Allows gas exchange so the fetus gets enough oxygen Helps the fetus get sufficient nutrition (folate, vitamins, glucose, etc) Helps regulate the fetus’ body temperature Removes waste from the fetus for processing by the mother’s body (excretion) Filters out some microbes that could cause infection Transfers antibodies from the mother to the fetus, conferring some immune protection (immunity function). Produces hormones that keep the mother’s body primed to support pregnancy (endocrine function)

1. BY C SETTLEY

2. What does the placenta do?
 The placenta is an organ that develops
in the uterus during pregnancy.This
structure provides oxygen and
nutrients to the growing baby and
removes waste products from the
baby's blood.
 The placenta attaches to the wall of
the uterus, and the baby's umbilical
cord arises from it.
 The organ is usually attached to the
top, side, front or back of the uterus.
 In rare cases, the placenta might attach
in the lower area of the uterus. When
this happens, it's called a low-lying
placenta (placenta previa).
What affects placental health?
 Maternal age.
 A break in water before labor.
 High blood pressure.
 Twin or other multiple pregnancy.
 Blood-clotting disorders
 Previous uterine surgery.
 Previous placental problems.
 Substance use.
 Abdominal trauma.

3.  Allows gas exchange so the fetus gets enough oxygen
 Helps the fetus get sufficient nutrition (folate, vitamins, glucose, etc)
 Helps regulate the fetus’ body temperature
 Removes waste from the fetus for processing by the mother’s body (excretion)
 Filters out some microbes that could cause infection
 Transfers antibodies from the mother to the fetus, conferring some immune
protection (immunity function).
 Produces hormones that keep the mother’s body primed to support pregnancy
(endocrine function)
 Video- Understanding the placenta

6. Placental abruption.
 If the placenta peels away from the
inner wall of the uterus before
delivery — either partially or
completely — a condition known
as placental abruption develops.
This can deprive the baby of oxygen
and nutrients and cause you to bleed
heavily. Placenta abruption could
result in an emergency situation
requiring early delivery.

7.  Symptoms
 Vaginal bleeding, although there might
not be any
 Abdominal pain
 Back pain
 Uterine tenderness or rigidity
 Uterine contractions, often coming one
right after another
 Abdominal pain and back pain often
begin suddenly.The amount of
vaginal bleeding can vary greatly,
and doesn't necessarily indicate how
much of the placenta has separated
from the uterus. It's possible for the
blood to become trapped inside the
uterus, so even with a severe
placental abruption, there might be
no visible bleeding.

8.  Diagnosis
 Physical exam- uterine tenderness
 Blood and urine tests
 Ultrasound
 Treatment
 Treatment options for placental abruption depend on the circumstances:
 The baby isn't close to full term
 Hospitalised
 If bleeding stops- rest at home
 Meds
 The baby is close to full term.
 Delivery monitored
 C section

9. Placenta previa.
 This condition occurs when the
placenta partially or totally covers
the cervix — the outlet for the uterus.
Placenta previa is more common early
in pregnancy and might resolve as the
uterus grows.
 Placenta previa can cause severe
vaginal bleeding during pregnancy or
delivery.The management of this
condition depends on the amount of
bleeding, whether the bleeding stops,
how far along the pregnancy is, the
position of the placenta, and the baby's
health.
 If placenta previa persists late in the
third trimester, the health care provider
will recommend a C-section.

10.  Symptoms
 Bright red vaginal bleeding without pain during the second half of pregnancy is the main
sign of placenta previa. Some women also have contractions.
 In many women diagnosed with placenta previa early in their pregnancies, the
placenta previa resolves. As the uterus grows, it might increase the distance
between the cervix and the placenta.The more the placenta covers the cervix and
the later in the pregnancy that it remains over the cervix, the less likely it is to
resolve.
 The exact cause of placenta previa is unknown.
 Placenta previa is more common among women who:Have had a baby, Have scars
on the uterus, such as from previous surgery, including cesarean deliveries, uterine
fibroid removal, and dilation , Had placenta previa with a previous pregnanc, Are
carrying more than one fetus, Are age 35 or older, Are of a race other than white,
Smoke

11.  Ultrasound
 Routine appointments
 Transvaginal ultrasound
 The amount of bleeding
 Whether the bleeding has stopped
 How far along the pregnancy is
 Overall health
 The baby's health
 The position of the placenta and the
baby

12. Retained placenta.
 If the placenta isn't delivered
within 30 minutes after childbirth,
it's known as a retained placenta. A
retained placenta might occur
because the placenta becomes
trapped behind a partially closed
cervix or because the placenta is still
attached to the uterine wall. Left
untreated, a retained placenta can
cause severe infection or life-
threatening blood loss.

13. Placenta accreta.
 Typically, the placenta detaches from the
uterine wall after childbirth.With placenta
accreta, part or all of the placenta remains
firmly attached to the uterus.This condition
occurs when the blood vessels and other
parts of the placenta grow too deeply into
the uterine wall.This can cause severe
blood loss during delivery.
 In aggressive cases, the placenta invades
the muscles of the uterus or grows through
the uterine wall.The health care provider
will likely recommend a C-section followed
by removal of the uterus.

14.  Video: Delivery of the placenta: https://youtu.be/bpIDPclfimc
 Video: Manual removal of the placenta: https://youtu.be/KVpFIl2cp-8
 Video: Examination of the placenta: https://youtu.be/4tAFOszuEdI

15. 1.Why are mammals such as dogs, cats,
and humans called “placental mammals?”
 A. Because the placenta is the evolutionary
adaptation we all share, while monotremes,
marsupials, and non-mammals do not.
 B. Because all placental mammals have
placentas, while only some non-mammals
have placentas.
 C. Both of the above.
 A is correct. Only placental mammals have
fully developed placentas, while non-
mammals and older mammal lineages such
as monotremes and marsupials do not.
2.Which of the following is true of
the placental filtration system?
 A. It is able to filter out all diseases and toxins,
protecting the fetus.
 B. It allows nutrients and oxygen to pass through,
nourishing the fetus.
 C. It is able to filter out some diseases and toxins, but
not all of them.
 D. Both B and C.
 D is correct.The placenta allows nutrients, oxygen,
and other beneficial substances to pass from the
mother to the fetus. It screens out some bacteria and
toxins, but is unfortunately not able to screen out all of
them.That’s why pregnant women are counseled to
avoid potential sources of toxins and disease.

16. 3.Which of the following is NOT true
of placental anatomy?
 A. It contains many blood vessels from both the
mother and fetus.
 B. It is composed of both maternal and fetal
tissue.
 C. It allows the mother’s blood to flow into the
fetus, nourishing it.
 D. None of the above.
 C is correct.The placenta separates the
maternal and fetal blood supplies, to prevent
the mother’s immune system from attacking
fetal blood cells. However, it does allow some
substances such as nutrients, gases, and
antibodies to be exchanged.

17.  Amniotic fluid is a clear, yellow
fluid which is found within the first
12 days following conception within
the amniotic sac.
 It surrounds the growing baby in
the uterus.
 Amniotic fluid has many important
functions and is vital for healthy
fetal development.
 However, if the amount of amniotic
fluid inside the uterus is too little or
too great, complications can occur.

18.  At first, amniotic fluid consists of water from the mother’s body, but gradually, the
larger proportion is made up of the baby’s urine.
 It also contains important nutrients, hormones, and antibodies and it helps protect
the baby from bumps and injury.
 If the levels of amniotic fluid levels are too low or too high, this can pose a problem.
 While a baby is in the womb, it is situated within the amniotic sac, a bag formed of two
membranes, the amnion, and the chorion.The fetus grows and develops inside this sac,
surrounded by amniotic fluid.
 Initially, the fluid is comprised of water produced by the mother. By around 20 week’s
gestation, however, this is entirely replaced by fetal urine, as the fetus swallows and
excretes the fluid.
 Amniotic fluid also contains vital components, such as nutrients, hormones, and
infection-fighting antibodies.
 When amniotic fluid is green or brown, this indicates that the baby has passed
meconium before birth.

19.  Protecting the fetus
 Temperature control.
 Infection control
 Lung and digestive system development
 Muscle and bone development
 Lubrication
 Umbilical cord support

21.  Low levels of amniotic fluid,
 This may be evident in cases of leaking fluid from a tear in the amniotic membranes,
measuring small for a certain stage of pregnancy or if the fetus is not moving as much
as it would be expected to.
 It may also occur in mothers with a history of any of the following medical conditions:
 prior growth-restricted pregnancies
 chronic high blood pressure (hypertension)
 problems with the placenta, for example, abruption
 preeclampsia
 diabetes
 lupus
 multiple pregnancies, for example twins or triplets
 birth defects, such as kidney abnormalities
 delivering past the due date
 other unknown reasons, known as idiopathic

22.  Oligohydramnios can happen during any trimester but is a more concerning
problem during the first 6 months of pregnancy.
 During that time, there is a higher risk of birth defects, loss of pregnancy,
preterm birth, or neonatal loss of life.
 If fluid levels are low in the last trimester, the risks include:
 slow fetal growth
 labor complications
 the need for a Cesarean delivery
 The rest of the pregnancy will be monitored closely to ensure normal development is
taking place.

23.  Diagnostic testing/ investigation
 No stress tests
 Biophysical profiling:
 Fetal kick count
 Doppler studies
 In some cases, doctors may decide that labor will need to be induced, in order to protect
the mother or the child. Amnioinfusion (the infusion of saline into the uterus), increasing
maternal fluids, and bed rest may also be necessary.
 There is a higher chance of labor complications, due to the risk of umbilical cord
compression. Amnioinfusion may be needed during labor. In some cases, a cesarian
delivery may be necessary.

24.  When there is too much amniotic fluid, this is called polyhydramnios.
 Fetal disorders that can lead to polyhydramnios include:
 gastrointestinal disorders, including duodenal or esophageal atresia, gastroschisis,and diaphragmatic hernia
 brain or nervous system disorders, such as anencephaly or myotonic dystrophy
 achondroplasia, a bone growth disorder
 fetal heart rate problems
 infection
 Beckwith-Wiedemann syndrome, which is a congenital growth disorder
 fetal lung abnormalities
 hydrops fetalis, in which an abnormal level of water builds up inside multiple body areas of a fetus
 twin-to-twin transfusion syndrome, where one child gets more blood flow than the other
 mismatched blood between mother and child, for example Rh incompatibility or Kell diseases
 Poorly controlled maternal diabetes also increases the risk.
 Too much fluid can also be produced during multiple pregnancies, when the mother is carrying more
than one fetus.

26.  Maternal symptoms can include abdominal pain and difficulty breathing due to the enlargement
of the uterus.
 Other complications include:
 preterm labor
 premature rupture of membranes
 placental abruption
 stillbirth
 postpartum hemorrhage
 fetal malposition
 cord prolapse
 Testing for maternal diabetes may be recommended, and frequent ultrasounds will be obtained to monitor
the levels of amniotic fluid in the uterus.
 Mild cases of polyhydramnios typically resolve without treatment.
 In more severe cases, fluid may need to be reduced with either amniocentesis or a medication
called indomethacin.This reduces the amount of urine the baby produces.

27.  Sometimes, fluid leaks before the waters break.
 What looks like fluid leaking is actually urine, because the uterus is pressing on the
bladder.
 If the fluid has no color and no smell, it will be amniotic fluid.
 If the fluid is green, brownish-green, or foul-smelling, this may indicate the
presence of meconium or an infection.
 Premature rupture of membranes
 If leaking or rupture happens before 37 weeks, this is known as premature rupture of
membranes (PROM). Depending on how early this happens, it can have serious
consequences for the mother and the unborn child. It affects around 2 in 100 pregnancies.
 This is known as premature rupture preterm, but it is also possible to have premature
rupture at term.That is when 37 weeks or more of pregnancy are complete, but labor
does not start spontaneously within 6 hours of the membrane rupturing.

28.  Amniotic fluid embolism is a rare but serious condition that occurs when
amniotic fluid — the fluid that surrounds a baby in the uterus during pregnancy
— or fetal material, such as fetal cells, enters the mother's bloodstream.Amniotic
fluid embolism is most likely to occur during delivery or in the immediate
postpartum period.
 Causes:
 Amniotic fluid embolism occurs when amniotic fluid or fetal material enters the
mother's bloodstream. A likely cause is a breakdown in the placental barrier, such as
from trauma.
 When this breakdown happens, the immune system responds by releasing products
that cause an inflammatory reaction, which activates abnormal clotting in the
mother's lungs and blood vessels. This can result in a serious blood-clotting disorder
known as disseminated intravascular coagulation.

29.  Symptoms:
 Sudden shortness of breath
 Excess fluid in the lungs (pulmonary edema)
 Sudden low blood pressure
 Sudden failure of the heart to effectively pump blood (cardiovascular collapse)
 Life-threatening problems with blood clotting (disseminated intravascular coagulopathy)
 Bleeding from the uterus, cesarean incision or intravenous (IV) sites
 Altered mental status, such as anxiety or a sense of doom
 Chills
 Rapid heart rate or disturbances in the rhythm of the heart rate
 Fetal distress, such as a slow heart rate, or other fetal heart rate abnormalities
 Seizures
 Loss of consciousness

30.  Risk factors:
 Advanced maternal age.
 Placenta problems.
 Preeclampsia.
 Medically induced labor.
 Operative delivery.
 Polyhydramnios.

31.  Complications:
 Brain injury. Low blood oxygen can cause permanent, severe neurological damage or
brain death.
 Lengthy hospital stay. Women who survive an amniotic fluid embolism often require
treatment in the intensive care unit and — depending on the extent of their complications
— might spend weeks or months in the hospital.
 Maternal death. The number of women who die of amniotic fluid embolism (mortality
rate) is very high.The numbers vary, but as many as 20 percent of maternal deaths in
developed countries may be due to amniotic fluid embolisms.
 Infant death. The baby is at risk of brain injury or death. Prompt evaluation and delivery
of the baby improves survival.

32.  Diagnosis:
 Blood tests, including those that evaluate clotting, heart enzymes, electrolytes and blood
type, as well as a complete blood count (CBC)
 Electrocardiogram (ECG or EKG) to evaluate the heart's rhythm
 Pulse oximetry to check the amount of oxygen in blood
 Chest X-ray to look for fluid around the heart
 Echocardiography to evaluate the heart's function

33.  Treatment:
 Catheter placement
 Oxygen
 Medication
 Transfusions
 NB- Coping and support

34.  https://www.medicalnewstoday.com/articles/307082#leaking
 https://www.mayoclinic.org/diseases-conditions/amniotic-fluid-
embolism/diagnosis-treatment/drc-20369328
 Slater, D. (2017, April 03).The Myth Of The Placental Barrier. Retrieved July 08,
2017, from https://www.fitpregnancy.com/pregnancy/pregnancy-health/myth-
placental-barrier
 10.2 Development of the placental villi. (n.d.). Retrieved July 08, 2017, from
http://www.embryology.ch/anglais/fplacenta/villosite01.html
 Should I Eat My Placenta? (n.d.). Retrieved July 08, 2017, from
http://www.webmd.com/baby/should-i-eat-my-placenta