Placenta

The placenta is a temporary organ that connects the developing fetus via the umbilical cord to the uterine wall to allow nutrient uptake, thermo-regulation, waste elimination, and gas exchange via the mother's blood supply; to fight against internal infection; and to produce hormones which support pregnancy. Placentas are a defining characteristic of placental mammals, but are also found in marsupials and some non-mammals with varying levels of development.[1]

The placenta functions as a fetomaternal organ with two components:[2] the fetal placenta (Chorion frondosum), which develops from the same blastocyst that forms the fetus, and the maternal placenta (Decidua basalis), which develops from the maternal uterine tissue.[3] It metabolizes a number of substances and can release metabolic products into maternal or fetal circulations. The placenta is expelled from the body upon birth of the fetus.

The word placenta comes from the Latin word for a type of cake, from Greek πλακόεντα/πλακοῦντα plakóenta/plakoúnta, accusative of πλακόεις/πλακούς plakóeis/plakoús, "flat, slab-like",[4][5] in reference to its round, flat appearance in humans. The classical plural is placentae, but the form placentas is common in modern English and probably has the wider currency at present.

Placenta
Placenta
Placenta
Human placenta baby side
Human placenta from just after birth with the umbilical cord in place
Details
Precursordecidua basalis, chorion frondosum
Identifiers
LatinPlacento
MeSHD010920
TEE5.11.3.1.1.0.5
Anatomical terminology

Structure

Placental mammals, such as humans, have a chorioallantoic placenta that forms from the chorion and allantois. In humans, the placenta averages 22 cm (9 inch) in length and 2–2.5 cm (0.8–1 inch) in thickness, with the center being the thickest, and the edges being the thinnest. It typically weighs approximately 500 grams (just over 1 lb). It has a dark reddish-blue or crimson color. It connects to the fetus by an umbilical cord of approximately 55–60 cm (22–24 inch) in length, which contains two umbilical arteries and one umbilical vein.[6] The umbilical cord inserts into the chorionic plate (has an eccentric attachment). Vessels branch out over the surface of the placenta and further divide to form a network covered by a thin layer of cells. This results in the formation of villous tree structures. On the maternal side, these villous tree structures are grouped into lobules called cotyledons. In humans, the placenta usually has a disc shape, but size varies vastly between different mammalian species.[7]

The placenta occasionally takes a form in which it comprises several distinct parts connected by blood vessels.[8] The parts, called lobes, may number two, three, four, or more. Such placentas are described as bilobed/bilobular/bipartite, trilobed/trilobular/tripartite, and so on. If there is a clearly discernible main lobe and auxiliary lobe, the latter is called a succenturiate placenta. Sometimes the blood vessels connecting the lobes get in the way of fetal presentation during labor, which is called vasa previa.

Gene and protein expression

About 20,000 protein coding genes are expressed in human cells and 70% of these genes are expressed in the normal mature placenta.[9][10] Some 350 of these genes are more specifically expressed in the placenta and fewer than 100 genes are highly placenta specific. The corresponding specific proteins are mainly expressed in trophoblasts and have functions related to female pregnancy. Examples of proteins with elevated expression in placenta compared to other organs and tissues are PEG10 and the cancer testis antigen PAGE4 expressed in cytotrophoblasts, CSH1and KISS1 expressed in syncytiotrophoblasts, and PAPPA2 and PRG2 expressed in extravillous trophoblasts.

Physiology

Development

Placenta
Placenta
HumanEmbryogenesis
The initial stages of human embryogenesis.

The placenta begins to develop upon implantation of the blastocyst into the maternal endometrium. The outer layer of the blastocyst becomes the trophoblast, which forms the outer layer of the placenta. This outer layer is divided into two further layers: the underlying cytotrophoblast layer and the overlying syncytiotrophoblast layer. The syncytiotrophoblast is a multinucleated continuous cell layer that covers the surface of the placenta. It forms as a result of differentiation and fusion of the underlying cytotrophoblast cells, a process that continues throughout placental development. The syncytiotrophoblast (otherwise known as syncytium), thereby contributes to the barrier function of the placenta.

The placenta grows throughout pregnancy. Development of the maternal blood supply to the placenta is complete by the end of the first trimester of pregnancy week 14 (DM).

Placental circulation

Gray39
Maternal blood fills the intervillous space, nutrients, water, and gases are actively and passively exchanged, then deoxygenated blood is displaced by the next maternal pulse.

Maternal placental circulation

In preparation for implantation of the blastocyst, the endometrium undergoes decidualization. Spiral arteries in the decidua are remodeled so that they become less convoluted and their diameter is increased. The increased diameter and straighter flow path both act to increase maternal blood flow to the placenta. There is relatively high pressure as the maternal blood fills intervillous space through these spiral arteries which bathe the fetal villi in blood, allowing an exchange of gases to take place. In humans and other hemochorial placentals, the maternal blood comes into direct contact with the fetal chorion, though no fluid is exchanged. As the pressure decreases between pulses, the deoxygenated blood flows back through the endometrial veins.

Maternal blood flow is approximately 600–700 ml/min at term.

This begins at day 5 - day 12 [11]

Fetoplacental circulation

Deoxygenated fetal blood passes through umbilical arteries to the placenta. At the junction of umbilical cord and placenta, the umbilical arteries branch radially to form chorionic arteries. Chorionic arteries, in turn, branch into cotyledon arteries. In the villi, these vessels eventually branch to form an extensive arterio-capillary-venous system, bringing the fetal blood extremely close to the maternal blood; but no intermingling of fetal and maternal blood occurs ("placental barrier").[12]

Endothelin and prostanoids cause vasoconstriction in placental arteries, while nitric oxide causes vasodilation.[13] On the other hand, there is no neural vascular regulation, and catecholamines have only little effect.[13]

The fetoplacental circulation is vulnerable to persistent hypoxia or intermittent hypoxia and reoxygenation, which can lead to generation of excessive free radicals. This may contribute to pre-eclampsia and other pregnancy complications.[14] It is proposed that melatonin plays a role as an antioxidant in the placenta.[14]

This begins at day 17 - day 22 [15]

Birth

Placental expulsion begins as a physiological separation from the wall of the uterus. The period from just after the child is born until just after the placenta is expelled is called the "third stage of labor". The placenta is usually expelled within 15–30 minutes of birth.

Placental expulsion can be managed actively, for example by giving oxytocin via intramuscular injection followed by cord traction to assist in delivering the placenta. Alternatively, it can be managed expectantly, allowing the placenta to be expelled without medical assistance. Blood loss and the risk of postpartum bleeding may be reduced in women offered active management of the third stage of labour, however there may be adverse effects and more research is necessary.[16]

The habit is to cut the cord immediately after birth, but it is theorised that there is no medical reason to do this; on the contrary, it is theorized that not cutting the cord helps the baby in its adaptation to extrauterine life, especially in preterm infants.[17]

Microbiome

The placenta is traditionally thought to be sterile, but recent research suggests that a resident, non-pathogenic, and diverse population of microorganisms may be present in healthy tissue. However, whether these microbes exist or are clinically important is highly controversial and is the subject of active research.[18][19][20][21]

Functions

Nutrition

Human placenta 01
Maternal side of a placenta shortly after birth.

The placenta intermediates the transfer of nutrients between mother and fetus. The perfusion of the intervillous spaces of the placenta with maternal blood allows the transfer of nutrients and oxygen from the mother to the fetus and the transfer of waste products and carbon dioxide back from the fetus to the maternal blood. Nutrient transfer to the fetus can occur via both active and passive transport.[22] Placental nutrient metabolism was found to play a key role in limiting the transfer of some nutrients.[23] Adverse pregnancy situations, such as those involving maternal diabetes or obesity, can increase or decrease levels of nutrient transporters in the placenta potentially resulting in overgrowth or restricted growth of the fetus.[24]

Excretion

Waste products excreted from the fetus such as urea, uric acid, and creatinine are transferred to the maternal blood by diffusion across the placenta.

Immunity

IgG antibodies can pass through the human placenta, thereby providing protection to the fetus in utero.[25] This transfer of antibodies begins as early as the 20th week of gestational age, and certainly by the 24th week.[26] This passive immunity lingers for several months after birth, thus providing the newborn with a carbon copy of the mother's long-term humoral immunity to see the infant through the crucial first months of extrauterine life. IgM, however, cannot cross the placenta, which is why some infections acquired during pregnancy can be hazardous for the fetus.

Furthermore, the placenta functions as a selective maternal-fetal barrier against transmission of microbes. However, insufficiency in this function may still cause mother-to-child transmission of infectious diseases.

Endocrine function

  • The first hormone released by the placenta is called the human chorionic gonadotropin hormone. This is responsible for stopping the process at the end of menses when the Corpus luteum ceases activity and atrophies. If hCG did not interrupt this process, it would lead to spontaneous abortion of the fetus. The corpus luteum also produces and releases progesterone and estrogen, and hCG stimulates it to increase the amount that it releases. hCG is the indicator of pregnancy that pregnancy tests look for. These tests will work when menses has not occurred or after implantation has happened on days seven to ten. hCG may also have an anti-antibody effect, protecting it from being rejected by the mother’s body. hCG also assists the male fetus by stimulating the testes to produce testosterone, which is the hormone needed to allow the sex organs of the male to grow.
  • Progesterone helps the embryo implant by assisting passage through the fallopian tubes. It also affects the fallopian tubes and the uterus by stimulating an increase in secretions necessary for fetal nutrition. Progesterone, like hCG, is necessary to prevent spontaneous abortion because it prevents contractions of the uterus and is necessary for implantation.
  • Estrogen is a crucial hormone in the process of proliferation. This involves the enlargement of the breasts and uterus, allowing for growth of the fetus and production of milk. Estrogen is also responsible for increased blood supply towards the end of pregnancy through vasodilation. The levels of estrogen during pregnancy can increase so that they are thirty times what a non-pregnant woman mid-cycles estrogen level would be.
  • Human placental lactogen is a hormone used in pregnancy to develop fetal metabolism and general growth and development. Human placental lactogen works with Growth hormone to stimulate Insulin-like growth factor production and regulating intermediary metabolism. In the fetus, hPL acts on lactogenic receptors to modulate embryonic development, metabolism and stimulate production of IGF, insulin, surfactant and adrenocortical hormones. hPL values increase with multiple pregnancies, intact molar pregnancy, diabetes and Rh incompatibility. They are decreased with toxemia, choriocarcinoma, and Placental insufficiency.[27][28]

Immunological barrier

The placenta and fetus may be regarded as a foreign body inside the mother, and needs to be protected from the normal immune response of the mother that would cause it to be rejected. The placenta and fetus are thus treated as sites of immune privilege, with immune tolerance.

For this purpose, the placenta uses several mechanisms:

However, the Placental barrier is not the sole means to evade the immune system, as foreign fetal cells also persist in the maternal circulation, on the other side of the placental barrier.[31]

Other

The placenta also provides a reservoir of blood for the fetus, delivering blood to it in case of hypotension and vice versa, comparable to a capacitor.[32]

Human placenta umbilical cord Ultrasound by Dr. W. Moroder
Ultrasound image of human placenta and umbilical cord (color Doppler rendering) with central cord insertion and three umbilical vessels, at 20 weeks of pregnancy

Clinical significance

CMV placentitis1 mini
Micrograph of a cytomegalovirus (CMV) infection of the placenta (CMV placentitis). The characteristic large nucleus of a CMV-infected cell is seen off-centre at the bottom-right of the image. H&E stain.

Numerous pathologies can affect the placenta.

  • Placenta accreta, when the placenta implants too deeply, all the way to the actual muscle of uterine wall (without penetrating it)
  • Placenta praevia, when the placement of the placenta is too close to or blocks the cervix
  • Placental abruption/abruptio placentae, premature detachment of the placenta

Infections involving the placenta:

Society and culture

The placenta often plays an important role in various cultures, with many societies conducting rituals regarding its disposal. In the Western world, the placenta is most often incinerated.[33]

Some cultures bury the placenta for various reasons. The Māori of New Zealand traditionally bury the placenta from a newborn child to emphasize the relationship between humans and the earth.[34] Likewise, the Navajo bury the placenta and umbilical cord at a specially chosen site,[35] particularly if the baby dies during birth.[36] In Cambodia and Costa Rica, burial of the placenta is believed to protect and ensure the health of the baby and the mother.[37] If a mother dies in childbirth, the Aymara of Bolivia bury the placenta in a secret place so that the mother's spirit will not return to claim her baby's life.[38]

The placenta is believed by some communities to have power over the lives of the baby or its parents. The Kwakiutl of British Columbia bury girls' placentas to give the girl skill in digging clams, and expose boys' placentas to ravens to encourage future prophetic visions. In Turkey, the proper disposal of the placenta and umbilical cord is believed to promote devoutness in the child later in life. In Ukraine, Transylvania, and Japan, interaction with a disposed placenta is thought to influence the parents' future fertility.

Several cultures believe the placenta to be or have been alive, often a relative of the baby. Nepalese think of the placenta as a friend of the baby; Malaysian Orang Asli regard it as the baby's older sibling.[37] Native Hawaiians believe that the placenta is a part of the baby, and traditionally plant it with a tree that can then grow alongside the child.[33] Various cultures in Indonesia, such as Javanese, believe that the placenta has a spirit and needs to be buried outside the family house.

In some cultures, the placenta is eaten, a practice known as placentophagy. In some eastern cultures, such as China, the dried placenta (ziheche , literally "purple river cart") is thought to be a healthful restorative and is sometimes used in preparations of traditional Chinese medicine and various health products.[39] The practice of human placentophagy has become a more recent trend in western cultures and is not without controversy; its practice being considered cannibalism is debated.

Some cultures have alternative uses for placenta that include the manufacturing of cosmetics, pharmaceuticals and food.

Additional images

Gray30

Fetus of about 8 weeks, enclosed in the amnion. Magnified a little over two diameters.

Cord & Placenta

Picture of freshly delivered placenta and umbilical cord wrapped around Kelly clamps

Human placenta

Fresh human placenta

CMV placentitis1

Micrograph of a placental infection (CMV placentitis).

CMV placentitis2

Micrograph of CMV placentitis.

Placenta vasculature 3D power doppler 00001

A 3D Power doppler image of vasculature in 20-week placenta

Placenta held

Placenta held.

2910 The Placenta-02

Schematic view of the placenta

Human placenta 01

Maternal side of a whole human placenta, just after birth

Human placenta 02

Fetal side of same placenta

Fetal side close-up of freshly delivered placenta.jpeg

Close-up of umbilical attachment to fetal side of freshly delivered placenta

Ziheche

Ziheche (紫河车), dried human placenta used in traditional Chinese medicine

See also

References

  1. ^ Pough et al. 1992. Herpetology: Third Edition. Pearson Prentice Hall:Pearson Education, Inc., 2002.
  2. ^ "How is Placenta Formed". Archived from the original on 2017-11-07.
  3. ^ Definitions of placental- related terms.
  4. ^ Henry George Liddell, Robert Scott, "A Greek-English Lexicon", at Perseus Archived 2012-04-05 at the Wayback Machine.
  5. ^ "placenta" Archived 2016-01-30 at the Wayback Machine. Online Etymology Dictionary.
  6. ^ Examination of the placenta Archived 2011-10-16 at the Wayback Machine
  7. ^ Placental Structure and Classification Archived 2016-02-11 at the Wayback Machine
  8. ^ Fujikura, Toshio; Benson, Ralph C; Driscoll, Shirley G; et al. (1970), "The bipartite placenta and its clinical features", American Journal of Obstetrics and Gynecology, 107 (7): 1013–1017, doi:10.1016/0002-9378(70)90621-6, PMID 5429965, Bipartite placenta represented 4.2 per cent (366 of 8,505) of placentas of white women at the Boston Hospital for Women who were enrolled in the Collaborative Project.
  9. ^ "The human proteome in placenta - The Human Protein Atlas". www.proteinatlas.org. Archived from the original on 2017-09-26. Retrieved 2017-09-26.
  10. ^ Uhlén, Mathias; Fagerberg, Linn; Hallström, Björn M.; Lindskog, Cecilia; Oksvold, Per; Mardinoglu, Adil; Sivertsson, Åsa; Kampf, Caroline; Sjöstedt, Evelina (2015-01-23). "Tissue-based map of the human proteome". Science. 347 (6220): 1260419. doi:10.1126/science.1260419. ISSN 0036-8075. PMID 25613900.
  11. ^ Williams book of obstretics.
  12. ^ Placental blood circulation Archived 2011-09-28 at the Wayback Machine
  13. ^ a b Kiserud T, Acharya G (2004). "The fetal circulation". Prenatal Diagnosis. 24 (13): 1049–1059. doi:10.1002/pd.1062. PMID 15614842.
  14. ^ a b Reiter, R. J.; Tan, D. X.; Korkmaz, A.; Rosales-Corral, S. A. (2013). "Melatonin and stable circadian rhythms optimize maternal, placental and fetal physiology". Human Reproduction Update. 20 (2): 293–307. doi:10.1093/humupd/dmt054. ISSN 1355-4786. PMID 24132226.
  15. ^ Williams book of obsteritcis.
  16. ^ Begley, Cecily M.; Gyte, Gillian M. L.; Devane, Declan; McGuire, William; Weeks, Andrew (2015-03-02). "Active versus expectant management for women in the third stage of labour". The Cochrane Database of Systematic Reviews (3): CD007412. doi:10.1002/14651858.CD007412.pub4. ISSN 1469-493X. PMC 4026059. PMID 25730178.
  17. ^ Mercer JS, Vohr BR, Erickson-Owens DA, Padbury JF, Oh W (2010). "Seven-month developmental outcomes of very low birth weight infants enrolled in a randomized controlled trial of delayed versus immediate cord clamping". Journal of Perinatology. 30 (1): 11–6. doi:10.1038/jp.2009.170. PMC 2799542. PMID 19847185.
  18. ^ Perez-Muñoz, Maria Elisa; Arrieta, Marie-Claire; Ramer-Tait, Amanda E.; Walter, Jens (2017). "A critical assessment of the "sterile womb" and "in utero colonization" hypotheses: implications for research on the pioneer infant icrobiome". Microbiome. 5 (1): 48. doi:10.1186/s40168-017-0268-4. ISSN 2049-2618. PMC 5410102. PMID 28454555.
  19. ^ Mor, Gil; Kwon, Ja-Young (2015). "Trophoblast-microbiome interaction: a new paradigm on immune regulation". American Journal of Obstetrics and Gynecology. 213 (4): S131–S137. doi:10.1016/j.ajog.2015.06.039. ISSN 0002-9378. PMID 26428492.
  20. ^ Prince, Amanda L.; Antony, Kathleen M.; Chu, Derrick M.; Aagaard, Kjersti M. (2014). "The microbiome, parturition, and timing of birth: more questions than answers". Journal of ReproductiveImmunology. 104–105: 12–19. doi:10.1016/j.jri.2014.03.006. ISSN 0165-0378. PMC 4157949. PMID 24793619.
  21. ^ Hornef, M; Penders, J (2017). "Does a prenatal bacterial microbiota exist?". Mucosal Immunology. 10 (3): 598–601. doi:10.1038/mi.2016.141. PMID 28120852.
  22. ^ Wright C, Sibley CP (2011). "Placental Transfer in Health and Disease". In Kay H, Nelson M, Yuping W (eds.). The Placenta: From Development to Disease. John Wiley and Sons. p. 66. ISBN 9781444333664.
  23. ^ Perazzolo S, Hirschmugl B, Wadsack C, Desoye G, Lewis RM, Sengers BG (February 2017). "The influence of placental metabolism on fatty acid transfer to the fetus". J. Lipid Res. 58 (2): 443–454. doi:10.1194/jlr.P072355. PMC 5282960. PMID 27913585.
  24. ^ Kappen C, Kruger C, MacGowan J, Salbaum JM (2012). "Maternal diet modulates placenta growth and gene expression in a mouse model of diabetic pregnancy". PLoS ONE. 7 (6): e38445. doi:10.1371/journal.pone.0038445. PMC 3372526. PMID 22701643.
  25. ^ Simister N. E., Story C. M. (1997). "Human placental Fc receptors and the transmission of antibodies from mother to fetus". Journal of Reproductive Immunology. 37 (1): 1–23. doi:10.1016/s0165-0378(97)00068-5. PMID 9501287.
  26. ^ Page 202 in: Pillitteri, Adele (2009). Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 978-1-58255-999-5.
  27. ^ Handwerger S, Freemark M (2000). "The roles of placental growth hormone and placental lactogen in the regulation of human fetal growth and development". Journal of Pediatric Endocrinology & Metabolism. 13 (4): 343–56. doi:10.1515/jpem.2000.13.4.343. PMID 10776988.
  28. ^ "Human Placental Lactogen". www.ucsfhealth.org. May 17, 2009. Archived from the original on April 29, 2017. Retrieved July 21, 2017.
  29. ^ "Placenta 'fools body's defences'". BBC News. 10 November 2007. Archived from the original on 22 April 2012.
  30. ^ Clark DA, Chaput A, Tutton D (March 1986). "Active suppression of host-vs-graft reaction in pregnant mice. VII. Spontaneous abortion of allogeneic CBA/J x DBA/2 fetuses in the uterus of CBA/J mice correlates with deficient non-T suppressor cell activity". J. Immunol. 136 (5): 1668–75. PMID 2936806.
  31. ^ Williams Z, Zepf D, Longtine J, Anchan R, Broadman B, Missmer SA, Hornstein MD (March 2008). "Foreign fetal cells persist in the maternal circulation". Fertil. Steril. 91 (6): 2593–5. doi:10.1016/j.fertnstert.2008.02.008. PMID 18384774.
  32. ^ Assad RS, Lee FY, Hanley FL (2001). "Placental compliance during fetal extracorporeal circulation". Journal of Applied Physiology. 90 (5): 1882–1886. doi:10.1152/jappl.2001.90.5.1882. PMID 11299282.
  33. ^ a b "Why eat a placenta?". BBC. 18 April 2006. Archived from the original on 26 November 2007. Retrieved 8 January 2008.
  34. ^ Metge, Joan. 2005. "Working in/Playing with three languages: English, Te Reo Maori, and Maori Bod Language." In Sites N.S vol. 2, No 2:83-90.
  35. ^ Francisco, Edna (3 December 2004). "Bridging the Cultural Divide in Medicine". Minority Scientists Network. Archived from the original on 19 December 2007. Retrieved 7 January 2008.
  36. ^ Shepardson, Mary (1978). "Changes in Navajo mortuary practices and beliefs". American Indian Quarterly. 4 (4): 383–96. doi:10.2307/1184564. JSTOR 1184564. PMID 11614175.
  37. ^ a b Buckley, Sarah J. "Placenta Rituals and Folklore from around the World". Mothering. Archived from the original on 6 January 2008. Retrieved 7 January 2008.
  38. ^ Davenport, Ann (June 2005). "The Love Offer". Johns Hopkins Magazine. Archived from the original on 11 January 2008. Retrieved 7 January 2008.
  39. ^ Falcao, Ronnie. "Medicinal Uses of the Placenta". Archived from the original on 5 December 2008. Retrieved 25 November 2008.

External links

Amniotic sac

The amniotic sac, commonly called the bag of waters, sometimes the membranes, is the sac in which the fetus develops in amniotes. It is a thin but tough transparent pair of membranes that hold a developing embryo (and later fetus) until shortly before birth. The inner of these fetal membranes, the amnion, encloses the amniotic cavity, containing the amniotic fluid and the fetus. The outer membrane, the chorion, contains the amnion and is part of the placenta. On the outer side, the amniotic sac is connected to the yolk sac, the allantois and, via the umbilical cord, to the placenta.Amniocentesis is a medical procedure where fluid from the sac is sampled to be used in prenatal diagnosis of chromosomal abnormalities and fetal infections.

Antepartum bleeding

Antepartum bleeding, also known as antepartum haemorrhage or prepartum hemorrhage, is genital bleeding during pregnancy after the 20th to 24th week of pregnancy up to delivery.It can be associated with reduced fetal birth weight. Use of aspirin before 16 weeks of pregnancy to prevent pre-eclampsia also appears effective at preventing antepartum bleeding.In regard to treatment, it should be considered a medical emergency (regardless of whether there is pain), as if it is left untreated it can lead to death of the mother or baby.

Artificial uterus

An artificial uterus (or artificial womb) is a device that would allow for extracorporeal pregnancy by growing a fetus outside the body of an organism that would normally carry the fetus to term.

An artificial uterus, as a replacement organ, would have many applications. It could be used to assist male or female couples in the development of a fetus. This can potentially be performed as a switch from a natural uterus to an artificial uterus, thereby moving the threshold of fetal viability to a much earlier stage of pregnancy. In this sense, it can be regarded as a neonatal incubator with very extended functions. It could also be used for the initiation of fetal development. An artificial uterus could also help make fetal surgery procedures at an early stage an option instead of having to postpone them until term of pregnancy.In 2016 scientists published two studies regarding human embryos developing for thirteen days within an ecto-uterine environment. Currently, a 14-day rule prevents human embryos from being kept in artificial wombs longer than 14 days. This rule has been codified into law in twelve countries.In 2017 fetal researchers at the Children's Hospital of Philadelphia published a study showing they had grown premature lamb fetuses for four weeks in an extra-uterine life support system.

Circumvallate placenta

Circumvallate placenta is a placental morphological abnormalitiy, a subtype of placenta extrachorialis in which the fetal membranes (chorion and amnion) "double back" on the fetal side around the edge of the placenta. After delivery, a circumvallate placenta has a thick ring of membranes on its fetal surface.The fetal surface is divided into a central depressed zone surrounded by a thickened white ring which is incomplete. The ring is situated at varying distance from the margin of the placenta. The ring is composed of a double fold of amnion and chorion with degenerated decidua vera and fibrin in between. Vessels radiate from the cord insertion as far as the ring and then disappear from the view.

Complete circumvallate placenta occurs in approximately 1% of pregnancies. It is diagnosed prenatally by medical ultrasonography, although one 1997 study of prenatal ultrasounds found that "of the normal placentas, 35% were graded as probably or definitely circumvallate by at least one sonologist," and "all sonologists misgraded the case of complete circumvallation as normal." The condition is associated with perinatal complications such as placental abruption, oligohydramnios, abnormal cardiotocography, preterm birth, and miscarriage.

Fetal circulation

In animals that give live birth, the fetal circulation is the circulatory system of a fetus. The term usually encompasses the entire fetoplacental circulation, which includes the umbilical cord and the blood vessels within the placenta that carry fetal blood.

The fetal (prenatal) circulation works differently from normal postnatal circulation, mainly because the lungs are not in use. Instead, the fetus obtains oxygen and nutrients from the mother through the placenta and the umbilical cord. The advent of breathing and the severance of the umbilical cord prompt various neuroendocrine changes that shortly transform fetal circulation into postnatal circulation.

The fetal circulation of humans has been extensively studied by the health sciences. Much is known also of fetal circulation in other animals, especially livestock and model organisms such as mice, through the health sciences, veterinary science, and life sciences generally.

Monochorionic twins

Monochorionic twins are monozygotic (identical) twins that share the same placenta. If the placenta is shared by more than two twins (see multiple birth), these are monochorionic multiples. Monochorionic twins occur in 0.3% of all pregnancies. 75% of monozygotic twin pregnancies are monochorionic; the remaining 25% are dichorionic diamniotic. If the placenta divides, this takes place after the third day after fertilization.

Placenta accreta

Placenta accreta occurs when all or part of the placenta attaches abnormally to the myometrium (the muscular layer of the uterine wall). Three grades of abnormal placental attachment are defined according to the depth of attachment and invasion into the muscular layers of the uterus:

Accreta – chorionic villi attach to the myometrium, rather than being restricted within the decidua basalis.

Increta – chorionic villi invade into the myometrium.

Percreta – chorionic villi invade through the perimetrium (uterine serosa).Because of abnormal attachment to the myometrium, placenta accreta is associated with an increased risk of heavy bleeding at the time of attempted vaginal delivery. The need for transfusion of blood products is frequent, and surgical removal of the uterus (hysterectomy) is sometimes required to control life-threatening bleeding.Rates of placenta accreta are increasing. As of 2016, placenta accreta affects an estimated 1 in 272 pregnancies.

Placenta praevia

Placenta praevia is when the placenta attaches inside the uterus but near or over the cervical opening. Symptoms include vaginal bleeding in the second half of pregnancy. The bleeding is bright red and tends not to be associated with pain. Complications may include placenta accreta, dangerously low blood pressure, or bleeding after delivery. Complications for the baby may include fetal growth restriction.Risk factors include pregnancy at an older age and smoking as well as prior cesarean section, labor induction, or termination of pregnancy. Diagnosis is by ultrasound. It is classified as a complication of pregnancy.For those who are less than 36 weeks pregnant with only a small amount of bleeding recommendations may include bed rest and avoiding sexual intercourse. For those after 36 weeks of pregnancy or with a significant amount of bleeding, cesarean section is generally recommended. In those less than 36 weeks pregnant, corticosteroids may be given to speed development of the baby's lungs. Cases that occur in early pregnancy may resolve on their own.It affects approximately 0.5% of pregnancies. After four cesarean sections, however, it affects 10% of pregnancies. Rates of disease have increased over the late 20th century and early 21st century. The condition was first described in 1685 by Paul Portal.

Placental abruption

Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure. Complications for the mother can include disseminated intravascular coagulopathy and kidney failure. Complications for the baby can include fetal distress, low birthweight, preterm delivery, and stillbirth.The cause of placental abruption is not entirely clear. Risk factors include smoking, preeclampsia, prior abruption, trauma during pregnancy, cocaine use, and previous cesarean section. Diagnosis is based on symptoms and supported by ultrasound. It is classified as a complication of pregnancy.For small abruption bed rest may be recommended while for more significant abruptions or those that occur near term, delivery may be recommended. If everything is stable vaginal delivery may be tried, otherwise cesarean section is recommended. In those less than 36 weeks pregnant, corticosteroids may be given to speed development of the baby's lungs. Treatment may require blood transfusion or emergency hysterectomy.Placental abruption occurs in about 1 in 200 pregnancies. Along with placenta previa and uterine rupture it is one of the most common causes of vaginal bleeding in the later part of pregnancy. Placental abruption is the reason for about 15% of infant deaths around the time of birth. The condition was described at least as early as 1664.

Placental disease

A placental disease is any disease, disorder, or pathology of the placenta.Ischemic placental disease leads to the attachment of the placenta to the uterine wall to become under-perfused, causing uteroplacental ischemia. Where the term overarches the pathology associated with preeclampsia, placental abruptions and intrauterine growth restriction (IUGR). These factors are known to be the primary pathophysiology cause placental disease. Which is considered to be associated with more than half of premature births.Abnormalities present within the spiral arteries lead to higher velocities in blood, in turn causes the maternal villi to shred. Which trigger pro-coagulator molecules to be released into the blood stream causing action of the coagulator cascade, eventually leading to placental infarction. Risk factors such as diabetes, chronic blood pressure and multiple pregnancies can increase the risk of developing placental disease. Also, exposure to sudden trauma can increase the risk of placental abruption which coincides with placental disease.There is no target treatment available for placental disease. Associative prevention mechanisms can be a method of minimising the risk of developing the disease, within early stages of pregnancy.

Placental expulsion

Placental expulsion (also called afterbirth) occurs when the placenta comes out of the birth canal after childbirth. The period from just after the baby is expelled until just after the placenta is expelled is called the third stage of labor.

The third stage of labor can be managed actively with several standard procedures, or it can be managed expectantly (also known as physiological management or passive management), the latter allowing the placenta to be expelled without medical assistance.

Although uncommon, in some cultures the placenta is kept and consumed by the mother over the weeks following the birth. This practice is termed placentophagy.

Placental growth factor

Placental growth factor is a protein that in humans is encoded by the PGF gene.Placental growth factor (PGF) is a member of the VEGF (vascular endothelial growth factor) sub-family - a key molecule in angiogenesis and vasculogenesis, in particular during embryogenesis. The main source of PGF during pregnancy is the placental trophoblast. PGF is also expressed in many other tissues, including the villous trophoblast.Placental growth factor (PGF) is a protein-coding gene and a member of the vascular endothelial growth factor (VEGF) family. PGF is ultimately associated with angiogenesis. Specifically, PGF plays a role in trophoblast growth and differentiation. Trophoblast cells, specifically extravillous trophoblast cells, are responsible for invading maternal arteries. Proper development of blood vessels in the placenta is crucial for proper embryonic development.

Under normal physiologic conditions, PGF is also expressed at a low level in other organs including the heart, lung, thyroid, and skeletal muscle.

Placentation

In biology, placentation refers to the formation, type and structure, or arrangement of the placenta. The function of placentation is to transfer nutrients, respiratory gases, and water from maternal tissue to a growing embryo, and in some instances to remove waste from the embryo. Placentation is best known in live-bearing mammals (theria), but also occurs in some fish, reptiles, amphibians, a diversity of invertebrates, and flowering plants. In vertebrates, placentas have evolved more than 100 times independently, with the majority of these instances occurring in squamate reptiles.

The placenta can be defined as an organ formed by the sustained apposition or fusion of fetal membranes and parental tissue for physiological exchange. This definition is modified from the original Mossman (1937) definition, which constrained placentation in animals to only those instances where it occurred in the uterus.

Placentophagy

Placentophagy (from 'placenta' + Greek: φαγειν, to eat; also referred to as placentophagia) is the act of mammals eating the placenta of their young after childbirth. The placenta contains small amounts of oxytocin which eases birth stress and causes the smooth muscles around the mammary cells to contract and eject milk. There have been no studies of whether placentophagy provides hormonal effects in humans.There is also a school of thought that holds that placentophagy naturally occurred to hide any trace of childbirth from predators in the wild. Many placental mammals participate in placentophagy, including herbivores; exceptions include mainly humans, Pinnipedia, Cetacea, and camels. Placentophagy has been observed in Insectivora, Rodentia, Chiroptera, Lagomorpha, Carnivora, Perissodactyla, Artiodactyla (with the camel as a noted exception), and Primates. Marsupials, which are an order of metatherian (pouched) mammals, resorb rather than deliver the placenta, and therefore cannot engage in placentophagy; they do, however, vigorously lick birth fluids as they are excreted.Some research has shown that ingestion of the placenta can increase the pain threshold in pregnant rats. Rats that consumed the placenta experienced a modest amount of elevation of naturally occurring opioid-mediated analgesia. Endogenous opioids, such as endorphin and dynorphin, are natural chemicals, related to the opium molecule, that are produced in the central nervous system. Production of these endogenous opioids is increased during the birthing process. They have the ability to raise the threshold of pain tolerance in the mother. When coupled with ingested placenta or amniotic fluid, the opioid effect on pain threshold is dramatically increased. Rats that were given meat instead of the placenta showed no increase in the pain threshold. There are no studies that show any benefits of placenta ingestions in humans. There have been no scientific studies which show that placentophagy enhances analgesia in humans or that it has any other benefits.

Pre-eclampsia

Pre-eclampsia (PE) is a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine. When it arises, the condition begins after 20 weeks of pregnancy. In severe disease there may be red blood cell breakdown, a low blood platelet count, impaired liver function, kidney dysfunction, swelling, shortness of breath due to fluid in the lungs, or visual disturbances. Pre-eclampsia increases the risk of poor outcomes for both the mother and the baby. If left untreated, it may result in seizures at which point it is known as eclampsia.Risk factors for pre-eclampsia include obesity, prior hypertension, older age, and diabetes mellitus. It is also more frequent in a woman's first pregnancy and if she is carrying twins. The underlying mechanism involves abnormal formation of blood vessels in the placenta amongst other factors. Most cases are diagnosed before delivery. Rarely, pre-eclampsia may begin in the period after delivery. While historically both high blood pressure and protein in the urine were required to make the diagnosis, some definitions also include those with hypertension and any associated organ dysfunction. Blood pressure is defined as high when it is greater than 140 mmHg systolic or 90 mmHg diastolic at two separate times, more than four hours apart in a woman after twenty weeks of pregnancy. Pre-eclampsia is routinely screened for during prenatal care.Recommendations for prevention include: aspirin in those at high risk, calcium supplementation in areas with low intake, and treatment of prior hypertension with medications. In those with pre-eclampsia delivery of the baby and placenta is an effective treatment. When delivery becomes recommended depends on how severe the pre-eclampsia and how far along in pregnancy a woman is. Blood pressure medication, such as labetalol and methyldopa, may be used to improve the mother's condition before delivery. Magnesium sulfate may be used to prevent eclampsia in those with severe disease. Bedrest and salt intake have not been found to be useful for either treatment or prevention.Pre-eclampsia affects 2–8% of pregnancies worldwide. Hypertensive disorders of pregnancy (which include pre-eclampsia) are one of the most common causes of death due to pregnancy. They resulted in 46,900 deaths in 2015. Pre-eclampsia usually occurs after 32 weeks; however, if it occurs earlier it is associated with worse outcomes. Women who have had pre-eclampsia are at increased risk of heart disease and stroke later in life. The word "eclampsia" is from the Greek term for lightning. The first known description of the condition was by Hippocrates in the 5th century BC.

Trophoblast

Trophoblasts (from Greek trephein: to feed, and blastos: germinator) are cells forming the outer layer of a blastocyst, which provide nutrients to the embryo and develop into a large part of the placenta. They are formed during the first stage of pregnancy and are the first cells to differentiate from the fertilized egg. This layer of trophoblasts is also collectively referred to as "the trophoblast", or, after gastrulation, the trophectoderm, as it is then contiguous with the ectoderm of the embryo.

Umbilical cord

In placental mammals, the umbilical cord (also called the navel string, birth cord or funiculus umbilicalis) is a conduit between the developing embryo or fetus and the placenta. During prenatal development, the umbilical cord is physiologically and genetically part of the fetus and (in humans) normally contains two arteries (the umbilical arteries) and one vein (the umbilical vein), buried within Wharton's jelly. The umbilical vein supplies the fetus with oxygenated, nutrient-rich blood from the placenta. Conversely, the fetal heart pumps low oxygen containing blood, nutrient-depleted blood through the umbilical arteries back to the placenta.

Vasa praevia

Vasa praevia is a condition in which fetal blood vessels cross or run near the internal opening of the uterus. These vessels are at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue.

Risk factors include in vitro fertilization.Vasa praevia occurs in about 0.6 per 1000 pregnancies. The term "vasa previa" is derived from the Latin; "vasa" means vessels and "previa" comes from "pre" meaning "before" and "via" meaning "way". In other words, vessels lie before the fetus in the birth canal and in the way.

Windowpane oyster

The windowpane oyster (Placuna placenta) is a bivalve marine mollusk in the family of Placunidae. They are edible, but valued more for their shells (and the rather small pearls). The shells have been used for thousands of years as a glass substitute because of their durability and translucence. More recently, they have been used in the manufacture of decorative items such as chandeliers and lampshades; in this use, the shell is known as the capiz or kapis. Capiz shells are also used as raw materials for glue, chalk and varnish.

Distribution extends from the shallows of the Gulf of Aden, to around the Philippines, where it is abundant in the eponymous province of Capiz. The mollusks are found in muddy or sandy shores, in bays, coves and lagoons to a depth of about 100 m (330 ft). Populations have been in decline because of destructive methods of fishing and gathering such as trawling, dredging, blast fishing and surface-supplied diving. In the Philippines, fisheries are now regulated through permits, quotas, size limits and protected habitats. In spite of this, resources continue to be depleted.

The nearly flat shells of the capiz can grow to over 150 mm (5.9 in) in diameter, reaching maturity between 70 to 100 mm (2.8 to 3.9 in). The shell is secured by a V-shaped ligament. Males and females are distinguished by the color of the gonads. Fertilization is external and larvae are free-swimming like plankton for 14 days or attached to surfaces via byssal thread during metamorphosis, eventually settling on the bottom. They consume plankton filtered from the water passing through their slightly opened shell; the shell closes if the bivalve is above water during low tide.

Membranes of the fetus and embryo
Embryo
Fetus
Circulatory
Other
Development of the circulatory system
Heart
Vessels
Extraembryonic
hemangiogenesis
Fetal circulation

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