The Placenta and the Embryo Per Brodal Institutt for medisinske basalfag Universitetet i Oslo 9th Semester 2008 Week 12 Approx. 6 cm Crown Rump (CR) length England 1983 P. Brodal 2008 2 Week 12 (approx.) Placenta Fetal membranes England 1983 P. Brodal 2008 3 Week 7 Placental villi Amnion P. Brodal 2008 England 1983 4 Placenta Larsen, 3d Edition P. Brodal 2008 Placental villi 5 The First Week Day 4: Morula Shedding of the zona pellucida Day 5: Blastocyst Day 6: Implantation Fertilization P. Brodal 2008 6 Implantation – 6th day Endometrium Inner cell mass: gives rise to the embryo Trophoblast start to invade the endometrium Outer cell mass (trophoblast): gives rise to the placenta Langman, 8 Ed. P. Brodal 2008 7 Chorion and Decidua (End of Second Month) Decidua parietalis Decidua capsularis Decidua basalis Chorion frondosum (villi) Amniotic cavity Chorion laeve Chorion: forms fetal part of the placenta Langman, 8 Ed. P. Brodal 2008 Decidua: forms maternal part of the placenta 8 Decidua – Transformed Cells of the Endometrial Stroma Decidua parietalis Decidua capsularis large, round, epithelial-like cells secrete nutrients and regulatory substances Important for successful placentation P. Brodal 2008 9 7th day Endometrium changes: Decidual reaction Syncytiotrophoblast Cytotrophoblast Amnioblasts Ectodermal cells Langman, 8 Ed. P. Brodal 2008 Entodermal cells 10 9th day: Further Development of the Placenta Maternal blood vessels Lacunae in the syncytiotrophopblast Cytotrophoblast P. Brodal 2008 11 12 days Maternal sinusoids connect with lacunae in the trophoblast Primitive yolk sac Endometrial epithelium Langman, 8 Ed. P. Brodal 2008 12 13 days Amniotic cavity Trophoblastic lacunae present all around the embryo Yolk sac Extra-embryonal coelom (chorionic cavity) Sometimes a small bleeding occurs at this stage Langman, 8 Ed. P. Brodal 2008 13 End of Third Week Cytotrophoblast Syncytiotrophoblast The cytotrophoblast grows through the syncytiotrophoblast to form an external shell Langman, 8 Ed. P. Brodal 2008 14 The Cytotrophoblastic Shell (End of 3d Week) Cytotrophoblasts Syncytiotrophoblast Umbilical cord Langman, 8 Ed. P. Brodal 2008 15 Placental Villi – at Fourth Week and Fourth Month Maternal blood vessels Cytotrophoblast shell Syncytiotrophoblast Decidua (endometrium) Intervillous space (maternal blood) Villous blood vessels (fetal) P. Brodal 2008 Villus with extra-embryonal mesoderm 16 Development of the Villi Primary villus Secondary villus Tertiary villus (end of third week) Diffusion barriere Langman, 8 Ed. Early P. Brodal 2008 Late 17 Foeto-Placental Circulation (End of 4th Week) Cardinal veins (anterior and posterior) Dorsal aorta Umbilical artery (2) Placental villi Vitelline artery Yolk sac P. Brodal 2008 Umbilical vein (1) 18 The Placenta at Term Decidual plate Amnion P. Brodal 2008 Decidual septum Spiral artery Chorionic plate Umbilical cord 19 The Placenta at Term 15-25 cm diameter, 500-600 g, 3 cm thick Exchange area: ~ 10 m2 Blood flow: 600 ml/min Cotyledon Amnion P. Brodal 2008 Umbilical cord Decidual layer removed 20 Extravillous Trophoblast Trophoblastic cells growing as columns into the decidua, forming anchoring villi Invading also the uterine arteries – eroding the media and forming the intima Important for maintaining perfusion of the placenta Inadequate formation: related to preeclampsia Ecxessive: invasive growth, e.g. choriocarcinoma P. Brodal 2008 Langman, 8 Ed. 21 The Fetal Membranes (End of 4th Month) Fusion of amnion, chorion laeve, decidua capsularis and decidua parietalis Fusion of amnion, chorion laeve and decidua capsularis P. Brodal 2008 22 Fetal Membranes Amnion (vannhinnen) P. Brodal 2008 23 Fetal membranes – Dizygotic twins 2 cell zygote Fused chorions Langman P. Brodal 2008 24 Fetal membranes - Monozygotic Twins 2-cell zygote Split at 2-cell stage; separate chorion and amnion Split of inner cell mass early; share chorion, separate amnion Split of inner cell mass late; share chorion and amnion Langman P. Brodal 2008 25 Formation of The Umbilical Cord Amnion Yolk sac P. Brodal 2008 26 Bilaminar germ disk (2d week) Amnion Ectoderm Entoderm Langman, 8 Ed. P. Brodal 2008 27 Formation of the Mesoderm (2d-3d Week) Ectoderm Entoderm Mesoderm Week 3 Langman, 8 Ed. P. Brodal 2008 28 Third week – Trilaminated Disc Amniotic cavity Amnion Ectoderm Intra-embryonic coelom (starting to form) Mesoderm (paraxial) Entoderm Langman P. Brodal 2008 Yolk sac 29 Foldings Determine the Shape of the Embryo (Fourth week) Neural tube Amniotic cavity Intermediate mesoderm (nephrotomes) Paraxial mesoderm (somit) Intraembryonic coelom Midgut Yolk sac P.Langman Brodal 2008 30 Some Landmarks in Embryonic Development 2d-3d week: The trilaminar germ disc formed 3d week: The heart develops, links up with the vascular system 4th week: Formation of the gut 6th week: Urogenital sinus formed 7th week: most organs have formed P. Brodal 2008 31 Some Landmarks in Fetal Development (weeks after fertilization) 6 weeks ~ 2 cm CR-length; nose, ears, fingers identifiable 10 weeks ~ 6 cm; external genitals formed but undifferentiated 14 weeks ~ 12 cm; external genitals can be differentiated, skin transparent red 18 weeks ~ 15 cm; fine hairs (lanugo) covers the body, skin opaque 22 weeks ~ 21 cm; eyebrows and fingernails present 26 weeks ~ 26 cm; eyes open, scalp hair growing Llewellyn-Jones 7th Ed. P. Brodal 2008 32