Tuesday, September 18, 2018

The Placenta, Its Membranes, and the Umbilical Cord

The human placenta is a highly sophisticated organ of interface between mother and fetus, often
referred to as the “gate-keeper to the fetus.” Careful examination of the placenta, its membranes,
and the umbilical cord can prove to be a valuable aid in the diagnosis and treatment of the
neonate. Gross examination of the placenta takes five minutes, and more sophisticated examination
should be considered when there is poor pregnancy outcome, recognizable malformations or
abnormalities, multiple gestation, extremes of amniotic fluid volume, severe intrauterine growth
retardation, short umbilical cord (< 32 cm), and profound acidemia.
The maternal surface of the placenta (decidual plate) is soft, spongy and dark red; and the fetal surface (chorionic plate) is shiny and steel blue to gray.
The placenta, membranes, and umbilical cord weigh approximately 400 to 600 g at birth.

Abnormalities in structure can result in an inefficient transport of oxygen and nutrients to the developing baby. Despite this importance, it is one of the least understood and investigated human organs.

A succenturiate (accessory) lobe is common and has no effect on the fetus. This occurs in about 3 to 5% of deliveries.  Its importance arises from the fact that it may be retained within the uterus and cause postpartum bleeding.


Fetal surface of a bipartite or bilobed placenta (placenta duplex). The two parts of the placenta
are of nearly equal size and this occurs in about 1% of deliveries. Note that the lobes are separated by membranes. The umbilical cord may insert into one or other lobe, or may insert between the two.


In a circumvallate (circummarginate) placenta the fetal surface may be reduced if decidual tissue has made its way between the amnion and chorion. This appears as a yellow, peripheral, hyalinized fold circumscribing the edge of the chorionic plate. This type of placenta has been reported to be a cause of antepartum bleeding and premature labor


This is an example of placenta membranacea (placenta diffusa). These placentas are rare. The ovum implants too deeply, the villae of the chorion fail to regress, and the placental tissue develops over the entire surface of the chorion. The placenta is very thin and is associated with poor fetal growth and antepartum hemorrhage. There may be previa type bleeding.



An annular (“girdle” or ring-shaped) is a  rare form of placenta which resembles a segment of a hollow cylinder. Sometimes a complex ring of placental tissue is seen. More commonly a portion of the ring undergoes atrophy resulting in a placenta which is approximately horseshoe-shaped. This type of placenta is probably a variant of placenta membranacea.
Its clinical significance is uncertain but it appears to be associated with a high incidence of both ante and postpartum bleeding. The fetus is often small for gestational age.



An example of abruptio placentae - premature separation of the placenta . A large abruptio placentae may result in poor growth of the infant and fetal blood loss.


Fetal surface of a placenta with a large chorangioma (hemangioma of the placenta). These infants may present with severe nonimmune hydrops fetalis. The majority of cases of hydrops fetalis are now
due to nonimmune causes.


A calcified, small placenta. This infant had severe intrauterine growth retardation at term as a result of poor fetal nutrition.


In velamentous insertion of the cord the umbilical vessels traverse the fetal membranes unsupported
by either the umbilical cord or by placental tissue. If tearing of these unsupported vessels occurs
before or during delivery, it can result in massive fetal blood loss.


Fetus born in a caul. Note that the membranes completely surround the fetus and that the umbilical cord (nuchal cord) encircles the neck twice. A cord around the neck once occurs in about 20%, and twice in about 2% of pregnancies. Whether the cord causes any problems depends on its tightness around the neck.


A hematoma of the umbilical cord (intrafunicular hemorrhage) resulted from a short umbilical cord.


A true knot in the umbilical cord of this fetus resulted in intrauterine death. The incidence of  true knots in the umbilical cord is 0.1 to 1%, and is strongly associated with long cords and other markers
of vigorous fetal activity. It is associated with about 10% of stillbirths. The knots must be very tight to obstruct blood flow. At the site of a long standing knot, such as in this fetus, there is a loss of Wharton’s jelly and a constriction of umbilical vessels. Wharton’s jelly probably prevents umbilical cord blood vessel compression by diffusing the pressure exerted by knots. The jelly is also slippery and this makes it difficult to maintain a knot.


The diagnosis of single umbilical artery is made by examining a section through the surface of the umbilical cord. This anomaly is present in 0.7 to 1.0% of single placentas and in 3 to 7.0% of multiple birth placentas. The incidence is low in black infants, but is increased in infants with associated congenital malformations. Further investigation is recommended if a single umbilical artery is associated with one other major anomaly.


This thin, narrow umbilical cord with total lack of Wharton’s jelly was present at birth in an infant with postmaturity and oligohydramnios. Cord compression is probably more frequent with a narrow cord, perhaps because the Wharton’s jelly does not “cushion” the cord.


This infant has a large cyst in the umbilical cord. The chemical composition of the fluid in this cyst was that of serum rather than urine. These cysts are thought to arise from the allantois.



2 comments:

  1. So the big question remains how can we cure HIV? Here is the answer Dr Itua Has a cure and he
    saves my life from misery, I will share this round all blogs so all HIV/Aids patent can get cured
    with this Wonderful Man(Dr Itua) Dr Itua cured my HIV and he also Assures me that he can as well cure
    the following diseases HIV/Aids, Infertility, Lottery Spell, Herpes Virus, Love Spell, Epilepsy, Diabetes,
    Hepatitis, and other health problems, drank his herbal medicine for two weeks and after two weeks
    I went to diagnosis then I find out I was cured and healthy like never before, Here is Dr Itua contact if you are
    a sick person. What's app call.+2348149277967 then Mail. drituaherbalcenter@gmail.com and to everyone suffer from HIV/Herpes those stubborn virus Dr Itua will give your life Back.

    ReplyDelete
  2. My life is beautiful thanks to you, Mein Helfer. Lord Jesus in my life as a candle light in the darkness. You showed me the meaning of faith with your words. I know that even when I cried all day thinking about how to recover, you were not sleeping, you were dear to me. I contacted the herbal center Dr Itua, who lived in West Africa. A friend of mine here in Hamburg is also from Africa. She told me about African herbs but I was nervous. I am very afraid when it comes to Africa because I heard many terrible things about them because of my Christianity. god for direction, take a bold step and get in touch with him in the email and then move to WhatsApp, he asked me if I can come for treatment or I want a delivery, I told him I wanted to know him I buy ticket in 2 ways to Africa To meet Dr. Itua, I went there and I was speechless from the people I saw there. Patent, sick people. Itua is a god sent to the world, I told my pastor about what I am doing, Pastor Bill Scheer. We have a real battle beautifully with Spirit and Flesh. Adoration that same night. He prayed for me and asked me to lead. I spent 2 weeks and 2 days in Africa at Dr Itua Herbal Home. After the treatment, he asked me to meet his nurse for the HIV test when I did it. It was negative, I asked my friend to take me to another nearby hospital when I arrived, it was negative. I was overwhite with the result, but happy inside of me. We went with Dr. Itua, I thank him but I explain that I do not have enough to show him my appreciation, that he understands my situation, but I promise that he will testify about his good work. Thank God for my dear friend, Emma, I know I could be reading this now, I want to thank you. And many thanks to Dr. Itua Herbal Center. He gave me his calendar that I put on my wall in my house. Dr. Itua can also cure the following diseases ... Cancer, HIV, Herpes, Hepatitis B, Inflammatory Liver, Diabetis, Bladder Cancer,Colorectal Cancer,HPV,Breast Cancer,Kidney Cancer,Leukemia,Lun,Fribroid,Infertility,Parkinson's disease,Inflammatory bowel disease ,Fibromyalgia, recover your ex. You can contact him by email or whatsapp, @ .. drituaherbalcenter@gmail.com, phone number .. + 2348149277967 .. He is a good doctor, talk to him kindly. I'm sure he will also listen to you.

    ReplyDelete