PEMBANGUN

AN
PLACENTA
The placenta (Greek, plakuos = flat cake)

The placenta a mateno-fetal organ which begins developing at implantation of the blastocyst and is delivered with the fetus
at birth.

During that 9 month period it provides nutrition, gas exchange, waste removal, a source of hematopoietic stem cells,
endocrine and immune support for the developing fetus.

There are essentially 3 separate aortic/venous circulatory systems: umbilical, systemic and vitelline. The umbilical system is
lost at birth, the vitelline contributes to the portal system and the systemic (embryonic) is extensively remodelled to form
the mature cardiovascular system.

Nutrition is derived from about 100–150 maternal uterine spiral arteries located in the basal plate and the human term placenta
is about 9 cm in diameter. There appears to also be differences in placentation (function) between the sexes.
Tahapan pengembangan
The trophoblast has two layers: the cytotrophoblast and the syncytiotrophoblast.

Syncytiotrophoblast is formed from the underlying cytotrophoblast.

Fetal vessels with nucleated fetal red blood cells appear at 21 days' gestation.

The presence of both trophoblast cell layers in the absence of vessels indicates a pregnancy of <21 days.

Fetal vessels and red blood cells, along with two cell layers of trophoblast, indicate a pregnancy of 21 days to 5
months

After the fifth month of pregnancy, the cytotrophoblast, when viewed under a light microscope, appears to
degenerate.

The mesenchymal core of each villus becomes more dense and compact, and the fetal vessels closer to the
overlying syncytiotrophoblast, These changes, combined with fibrin deposition within the intervillous space and
occasional syncytial knots, are characteristic of a term placenta.

At term, the human placenta weighs approximately 500 g.

Tahapan pengembangan
The amnion forms from splitting of the cytotrophoblast.

By the end of the third month of pregnancy, the amnion has expanded to obliterate the yolk sac, the allantoic sac, and the
extracoelomic space within the chorion.

The endometrial cavity has been obliterated by the fourth month of pregnancy, allowing the fused membranes to be in
contact with the decidua parietalis throughout the uterus.

Amniotic fluid volume at term is approximately 1000 ml, with a turnover rate of 500 ml/hour. The fetus floats freely within
the amniotic sac connected to the placenta and the mother by the umbilical cord, which contains two arteries and one vein.
STRUKTUR PLASENTA
FETAL SURFACE
• The fetal surface of the placenta is covered by a structure called the amnion, or
amniotic membrane.
• The amniotic membrane secretes amniotic fluid, a fluid that is breathed in and out
by the fetus and serves as a form of protection and cushion against the walls of
the uterus. It also helps maintain constant pressures and temperatures, allows
space for fetal growth and protects against infection
• Amniotic membrane that gives this surface a shinny appearance.
• Underlying the amnion is the chorion, a thicker membrane. This structure of the
placenta is continuous with the lining of the uterine wall.
• Emerging from the chorion are the villi where lies a system of fetal capillaries
(blood vessels) to allow maximum contact area with the maternal blood (also
known as the intervillous space) for gas,nutrient and waste exchange.
• Also visible on the fetal surface of the placenta are the umbilical veins and arteries
that spread out from where is situated the umbilical cord, near the center of the
organ
 MATERNAL SURFACE
• The maternal surface of the placenta is composed of the
decidua, what is known as the uterine lining during
pregnancy.
• Also visible on the maternal surface are lobules,
approximately 15 to 20 called cotyledons. They are
divided by deep channels more commonly known as sulci.
• Each individual lobule is divided into smaller sections
containing one villi.
• These villi are the same ones emerging from the chorion,
containing fetal capillaries, which bathe in the intervillous
space
• Embeded in the decidua are maternal veins and arteries
that end in the intervillous space. They are also in
continuous with the maternal circulation.
UMBILICAL CORD
• The umbilical cord emerges from the fetal side of the placenta to the
belly button region of the fetus.
• At its full length, the cord has an average length of about 50 to 60
cm and can have a width of 2 to 3 cm.
• The cord contains 2 arteries and 1 vein that are in continuation with
the fetal circulation.
• These vessels are longer then the cord and tend to twist and spiral to
add strength and protect against entanglement, compression and
tension.
• The cord itself is composed of a jelly substance known as whartons
jelly. This substance helps to protect the vessels within the cord.
• The whole of the umbilical cord is encased by the continuous layer of
the amnion that is also covering the fetal surface of the placenta.
PLACENTAL CIRCULATION
• Placental circulation encompasses two different circulation
systems, thematernal and the fetal.
• Although these two come in very close contact with each other,
they will never mix together, they are separated by what is known
as the placental barrier. This organisation keeps the mothers body
from rejecting the fetus as an object of foreign origin.
• These two independent blood flows can be influenced by
different factors such as blood pressure, medication, uterine
contractions, hormones, etc.
• It is the nutrients, gases, wastes and hormones that flow through
these circulation which can then switch systems (fetal to maternal
or vise versa) by mainly diffusion.
• Diffusion is the process by which particles flow from areas of
higher concentration to areas of lower concentrations.
• These nutrient particles, gases, hormones and wastes can cross
directly through the placental membrane by diffusion in either
direction to alter fetal or maternal blood concentrations.
FETAL CIRCULATION
• This circulation system takes place in the
fetus, umbilical cord and villi located in the
placenta.
• Deoxygenated blood (low oxygen content in
blood) from the fetus goes through the two
umbilical arteries into the fetal capillaries
located in the villi of the placenta. In this
section, waste and carbon dioxide (CO2) are
eliminated from the fetus by diffusing into
the maternal circulation and leave the
placenta by the maternal vein.
MATERNAL CIRCULATION

• This circulation takes place in the mother and the intervillous space of the
placenta.
• This circulation is constantly changing to meet the needs of the growing fetus.
• Oxygenated blood (high oxygen content in blood) arriving from the mother
enters the placenta through the maternal arteries into the intervillous space.
• From here, oxygen,
• nutrients and hormones diffuse into the villi, then into fetal capillaries, where
they are
• now delivered to the baby via the umbilical vein.
HORMON PROTEIN

The two most important protein hormones produced by the placenta are human
chorionic gonadotropin (hCG), and human placental lactogen (hPL).

hCG is a glycoprotein in which the carbohydrate portion represents approximately

30% of the molecule. The highest concentration of hCG is found in the placenta, hCG
is produced in molar pregnancies in the absence of a fetus, i.e. incomplete mole.

hCG can be detected in serum as early as 10 days after conception, with a peak at 45
to 60 days after conception. Serum levels then drop abruptly to low levels, which
persist to term

Corpus luteum function definitely is prolonged by the action of hCG.

Small amounts of hCG reach the fetus and may play a role in the early development
of steroid synthesis in the fetal adrenal and testes.
 HORMON PROTEIN
hPL is produced by the trophoblast. It disappears
from maternal serum within a few hours after
delivery of the placenta.

the amount of hPL formed is related to placental

size, but other factors, such as ionic environment
and nutrient variables, may also contribute.

In pregnancy the increasing of the steroid

placenta hormones will reduce insulin secretion
so it will increase the glucose level in blood
which can lead to diabetic

hPL increase insulin secretion that will help to

allow glucose to enter the cells to use glucose as
the energy source
HORMON STEROID
During pregnancy, there is a gradual increase in the urinary excretion of progestins and
estrogens

Three estrogens are produced by the placenta: estrone, 17β-estradiol, and estriol (Fig. 13).

The fetus and placenta must be present for the production of the large amounts of maternal
estrogen normally found in serum and urine during pregnancy

The placenta aromatizes the androgens dehydroepiandrosterone, androstenedione, and

testosterone, produced by the fetus, to estrogens.

The synthesis of estrogen is known to be stimulated by hCG and hPL, and the placenta may
regulate its own estrogen synthesis.
The function of the elevated estrogen to stimulate growth of the uterus, particularly the myometrium and its
vascular supply, as well as the breasts.

The elevated levels of estrogen, which rise progressively to term, form the basis for the best clinical test
available for assessing fetoplacental well-being.

absence of the fetal adrenal gland (as in anencephaly) or chronic maternal illness causing fetoplacental
deprivation lowers the amount of estriol, and thus total estrogen, excreted in maternal urine.

Maternal 24-hour urinary estriol excretion is a valuable screening test for fetal well-being in patients with
diabetes mellitus, chronic renal disease, and hypertension (Fig. 14). It is also helpful in estimating fetal
maturity.
Progesterone is also synthesized in large amounts by the placent

The fetus contributes very little to the total progesterone production.

Progesterone are found in maternal serum and urine as long as the placenta is in situ and
functioning.

Near term, the human placenta produces about 250 mg of progesterone daily, of which
about 75 mg are delivered to the fetus for adrenal biosynthesis of steroid hormones.
 FUNGSI PLACENTA
Respiration Nutrition and Excretion Protection and Immunity
• Early in pregnancy, the fetus does not have adequate • A good supply of nutrients for the fetus is needed for • The placenta is a very important form of protection.
developed lungs to breath on its own, therefore, one energy and a healthy growth. One of its functions is to prevent the mothers body
of the main functions of the placenta is to help the • Nutrients such as glucose, amino acids and fatty acids from rejecting the fetus. Because the two can have
fetus breathe. are essential to life and are mostly found in the foods different chromosomes and blood types, the mother
• In response to a pressure gradient between the we eat. Mother that supplies these nutrients via the would perceive the fetus as an object of foreign
mothers circulation and the placenta circulation, placenta. origin and would want to reject it because it is not
oxygen rich blood coming from the mother enters • Different foods that the mother eats are broken part of her own tissues. However, this scenario does
the placenta by the maternal artery and diffuses into down and transported by the bloodto the uterine not happen because the placenta serves as a barrier
the fetal blood. The oxygen will travel along the wall. These nutrients found in the maternal to prevent the two different circulation from mixing
umbilical vein and finally reach the fetus. circulation are absorbed by the placenta and can be therefore the mothers immune system will not attack
• On the other hand, the fetus produces more carbon broken down into smaller particles to facilitate the the fetus.
dioxide then the mother which needs to be uptake of these molecules by fetal cells. Some of • The placenta also plays a role as a protective barrier
eliminated. these nutrients can also be stored in the placenta against bacteria. Most bacteria are too big to cross
• The carbone dioxide will thus make it’s way through and used later on when they are needed. into the fetal circulation, however, micro-organisms
the umbilical arteries to the placenta and diffuse • When we eat, we also produce waste that is such as viruses can do so and infect the fetus.
from the villi into the intervillous space to be added eventually excreted. The fetus also produces waste • Drugs can also cross the barrier and cause harm to
to the maternal circulation and eliminated by the which needs to be eliminated. These fetal wastes the baby. Drugs such as acetaminophen (tylenol) are
mothers lungs. cross over into the maternal circulation via the harmless however others such as warfarin (an
placenta to be also be eventually excreted by the anticoagulant) are dangerous to the growing fetus.
mother. • The placenta can also allow certain maternal
protective antibodies to cross into the fetal
circulation and help protect the fetus from dangerous
organisme which can last up to several month after
birth. (It is important to consider that not all
antibodies are protective and some can be
dangerous and cause harm to the fetus.)