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Quiz

Anatomy of the placenta Quiz 04

In order to understand the chronological development of the


chorionic villi it is important to have a comprehensive
overview of placental anatomy. In this diagram, the placenta
is roughly four months old and various fundamental
structures can be recognized, namely the umbilical cord, the
amnion, the chorionic plate, the already advanced branching
of the villi, the basal plate and the cotyledon.

Fig. 13 - Placenta at around the fourth month Legend


Fig. 13
Schematic
diagram of the
placenta at
around the fourth
month in a sagittal
section.

Note: Zone A
corresponds to
theinteractive
diagramof this
module
1 Umbilical cord
2 Amnion
3 Chorionic plate
4 Intervillous space (maternal blood)
5 Basal plate
6 Cotyledon
7 Villus

At birth, the placenta consists of two parts:

 maternal portion
 fetal portion

Quiz 11
Fig. 14 - maternal side Fig. 15 - fetal side Legend
Fig. 14
Placenta: View
from the maternal
side
Fig. 15
Placenta: view
from the fetal side

1 Cotyledon 3 Umbilical cord


2 Cut edge of the amnion 4 Decidua with the compact layer
after the release of the
placenta

Fig. 16 - Placenta: the Fig. 17 - Placenta: the fetal Legend


maternal side side
Fig. 16
From the
maternal side the
placenta has a
wrinkled surface,
characterized by
the cotyledons.
Fig. 17
From the fetal
side, the placenta
is smooth and
shiny. Notice the
normal, central
insertion of the
1 Cotyledon 3 Umbilical cord umbilical cord in
2 Cut edge of the amnion this case.

The three villus types


While the embryo is nourished in the first weeks through simple diffusion, later, due to Quiz
its rapid growth, it needs a more powerful gas and nutrient exchange system. This is Quiz 03
made possible by the development of the utero-placental circulation system in which
the circulation systems of the mother and of the embryo get closer together, thus
allowing an exchange of gases and metabolites via diffusion.
It must be always kept in mind, though, that maternal and fetal blood never come into
direct contact with each other.

This system decays after the ninth day in the lacunar stage 5b .

Through the lytic activity of the syncytiotrophoblast (Fig. 18 and 19) the maternal
capillaries are eroded and anastomose with the trophoblast lacunae, forming the
sinusoids. At the end of the pregnancy the lacunae communicate with each other and
form a single, connected system that is delimited by the syncytiotrophoblast and is
termed the intervillous space.

Fig. 18: 9th .10th day - Lacunar stage Fig. 19: 9th -10th day – Primary villus Legend
Lacunar stage (Fig. 18)
and primary villus (Fig.
19)
Spaces form in the
trophoblast (Fig. 18).
Subsequently, due to the
erosion of the maternal
capillaries, blood gets into
the vacuoles, engendering
the maternal sinusoids.
(Fig. 19)

1 Cytotrophoblast 5 Maternal vessel, eroded by the ST,


2 Syncytiotrophoblast which form the maternal sinusoids
3 Spaces between through communication with the
syncytiotrophoblast (Lacunae) lacunae
4 Maternal vessel A See enlarged version in figure 20

Between the 11th and 13th day cytotrophoblast cells penetrate into the cords of the
syncytiotrophoblast creating the primary trophoblast villi 5b .
Fig. 20: 11th -13th day 11th -13th day Legend
Primary villus with the
cytotrophoblast, which
penetrates into the
processes of the
syncytiotrophoblast,
forming the primary
trophoblast villi.

1 Cytotrophoblast
2 Syncytiotrophoblast

After the 16th day the extra-embryonic mesoblast also grows into this primary
trophoblast villus, which is now called a secondary villus 5c and expands into the
lacunae that are filled with maternal blood. As was already mentioned, the ST forms the
outermost layer of every villus.

Fig. 21: 16th day 16th day Legend


Secondary villi with
extra-embryonic
mesoblast in the center,
surrounded by
cytotrophoblast and
syncytiotrophoblast.

1 Extra-embryonic mesoblast
2 Cytotrophoblast
3 Syncytiotrophoblast

At the end of the 3rd week the villus mesoblast differentiates into connective tissue
and blood vessels. They connect up with the embryonic blood vessels. Villi that contain
differentiated blood vessels are called tertiary villi 6 .
Fig. 22: 21rst day 21rst day Legend
Tertiary villi with extra-
embryonic mesoblast
(EEM) in the center and
additional embryonic
blood vessels. The EEM
remains in this stage, still
surrounded by
cytotrophoblast. The outer
envelope of the villus is
still formed by the ST.

1 Extra-embryonic mesoblast
2 Cytotrophoblast
3 Syncytiotrophoblast
4 Fetal capillaries

From this time on gases, nutrients, and waste products that diffuse through the
maternal and fetal blood must pass through a total of four layers:

 Capillary endothelium of the villus


 Loose connective tissue that surrounds the endothelium
 Cytotrophoblast
 Syncytiotrophoblast

These four elements together form the placental barrier.


Note! The endothelium that surrounds the maternal blood vessels never penetrates
into the trophoblast lacunae, but comes just to their boundaries.
Numerous "daughter" villi arise out of the tertiary villi. These remain either free and
project into the intervillous space (free villi), or they anchor themselves to the basal
plate (anchoring villi). (Interactive diagram).

After the 4th month the cytotrophoblast in the tertiary villi disappear slowly, the villi Reminder
divide further and become very thin, whereby the distance between the intervillous Histological comparison
space with maternal blood and the fetal vessels gets smaller. The villi that arise in this between a young
way are called free villi. placenta and one at the
end of pregnancy
Fig. 23 - After the end of the 4th month Placenta at term Legend
Free villi with extra-
embryonic mesoblast
(EEM) and fetal blood
vessels in the center.

1 Extra-embryonic mesoblast
2 Remains of cytotrophoblast
3 Syncytiotrophoblast
4 Fetal capillaries

The cytotrophoblast layer


The cytotrophoblast of the Fig. 24 - Development of the Legend
anchoring villus expands cytotrophoblast layer
until a further layer outside To be recognized
the syncytiotrophoblast are the anchoring
villus with the
arises, forming the cytotrophoblast
cytotrophoblast layer shown in dark
(interactive diagram). It slips green that
in between the infiltrates more and
syncytiotrophoblast and the more the basal
uterine endometrium. plate and gets in
between the
syncytiotrophoblast
(light green) and
the compact layer
of the decidua in
1 Anchoring villus order to form the
2 Syncytiotrophoblast cytotrophoblast
3 Cytotrophoblast layer. Note that the
4 Cytotrophoblast layer syncytiotrophoblast
5 Uterine endometrium completely covers
the interior of the
intervillous spaces.
Over the course of the 4th month the cytotrophoblast cells
slowly disappear out of the villus wall and the chorionic
plate. They persist, however, in the cytotrophoblast layer.
The cytotrophoblast cells penetrate into the decidua and the
myometrium and also colonize the wall of the spiral arteries
close to their openings.

Fig. 25 - Growth of the CT Fig. 26 - Growth of the CT Legend


into the walls of the maternal into the walls of the maternal
vessels vessels
Fig. 25, Fig. 26
Progressive
growth of the
cytotrophoblast
cells into the
decidua and into
the wall of the
spiral arteries.

1 Syncytiotrophoblast (ST) 5 Spiral arteries


2 Cytotrophoblast (CT) 6 Endovascular cytotrophoblast
3 Endothelial cells
4 Smooth muscle cells

This invasion of the maternal vessels by the cytotrophoblast More info


leads to the destruction of the smooth muscle layer and to a Supplementary
partial replacement of the endothelial cells. It is responsible information
for the change in elasticity of the spiral arteries, whereby the regarding the
physiopathology
blood circulation of this fetoplacental unit is adapted to the
of the
rapid growth of the fetus. This phenomenon of cell exchange mechanisms of
is absent in preeclampsia or an intra-uterine growth preeclampsia
retardation.An excessive proliferation of the cytotrophoblast
can lead to tumor formation, especially to a chorion Physiopathology
carcinoma. of preeclampsia
(French)

HTA of the
pregnancy
(French)
More info
During a normal pregancy the maternal spiral arteries that
nourish the placenta are continuosly pulled into the lacunar
system.
These structural adaptations are accompanied by an
edema, the dissolution of the endothelium and destruction
of the tunica media and the membrana elastica interna,
which are replaced by fibrous tissue. Through these
alterations the arteries are removed from neuro-vascular
control and the influence of the tone-producing vessel
mediators (prostaglandin, nitrous oxide, endothelin). Thus,
a larger blood flow is allowed in the placenta.
The migration of the trophoblast cells stands under a strict
temporal-spatial control, an alteration of which can provoke
a disorder in placental function. This ranges from a
preeclampsia (characterized by insufficient penetration by
the trophoblast) to a chorion carcinoma (characterized by
an excessive trophoblast invasion).

Connections between maternal and fetal


tissues

Placental tissue structure

Maternal and fetal tissues form two units that are closely Quiz
bound together at the placental level. Quiz 12
The fetal part of the placenta is made up of the chorionic
plate with its placental villi, the cytotrophoblast layer and
the intervillous spaces. The chorionic plate (great part of
the placenta on the fetal side) consists of the amnion, the
extra-embryonic mesenchyma, the cytotrophoblast and
the syncytiotrophoblast.
The basal plate, the peripheral region of the placenta on
the maternal side that is in contact with the uterine wall, is
made up of two tissues: embryonic tissue
(cytotrophoblast, syncytiotrophoblast), on the one side,
and of maternal tissue (decidua basalis) on the other.

The maternal side of the placenta is made up of the decidua


basalis, uterine vessels and glands.

Fig. 27 - Chorionic plate Fig. 28 - Basal plate Legend

The chorionic
plate (Fig. 27)
(namely the
fetal part of the
placenta) and
the basal plate
(Fig. 28),
(maternal part
of the placenta)
form two units
closely
connected at
the placental
level.

1 Amnion 5 Zona compacta


2 Extra-embryonic 6 Zona spongiosa
3 mesoblast 7 Decidua basalis
4 Cytotrophoblast 8 Myometrium
Syncytiotrophoblast

Development of the placenta

After the 4th month the cytotrophoblast slowly disappears Quiz


from the walls of the tertiary villi (interactive diagram), Quiz 13
whereby the distance between the maternal and fetal
vessels diminishes. They also disappear from the chorionic
plate. In the basal plate the cytotrophoblast remains mainly
at the level of the cytotrophoblast layer. Together with the
decidua and fibrin deposits, they form protrusions (inter-
cotyledon septa) that project into the intervillous space,
dividing it to some extent into so-called cotyledons.The
formative mechanism of these inter-cotyledon septa remains
speculative and probably depends on the folding together of
the basal plate which, for its part, has resulted from the
proliferation of the stem villi. They push the basal plate back.
In addition, the spread of the placenta into the uterine cavity
also appears to contribute to the creation of the septa (15) .

Fig. 29 - Development of the placenta (> 4th month) Legend


Fig. 29
The
cytotrophoblast
islands move
into the
periphery of
the cotyledons
and, together
with the
decidual tissue,
are involved
with formation
of the placental
inter-cotyledon
septa.

1 Decidual tissue
2 Syncytiotrophoblast
3 Cytotrophoblast islands
4 Septum

These septa delimit the cotyledons but never merge with the
chorionic plate. Maternal blood can accordingly circulate
freely from one cotyledon to the other (interactive diagram).
The villus stems of the placenta lengthen considerably
towards the end of the pregnancy and the fibrinoid deposits
(extra-cellular substance made up of fibrin, placental
secretions and dead trophoblast cells), accumulate in the
placenta. This happens especially under the chorionic plate,
where they form the subchorialLanghans' layer, as well as
at the level of the basal plate beneath the stem villi and the
cytotrophoblast layer, where the fibrin deposits form Rohr's
layer. Still deeper in the decidua basalis these deposits
form Nitabuch's layer. This is where the placenta detaches
itself from the uterus at birth (interactive diagram).

Fig. 30 - Definitive placenta Legend


Fig. 30
The fibrinoid
deposits form
the sub-
chorionic
Langhans'
layer A. Rohr's
layer B is
found at the
level of the
basal plate
beneath the
stem villi. Lying
still deeper in
the decidua
basalis they
form
Nitabuch's
A Subchorial Langhans' layer
layerC. This is
B Rohr's layer
located at the
C Nitabuch's layer
boundary
between the
zona
spongiosa and
the zona
compacta
(where the
release of the
placenta takes
place).

More info
The fibrinoid deposits are structurally and chemically
closely related to fibrin that is formed by the activation of
fibrinogen in the blood vessels. Recent research results
emphasize the existence of two types of fibrinoid (16).
The fibrinoid deposits are present in all normal placentas,
increase in thickness during the pregnancy, and can take
up a maximum of 30% of the placental volume without
affecting its function. Normally, at the end of the pregnancy,
they do not occupy more than 10 to 20% of the placenta
volume.
It seems their generation is connected with micro-lesions of
the syncytiotrophoblast. Through these injuries, the
mesenchyma comes into contact with maternal blood. This
provokes the activation of local coagulation mechanisms.
The mechanism resembles those which are brought about
through endothelial lesions in the blood vessels of adults.
Fibrinoid deposits also envelop all necrotic material that
ensues from placental degeneration. When these deposits
are massive and block one or more vessels to the villi, they
form white infarcts, which can be seen macroscopically on
the placenta.
The functional importance of the fibrinoid seems to be
quite complex. Besides their sealing effects, they also play
a role in the immunologic "barrier" between feto-maternal
tissue as well in the anchoring of the placenta.

The decidua

At the implantation location, the maternal endometrium is Quiz


changed by the decidual reaction (epithelial transformation Quiz 05
of the fibroblasts of the uterine stroma, in that lipids and
glycogen accumulate) and is called the decidua.

The decidua consists of various parts, depending on its


relationship with the embryo:

 Decidua basalis, where the implantation takes place


and the basal plate is formed. This can be subdivided
into a zona compacta and a zona spongiosa (where
the detachment of the placenta takes place following
birth).
 Decidua capsularis, lies like a capsule around the
chorion
 Decidua parietalis, on the opposite uterus wall
At around the 4th month, the fetus is so large that the
decidua capsularis comes into contact with the decidua
parietalis. The merging of these two deciduae causes the
uterine cavity to obliterate.

Fig. 31 - 8th week Fig. 32 - 12th week Legend


Fig. 31, Fig. 32
The three
deciduae in the
second month
of pregnancy.
After the 4th
month the
growing fetus
brings the
decidua
capsularis into
contact with
1 Decidua parietalis 5 Smooth chorion (laeve) the decidua
2 Decidua capsularis 6 Chorionic villi parietalis. The
3 Decidua basalis 7 Amniotic cavity fusion of the
4 Uterine cavity 8 Decidua capsularis and two deciduae
parietalis, grown together leads to the
disappearance
of the uterine
cavity.
 Development of the villi 

 In the early stage of development the trophoblastic  Quiz


villi form all around the embryo and give it the
appearance of a "hairy ball".  Quiz 23
 During the 3rd month most placental villi disappear
but remain present at the basal plate:
 The chorion gets here to be a villus-rich chorion
(chorion frondosum), a major component of the

placenta.
 At other locations, where the villi degenerate, the
chorion becomes smooth (chorion laeve). At these
locations, no exchange between the maternal and
fetal blood circulation systems takes place.
 The chorion laeve is formed from a chorion layer
(consisting of extra-embryonic mesenchyma and
cytotrophoblast).
 In this stage all placental villi are tertiary villi. After the
9th week the tertiary villi lengthen through the
proliferation of the terminal villus mesenchyma (see
more info).

 Definitive placental villi > 4th month   Lege


 Scannin
electro-
microsc
image o
placent
villus tre


 

 More info

 After the end of the 4th week all of the placental villi
are tertiary villi. Histologically and morphologically
they develop themselves further in the direction of a
new type of villus that is better adapted to the
growing embryonic needs. The tertiary villi, with a
diameter between 60 -200 mm, are homogenous and
rich in mesenchyma with few capillaries. They grow
first in length and later, through proliferation of the
trophoblast and extra-embryonic mesoblast (EEM) as
well as of endothelial cells, they also increase in
density and width. The trophoblast covering forms
numerous trophoblast buds, which at the beginning
are formed by the syncytiotrophoblast (similar to the
primary villi), but nevertheless cytotrophoblast and
the EEM grow very rapidly into these villi.

After the ninth and up to the 16th week the tertiary


villi mesh and change through proliferation of the
terminal villus mesenchyma, the trophoblast and the
fetal endothelial cells in order to finally form
intermediate immature villi. The latter generate
trophoblast buds, out of which new, thinner villi arise.
These villi are rich in large diameter vessels,
guaranteeing increased perfusion.

After the 26th week, the (mesenchymatous) tertiary


villi develop longer and thinner villi (60 to 200 mm in
diameter) in which the fetal capillary network gets
richer. These are termed mature intermediate villi
that, for their part, form small meshes, terminal or
free villi (diameter 40 - 80 mm), as well as new
trophoblast buds.
 At the end of the pregnancy six types of villi are
to be found in the placenta:
 Stem villi
 Tertiary mesenchymatous villi
 Immature intermediate villi
 Mature intermediate villi
 Terminal or free villi
 Trophoblast buds
 The stem villi guarantee the mechanical
stability of the villus tree, the immature
intermediate villi are the place of the proliferation of
the trophoblast and the trophoblast buds. Tertiary
villi (mesenchymatous) are responsible for the
lengthening of the villus tree.
From the mature intermediate villi the free villi or
terminal villi arise which makes up 40% of the
volume and 50% of the exchange surface of the
placenta before birth. (17)