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What does the placenta do? Learn about the placenta!: Garden OB/GYN: Obstetrics

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What is the placenta exactly?

The placenta is frequently talked about during pregnancy, but do you know what it is?

It’s an organ! The placenta develops when you become pregnant as a way to protect and nurture your developing baby. It then leaves your body through the birthing canal following the birth of your baby. It’s actually essential that the entire placenta leaves your body following birth, otherwise you may experience bleeding or an infection. So, if you were wondering if you always have a placenta your whole life, the answer is you don’t! It only exists during pregnancy.

What is the purpose of the placenta?

Think of it as the organ of life. The mother’s placenta is connected to her baby through the umbilical cord. Through this connection, the placenta is able to filter and deliver important nutrients to the developing baby, including oxygen. The placenta also keeps your baby’s body safe and healthy by removing waste products from your baby’s blood. Amazingly, the placenta enables the support, nourishment, and protection of the baby, all without the mother’s and baby’s blood mixing, preventing infections in the baby.

Where is the placenta?

It is attached to your uterus’ wall at either the top, side, front or back.

Can there be issues with the placenta?

A condition known as placenta previa occurs if the placenta attaches to the bottom of the uterus. This condition usually resolves itself as the pregnancy progresses, but if the placenta is covering the cervix during labor, a caesarean section will be necessary.

Placenta accreta occurs if the placenta does not attach to the uterus or is improperly attached, which may result in heavy bleeding and can be life-threatening.

If you experience placental abruption, it means the placenta has become detached from the uterus prematurely, before labor. This condition will impact the delivery of nutrients to the baby and may require early delivery of the baby.

What can I do to keep my placenta healthy?

To keep your placenta and baby healthy, be sure to go to all your regular pregnancy check-ups with your obstetrician. This can ensure routine monitoring of your body and pregnancy so that any possible issues can be detected early.

Abstain from alcohol and any drug use, including smoking cigarettes.

Notify your doctor of any medications or supplements you are taking and also be sure to inform them of any prior placenta issues you may have had with previous pregnancies.

If you have further questions about placentas and/or pregnancy, we encourage you to ask your healthcare provider or schedule a consult with one of our pregnancy expert Garden OB/GYN Obstetricians. Contact one of our office locations or book an appointment online to schedule your visit!

Sources:

https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/placenta/art-20044425

https://www.pregnancybirthbaby.org.au/what-is-the-placenta

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Maternity hospital №7, Novosibirsk - What is the placenta?

Anna Valentinovna Yakimova, obstetrician-gynecologist, MD talks about the placenta and placental insufficiency.

Picture from the site http://s7ya7.zdorovo-zivi.ru

Placenta. The name of the organ comes from lat. placenta - cake, cake, pancake. This is an extra-embryonic organ, consisting of villi, thanks to which the fetus is nourished, respired, and waste products are removed from its blood. There are free and fixing (anchor) villi. The placenta is formed in the place where the embryo was implanted, arises as a result of the connection of the chorion - extraembryonic tissue with a thickened uterine mucosa (decidual tissue). Despite the fact that the blood of the mother and fetus does not mix, as they are separated by the placental barrier, the fetus receives all the necessary nutrients and oxygen from the mother's blood. In addition, the placenta produces hormones that ensure the preservation of pregnancy. The placenta has two surfaces. The surface that faces the fetus is called the fetal. It is covered with a smooth shell - the amnion, through which large vessels shine through. The one that is attached to the wall of the uterus is called maternal. nine0003

The main structural unit of the placenta is cotelidone. Cotyledon of the placenta is conditionally comparable to a tree. Each cotyledon is formed by a stem villus, from which, like branches of a tree, villi of the second and third order extend, containing vessels. The central part of the cotyledon forms a cavity, which is surrounded by many villi. Between the cotyledons there is a space - mejvirus, which on the maternal side is limited by partitions (septa) extending from the mucous membrane of the uterus. Most of the placental villi are freely immersed in the intervillous space (free villi) and are bathed in maternal blood. The spiral arteries, which are small branches of the arteries that supply the uterus, open into the intervillous space and supply oxygen-rich blood to the intervillous space. Due to the pressure difference, which is higher in the mother's arterial bed compared to the intervillous space, oxygenated blood from the mouths of the spiral arteries is directed through the center of the cotyledon to the villi, washes them, reaches the chorionic plate and returns to the maternal circulation through the venous orifices through the separating septa. . In this case, the blood flow of the mother and fetus are separated from each other. Those. maternal and fetal blood does not mix. Thus, the concept of the placental barrier appears: the blood of the mother of the fetus does not mix, because they are separated by the wall of the villus, loose connective tissue inside the villus and the wall of the vessel that is inside the villus, and in which the blood of the fetus circulates. nine0003

At the end of pregnancy, the placenta is a soft disk 15-18 cm in diameter, 2-4 cm thick in the central part, weighing about 500-600 g. their capillaries - 12 m2. The placenta, membranes, and umbilical cord together form the afterbirth, which is expelled from the uterus after the baby is born.

Normally, the placenta is attached to the uterine cavity on its anterior or posterior surface, sometimes in the fundus. If the placenta is attached in the lower part of the uterine cavity, close to the internal opening of the cervix - the internal pharynx, then its blood supply is often insufficient and the fetus may suffer from lack of oxygen and nutrients - a phenomenon called placental insufficiency occurs. nine0003

Placental insufficiency is a violation of all or some of the functions of the placenta, ultimately leading to oxygen starvation (hypoxia), fetal growth retardation or death and / or early termination of pregnancy.

Placental insufficiency may occur early in pregnancy due to impaired placental formation, for example, if the spiral arteries that supply blood to the villi do not lose the ability to narrow their lumen in response to exposure to vasoconstrictor substances. It is possible that there is a violation of the development of blood vessels inside the villi, the vessels can form in the central part of the villus, and not close to its wall, then the transfer of nutrients from the mother's blood to the fetal blood and the flow of metabolic products back will be difficult. The process of development of the placenta (in particular, vascular formation) occurs to a greater extent in the first and second trimesters of pregnancy, ending at about 30-32 weeks. After this period, involutive processes predominate ("aging", immuring the villi with fibrinoid). Along with the processes of involution in the placenta during pregnancy, young villi develop, more often avascular, which, however, only partially compensate for the function of mature villi containing vessels that have “fallen out” of the circulation. nine0003

In another scenario, placental insufficiency occurs at a later date, as a result of damage to the placenta in inflammatory processes, diabetes in a pregnant woman, or high blood pressure, when blood flow to the uterus is disturbed, which can also occur with increased maternal blood clotting . It is believed that it is the violation of the uteroplacental circulation that plays the main role in the formation of the intrauterine growth retardation syndrome. Before the advent of Doppler ultrasound research methods in obstetric practice, there were no non-invasive methods for studying blood flow in the mother-placenta-fetus system. To date, Doppler is the most preferred instrumental method that provides useful information in relation to the detection of blood flow disorders and the determination of pregnancy management tactics for placental insufficiency. If there are symptoms of placental insufficiency - a mismatch in the height of the uterine fundus, signs of a threat of early termination of pregnancy, rapid or slow fetal heart rate (normal: 120-160 beats per minute), an altered amount of amniotic fluid - it is necessary to conduct an ultrasound examination, Doppler blood flow in the vessels of the uterus, umbilical cord and fetus, and in the third trimester - cardiotocography. The earliest sign of placental dysfunction is a decrease in its production of hormones and proteins, therefore, in pregnant women with a known risk of placental dysfunction (for example, if she has a chronic inflammatory process or often / constantly increased blood pressure, etc.), you can examine the level placental lactogen, progesterone, unconjugated estriol in the blood. And on the basis of the data obtained, predict the further development of pregnancy and take preventive measures. nine0003

Can placental insufficiency be treated? The answer to this question is ambiguous. It is possible to influence the development of the placenta when it is incomplete, improving the conditions for development - by eliminating, for example, the inflammatory process, normalizing blood pressure, lowering the tone of the uterus, and normalizing blood clotting. You can influence the metabolism in the cells of the placenta - by doing this, for example, by introducing drugs into the body of a pregnant woman that help improve the utilization of glucose by cells. It is possible to influence the tone of the vessels, reduce the permeability of the wall and, in this way, the swelling of the tissues decreases and the penetration of oxygen into them improves. But we must understand that we do not cure placental insufficiency, we are only trying to influence the compensatory mechanisms that exist in the placenta, if this succeeds, the manifestations of placental insufficiency disappear. But more often, treatment is aimed at prolonging the pregnancy to the term of a viable fetus. nine0003

But if the signs of placental insufficiency increase, and the gestation period is more than 32 weeks, when even in a normal placenta it undergoes involution, the placenta initially developed incorrectly, and now it performs its functions worse, the fetus suffers, then it is useless to treat placental insufficiency, it is better to carry out early delivery and to nurse the newborn without the risk of intrauterine death, which is possible if the placenta depletes its reserves. Sometimes it is necessary to make a decision on early delivery and at an earlier date, when the treatment of placental insufficiency is impossible and the delay threatens the life of the fetus. nine0003

What is the placenta

It connects two organisms - the mother and the fetus, providing it with the necessary nutrients.

Where is the placenta located and what does it look like?

In a normal pregnancy, the placenta is located in the body of the uterus along its posterior (more often) or anterior wall. It is fully formed by the 15-16th week of pregnancy, after the 20th week, active exchange begins through the placental vessels. From the 22nd to the 36th week of pregnancy, an increase in the mass of the placenta occurs, and by the 36th week it reaches full functional maturity. nine0003 Figure 1. Schematic representation of the location of the placenta in the uterus of a pregnant woman. Photo: Wikipedia (Public Domain)

In appearance, the placenta looks like a round flat disk. By the time of delivery, the weight of the placenta is 500-600 g, the diameter is 15-18 cm and the thickness is 2-3 cm.

Functions of the placenta

• First, gas exchange occurs through the placenta: oxygen penetrates from the mother's blood to the fetus, and carbon dioxide is transported in the opposite direction. nine0044
• Secondly, the fetus receives through the placenta the nutrients necessary for its growth and development. It must be remembered that many substances (alcohol, nicotine, drugs, many drugs, viruses) easily penetrate through it and can have a damaging effect on the fetus. In addition, with its help, the fetus gets rid of the products of its vital activity.
• Thirdly, the placenta provides immunological protection to the fetus, delaying the cells of the mother's immune system, which, having penetrated to the fetus and recognized a foreign object in it, could trigger its rejection reactions. At the same time, the placenta passes maternal antibodies that protect the fetus from infections. nine0044
• Fourthly, the placenta plays the role of an endocrine gland and synthesizes hormones (human chorionic gonadotropin (hCG), placental lactogen, prolactin, etc.) necessary to maintain pregnancy, growth and development of the fetus.

Normally, the placenta together with the membranes (afterbirth) is born 10-15 minutes after the birth of the fetus. She is carefully examined and sent for a morphological study. First, it is very important to make sure that the whole placenta was born (that is, there are no damages on its surface and there is no reason to believe that pieces of the placenta remained in the uterine cavity). Secondly, according to the state of the placenta, one can judge the course of pregnancy (whether there was an abruption, infectious processes, etc.). nine0003

What do doctors want to know about the placenta?

During pregnancy, it is important to look for signs of placental dysfunction - placental insufficiency. To do this, during an ultrasound study, the structure of the placenta, its location in the uterine cavity, thickness, and the correspondence of the size of the fetus to the gestational age are studied. In addition, the blood flow in the placental vessels is studied.

Degree of maturity

This parameter, as doctors say, is "ultrasonic", that is, it depends on the density of the structures of the placenta determined by ultrasound. nine0003

There are four degrees of placental maturity:

• Normally, zero degree of placental maturity should be determined before 30 weeks of pregnancy.
• The first degree is considered valid from 27 to 34 weeks.
• Second - from 34 to 39.
• Starting from 37 weeks, the third degree of placental maturity can be determined.

At the end of pregnancy, the so-called physiological aging of the placenta occurs, accompanied by a decrease in the area of ​​its exchange surface, the appearance of areas of salt deposition. nine0003

Place of attachment

Determined by ultrasound. As mentioned above, during a normal pregnancy, the placenta is located in the body of the uterus. Sometimes, during an ultrasound examination in the first half of pregnancy, it is found that the placenta is located in the lower parts of the uterus, reaching or even overlapping the area of ​​​​the internal os of the cervix. In the future, as pregnancy progresses, the placenta most often shifts from the lower sections of the uterus to the top. However, if after 32 weeks the placenta still overlaps the area of ​​the internal os, this condition is called *placenta previa**, which is a serious complication of pregnancy. nine0003

Placenta previa can lead to bleeding, which can occur during the second or third trimester of pregnancy or during childbirth.

Thickness

Also determined by ultrasound - placentometry: after establishing the placenta attachment, the area where it has the largest size is found, which is determined. The thickness of the placenta, as already mentioned, continuously increases until 36-37 weeks of pregnancy (by this time it ranges from 20 to 40 mm). Then its growth stops, and in the future the thickness of the placenta either decreases or remains at the same level. nine0003

Deviation from the norm of at least one of these indicators may indicate trouble during pregnancy.

References

• Tiwari D., Das CR., Sultana R., Kashyap N., Islam M., Bose PD., Saikia AK., Bose S. Increased homocysteine ​​mediated oxidative stress as a key determinant of hepatitis E virus ( HEV) infected pregnancy complication and outcome: A study from Northeast India. // Infect Genet Evol - 2021 - Vol - NNULL - p.104882; PMID:33905889
nine0043 Salmanian B., Belfort M.A., Shamshirsaz A.A. The risk of placenta accreta spectrum in women with in vitro fertilization in different populations. // Am J Obstet Gynecol - 2021 - Vol - NNULL - p.; PMID:33905744
• Olmos-Ortiz A., Olivares-Huerta A., García-Quiroz J., Zariñán T., Chavira R., Zaga-Clavellina V., Avila E., Halhali A., Durand M., Larrea F., Díaz L. Placentas associated with female neonates from pregnancies complicated by urinary-tract infections have higher cAMP content and cytokines expression than males. // Am J Reprod Immunol - 2021 - Vol - NNULL - p.e13434; PMID:33905581
• Tandl V., Hoch D., Bandres-Meriz J., Nikodijevic S., Desoye G., Majali-Martinez A. Different regulation of IRE1α and eIF2α pathways by oxygen and insulin in ACH-3P trophoblast model. // Reproduction - 2021 - Vol - NNULL - p.; PMID:33904834
• Ji S., Gumina D., McPeak K., Moldovan R., Post MD., Su EJ. Human placental villous stromal extracellular matrix regulates fetoplacental angiogenesis in severe fetal growth restriction. // Clin Sci (Lond) - 2021 - Vol - NNULL - p.; PMID:33904582
• Shmeleva EV., Colucci F. Maternal natural killer cells at the intersection between reproduction and mucosal immunity. // Mucosal Immunol - 2021 - Vol - NNULL - p.; PMID:33903735
• Moreno-Sepulveda J., Espinós JJ., Checa MA. Lower risk of adverse perinatal outcomes in natural versus artificial frozen-thawed embryo transfer cycles: a systematic review and meta-analysis. // Reprod Biomed Online - 2021 - Vol - NNULL - p.

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