Fetal Development and Amniotic Fluid Quiz
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Questions and Answers

Where does the amniotic fluid go after being swallowed by the fetus?

  • It is used to develop the fetal lungs.
  • It is reabsorbed through the umbilical cord and returned to the placenta.
  • It is excreted through the fetal kidneys.
  • It is absorbed by the fetus's digestive system. (correct)
  • What is the primary function of amniotic fluid in fetal development?

  • It provides the fetus with its primary source of nutrients.
  • It protects the fetus from infection and physical injury. (correct)
  • It regulates the fetal body temperature.
  • It helps distribute the mother's heartbeat to the fetus.
  • What happens to the excess water in the fetal blood?

  • It is absorbed by the fetal intestines.
  • It is stored in the amniotic sac for future use.
  • It is passed back to the mother through the placenta.
  • It is excreted through the fetal urinary tract. (correct)
  • What is a key component of amniotic fluid in late pregnancy?

    <p>Fetal urine. (A)</p> Signup and view all the answers

    Which of the following is NOT a function of amniotic fluid?

    <p>It helps in the development of fetal bones. (D)</p> Signup and view all the answers

    What is the approximate length of the umbilical cord at full term?

    <p>50-55 cm (A)</p> Signup and view all the answers

    What is the primary function of the umbilical cord?

    <p>To transport oxygen and nutrients from the mother to the fetus. (D)</p> Signup and view all the answers

    Where does one end of the umbilical cord attach to the fetus?

    <p>The center of the fetal anterior abdominal wall. (C)</p> Signup and view all the answers

    What occurs about 6 days after fertilization?

    <p>The blastocyst attaches to the endometrial epithelium. (A)</p> Signup and view all the answers

    Which layer of the trophoblast is highly invasive?

    <p>Syncytiotrophoblast (C)</p> Signup and view all the answers

    What is a key transformation that occurs in the endometrial stromal cells during the decidua reaction?

    <p>They become polyhedral and filled with glycogen. (B)</p> Signup and view all the answers

    Which hormone is secreted by the syncytiotrophoblast after implantation?

    <p>Human chorionic gonadotrophin (HCG) (D)</p> Signup and view all the answers

    By day 11 to 12, what happens to the blastocyst during implantation?

    <p>It is completely embedded in the endometrial stroma. (B)</p> Signup and view all the answers

    What is the primary role of the chorionic villi during placentation?

    <p>To facilitate gas and nutrient exchange between mother and fetus. (A)</p> Signup and view all the answers

    What structure closes the penetration defect in the surface epithelium at the implantation site?

    <p>Fibrin coagulum (D)</p> Signup and view all the answers

    What occurs to the endometrium during the secretory phase of the menstrual cycle at the time of implantation?

    <p>It thickens and becomes receptive to the blastocyst. (B)</p> Signup and view all the answers

    Which structure is responsible for the formation of Wharton's jelly?

    <p>Mesoderm of the stalk (A)</p> Signup and view all the answers

    What are monozygotic twins derived from?

    <p>A single fertilized ovum that splits (B)</p> Signup and view all the answers

    Which of the following regions is noted for its high incidence of twins occurring naturally?

    <p>Igbo-Ora in Oyo State, Nigeria (B)</p> Signup and view all the answers

    Which components are primarily found in the umbilical cord?

    <p>Two umbilical arteries and one umbilical vein (D)</p> Signup and view all the answers

    What is a characteristic of dizygotic twins?

    <p>They develop from two separate fertilized ova (A)</p> Signup and view all the answers

    The umbilical arteries are responsible for what function?

    <p>Carrying deoxygenated blood from the fetus to the placenta (A)</p> Signup and view all the answers

    What process is referred to by craniocaudal folding during fetal development?

    <p>The movement of the connecting stalk to a ventral position (D)</p> Signup and view all the answers

    What is the primary function of the decidual reaction?

    <p>To provide nutrition for the early embryo and an immunologically privileged site (A)</p> Signup and view all the answers

    Which part of the decidua covers the implanted embryo?

    <p>Decidua capsularis (C)</p> Signup and view all the answers

    What happens to the decidua capsularis by weeks 22 to 24 of development?

    <p>It degenerates and disappears (C)</p> Signup and view all the answers

    During which developmental stage do lacunae form in the syncytium?

    <p>Second week (A)</p> Signup and view all the answers

    What is the term for maternal blood vessels that are congested and dilated after trophoblastic erosion?

    <p>Sinusoids (D)</p> Signup and view all the answers

    What structure forms as the trophoblast penetrates deeper into the uterine stroma?

    <p>Lacunar networks (C)</p> Signup and view all the answers

    What distinguishes secondary chorionic villi from primary villi?

    <p>Invasion of mesodermal cells into the core (B)</p> Signup and view all the answers

    What is the primary purpose of the primary villi formed by day 13?

    <p>To supply oxygen and nutrients to the embryo (B)</p> Signup and view all the answers

    Which process occurs to the chorionic villi in the third week of development?

    <p>They begin to branch and differentiate into arteriocapillary networks (C)</p> Signup and view all the answers

    What is formed when the capillaries in the chorionic villi fuse?

    <p>Embryonic blood circulation (B)</p> Signup and view all the answers

    What is the primary function of uterine contraction after the detachment of the placenta?

    <p>To close off exposed spiral arteries (A)</p> Signup and view all the answers

    Which of the following signs indicates separation of the placenta?

    <p>Cord lengthening (A)</p> Signup and view all the answers

    What is placental abruption associated with?

    <p>Bleeding and haematoma formation (A)</p> Signup and view all the answers

    Which condition is characterized by high blood pressure, protein in urine, and fluid retention during pregnancy?

    <p>Preeclampsia (B)</p> Signup and view all the answers

    What type of placenta consists of more than two lobes?

    <p>Multilobular placenta (B)</p> Signup and view all the answers

    What happens in cord prolapse during labor?

    <p>Cord is compressed between the fetal head and pelvic wall (A)</p> Signup and view all the answers

    Which condition occurs when there is an unequal distribution of blood from a shared placenta in MZ twins?

    <p>Twin twin transfusion syndrome (A)</p> Signup and view all the answers

    Which type of twins occur when the embryo splits incompletely?

    <p>Conjoint twins (A)</p> Signup and view all the answers

    Which layer of the placenta disappears altogether after 20 weeks?

    <p>Cytotrophoblast (B)</p> Signup and view all the answers

    What does the term 'velamentous placenta' refer to?

    <p>Umbilical vessels attach to the amnion and ramify (D)</p> Signup and view all the answers

    What is the average weight of the placenta at term?

    <p>500-600 grams (B)</p> Signup and view all the answers

    What is indicated by a gush of blood during the placental separation process?

    <p>Separation of the placenta (B)</p> Signup and view all the answers

    What shape is the mature/term placenta?

    <p>Discoid (D)</p> Signup and view all the answers

    What is one of the main functions of the placenta?

    <p>Endocrine secretion (C)</p> Signup and view all the answers

    Which of the following substances is NOT transferred from maternal to fetal blood?

    <p>Metabolic waste (D)</p> Signup and view all the answers

    How often is the blood volume in the intervillous space replaced?

    <p>Every 15-20 seconds (D)</p> Signup and view all the answers

    What is the predominant mechanism of transport for oxygen across the placenta?

    <p>Simple diffusion (D)</p> Signup and view all the answers

    Which type of artery supplies blood to the intervillous spaces?

    <p>Spiral arteries (B)</p> Signup and view all the answers

    What happens to the amniotic membranes during labor?

    <p>They rupture (C)</p> Signup and view all the answers

    What is the purpose of the amniotic fluid?

    <p>To protect and cushion the fetus (B)</p> Signup and view all the answers

    What change occurs to the chorionic sac as the pregnancy progresses?

    <p>It enlarges faster than the amniotic sac (A)</p> Signup and view all the answers

    Which hormone is NOT produced by the placenta?

    <p>Testosterone (A)</p> Signup and view all the answers

    What is the volume of amniotic fluid at term (37 weeks)?

    <p>800-1000 ml (D)</p> Signup and view all the answers

    Flashcards

    Umbilical Cord

    A structure connecting the fetus to the placenta, containing vessels and protective gel.

    Wharton's Jelly

    A gelatinous substance found in the umbilical cord, providing cushioning and protection to vessels.

    Umbilical Vein

    The blood vessel in the umbilical cord that carries oxygenated blood from the placenta to the fetus.

    Umbilical Arteries

    The blood vessels that carry deoxygenated blood from the fetus back to the placenta.

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    Monozygotic Twins

    Identical twins formed from a single fertilized egg that splits into two embryos.

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    Dizygotic Twins

    Fraternal twins formed from two separate fertilized eggs during the same pregnancy.

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    Multiple Pregnancies

    Gestations involving two or more fetuses, often referred to as twins, triplets, etc.

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    Twinning Risks

    Increased health risks associated with pregnancies that have multiple fetuses.

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    Implantation

    The attachment of the blastocyst to endometrial epithelium about 6 days post-fertilization.

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    Trophoblast

    Outer cells of the blastocyst that differentiate into two layers: cytotrophoblast and syncytiotrophoblast.

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    Cytotrophoblast

    Inner layer of mononucleated cells in the trophoblast.

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    Syncytiotrophoblast

    Multinucleated outer layer of the trophoblast, highly invasive with no cell boundaries.

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    Decidua reaction

    Transformation of endometrial stromal cells due to implantation events.

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    Human Chorionic Gonadotrophin (HCG)

    A hormone secreted by syncytiotrophoblast that supports the pregnancy.

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    Functional endometrium

    The layer of the endometrium that undergoes changes during the menstrual cycle and supports implantation.

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    Blastocyst embedding

    Process where the blastocyst becomes deeper in the endometrial layer, confirmed by day 11-12 after fertilization.

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    Decidual cells

    Cells derived from the endometrium after implantation that aid in supporting the embryo.

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    Decidua

    The functional endometrium during pregnancy, involved in nourishing the embryo and immune protection.

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    Decidua basalis

    Part of the decidua located deep to the embryo, anchoring the villi.

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    Decidua capsularis

    Part of the decidua that forms a capsule over the implanted embryo.

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    Decidua parietalis

    The remaining part of the decidua, excluding the basalis and capsularis.

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    Lacunar stage

    Stage of trophoblast development where vacuoles merge to form lacunae after implantation.

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    Sinusoids

    Dilated, thin-walled maternal capillaries that are eroded by the trophoblast.

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    Primary villi

    Structures formed by the proliferation of cytotrophoblast cells into the syncytiotrophoblast.

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    Secondary villi

    Villi that form when the embryonic mesoderm invades primary villi.

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    Tertiary chorionic villi

    Developed villi that contain capillaries and blood cells, crucial for nutrient exchange.

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    Uterotonic agents

    Medications like oxytocin that help control bleeding after childbirth by promoting uterine contractions.

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    Placental abruption

    Premature separation of the placenta from the uterine wall, causing bleeding and possible complications.

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    Preeclampsia

    A pregnancy condition characterized by high blood pressure, protein in urine, and edema.

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    Eclampsia

    Severe complication of preeclampsia marked by convulsions in a pregnant woman.

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    Bilobed placenta

    A placenta consisting of two distinct lobes.

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    Velamentous placenta

    A condition where umbilical vessels attach to the amnion before reaching the placenta, leading to risks.

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    Cord prolapse

    When the umbilical cord slips through the cervix during labor, potentially causing fetal hypoxia.

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    Twin Twin Transfusion Syndrome

    A condition in MZ twins with unequal blood distribution leading to size discrepancies.

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    Conjoint twins

    A condition in identical twins caused by incomplete splitting of the embryo, resulting in twins connected by tissue.

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    Retroplacental clot

    A hematoma that forms behind the placenta during placental abruption.

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    Amniotic Fluid Function

    Amniotic fluid supports fetal growth, protects against injury, and aids development.

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    Fetal Swallowing

    The fetus swallows amniotic fluid, aiding digestion and lung development.

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    Waste Exchange

    Waste products from fetal blood are transferred to maternal blood via the placenta.

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    Amniotic Fluid Composition

    Aqueous solution containing fetal cells, salts, proteins, and waste by-products.

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    Fetal Kidney Role

    Fetal kidneys excrete excess water into the amniotic sac as urine.

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    Amniotic Fluid Temperature Control

    Helps maintain a constant temperature for the developing fetus.

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    Cervical Dilation Assist

    Amniotic fluid forms a hydrostatic bag aiding in cervix dilation during labor.

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    Amniochorionic membrane

    Membrane formed by fusion of the amnion and chorion, surrounding the amniotic cavity.

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    Functions of the placenta

    Metabolism, endocrine secretion, and placental transfer between mother and fetus.

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    Placental transfer

    The process of substances moving between maternal and fetal blood across the placenta.

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    Fetal placental circulation

    Blood flow from the fetus to the placenta through umbilical arteries and back through the umbilical vein.

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    Maternal placental circulation

    Blood circulation in the intervillous spaces from maternal blood supply to the placenta.

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    Chorionic villi

    Finger-like projections that extend from the chorion into the placenta for blood exchange.

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    Amniotic fluid

    Clear fluid surrounding the fetus within the amniotic cavity, essential for protection and development.

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    Volume of amniotic fluid

    Changes from 30ml at 10 weeks to 800-1000ml at term, replenished every 3 hours.

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    Endocrine secretion by placenta

    Production of hormones by the placenta, including hCG, progesterone, and estrogen.

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    Placenta anatomy shape

    The placenta is discoid with a diameter of 15-25 cm and thickness of 3 cm.

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    Intervillous spaces

    Spaces between chorionic villi filled with maternal blood for nutrient exchange.

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    Rupture of membranes

    Breaking of the amniochorionic membrane at labor onset, signaling that labor has begun.

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    Study Notes

    Placentation and Twinning

    • The placenta is a temporary fetomaternal organ
    • It forms in the uterus during pregnancy
    • It attaches the fetus to the mother's uterine wall via the umbilical cord
    • It is highly vascular and endocrine in nature
    • The placenta has a circular/discoid shape
    • Its purpose is to provide oxygen and nutrients to the fetus, remove waste products of metabolism from the fetus, and secrete hormones necessary for pregnancy maintenance

    Placentation: Outline

    • Placentation
    • Preceding events in 2nd and 3rd week
    • Implantation
    • Decidua reaction and formation
    • Development of the lacunar system in the trophoblast layer
    • Development of chorionic villi and formation of the chorion frondosum
    • Formation of the placenta proper
    • Placental membrane
    • Anatomy of the mature placenta
    • Functions of the placenta
    • Placental circulation
    • Fetal membranes and amniotic fluid
    • Umbilical cord
    • Twinning
    • Clinical relevance

    Implantation

    • About 6 days after fertilization, the blastocyst attaches to the endometrial epithelium, usually adjacent to the embryonic pole
    • The trophoblast starts to proliferate rapidly and differentiates into two layers:
      • Cytotrophoblast: a layer of mononucleated cells
      • Syncytiotrophoblast: a highly invasive layer of multinucleated protoplasmic mass with no visible cell boundaries
    • Finger-like processes of the syncytiotrophoblast invade the endometrial epithelium and underlying connective tissue of the endometrium.
    • By day 9, the blastocyst is deeply embedded in the endometrium
    • The penetration defect in the surface epithelium is closed by a fibrin coagulum
    • By the 11th-12th day, the blastocyst is completely embedded.
    • The blastocyst now produces a slight protrusion into the lumen of the uterus
    • Implantation is complete

    Decidua Reaction

    • The characteristic transformation of the functional endometrial stromal cells following implantation
    • The endometrium is in the secretory phase of the menstrual cycle at the time of implantation
    • Soon, the syncytiotrophoblast secretes Human Chorionic Gonadotrophin (HCG)
    • HCG intensifes changes in the stromal cells, causing them to enlarge, vacuolate, and load with glycogen and lipids.
    • These cells become polyhedral and are called decidual cells.
    • The reaction initially is confined to the endometrium near the implantation site but spreads throughout the endometrium of the uterus shortly after.
    • The functional endometrium is now called the decidua or gravid endometrium.
    • The primary function of the decidual reaction is to provide nutrition for the early embryo and provide an immunologically privileged site for the conceptus

    ### Decidua divisions

    • The decidua is subdivided into three parts:
      • Decidua basalis: lies deep to the embryo, anchored to the cytotrophoblastic shell. Consists of a compact layer of large decidual cells.
      • Decidua capsularis: covers the implanted embryo at the abembryonic pole, forming a capsule that separates it from the uterine cavity.
      • Decidua parietalis: the rest of the endometrium

    ### Second week of development

    • Lacunar stage of trophoblast development
    • Following implantation, vacuoles appear in the syncytium forming large lacunae
    • Lacunae are separated by trabeculae (partitions of syncytium )
    • The syncytiotrophoblast appears spongelike
    • By the 11th-12th day, lacunar spaces form intercommunicating networks.
    • The lacunae networks are more evident at the embryonic pole.
    • The syncytiotrophoblast continues to penetrate deeper into the stroma and erode endothelial lining of the maternal capillaries.
    • These capillaries (sinusoids) become congested and dilated.
    • The mixture of maternal blood, cellular debris from eroded glands enters the lacunar system.
    • Maternal blood begins flowing through the trophoblastic system, establishing the primordial uteroplacental circulation
    • The trophoblast absorbs nutrients from the lacunar networks and transfers them to the embryo
    • By day 13, primary villi formation occurs.
    • Each trabecula is initially entirely made of syncytiotrophoblast.
    • The cytotrophoblast cells proliferate locally, penetrating the syncytiotrophoblast (trabecula), forming cellular columns surrounded by syncytium.
    • These columns are termed primary villi and are surrounded by maternal blood filling the lacunar spaces (now called intervillous spaces).

    ### Third week of development

    • Primary villi begin to branch shortly after appearing.
    • The cytotrophoblast invades the primary villi's center/core, becoming secondary villi.
    • These secondary villi cover the entire surface of the chorionic sac.
    • Mesoderm (mesenchymal) cells differentiate into capillaries and blood cells, becoming tertiary chorionic villi

    Third week of development (continued)

    • Capillaries in the chorionic villi fuse, forming arteriocapillary networks
    • These networks connect with the embryonic heart via vessels that differentiate in the mesenchyme of the chorion
    • By the end of the 3rd week, embryonic blood begins flowing through the capillaries in the chorionic villi
    • Oxygen and nutrients in maternal blood diffuse through villi walls, entering the embryo's blood
    • Carbon dioxide and waste products diffuse from fetal capillaries into the maternal blood through the villi walls
    • Cytotrophoblast cells in the apical region of each villus proliferate, crossing the syncytiotrophoblast and forming a continuous layer on the surface of the decidua.
    • This layer is called the cytotrophoblastic shell.
    • The shell completely isolates the syncytiotrophoblast from the decidua basalis
    • Villi, anchoring the chorion to the decidua, are called anchoring villi (stem chorionic villi

    Third week of development (continued II)

    • Each anchoring villus consists of a stem (truncus chorii, which branches into ramuli chorii)
    • The ramuli chorii are attached to the cytotrophoblastic shell
    • The anchoring villi sprout free villi into the intervillous space.
    • Almost the entire intervillous space becomes filled with villi. This large surface area is for efficient maternal/fetal exchange

    Third week of development (continued III)

    • Until week 8, villi on the embryonic pole (decidua basalis) extend extensively, forming the chorion frondosum (bushy chorion).
    • As the chorionic sac enlarges, the villi on the abembryonic pole degenerate, forming the chorion laeve (smooth chorion).

    Placentation: Introduction

    • The placenta is a temporary fetomaternal organ.
    • It is formed during pregnancy in the uterus.
    • It attaches the fetus to the mother via the umbilical cord.
    • It is a highly vascular and endocrine organ.
    • The placenta has a circular and discoid shape.

    Placentation: Formation

    • It has two parts with distinct origins:
      • Fetal part: develops from the chorion frondosum
      • Maternal part: develops from the decidua basalis.
    • Formation is preceded by events including implantation, development of the lacunae system, decidua reaction, development of chorionic villi, and formation of the chorion frondosum.

    Placentation : Formation of placenta proper

    • Following anchoring villi formation, septa grow inward from the uterine endometrium into the intervillous spaces.
    • These decidual septa divide the placenta into 15-20 lobes called cotyledons.
    • Cotyledons do not reach the chorionic plate.
    • Each cotyledon comprises 2-3 anchoring villi.

    ### Placentation: Details of each component

    • Each decidual septum has a maternal tissue core covered by syncytial cells.
    • This structure ensures maternal blood in the intervillous spaces is separated from fetal tissue of the villi.
    • Endometrial (spiral) arteries and veins freely traverse the cytotrophoblastic shell and open into the intervillous spaces.
    • The placenta grows and expands, covering approximately 15-30% of the uterus’s internal surface.
    • Placental thickening stems from villus arborization, not further penetration into maternal tissue.

    Placentation: Membranes/barriers

    • Membranes/barriers separate maternal and fetal blood within the placenta
    • There is no mixing of maternal and fetal blood in the placenta.
    • Exchange of gases, nutrients, and waste occur across the placental barrier.

    Placentation:: Blood sources

    • Maternal blood from the endometrial arteries fills the intervillous spaces.
    • Endometrial veins drain the blood from the intervillous spaces.
    • Fetal blood circulates within the fetal blood vessels in the chorionic villi.

    Placentation: Membranes thickness

    • Until the 20th week, the placental membrane has four layers, measuring approximately 0.025 mm.
    • The layers include syncytiotrophoblast, cytotrophoblast, mesoderm of the villus, and endothelium of fetal capillaries.
    • After the 20th week, the layers progressively thin out, with the cytotrophoblast disappearing.
    • The membrane's thickness then decreases to approximately 0.002 mm, facilitating efficient transport.

    ### Placentation: Anatomy of mature placenta

    • Shape: discoid
    • Dimensions: ~15-25cm diameter & ~3cm thickness
    • Weight: ~1/6th of the fetal weight (~500-600 grams)
    • Fetal surface: covered by the chorionic plate, smooth, and shiny, covered by the amniotic membrane
    • Umbilical cord attachment: at the center

    ### Placentation: Maternal Surface

    • The maternal surface has a cobble-stone appearance due to 15-20 rounded elevations (cotyledons) separated by grooves made by decidual septa.
    • It’s covered by a thin layer of decidua basalis.

    ### Placentation: Internal Structure

    • The chorionic plate contains chorionic vessels, surrounded by mesoderm and syncytiotrophoblast.
    • These vessels are continuous with those in the umbilical cord.

    Placental Circulation: Maternal

    • Blood enters intervillous spaces via spiral arteries, under pressure, reaching the chorionic plate.
    • The blood then circulates around the villi for exchange across the thin placental membrane.
    • The blood is drained from the space by veins of the decidua basalis.
    • In the fully formed placenta, the 150ml of intervillous blood is replaced every 15-20 seconds (at 3-4 times per minute).

    ### Placental Circulation: Fetal

    • Fetal blood arrives at the placenta through the umbilical arteries.
    • Inside the placenta, these arteries ramify freely within the chorion and its branches enter the chorionic villi.
    • Veins from the chorionic villi drain into the umbilical vein, carrying oxygen-rich blood and nutrients to the fetus.

    Fetal Membranes

    • Formation of the amniochorionic membrane is preceded by events, including amnion formation, formation of the chorionic sac and chorion, formation of the decidua capsularis and parietalis, and chorionic villi enlargement.
    • The chorion laeve (smooth chorion) forms by the degeneration of chorionic villi on the abembryonic pole of the chorionic sac in later pregnancy.
    • The enlarging amniotic cavity obliterates the chorionic sac, and the amnion and smooth chorion fuse to form the amniochorionic membrane.
    • The amniochorionic membrane fuses temporarily with the decidua capsularis, eventually adhering to the decidua parietalis.

    Amniotic Fluid

    • Transparent fluid within the amniotic cavity
    • Derived from maternal blood by diffusion across the amniochorionic membrane from the decidua parietalis.
    • Also from secretions by amniotic cells, the fetus’s respiratory and digestive tracts (lung, intestine, GI tract), and the fetal kidneys through the fetal urinary tract.
    • Is also secreted by the fetal skin before keratinization.

    Amniotic Fluid: Volume

    • 30ml at 10 weeks
    • 450ml at 20 weeks
    • ~800–1000 ml at term (~37 weeks).
    • Amniotic fluid volume is replaced every 3 hours.

    Amniotic Fluid: Function and significance

    • Maintains a balanced relationship with the fetal circulation, changing with fetal growth and development
    • Large amounts of amniotic fluid pass across the amniochorionic membrane into maternal tissue fluid, entering the uterine capillaries.
    • Fetus swallows up to 400ml of amniotic fluid per day (nutrients and waste products exchange)
    • Excess amniotic fluid from the fetal kidneys is excreted and returned back to the amniotic sac.
    • This process helps maintain fetal homeostasis.
    • Acts as a hydrostatic bag (bag of waters) in aiding cervical dilatation at the beginning of labor

    Umbilical Cord

    • A long cord by which the fetus is attached to the uterine wall via the placenta.  - At term, it is around 50-55cm long and 1-2cm thick.  - Covered by a glistening amniotic membrane.  - Twisted (with a potential for false knots). 
    • One end attaches to the center of the anterior abdominal wall of the fetus (umbilical region). 
    • The other end attaches to the center of the fetal surface of the placenta.

    Umbilical Cord: Formation

    • Involves formation of the connecting stalk, the allantoic diverticulum, and the folding of the embryo.
    • Incorporation of the yolk sac, vitello-intestinal duct, and allantois into the stalk.
    • Development of blood vessels into the umbilical cord also occurs within the stalk. 
    • Wharton's jelly forms from the mucoid generation of the mesoderm in the umbilical cord stalk

    Umbilical Cord: Contents

    • Contains two umbilical arteries and one umbilical vein
    • Wharton's jelly
    • Remains of allantoic diverticulum
    • Remains of the vitellointestinal duct and yolk sac

    Umbilical Cord: Function

    • The umbilical vein carries oxygenated blood from the placenta to the fetus.
    • The umbilical arteries carry deoxygenated blood from the fetus to the placenta.

    Twinning

    • Multiple pregnancies (2 or more fetuses)
    • Twins: two fetuses
    • Multiple births are becoming more common due to wider access to fertility treatments.
    • Some regions (e.g., Igbo-Ora, Oyo State) have a naturally high twinning rate.
    • Higher risks associated with multiple gestations due to the increased number of fetuses.

    Twinning: Types (monozygotic and dizygotic)

    • Monozygotic (identical) twins: result from a single fertilized ovum/zygote splitting.  - Dizygotic (fraternal) twins: result from the release and fertilization of two ova/oocytes.

    Twinning: Monozygotic types

    • Early splitting (two-cell stage): dichorionic diamniotic twins (separate chorionic sacs/placentas, separate amniotic sacs).
    • Later splitting (early blastocyst stage): monochorionic diamniotic twins (common chorionic sac/placenta, separate amniotic sacs).
    • Very late splitting (bilaminar germ disc stage): monochorionic monoamniotic twins (common chorionic sac/placenta, common amniotic sac). 

    Twinning: Dizygotic types

    • Result from two separate zygotes, with each zygote developing its own embryo, developing its own placenta, amnion, and chorionic sac, and two separate fetuses
    • Dizygotic twins are genetically as similar as any two siblings with a shared parentage

    Clinical Relevance: Labor/Parturition

    • Labour/Parturition: process of fetal and placental expulsion from the uterus.
    • Characterized by regular uterine contractions that progressively dilate the cervix.
    • Three stages:     1st: Onset of uterine contractions until complete cervical dilation (10 cm).     2nd: Complete cervical dilation to infant delivery.     3rd: Infant delivery to placental delivery.

    Clinical Relevance: Placenta delivery

    • Placenta expelled 15-30 minutes after infant delivery via the three stages of labor. Placenta separation from the uterine wall due to:
      • Reduction in placental site surface area (uterine muscle contraction)
      • Haematoma formation as spiral arteries close post-delivery.

    Clinical Relevance: Uterotonic Agents

    • Uterotonic agents, like oxytocin, are administered post-delivery to promote placental separation.
    • Signs of separation include lengthening of the umbilical cord, uterus rising in the abdomen, becoming more globular, and a gush of blood

    Clinical Relevance: Placental Abruption

    • Placental abruption, also called abruptio placentae, involves premature placental separation from the uterine wall.
    • This can lead to bleeding and accumulation of blood behind the placenta. Risk factors include uterine tenderness, vaginal bleeding, decreased fetal movement, and shock.

    Clinical Relevance: Preeclampsia/Eclampsia

    • Preeclampsia is a condition characterized by elevated blood pressure, proteinuria (protein in urine), and edema (fluid retention) in pregnancy.
    • Eclampsia is a more severe condition in pregnancy with preeclampsia-associated convulsions
    • Placental abnormalities are a contributing factor to the development of preeclampsia/eclampsia.

    Clinical Relevance: Placenta Shape Variations

    • Placenta shape variations include bilobed (two lobes), multilobular (more than two lobes), diffuse (not disc-shaped), placenta succenturiata (a small separated part of the placenta still connected to the main part), placenta fenestrata (a hole in the placental disc), and circumvallate (peripheral edge of the placenta covered with a circular fold of the decidua).

    Clinical Relevance: Umbilical cord abnormalities

    • Cord Prolapse: Umbilical cord protruding through the cervix during labor, potentially compressing the cord between the fetal head and maternal pelvic floor, leading to fetal hypoxia
    • Prolonged Cord: Cord encircling the fetal neck during delivery, potentially strangling the fetus.
    • Shortened Cord: Pulling the placenta away from the uterus during delivery, causing premature separation.
    • Cord knots: True knots in the umbilical cord can reduce blood flow and potentially cause fetal hypoxia and death.

    Clinical Relevance: Conjoined Twins

    • Conjoined twins (Siamese twins): result from incomplete separation of MZ twins.
    • They are connected by a tissue bridge, and separation is only possible if vital parts are not shared. The different types of conjoined twins based on the site and extent of fusion are craniopagus (fusion of heads), thoracopagus (fusion of thorax), and cephalthoracopagus (fusion of head and thorax) and pygophagus (fusion of sacral regions).

    Clinical Relevance: Twin-Twin Transfusion Syndrome

    • Unequal blood distribution in MZ twins from a shared placenta.
    • One twin receives too much blood (becoming larger) and the other twin receives insufficient blood (becoming smaller).
    • It could potentially lead to death in one or both twins.

    Clinical Relevance: Vanishing Twin

    • Refers to the death of one twin (often in the first or second trimester).
    • The dead twin is resorbed or remains as a compressed dehydrated mass, resembling parchment paper (fetus papyraceus). 

    Clinical Relevance: Drug Exposure in Pregnancies

    • Drugs and their metabolites cross the placenta, affecting the fetus.
    • Substances like alcohol can cause congenital anomalies, and heroin can result in fetal addiction and withdrawal symptoms.
    • Certain medications taken during labor or obstetric surgeries can impact the fetus via placental transfer potentially leading to respiratory depression

    Clinical Relevance: Prenatal Diagnostic testing

    • Amniocentesis: sampling amniotic fluid, often guided by ultrasound, allowing for cell analysis and early diagnosis of chromosomal anomalies (such as trisomy 21 - Down syndrome) and other genetic disorders.

    Clinical Relevance: Amniotic Fluid Disorders

    • Hydramnios/polyhydramnios: excess amniotic fluid (1500–2000 ml) often related to maternal diabetes or fetal CNS/GIT abnormalities (e.g., anencephaly, esophageal atresia).
    • Oligohydramnios: decreased amniotic fluid (<400 ml) potentially related to premature rupture of the amnion, leading to clubfoot or lung hypoplasia. Amniotic bands form when tears in the amnion create fibrous bands that cause ring constrictions and limb amputations.

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    Placentation and Twinning PDF

    Description

    Test your knowledge on the role and functions of amniotic fluid and the umbilical cord in fetal development. This quiz covers key aspects such as the materials involved, the functions, and the physical characteristics associated with these vital components. Explore how they contribute to a healthy pregnancy.

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