on Days 20 – 24 Must be on Days 20 – 24 of the endometrial – of the endometrial – ovarian cycleovarian cycle
Apposition is the 1Apposition is the 1stst step of implantation step of implantation
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Biology of the TrophoblastBiology of the Trophoblast
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Trophoblast DifferentiationTrophoblast Differentiation
88thth day Post Fertilization day Post Fertilization
Trophoblast differentiates into:Trophoblast differentiates into:
Primitive Primitive SyncytiotrophoblastSyncytiotrophoblast
Primitive mononuclear Primitive mononuclear CytotrophoblastCytotrophoblast
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Primitive CytotrophoblastPrimitive Cytotrophoblast
Germinal cells of the Germinal cells of the syncytiumsyncytium
Well-demarcated cell Well-demarcated cell borderborder
Can undergo DNA Can undergo DNA synthesissynthesis
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Primitive SyncytiotrophoblastPrimitive Syncytiotrophoblast
Multi-nucleatedMulti-nucleated
No individual cellsNo individual cells
Lacks the ability for DNA Lacks the ability for DNA synthesissynthesis
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Trophoblast DifferentiationTrophoblast Differentiation
Villous TrophoblastVillous Trophoblast
Extravillous TrophoblastExtravillous Trophoblast
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Villous TrophoblastVillous Trophoblast
Gives rise to the Gives rise to the chorionic villichorionic villi
Function:Function:Transport of oxygen & Transport of oxygen & nutrientsnutrients
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Extravillous TrophoblastExtravillous Trophoblast
Migrates to the decidua & Migrates to the decidua & myometriummyometrium
Gives rise to the primary Gives rise to the primary villous stalkvillous stalk
Penetrates the maternal Penetrates the maternal vasculaturevasculatureInterstitial trophoblastInterstitial trophoblastEndovascular Endovascular trophoblasttrophoblast
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Interstitial TrophoblastInterstitial Trophoblast
Penetrates the maternal Penetrates the maternal decidua & myometriumdecidua & myometrium
Surrounds the maternal Surrounds the maternal spiral arteriesspiral arteries
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Endovascular TrophoblastEndovascular Trophoblast
Penetrates the lumen of Penetrates the lumen of the spiral arteriesthe spiral arteries
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Trophoblast InvasionTrophoblast Invasion
1010thth day the blastocyst is day the blastocyst is totally encased within the totally encased within the deciduadecidua
Similar invasion Similar invasion characteristic of characteristic of metastatic cancer cellsmetastatic cancer cells
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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ChorionChorion
Trophoblast with an Trophoblast with an underlying mesenchymeunderlying mesenchyme
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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VilliVilli
Primary VilliPrimary Villi
Secondary VilliSecondary Villi
Tertiary VilliTertiary Villi
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Placental OrganizationPlacental Organization
Hemochorial PlacentationHemochorial Placentation
Hemo: maternal Blood Hemo: maternal Blood bathing the bathing the SyncytiotrophoblastSyncytiotrophoblast
Chorio: Chorio:
Chorion PlacentaChorion Placenta
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Langhan’s CellsLanghan’s Cells
Inner layer of Inner layer of cytotrophoblast in a cytotrophoblast in a chorionic villichorionic villi
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Anchoring VilliAnchoring Villi
Proliferation of Proliferation of trophoblast at the tip that trophoblast at the tip that is anchored to the is anchored to the deciduadecidua
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Chorionic PlateChorionic Plate
Formed by 8 – 10 weeksFormed by 8 – 10 weeks
When amnion & When amnion & mesenchyme of chorion mesenchyme of chorion fuse togetherfuse together
HemodichorialHemodichorial
HemomonochorialHemomonochorial
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Placental DevelopmentPlacental Development
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Development of the Chorion & Development of the Chorion & DeciduaDeciduaBlastocystBlastocyst
Outer pole expands Outer pole expands towards the endometrial towards the endometrial cavitycavity
Inner pole forms the Inner pole forms the placentaplacenta
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Inner PoleInner Pole
Composed of the villous Composed of the villous trophoblast & anchoring trophoblast & anchoring cytotrophoblastcytotrophoblast
Chorionic villi proliferate Chorionic villi proliferate to form the chorionic to form the chorionic frondosumfrondosum
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Outer PoleOuter Pole
Forms the chorion laeveForms the chorion laeve
Due to the degeneration Due to the degeneration of the villi in contact with of the villi in contact with the decidua capsularisthe decidua capsularis
More translucent than the More translucent than the amnionamnion
Composed of Composed of cytotrophoblast and cytotrophoblast and mesenchymemesenchyme
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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AmniochorionAmniochorion
Formed by the union of Formed by the union of the amnion and chorionthe amnion and chorion
Site of molecular transfer Site of molecular transfer & metabolic activity& metabolic activity
Paracrine Arm of the Paracrine Arm of the Fetal-Maternal Fetal-Maternal Communication SystemCommunication System
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Trophoblast InvasionTrophoblast Invasion
Due to its ability to Due to its ability to secrete proteolytic secrete proteolytic enzymes to digest the enzymes to digest the extracellular matrixextracellular matrix
And activate proteinases And activate proteinases already present in the already present in the endometriumendometrium
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Trophoblast InvasionTrophoblast Invasion
Ability to invade in the 1Ability to invade in the 1stst trimester and limited trimester and limited Invasiveness in the last trimester is controlled by:Invasiveness in the last trimester is controlled by:
Autocrine & Paracrine Autocrine & Paracrine Trophoblastic Trophoblastic
Endometrial FactorsEndometrial Factors
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Trophoblast InvasionTrophoblast Invasion
TrophoblastTrophoblast
Insulin – like growth Insulin – like growth FactorFactor
Acts in an autocrine Acts in an autocrine mannermanner
Promotes invasion into Promotes invasion into the endometriumthe endometrium
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Trophoblast InvasionTrophoblast Invasion
Decidual CellsDecidual Cells
Insulin like growth factor Insulin like growth factor binding protein type 4binding protein type 4
Blocks the autocrine loopBlocks the autocrine loop
HENCE: controlled HENCE: controlled invasivenessinvasiveness
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Trophoblast InvasionTrophoblast Invasion
Secured by Fetal FibronectinSecured by Fetal Fibronectin
Oncofetal Fibronectin or Oncofetal Fibronectin or Fetal-Specific FibronectinFetal-Specific Fibronectin
A Trophoblastic GlueA Trophoblastic Glue
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Decidual Spiral Artery InvasionDecidual Spiral Artery Invasion
Carried out by two populations of Extravillous Carried out by two populations of Extravillous Trophoblast:Trophoblast:
Interstitial TrophoblastInterstitial Trophoblast
Endovascular Endovascular TrophoblastTrophoblast
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Decidual Spiral Artery InvasionDecidual Spiral Artery Invasion
Interstitial TrophoblastInterstitial Trophoblast
Aggregates around the Aggregates around the maternal spiral arteriesmaternal spiral arteries
Prepares the arteries to Prepares the arteries to facilitate invasionfacilitate invasion
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Decidual Spiral Artery InvasionDecidual Spiral Artery InvasionEndovascular TrophoblastEndovascular Trophoblast
Enters the lumen of the Enters the lumen of the spiral arteriesspiral arteries
Initially forming cellular Initially forming cellular plugsplugs
Destroys the Destroys the endotheliumendothelium
Fibrinoid material Fibrinoid material replaces muscle and replaces muscle and connective tissueconnective tissue
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Decidual Spiral Artery InvasionDecidual Spiral Artery Invasion
Does not involve the Does not involve the Decidua ParietalisDecidua Parietalis
Decidual Veins are not Decidual Veins are not invadedinvaded
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Decidual Spiral Artery InvasionDecidual Spiral Artery Invasion
Stages of Uteroplacental Vessel Development Stages of Uteroplacental Vessel Development
11stst Stage StageBefore 12 weeks AOGBefore 12 weeks AOGInvasion & Modification Invasion & Modification of Spiral Arteriesof Spiral Arteries
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Decidual Spiral Artery InvasionDecidual Spiral Artery Invasion
Stages of Uteroplacental Vessel DevelopmentStages of Uteroplacental Vessel Development
22ndnd Stage StageBetween 12 – 16 weeksBetween 12 – 16 weeksInvasion of Invasion of intramyometrial parts of intramyometrial parts of the spiral arteriesthe spiral arteriesProducing low-Producing low-resistance vesselsresistance vessels
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Establishment of Maternal Blood Establishment of Maternal Blood FlowFlow
Occurs approximately 4 Occurs approximately 4 weeks post fertilizationweeks post fertilization
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Villus BranchingVillus Branching
Some become Some become anchoring villianchoring villi
Majority would arborize Majority would arborize and end freely in the and end freely in the intervillous spaceintervillous space
Each truncal villi and Each truncal villi and ramification is one ramification is one lobule/ cotyledonlobule/ cotyledon
Each lobule has one Each lobule has one artery and veinartery and vein
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Placental Growth & MaturationPlacental Growth & Maturation
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Placental GrowthPlacental Growth
1717thth week AOG placenta week AOG placenta & fetal weights are & fetal weights are approximately equalapproximately equal
At Term, placenta is 1/6 At Term, placenta is 1/6 of the fetal weight of the fetal weight
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Placental DimensionsPlacental Dimensions
DiameterDiameter185 mm185 mm
ThicknessThickness23 mm23 mm
VolumeVolume497497
WeightWeight508 grams508 grams
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Placental MaturationPlacental Maturation
Stroma of the VilliStroma of the Villi
Abundant and loose Abundant and loose intracellular matrix early intracellular matrix early in gestationin gestation
Later becomes dense Later becomes dense and cells more spindly and cells more spindly and closely packedand closely packed
Infiltration of Hofbauer Infiltration of Hofbauer cellscells
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Placental MaturationPlacental Maturation
Hofbauer CellsHofbauer Cells
Fetal MacrophagesFetal Macrophages
Increase in number and Increase in number and maturation as pregnancy maturation as pregnancy progressprogress
Capable of paracrine Capable of paracrine regulation of Trophoblast regulation of Trophoblast FunctionFunction
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Placental MaturationPlacental Maturation
Histological Changes that provides an increased Histological Changes that provides an increased efficiency of transport & exchangeefficiency of transport & exchange
Decrease in thickness of Decrease in thickness of the syncytiumthe syncytium
Decrease StromaDecrease Stroma
Increase VascularityIncrease Vascularity
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Fetal & Maternal Blood Circulation in Fetal & Maternal Blood Circulation in Mature PlacentaMature Placenta
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Fetal CirculationFetal Circulation
Deoxygenated Blood Deoxygenated Blood flows through two flows through two umbilical arteriesumbilical arteries
Umbilical vessels branch Umbilical vessels branch repeatedly beneath the repeatedly beneath the amnion and diving villiamnion and diving villi
Blood with a higher O2 Blood with a higher O2 content passes thru the content passes thru the umbilical veinumbilical vein
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Fetal CirculationFetal Circulation
Placental Surface / Chorionic vesselsPlacental Surface / Chorionic vessels
Umbilical vessels along Umbilical vessels along the fetal surface of the the fetal surface of the chorionic platechorionic plate
Responsive to vasoactive Responsive to vasoactive substancessubstances
Arteries always cross Arteries always cross over the veinsover the veins
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Fetal CirculationFetal Circulation
Truncal ArteriesTruncal Arteries
Perforating branches of Perforating branches of the surface arteriesthe surface arteries
Each supply one Each supply one cotyledoncotyledon
Decrease amount of Decrease amount of smooth muscle but has smooth muscle but has increase in caliberincrease in caliber
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Maternal CirculationMaternal CirculationPhysiological Maternal-Placental CirculationPhysiological Maternal-Placental Circulation
Maternal blood thru the Maternal blood thru the basal plate and driven basal plate and driven high up to the chorionic high up to the chorionic plateplate
Blood flows back down Blood flows back down as it baths the as it baths the microvillous surfacemicrovillous surface
Maternal blood drains Maternal blood drains back to the venous back to the venous orificesorifices
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Maternal – Placental CirculationMaternal – Placental Circulation
Factors Regulating Blood FlowFactors Regulating Blood Flow
Arterial Blood PressureArterial Blood Pressure
Intrauterine PressureIntrauterine Pressure
Pattern of Uterine Pattern of Uterine ContractionsContractions
Factors acting on the Factors acting on the arterial wallarterial wall
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Immunological ConsiderationsImmunological Considerations
The acceptance and survival of the conceptus in the The acceptance and survival of the conceptus in the maternal uterus must be attributed to: maternal uterus must be attributed to:
Immunological peculiarity Immunological peculiarity of the Trophoblastof the Trophoblast
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Immunogenicity of the TrophoblastImmunogenicity of the Trophoblast
Major Histocompatibility Major Histocompatibility complex (MHC) class I complex (MHC) class I and II antigens are and II antigens are absent from villous absent from villous trophoblasttrophoblast
Making it appear Making it appear immunologically Inertimmunologically Inert
But invasive But invasive cytotrophoblast express cytotrophoblast express MHC class I moleculesMHC class I molecules
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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Trophoblast HLA (MHC) Class I Trophoblast HLA (MHC) Class I ExpressionExpression
“normal implantation is dependent on controlled trophoblastic invasion of maternal endometrium-decidua and spiral arteries”
Moffett-King (2002)
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Trophoblast HLA (MHC) Class I Trophoblast HLA (MHC) Class I ExpressionExpression
Human Leukocyte Antigens Express by the Human Leukocyte Antigens Express by the TrophoblastsTrophoblasts
Classical HLA - CClassical HLA - C
Non Classical HLA - ENon Classical HLA - E
Non – Classical HLA - GNon – Classical HLA - G
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
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AmnionAmnion
Provides almost all of the Provides almost all of the tensile strength of the tensile strength of the fetal membranesfetal membranes
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Amnion StructureAmnion StructureSingle layer of epithelial Single layer of epithelial cells-ectoderm derivedcells-ectoderm derived
Basement membraneBasement membrane
Acellular Compact Layer Acellular Compact Layer composed of interstitial composed of interstitial collagencollagen
Fibroblast-like Fibroblast-like mesenchymal cellsmesenchymal cells
Acellular zona Acellular zona spongiosaspongiosa
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
OUR LADY OF FATIMA UNIVERSITYOUR LADY OF FATIMA UNIVERSITY
Amnion DevelopmentAmnion DevelopmentAmniogenic cells – Amniogenic cells – precursor of amnionic precursor of amnionic epitheliumepithelium
Growth of the amnion Growth of the amnion eventually engulfs the eventually engulfs the embryo and prolapses embryo and prolapses into the cavityinto the cavity
End of the 1End of the 1stst trimester – trimester – apposition of the apposition of the mesoblast of the chorion mesoblast of the chorion and amnionand amnion
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
OUR LADY OF FATIMA UNIVERSITYOUR LADY OF FATIMA UNIVERSITY
Amnion Epithelial CellsAmnion Epithelial Cells
Major site of transfer Major site of transfer between AF and amnionbetween AF and amnion
Metabolically ActiveMetabolically Active
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
OUR LADY OF FATIMA UNIVERSITYOUR LADY OF FATIMA UNIVERSITY
Metabolic Activity of the AmnionMetabolic Activity of the Amnion
Inhibits metalloprotinase-Inhibits metalloprotinase-1 synthesis1 synthesis
Produce PGE2 & Fetal Produce PGE2 & Fetal FibronectinFibronectin
Site of Prostaglandin Site of Prostaglandin productionproduction
Synthesis of vasoactive Synthesis of vasoactive peptidespeptides
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
OUR LADY OF FATIMA UNIVERSITYOUR LADY OF FATIMA UNIVERSITY
Vasoactive peptides produced by the Vasoactive peptides produced by the AmnionAmnion
Endothelin - Endothelin - vasoconstrictorvasoconstrictor
Parathyroid – related Parathyroid – related protein - protein - vasodilatorvasodilator
Brain natriuretic peptide Brain natriuretic peptide – – smooth muscle relaxantsmooth muscle relaxant
Corticotrophin – Corticotrophin – Releasing Hormone – Releasing Hormone – smooth muscle relaxantsmooth muscle relaxant
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
OUR LADY OF FATIMA UNIVERSITYOUR LADY OF FATIMA UNIVERSITY
Importance of the Metabolic Activity Importance of the Metabolic Activity of the Amnionof the Amnion
Modulates chorionic Modulates chorionic vessel tone and blood vessel tone and blood flowflow
Availability to the fetus of Availability to the fetus of the bioactive agentsthe bioactive agents
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
OUR LADY OF FATIMA UNIVERSITYOUR LADY OF FATIMA UNIVERSITY
Amnion AnatomyAmnion Anatomy
Placental AmnionPlacental Amnion
Umbilical Cord AmnionUmbilical Cord Amnion
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
OUR LADY OF FATIMA UNIVERSITYOUR LADY OF FATIMA UNIVERSITY
Amnion Tensile StrengthAmnion Tensile Strength
Exclusively resides in the Exclusively resides in the compact layercompact layer
Composed of x-linked Composed of x-linked collagens I & IIIcollagens I & III
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
OUR LADY OF FATIMA UNIVERSITYOUR LADY OF FATIMA UNIVERSITY
Metabolic FunctionMetabolic Function
Maintain AF homeostasisMaintain AF homeostasis
Production of bioactive Production of bioactive agentsagents
Sensitive to mechanical Sensitive to mechanical stretching:stretching:Triggers autocrine & Triggers autocrine & paracrine responsesparacrine responses
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
OUR LADY OF FATIMA UNIVERSITYOUR LADY OF FATIMA UNIVERSITY
Amnionic FluidAmnionic Fluid
Clear fluidClear fluid
Continuously increase Continuously increase amount until 34 weeksamount until 34 weeks
Average Volume :Average Volume :
1,000 ml at term1,000 ml at term
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
OUR LADY OF FATIMA UNIVERSITYOUR LADY OF FATIMA UNIVERSITY
Umbilical Cord & Related StructuresUmbilical Cord & Related Structures
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
OUR LADY OF FATIMA UNIVERSITYOUR LADY OF FATIMA UNIVERSITY
Cord Structure & FunctionCord Structure & Function
Extends from the fetal Extends from the fetal umbilicus to the fetal umbilicus to the fetal surface of the placentasurface of the placenta
Dull whiteDull white
MoistMoist
Covered by amnionCovered by amnion
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
OUR LADY OF FATIMA UNIVERSITYOUR LADY OF FATIMA UNIVERSITY
Cord Structure & FunctionCord Structure & Function
Contains :Contains :2 arteries2 arteries1 vein1 vein
Diameter: 0.8 – 2.0 cmDiameter: 0.8 – 2.0 cm
Average Length: 55 cmAverage Length: 55 cm
Wharton jelly : Wharton jelly : extracellular extracellular matrixmatrix
Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology
OUR LADY OF FATIMA UNIVERSITYOUR LADY OF FATIMA UNIVERSITY
Thank You!Thank You!