BGDA Practical Placenta - Villi Development: Difference between revisions

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* '''stem villi''' - or anchoring villi, cytotrophoblast cells attached to maternal tissue.  
* '''anchoring villi''' - or stem villi cytotrophoblast cells attached to maternal tissue.  


* '''branched villi''' - grow from sides of stem villi, region of main exchange, surrounded by maternal blood in intervillous spaces.
* '''branched villi''' - grow from sides of anchoring villi, region of main exchange, surrounded by maternal blood in intervillous spaces.


* '''terminal villi''' - not active outgrowths caused by proliferation of the trophoblast. Passive protrusions induced by capillary coiling due to growth of the fetal capillaries within the mature intermediate villi (third trimester).
* '''terminal villi''' - not active outgrow is caused by proliferation of the trophoblast. Passive protrusions induced by capillary coiling due to growth of the fetal capillaries within the mature intermediate villi (third trimester).


* '''chorionic plate''' - region of membrane at the base of the villi through which placental arteries and vein passes.
* '''chorionic plate''' - region of membrane at the base of the villi through which larger placental arteries and vein passes.
 
 
==Placental Circulation==
 
{|
| Schematic representation of blood flow through the placenta and surrounding tissue.{{#pmid:29230859|PMID29230859}}
<br><br>
* Blue and red arrows show the flow directions of oxygenated (red) and deoxygenated (blue) fetal blood through the placental vasculature.
* Only the largest villi are included (normal placentas terminal villi make up 40% of villous tree volume)
* Dashed white arrows show idealized flow lines through intervillous space for maternal blood.
* Relative oxygenation states shown by the red to blue colour gradient.
* Maternal septa divide vascular spaces into the placental cotyledons.
| width=5px| &nbsp;&nbsp;&nbsp;&nbsp;
| [[File:Placental blood flow 01.jpg|700px]]
|}


==Anchoring Villi Histology==
==Anchoring Villi Histology==
 
Please note that there are additional slides listed in the current set, only the first placenta slide and the cord cross-section will be covered in detail in the practical class.
{|
{|
| [[File:Moodle icon2.jpg|link=http://moodle.telt.unsw.edu.au/mod/book/view.php?id=853422&chapterid=106721]]
| [[File:Moodle icon2.jpg|link=http://moodle.telt.unsw.edu.au/mod/book/view.php?id=853422&chapterid=106721]]
| [http://moodle.telt.unsw.edu.au/mod/book/view.php?id=853422&chapterid=106721 Moodle Lab Virtual Slides]
| [http://moodle.telt.unsw.edu.au/mod/book/view.php?id=853422&chapterid=106721 Moodle Placenta Virtual Slides]


(you must be logged in to Moodle)  
(you must be logged in to Moodle)  
|}
|}


Please note that there are additional slides listed in the current set, only the first placenta slide and the cord cross-section will be covered in detail in the practical class.
{|
{|
|
| width=250px|
{|
{|
| [[File:Moodle icon2.jpg|40px|link=https://www.best.edu.au/s/share?url=kaw1n2zn%2Fqhwg56f5&data=8%401!9%4033600!10%40-14702.5&version=1]]
| [[File:Moodle icon2.jpg|40px|link=https://www.best.edu.au/s/share?url=kaw1n2zn%2Fqhwg56f5&data=8%401!9%4033600!10%40-14702.5&version=1]]
| [https://www.best.edu.au/s/share?url=kaw1n2zn%2Fqhwg56f5&data=8%401!9%4033600!10%40-14702.5&version=1 Slide - Human Placenta]
| [https://www.best.edu.au/s/share?url=kaw1n2zn%2Fqhwg56f5&data=8%401!9%4033600!10%40-14702.5&version=1 Slide - Human Placenta]
|}
|}
|
| width=250px|
{|
{|
| [[File:Moodle icon2.jpg|40px|link=https://www.best.edu.au/s/share?url=r7xatnc7%2Fcrxpmx49&data=8%405!9%409298!10%40-5546&version=1]]
| [[File:Moodle icon2.jpg|40px|link=https://www.best.edu.au/s/share?url=r7xatnc7%2Fcrxpmx49&data=8%405!9%409298!10%40-5546&version=1]]
| [https://www.best.edu.au/s/share?url=r7xatnc7%2Fcrxpmx49&data=8%405!9%409298!10%40-5546&version=1 Placenta - mid-term (fetal side)]
| [https://www.best.edu.au/s/share?url=r7xatnc7%2Fcrxpmx49&data=8%405!9%409298!10%40-5546&version=1 Placenta - mid-term (fetal side)]
|}
|}
|
| width=250px|
{|
{|
| [[File:Moodle icon2.jpg|40px|link=https://www.best.edu.au/s/share?url=r7xatnc7%2Fcrxpmx49&data=8%401!9%4012030.5!10%40-7689.5&version=1]]
| [[File:Moodle icon2.jpg|40px|link=https://www.best.edu.au/s/share?url=r7xatnc7%2Fcrxpmx49&data=8%401!9%4012030.5!10%40-7689.5&version=1]]
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<br>
[[File:Placenta_anchoring_villi.jpg]]
[[File:Placenta_anchoring_villi.jpg]]


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| [[File:Embryo-membranes_stage_11.jpg|300px]]
| [[File:Embryo-membranes_stage_11.jpg|300px]]
| [[File:Stage13_bf4.jpg|300px]]
| [[File:Stage13_bf4.jpg|300px]]
| [[File:Placental membranes.jpg|300px]]
|-
|-
| <center>Week 4 (Stage 11)</center>
| <center>Week 4 (Stage 11)</center>
| <center>Week 4-5 (Stage 13)</center>
| <center>Week 4-5 (Stage 13)</center>
|-
| [[File:Stage18 bf10.jpg|300px]]
| [[File:Placental membranes.jpg|300px]]
|-
| <center>Week 7 (Stage 18)</center>
| <center>Week 7 (Stage 18)</center>
| <center>Week 7 (Stage 18)</center>
|}
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{|
{|
! colspan=4|Virtual slides
|-
| valign=bottom|{{SlideStage13bf04}}
| valign=bottom|{{SlideStage13bf04}}
| valign=bottom|{{SlideStage14bf18}}
| valign=bottom|{{SlideStage14bf18}}
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==Terms==
==Terms==
* '''anastomosis''' - Term used to describe the connection between two tubes. Applied to describe the connection between peripheral blood vessels without an intervening capillary bed.
{{Placenta terms}}
* '''angiogenesis''' - Term describing the development of new vessels from already existing vessels, this process is secondary to vasculogenesis which is the initial formation of first blood vessels by differentiation of pluripotent mesenchymal cells (extraembryonic mesoderm).
 
* '''chorion''' - The [[E#extraembryonic_membrane|extraembryonic membrane]] generated from [[T#trophoblast|trophoblast]] and extraembryonic mesoderm that forms [[P#placenta|placenta]]. chorion and [[A#amnion|amnion]] are made by the somatopleure. The chorion becomes incorporated into placental development. The avian and reptilian chorion lies beside the egg shell and allows gas exchange.
<br>
* '''chorionic cavity''' - The fluid-filled [[E#extraembryonic_coelom|extraembryonic coelom]] (cavity) formed initially from [[T#trophoblast|trophoblast]] and extraembryonic mesoderm that forms [[P#placenta|placenta]]. chorion and [[A#amnion|amnion]] are made by the somatopleure. The chorion becomes incorporated into placental development. The avian and reptilian chorion lies beside the egg shell and allows gas exchange. In humans, this cavity is lost during week 8 when the [[A#amniotic cavity|amniotic cavity]] expands and fuses with the chorion.
{{BGDA Practical 14 - Villi Interactive}}
* '''chorion frondosum''' - (''frondosum'' = leafy) The chorion found on [[C#conceptus|conceptus]] oriented towards maternal blood supply where the majority of villi form and proliferate, will contribute the fetal component of the future [[P#placenta|placenta]].
* '''chorion laeve''' - (''laeve'' = smooth) The smooth chorion found on [[C#conceptus|conceptus]] away from maternal blood supply (towards uterine epithelium and cavity) with very few villi present.
* '''chorionic villus sampling''' - (CVS) The taking a biopsy of the [[P#placenta|placenta]], usually at the end of the second month of pregnancy, to test the [[F#fetus|fetus]] for genetic abnormalities.
* '''cord blood''' - (human umbilical cord blood, HUCB) A term used to describe blood collected from the [[P#placenta|placenta]] usually after birth. Has been identified as a source of stem cells with potential therapeutic uses and is stored in Cord Blood Banks throughout the world.
* '''cotyledon''' - (Greek, ''kotyle'' = a deep cup) In the embryos of seed plants, the "seed leaves," in which nutrients are stored for use after germination. In placental animals, the term is also to describe the leaf-like structure of the [[P#placenta|placenta]] surface.
* '''cytotrophoblast''' - The "cellular" [[T#trophoblast|trophoblast]] layer surrounding (forming a "shell") the early implanting [[C#conceptus|conceptus]]. Beginning at uterine adplantation, proliferation and fusion of these cells is thought to form a second outer [[T#trophoblast|trophoblast]] layer, the [[S#syncytiotrophoblast|syncytiotrophoblast]]. The cytotrophoblast layer contributes to formation of the placental villi, the functional component of the fetal [[P#placenta|placenta]].
* '''decidua basalis''' - The term given to the uterine endometrium at the site of implantation where signaling transforms the uterine stromal cells (fibroblast-like) into decidual cells. This forms the maternal component of the [[P#placenta|placenta]], the decidualization process gradually spreads through the remainder of the [[U#uterus|uterus]], forming the decidua parietalis.
* '''decidua basalis reaction''' - Term describing the maternal endometrial changes that occur initially at the site of, and following, blastocyst implantation. Seen as a deposition of glycogen, fibrin and proliferation of blood vessels. See also [[D#decidualization|decidualization]].
* '''decidual cell''' - The uterine stromal cells (fibroblast-like) that differentiate in response to both steroid hormones (progesterone) and embryonic signals. These cells then alter uterine environment to support further embryonic development as well as producing cytokines related to prolactin (PRL) and have an innate immune function.
* '''decidualization''' - (decidualisation) The process by which uterine stromal cells differentiate in response to both steroid hormones and embryonic signals into large epitheliod decidual cells. This process is essential for the progress of implantation and establishing fetal-maternal communication.
* '''fibrinoid layer''' - ([[N#Nitabuch's layer|Nitabuch's layer]]) A layer formed at maternal/fetal interface during [[P#placenta|placentation]] and is thought to act to prevent excessively deep conceptus implantation. Fibrin-type fibrinoid (maternal blood-clot product) and matrix-type fibrinoid (secreted by invasive extravillous [[T#trophoblast|trophoblast]] cells).
* '''floating chorionic villi''' - Term used to describe the placental microanatomy structure of [[C#chorionic villi|chorionic villi]] that '''are not''' attached to the maternal decidua and float in the maternal blood-filled space (lacunae). Structurally the same as [[A#anchoring chorionic villi|anchoring chorionic villi]] conceptus side that are attached to the maternal decidua.These villi go through the same stages of development: [[P#primary villi|primary]], [[S#secondary villi|secondary]] and [[T#tertiary villi|tertiary]] villi.
* '''haemotrophic nutrition''' - Term used to describe in late [[P#placenta|placenta]] development the transfer of blood-borne nutrition from maternal to [[E#embryo|embryo]]/[[F#fetus|fetus]] compared to early [[H#histiotrophic_nutrition|histiotrophic nutrition]].
* '''histiotrophic nutrition''' - Term used to describe in early [[P#placenta|placenta]] development the intital transfer of nutrition from maternal to [[E#embryo|embryo]] (histiotrophic nutrition) compared to later blood-borne nutrition ([[H#hemotrophic_nutrition|hemotrophic nutrition]]). Histotroph is the nutritional material accumulated in spaces between the maternal and fetal tissues, derived from the maternal endometrium and the uterine glands. This nutritional material is absorbed by phagocytosis initially by blastocyst trophectoderm and then by [[T#trophoblast|trophoblast]] of the [[P#placenta|placenta]]. in later placental development nutrition is by the exchange of blood-borne materials between the maternal and fetal circulations, hemotrophic nutrition.
* '''Hofbauer cells''' - Cells found within [[P#placenta|placental]] villi connective tissue. Have a role as macrophages of mesenchymal origin with potentially additional functions (remodeling, vasculogenesis, regulation of stromal water content).
* '''hydatiform mole''' - A uterine tumour with "grape-like" [[P#placenta|placenta]] appearance without enclosed [[E#embryo|embryo]] formation, arises mainly from a haploid sperm fertilizing an egg without a female pronucleus. It is one form of [[G#gestational trophoblastic disease|gestational trophoblastic disease]] (GTD), a number of abnormalities including [[H#hydatiform mole|hydatiform mole]], invasive mole, choriocarcinoma and placental site trophoblastic tumor (PSTT).
* '''Langhans layer''' - cytotrophoblast cell layer.
* '''Nitabuch's layer''' - ([[F#fibrinoid layer|fibrinoid layer]]) The layer formed at maternal/fetal interface during [[P#placenta|placentation]] and is thought to act to prevent excessively deep conceptus [[I#implantation|implantation]]. Fibrin-type fibrinoid (maternal blood-clot product) and matrix-type fibrinoid (secreted by invasive extravillous [[T#trophoblast|trophoblast]] cells).
* '''persistent right umbilical vein''' - (PRUV) A placental cord abnormality associated with fetal abnormalities and poor neonatal prognosis. The estimated incidence of persistent right umbilical vein in a low-risk population is 1 : 526. PMID 12047534
* '''placenta''' - (Greek, ''plakuos'' = flat cake) The developmental organ formed from maternal and fetal contributions in animals with placental development. In human, the placenta at term is a discoid shape "flat cake" shape; 20 cm diameter, 3 cm thick and weighs 500-600 gm. Placenta are classified by the number of layers between maternal and fetal blood (Haemochorial, Endotheliochorial and Epitheliochorial) and shape (Discoid, Zonary, Cotyledenary and  Diffuse). The placenta has many different functions including metabolism, transport and endocrine.
* '''placental arteries''' - ([[U#umbilical arteries|umbilical arteries]]) In placental animals, the blood vessels which develop within the placental cord carrying relatively deoxygenated blood from the [[E#embryo|embryo]]/[[F#fetus|fetus]] to the [[P#placenta|placenta]]. In humans, there are two placental arteries continuous with the paired internal iliac arteries (hypogastric arteries) arising off the [[D#dorsal aorta|dorsal aortas]]. At birth this vessel regresses and form the remnant [[M#medial umbilical ligament|medial umbilical ligament]].
* '''placental cord''' - ([[U#umbilical cord|umbilical cord]]) The placental cord is the structure connecting the embryo/fetus to the [[P#placenta|placenta]]. It is initially extra-embryonic mesoderm forming the connecting stalk within which the placental blood vessels (arteries and veins) form. In human placental cords the placental blood vessels are initially paired, later in development only a single placental vein remains with a pair of placental arteries. This structure also contains the [[A#allantois|allantois]], an extension from the hindgut cloaca then urogenital sinus. Blood collected from the placental cord following delivery is a source of cord blood stem cells.)
* '''placental membranes''' - [[C#chorionic membrane|chorionic membrane]] [[A#amniotic membrane]]) General term to describe the membrane bound extra-embryonic fluid-filled cavities surrounding the embryo then fetus. In humans the [[A#amniotic membrane]] and [[C#chorionic membrane|chorionic membrane]] fuse.
* '''placental vein''' - ([[U#umbilical vein|umbilical vein]]) In placental animals, the blood vessels which develop within the placental cord carrying relatively oxygenated blood from the [[P#placenta|placenta]] to the [[E#embryo|embryo]]/[[F#fetus|fetus]]. In humans, there are initially two placental veins which fuse to form a single vein. The resence of paired veins in the placental cord can be indicative of developmental abnormalities.
* '''primary villi''' - (primary chorionic villi) Term describing the earliest stage of embryonic placenta development. In humans, the conceptus during week 2 this first stage of [[C#chorion|chorionic]] villi development consists of only the [[T#trophoblast|trophoblastic shell cells]] ([[S#syncitiotrophoblast|syncitiotrophoblasts]] and [[C#cytotrophoblast|cytotrophoblasts]]) forming finger-like extensions into maternal decidua.  Initially these finger-like projections cover the entire surface of chorionic sac and later become restricted to the placental surface. The villi stages are ongoing as the placenta continues to grow through both the embryonic and fetal development. '''Placental villi stages:''' [[P#primary villi|primary villi]] - [[S#secondary villi|secondary villi]] - [[T#tertiary villi|tertiary villi]]
* '''secondary villi''' - (secondary chorionic villi) Term describing the second stage of embryonic placenta development. In humans, the conceptus during week 3 onward this stage of [[C#chorion|chorionic]] villi development consists of the [[T#trophoblast|trophoblastic shell cells]] ([[S#syncitiotrophoblast|syncitiotrophoblasts]] and [[C#cytotrophoblast|cytotrophoblasts]]) filled with extraembryonic mesoderm forming finger-like extensions into maternal decidua. Initially these finger-like projections cover the entire surface of chorionic sac and later become restricted to the placental surface. The villi stages are ongoing as the placenta continues to grow through both the embryonic and fetal development. '''Placental villi stages:''' [[P#primary villi|primary villi]] - [[S#secondary villi|secondary villi]] - [[T#tertiary villi|tertiary villi]]
* '''syncytiotrophoblast''' - A multinucleated cell currently thought to form by the fusion of another [[T#trophoblast|trophoblast]] cell the [[C#cytotrophoblast|cytotrophoblasts]], within the [[T#trophoblast|trophoblast]] layer (shell) of the implanting [[C#conceptus|conceptus]]. In early development, these cells mediate implantation of the conceptus into the uterine wall and secrete the hormone ([[C#human_chorionic_gonadotrophin|human Chorionic Gonadotrophin]], hCG) responsible for feedback maintainance of the corpus luteum (in maternal [[O#ovary|ovary]]) and therefore maintaining early pregnancy.
* '''tertiary  villi''' - (tertiary  chorionic villi) Term describing the final stage of embryonic placenta development. In humans, the conceptus after week 3 the [[C#chorion|chorionic]] [[S#secondary villi|secondary villi]] now develop placental blood vessels within the core [[E#extraembryonic mesoderm|extraembryonic mesoderm]]. The villi form finger-like extensions that are either [[A#anchoring chorionic villi|anchoring chorionic villi]] attached to the maternal decidua or [[F#floating chorionic villi|floating chorionic villi]] in maternal lacunae. The villi stages are ongoing as the placenta continues to grow through both the embryonic and fetal development. '''Placental villi stages:''' [[P#primary villi|primary villi]] - [[S#secondary villi|secondary villi]] - [[T#tertiary villi|tertiary villi]]
* '''villi''' - Plural of villus, which is a thin projection from a surface. The term in development is used to describe the individual functional units together of the fetal [[P#placenta|placenta]].
* '''Wharton's jelly''' - [[P#placental cord|Placental cord]] (umbilical cord) gelatinous connective tissue composed of myofibroblast-like stromal cells, collagen fibers, and proteoglycans. Increases in volume (myxomatous, connective tissue embedded in mucus) at parturition (birth) to assist closure of placental blood vessels. Matrix cells from Wharton's jelly have recently been identified as a potential source of [[M#mesenchymal stem cell|mesenchymal stem cells]] (MSC), also called mesenchymal stromal cell. This placental cord substance is named after Thomas Wharton (1614-1673) an English physician and anatomist who first described this placental tissue.


<br>
{{BGDALabPlacenta}}
{{BGDALabPlacenta}}


==Additional Information==
==Additional Information==
{{Med Prac additional Information}}
{{Med Prac additional Information}}


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Mesenchymal villi continuously form out of the trophoblastic sprouts throughout pregnancy and have been considered the basis for growth and differentiation of the villous trees.
Mesenchymal villi continuously form out of the trophoblastic sprouts throughout pregnancy and have been considered the basis for growth and differentiation of the villous trees.


===Human Villi Timeline===
===Third Trimester Placental Blood Flow===
This is far more than even for additional information section [[Talk:BGDA_Practical_Placenta_-_Villi_Development|Timeline Table]]
{|
|+ Diffusion Tensor Magnetic Resonance Imaging (MRI)
|-
| width=605px|[[File:Placenta MRI01.jpg|600px]]
| valign=top|
<br><br>This is a third trimester placenta ({{GA}} 35 weeks + 6 days) showing the mean diffusivity maps for three slices of a single placental diffusion-weighted MRI scan.{{#pmid:29230859|PMID29230859}}
<br><br><br>
* Red and black outline the uterine wall and placenta ROIs respectively.
* Colour represents mean diffusivity in mm<sup>2</sup> s<sup>-1</sup> (note that the scale is a factor of 10 higher for the b = 4 40 s mm<sup>-2</sup> maps).


<gallery>
<br><br>
File:Gray0034.jpg|Decidua and villi location
{{MRI}} Diffusion tensor imaging (DTI) techniques provide information on the microstructural processes and has also been used to study brain development. Note that clinically, Doppler ultrasound has also been used to measure placental blood flow.
File:Bailey495.jpg|Chorionic villi
|}
</gallery>


===Human Villi Timeline===
Detailed overview of villi development.


{{Placenta Villi Timeline table}}


===Historic Images===


----
{|
! Decidua and villi location
! Chorionic villi
|-
| [[File:Gray0034.jpg|400px]]
| [[File:Bailey495.jpg|400px]]
|}


==References==
<references/>





Latest revision as of 22:27, 2 June 2019

BGDsmall.jpg
Practical 14: Implantation and Early Placentation | Villi Development | Maternal Decidua | Cord Development | Placental Functions | Diagnostic Techniques | Abnormalities


Chorionic Villi

Primary villi

Week 2 - first stage of chorionic villi development.

Trophoblastic shell cells (syncitiotrophoblasts and cytotrophoblasts) form finger-like extensions into maternal decidua.

Gray0036.jpg

Secondary villi

Week 3 - second stage of chorionic villi development

Extra-embryonic mesoderm grows into villi, covers the entire surface of chorionic sac.

Basal region will form chorionic plate.

Gray0037.jpg

Tertiary villi

Week 4 - third stage of chorionic villi development.

Mesenchyme differentiates into blood vessels and cells, forms arteriocapillary network, fuse with placental vessels, developing in connecting stalk.

Gray0031.jpg


  • anchoring villi - or stem villi cytotrophoblast cells attached to maternal tissue.
  • branched villi - grow from sides of anchoring villi, region of main exchange, surrounded by maternal blood in intervillous spaces.
  • terminal villi - not active outgrow is caused by proliferation of the trophoblast. Passive protrusions induced by capillary coiling due to growth of the fetal capillaries within the mature intermediate villi (third trimester).
  • chorionic plate - region of membrane at the base of the villi through which larger placental arteries and vein passes.


Placental Circulation

Schematic representation of blood flow through the placenta and surrounding tissue.[1]



  • Blue and red arrows show the flow directions of oxygenated (red) and deoxygenated (blue) fetal blood through the placental vasculature.
  • Only the largest villi are included (normal placentas terminal villi make up 40% of villous tree volume)
  • Dashed white arrows show idealized flow lines through intervillous space for maternal blood.
  • Relative oxygenation states shown by the red to blue colour gradient.
  • Maternal septa divide vascular spaces into the placental cotyledons.
     Placental blood flow 01.jpg

Anchoring Villi Histology

Please note that there are additional slides listed in the current set, only the first placenta slide and the cord cross-section will be covered in detail in the practical class.

Moodle icon2.jpg Moodle Placenta Virtual Slides

(you must be logged in to Moodle)

Moodle icon2.jpg Slide - Human Placenta
Moodle icon2.jpg Placenta - mid-term (fetal side)
Moodle icon2.jpg Placenta - (late))
Moodle icon2.jpg Slide - Human Placental Cord
Moodle icon2.jpg Placenta - mid-term (maternal side)


Placenta anchoring villi.jpg

Villi Development

First Trimester Third Trimester
Placental villi 2.jpg Placental villi 4.jpg

Human placental villi cartoon 01.jpg

Virtual Slide

We will now look at an example of first trimester placentation in a Virtual Slide.

Moodle icon2.jpg Slide - Human Placenta

Please note that there are additional slides listed in the current set, only the first placenta slide and the cord cross-section will be covered in detail in the practical class.

Chorionoic Villi Location

Originally villi cover entire chorionic surface and then become restricted to decidua basalis region forming 2 regions:

  1. Frondosum - "leafy" where villi are mainly located.
  2. Capsularis - smooth chorion, where villi are absent or not abundant.
Embryo-membranes stage 11.jpg Stage13 bf4.jpg
Week 4 (Stage 11)
Week 4-5 (Stage 13)
Stage18 bf10.jpg Placental membranes.jpg
Week 7 (Stage 18)
Week 7 (Stage 18)


Virtual slides
Stage 13 - Left Ventrolateral View

Stage13 bf4.jpg

 ‎‎Mobile | Desktop | Original

Stage 13 | Embryo Slides
Stage 14 - Lateral View

Stage14 bf18.jpg

 ‎‎Mobile | Desktop | Original

Stage 14 | Embryo Slides
Stage 14 - Ventral View

Stage14 bf21.jpg

 ‎‎Mobile | Desktop | Original

Stage 14 | Embryo Slides
Stage 18 - Left Lateral

Stage18 bf12.jpg

 ‎‎Mobile | Desktop | Original

Stage 18 | Embryo Slides

Terms

Placenta Terms (expand to view) 
  • after-birth - term used to describe the delivery of placenta and placental membranes following birth of the child.
  • allantois - An extraembryonic membrane, endoderm in origin extension from the early hindgut, then cloaca into the connecting stalk of placental animals, connected to the superior end of developing bladder. In reptiles and birds, acts as a reservoir for wastes and mediates gas exchange. In mammals is associated/incorporated with connecting stalk/placental cord fetal-maternal interface.
  • amniocentesis - Clinical term for a prenatal diagnostic test where an ultrasound guided needle is used to extract a sample of the amniotic fluid. Amniocentesis
  • anastomosis - Term used to describe the connection between two tubes. Applied to describe the connection between peripheral blood vessels without an intervening capillary bed.
  • anchoring villi - (stem villi) describes the placental villi (embryonic) that attach to the decidua (maternal) tissue. The tip of the villi consists of a column of trophoblast cells attached to an epithelial plaque.
  • angioblasts form clusters or blood islands on surface of yolk sac.
  • angiogenesis - Term describing the development of new vessels from already existing vessels, this process is secondary to vasculogenesis which is the initial formation of first blood vessels by differentiation of pluripotent mesenchymal cells (extraembryonic mesoderm).
  • capsularis - portion of maternal decidua that covers the conceptus facing towards the uterine cavity.
  • cerebroplacental ratio - (CPR) a doppler ultrasound measurement calculated as the simple ratio between the middle cerebral artery pulsatility index (MCA‐PI) and the umbilical artery pulsatility index (UA‐PI). Fetuses with an abnormal ratio are thought to be a predictor of adverse pregnancy outcome.
  • chorioamnionitis - (CA) An intraamniotic puerperal infection described as having 3 forms: histologic, clinical (clinical chorioamnionitis, IAI), and subclinical. Intraamniotic infection is a common (2-4%) event in labor and the systemic inflammatory response can also lead to preterm birth and neonatal complications.
  • chorion - The extraembryonic membrane generated from trophoblast and extraembryonic mesoderm that forms placenta. chorion and amnion are made by the somatopleure. The chorion becomes incorporated into placental development. The avian and reptilian chorion lies beside the egg shell and allows gas exchange.
  • chorionic cavity - The fluid-filled extraembryonic coelom (cavity) formed initially from trophoblast and extraembryonic mesoderm that forms placenta. chorion and amnion are made by the somatopleure. The chorion becomes incorporated into placental development. The avian and reptilian chorion lies beside the egg shell and allows gas exchange. In humans, this cavity is lost during week 8 when the amniotic cavity expands and fuses with the chorion.
  • chorion frondosum - (frondosum = leafy) The chorion found on conceptus oriented towards maternal blood supply where the majority of villi form and proliferate, will contribute the fetal component of the future placenta.
  • chorion laeve - (laeve = smooth) The smooth chorion found on conceptus away from maternal blood supply (towards uterine epithelium and cavity) with very few villi present.
  • chorionic somatomammotropin - (CSH, human lactogen) A hormone synthesized within the placenta by syncytiotrophoblast cells. This protein hormone (190 amino acid) has a structure is similar to pituitary growth hormone.
  • chorionic villus sampling - (CVS) The taking a biopsy of the placenta, usually at the end of the second month of pregnancy, to test the fetus for genetic abnormalities.
  • coelocentesis - A sampling of extracoelomic fluid usually for an early prenatal diagnostic technique.
  • connecting stalk - the original extra-embryonic mesoderm structure attaching the embryonic disc to the chorion. The placental blood vessels form within this structure.
  • cord blood - (human umbilical cord blood, HUCB) A term used to describe blood collected from the placenta usually after birth. Has been identified as a source of stem cells with potential therapeutic uses and is stored in Cord Blood Banks throughout the world.
  • cord knotting Term describing umbilical or placental cord knotting. This occurs in about 1% prevents the passage of placental blood, pseudoknots also occur usually with no effect.
  • cord presentation - A term used to describe at birth the presence of the umbilical cord between the fetal presenting part and the cervix, with or without membrane rupture.
  • cord prolapse - A term used to describe at birth the descent of the umbilical cord through the cervix alongside (occult) or past (overt) the presenting part in the presence of ruptured membranes (incidence of 0.1% to 0.6%).
  • cotyledon - (Greek, kotyle = a deep cup) In the embryos of seed plants, the "seed leaves," in which nutrients are stored for use after germination. In placental animals, the term is also to describe the leaf-like structure of the placenta surface.
  • cytotrophoblast - The "cellular" trophoblast layer surrounding (forming a "shell") the early implanting conceptus. Beginning at uterine adplantation, proliferation and fusion of these cells is thought to form a second outer trophoblast layer, the syncytiotrophoblast. The cytotrophoblast layer contributes to formation of the placental villi, the functional component of the fetal placenta.
  • decidua basalis - The term given to the uterine endometrium at the site of implantation where signaling transforms the uterine stromal cells (fibroblast-like) into decidual cells. This forms the maternal component of the placenta, the decidualization process gradually spreads through the remainder of the uterus, forming the decidua parietalis.
  • decidua basalis reaction - Term describing the maternal endometrial changes that occur initially at the site of, and following, blastocyst implantation. Seen as a deposition of glycogen, fibrin and proliferation of blood vessels. See also decidualization.
  • decidua capsularis - The term given to the uterine endometrium which has been converted to decidua surrounding the conceptus on the smooth chorion side.
  • decidua parietalis - The term given to the remainder of the uterine endometrium, away from the site of implantation, that gradually becomes comverted to decidua.
  • decidual cell - The uterine stromal cells (fibroblast-like) that differentiate in response to both steroid hormones (progesterone) and embryonic signals. These cells then alter uterine environment to support further embryonic development as well as producing cytokines related to prolactin (PRL) and have an innate immune function.
  • decidual reaction - maternal endometrial reaction invoked in order to block the rapid extension of the implanting syncytium.
  • decidualization - (decidualisation, decidual reaction) The process by which uterine stromal cells differentiate in response to both steroid hormones and embryonic signals into large epitheliod decidual cells. This process is essential for the progress of implantation and establishing fetal-maternal communication.
  • DHEA - (dehydroepiandrosterone, androstenolone) precursor of sex steroid hormones and is converted to testosterone and estradiol. Postnatally, an abundant circulating steroid produced in the adrenal gland. The fetal adrenal cortex produces dehydroepiandrosterone sulfate (DHEA-S) used by the placenta to produce estrogens. DHEA, androstenedione, and testosterone can be metabolized to epiandrosterone, and etiocholanolone. PMID 15635500
  • fetal drug addiction - occurs when drugs used maternally cross the placental barrier and can establish neural/physiological addiction in the unborn fetus. drugs
  • fetal erythroblastosis - (Haemolytic Disease of the Newborn) A clinical term describing an immune response between fetal and maternal blood groups; from fetus Rh+ / maternal Rh-. The leakage of blood from fetus, particularly at birth, causes maternal anti-Rh antibodies, which is then dangerous for a 2nd or future pregnancies.
  • fetal intra-abdominal umbilical vein varix - (FIUV, umbilical vein varix) focal dilatation of the umbilical venous diameter at the level of cord insertion, the dilatation diameter increases linearly with gestational age. Represent about 4% of umbilical cord abnormalities

with an incidence of about 2.8 per 1,000 pregnancies, there is also a rarer form of extra-abdominal varices.PMID 24883288

  • fibrinoid layer - (Nitabuch's layer) A layer formed at maternal/fetal interface during placentation and is thought to act to prevent excessively deep conceptus implantation. Fibrin-type fibrinoid (maternal blood-clot product) and matrix-type fibrinoid (secreted by invasive extravillous trophoblast cells).
  • floating chorionic villi - Term used to describe the placental microanatomy structure of chorionic villi that are not attached to the maternal decidua and float in the maternal blood-filled space (lacunae). Structurally the same as anchoring chorionic villi conceptus side that are attached to the maternal decidua.These villi go through the same stages of development: primary villi - secondary villi - tertiary villi
  • hemotrophic nutrition - Term used to describe in late placenta development the transfer of blood-borne nutrition from maternal to embryo/fetuscompared to early histiotrophic nutrition.
  • heterotopic pregnancy - (Greek, heteros = other) Clinical term for a very rare pregnancy of two or more embryos, consisting of both a uterine cavity embryo implantation and an ectopic implantation.
  • histiotrophic nutrition - Term used to describe in early placenta development the intital transfer of nutrition from maternal to embryo (histiotrophic nutrition) compared to later blood-borne nutrition (hemotrophic nutrition). Histotroph is the nutritional material accumulated in spaces between the maternal and fetal tissues, derived from the maternal endometrium and the uterine glands. This nutritional material is absorbed by phagocytosis initially by blastocyst trophectoderm and then by trophoblast of the placenta. in later placental development nutrition is by the exchange of blood-borne materials between the maternal and fetal circulations, hemotrophic nutrition.
  • Hofbauer cells - Cells found within placental villi connective tissue. Have a role as macrophages of mesenchymal origin with potentially additional functions (remodeling, vasculogenesis, regulation of stromal water content).
  • Human chorionic corticotropin - (hCACTH) placental derived hormone equivilant to corticotropin (ACTH) from the pituitary.
  • Human chorionic gonadotrophin - (hCG) like leutenizing hormone, supports corpus luteum, originally secreted by trophoblast cells.
  • Human chorionic somatommotropin - (hCS, placental lactogen) hormone level increases in maternal blood through pregnancy, decreases maternal insulin sensitivity (raising maternal blood glucose levels and decreasing maternal glucose utilization) aiding fetal nutrition.
  • Template:Hydatiform mole - A uterine tumour with "grape-like" placenta appearance without enclosed embryo formation, arises mainly from a haploid sperm fertilizing an egg without a female pronucleus. It is one form of gestational trophoblastic disease(GTD), a number of abnormalities including hydatiform mole, invasive mole, choriocarcinoma and placental site trophoblastic tumor (PSTT).
  • hysterectomy – clinical term for the surgical removal of the uterus.
  • Langhans layer - cytotrophoblast cell layer.
  • maternal antibodies - antibodies from the mother's immune system that are capable of crossing placental barrier. They can provide immune protection to the embryo, but may also participate in immune disease (fetal erythroblastosis).
  • maternal sinusoids - placental spaces around chorionic villi that are filled with maternal blood. This is the closest maternal/fetal exchange site.
  • Nitabuch's layer - (fibrinoid layer) The layer formed at maternal/fetal interface during placentation and is thought to act to prevent excessively deep conceptus implantation. Fibrin-type fibrinoid (maternal blood-clot product) and matrix-type fibrinoid (secreted by invasive extravillous trophoblast cells).
  • Morbidly adherent placenta (MAP) A general clinical term used to describe the different forms of abnormal placental implantation (Accreta, Increta and Percreta).
  • oligohydramnios - Clinical term for the accumulation a deficiency of amniotic fluid during pregnancy. See also polyhydramnios, an excess of amniotic fluid.
  • persistent right umbilical vein - (PRUV) A placental cord abnormality associated with fetal abnormalities and poor neonatal prognosis. The estimated incidence of persistent right umbilical vein in a low-risk population is 1 : 526. PMID 12047534
  • polyhydramnios - Clinical term for the accumulation of excess amniotic fluid during pregnancy. See also oligohydramnios, a deficiency of amniotic fluid.
  • placenta - (Greek, plakuos = flat cake) The developmental organ formed from maternal and fetal contributions in animals with placental development. In human, the placenta at term is a discoid shape "flat cake" shape; 20 cm diameter, 3 cm thick and weighs 500-600 gm. Placenta are classified by the number of layers between maternal and fetal blood (Haemochorial, Endotheliochorial and Epitheliochorial) and shape (Discoid, Zonary, Cotyledenary and Diffuse). The placenta has many different functions including metabolism, transport and endocrine.
  • placenta accreta - The abnormal placental adherence, either in whole or in part of the placenta with absence of decidua basalis, leading to retention as an after-birth to the underlying uterine wall. The incidence of placenta accreta also significantly increases in women with previous cesarean section compared to those without a prior surgical delivery.
  • placental arteries - (umbilical arteries) In placental animals, the blood vessels which develop within the placental cord carrying relatively deoxygenated blood from the embryo/fetus to the placenta. In humans, there are two placental arteries continuous with the paired internal iliac arteries (hypogastric arteries) arising off the dorsal aortas. At birth this vessel regresses and form the remnant medial umbilical ligament.
  • placental cord - (umbilical cord) The placental cord is the structure connecting the embryo/fetus to the placenta. It is initially extra-embryonic mesoderm forming the connecting stalk within which the placental blood vessels (arteries and veins) form. In human placental cords the placental blood vessels are initially paired, later in development only a single placental vein remains with a pair of placental arteries. This structure also contains the allantois, an extension from the hindgut cloaca then urogenital sinus. Blood collected from the placental cord following delivery is a source of cord blood stem cells.)
  • placental diameter - is measured in the transverse section by calculating the maximum dimensions of the chorionic surface.
  • placental growth factor - (PlGF) A growth factor of the vascular endothelial growth factor (VEGF) family, released from the placental trophoblast cells and other sources that stimulates blood vessel growth.
  • placental malaria - The malarial infection of the placenta by sequestration of the infected red blood cells. This condition can be common in regions where malaria is endemic with women carrying their first pregnancy (primigravida).
  • placenta membranacea - rare placental abnormality characterized by the presence of chorionic villi directly attached to and covering the fetal membranes. Placenta Membranacea
  • placenta previa - placenta overlies internal os of uterus, abnormal bleeding, may require cesarian delivery.
  • placental thickness - is measured at its mid-portion from the chorionic plate to the basilar plate, on a longitudinal plane (less than 4 cm at term). Excludes any abnormalities (fibroids, myometrial contractions, or venous lakes). The placental thickness approximates in millimeters to the weeks of gestation.
  • placental vein - (umbilical vein) In placental animals, the blood vessels which develop within the placental cord carrying relatively oxygenated blood from the placenta to the embryo/fetus. In humans, there are initially two placental veins which fuse to form a single vein. The resence of paired veins in the placental cord can be indicative of developmental abnormalities.
  • placentophagia - Term used to descrbe the maternal ingestion of afterbirth materials (placental membranes and amniotic fluid) that can occur following mammalian parturition (birth).
  • primary villi - (primary chorionic villi) Term describing the earliest stage of embryonic placenta development. In humans, the conceptus during week 2 this first stage of chorionic villi development consists of only the trophoblastic shell cells (syncitiotrophoblasts and cytotrophoblasts) forming finger-like extensions into maternal decidua. Initially these finger-like projections cover the entire surface of chorionic sac and later become restricted to the placental surface. The villi stages are ongoing as the placenta continues to grow through both the embryonic and fetal development.
  • pre-eclampsia - During pregnancy a combination of high blood pressure, protein in urine and fluid retention resulting in maternal sudden excessive swelling of the face, hands and feet. Eclampsia is the subsequent development of convulsions, kidney failure, liver failure, clotting problems or mortality.
  • Rh alloimmunization - feto-maternal haemorrhage generally in late pregnancy results in an Rh-negative woman becoming sensitised to Rh-positive fetal cells that enter her circulation. Clinically treated with anti-D immune globulin prophylaxis, alloimmunization occurs in 9–10% of at-risk pregnancies. immune
  • secondary villi - (secondary chorionic villi) Term describing the second stage of embryonic placenta development. In humans, the conceptus during week 3 onward this stage of chorionic villi development consists of the trophoblastic shell cells (syncytiotrophoblast and cytotrophoblasts) filled with extraembryonic mesoderm forming finger-like extensions into maternal decidua. Initially these finger-like projections cover the entire surface of chorionic sac and later become restricted to the placental surface. The villi stages are ongoing as the placenta continues to grow through both the embryonic and fetal development. Placental villi stages: primary villi - secondary villi - tertiary villi
  • syncytiotrophoblast - A multinucleated cell currently thought to form by the fusion of another trophoblast cell the cytotrophoblasts, within the trophoblast layer (shell) of the implanting conceptus. In early development, these cells mediate implantation of the conceptus into the uterine wall and secrete the hormone (Template:Human Chorionic Gonadotrophin, hCG) responsible for feedback maintainance of the corpus luteum (in maternal ovary) and therefore maintaining early pregnancy.
  • trophoblast - (trophectoderm, Greek, trophe = "nutrition" and blast = a primordial cell) cells that firstly support adplantation, implantation and endocrine support of pregnancy. Contribute to the extraembryonic tissues, fetal placenta and membranes. Initially form 2 populations individual cytotrophoblast cells and their fused multinucleate syncytiotrophoblast cells.
  • Twin-twin transfusion syndrome - (TTTS) in monozygotic twins with monochorionic and diamniotic placenta, with intrauterine blood transfusion from one twin (donor) to another twin (recipient) where there is an imbalance of blood flow from the donor twin to the recipient twin. Clinically diagnosed by the alternate presence of polyhydramnios in one fetus and oligohydramnios in the co-twin, occurs in about 10% of monochorionic twins.
  • umbilical cord (placental cord) fetal attachment cord 1-2 cm diameter, 30-90cm long, covered with amniotic attached to chorionic plate, umbilical vessels (artery, vein) branch into chorionic vessels. Vessels anastomose within the placenta.
  • umbilical vein varix - (fetal intra-abdominal umbilical vein varix, FIUV) focal dilatation of the umbilical venous diameter at the level of cord insertion, the dilatation diameter increases linearly with gestational age. Represent about 4% of umbilical cord abnormalities

with an incidence of about 2.8 per 1,000 pregnancies, there is also a rarer form of extra-abdominal varices. PMID 24883288

  • vasculogenesis - formation of first blood vessels by differentiation of pluripotent mesenchymal cells (extraembryonic mesoderm) followed by angiogenesis which is the development of new vessels from already existing vessels.
  • vasculosyncytial membranes - localised areas of the placental villous membrane where the barrier thickness separating maternal and fetal circulations is reduced to as little as 1-2 microns. PMID 1287078
  • villi - Plural of villus, which is a thin projection from a surface. The term in development is used to describe the individual functional units together of the fetal placenta.
  • virus - small infectious agents that may cross the placental barrier. Can infect embryo and/or placenta and cause developmental abnormalities. (e.g. cytomegalovirus, rubella, measles).
  • Wharton's jelly - placental cord (umbilical cord) gelatinous connective tissue composed of myofibroblast-like stromal cells, collagen fibers, and proteoglycans. Increases in volume (myxomatous, connective tissue embedded in mucus) at parturition (birth) to assist closure of placental blood vessels. Matrix cells from Wharton's jelly have recently been identified as a potential source of mesenchymal stem cells (MSC), also called mesenchymal stromal cell. This placental cord substance is named after Thomas Wharton (1614-1673) an English physician and anatomist who first described this placental tissue.
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Placental Villi Interactive Component

Attempt the Quiz - Placental Villi  
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Here are a few simple Quiz questions that relate to Placental Villi from the practical.

1 The stage of placental villi development where the core is initially solid mesoderm is:

  primary villi
  secondary villi
  tertiary villi
  quaternary villi

2 The developing placenta arises from the:

  decidua frondosum
  decidua capsularis

3 The developing amniotic membrane later fuses with the:

  chorionic membrane
  yolk sac
  maternal blood vessels
  maternal uterine glands
  none of the above


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Practical 14: Implantation and Early Placentation | Villi Development | Maternal Decidua | Cord Development | Placental Functions | Diagnostic Techniques | Abnormalities

Additional Information: placental villi


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Practical 14: Implantation and Early Placentation | Villi Development | Maternal Decidua | Cord Development | Placental Functions | Diagnostic Techniques | Abnormalities


Additional Information

Additional Information - Content shown under this heading is not part of the material covered in this class. It is provided for those students who would like to know about some concepts or current research in topics related to the current class page.
Placental villi cartoon

2013 Meeting Presentation - Placenta Embryology and Circulation

Cytotrophoblast Layer

There is a new interpretation of the changes that are occuring in the cytotrophoblast (CTB) layer during early to full-term human placenta development. Traditionally the interpretation was that the cytotrophoblast layer thinned and became discontinuous towards term. The thinning is thought due to the epithelium surface expanding at a faster rate than its volume. Two recent studies suggest that while the cytotrophoblast layer does indeed thin, it does not become discontinuous.

Syncytiotrophoblast Layer

The syncytiotrophoblast (STB) layer forms the epithelial covering of the entire villous tree. These cells are multinucleated, terminally-differentiated syncytium formed by the fusion of the underlying progenitor cytotrophoblast (CTB) cells. The process is described as "syncytialization" and is mediated by syncytin-1, an envelope protein of a human endogenous retrovirus W (HERV-W). The differentiation is regulated by chorionic gonadotropin (hCG) and the fusion of cytotrophoblast cells is ongoing during placental development.

Cellular parts derived from the syncytiotrophoblasts (apoptotic nuclei and microparticulate debris) can be shed into the maternal blood in which they are bathed. The apototic process appears to be part of the fusion mechanism between cytotrophoblast and the overlying multinucleate syncytiotrophoblast layer.

Studies have suggested that these cells are transcriptionally inactive. A recent study using a number of different detection techniques now suggests that at least some of the cells nuclei may still be transcriptionally inactive.

Mesenchymal Villi

Mesenchymal villi generate all other villous types:

  • immature intermediate villi
  • stem villi
  • mature intermediate villi
  • terminal villi

Mesenchymal villi continuously form out of the trophoblastic sprouts throughout pregnancy and have been considered the basis for growth and differentiation of the villous trees.

Third Trimester Placental Blood Flow

Diffusion Tensor Magnetic Resonance Imaging (MRI)
Placenta MRI01.jpg



This is a third trimester placenta (GA 35 weeks + 6 days) showing the mean diffusivity maps for three slices of a single placental diffusion-weighted MRI scan.[1]


  • Red and black outline the uterine wall and placenta ROIs respectively.
  • Colour represents mean diffusivity in mm2 s-1 (note that the scale is a factor of 10 higher for the b = 4 40 s mm-2 maps).



MRI Diffusion tensor imaging (DTI) techniques provide information on the microstructural processes and has also been used to study brain development. Note that clinically, Doppler ultrasound has also been used to measure placental blood flow.

Human Villi Timeline

Detailed overview of villi development.

Placenta Villi Timeline
Fertilization Age

(weeks)

Gestational Age

(weeks)

Vessel Lumen Diameter

(range in microns)

Features
3 to 4 5 and 6 10 - 15
  • complex network of cords and vessels with redundant connections
  • network comprises mainly cords already connected together
  • vessels and cords are connected to each other without any interruptions
  • chorionic villus dominated by this network of vascular elements
  • vessels and cords (centrally and peripherally) contact overlying trophoblastic layer
5 to 6 7 and 8 10 - 26
  • villi dominated by capillary network of vessels and cords
  • capillary network contains more vessels than cords
  • chorionic villus tip - regular small branched off (mesenchymal) chorionic villi are present containing CD31 positive cells
7 to 8 9 and 10 60 - 75 two central vessels

26 - 34 capillary network

  • villi have two large centrally located vessels
  • surrounded and connected to a peripheral capillary network
  • capillary network contains vessels with a lumen in tight contact with overlying trophoblastic layer
  • villous projections also contain blind ending capillary sprouts
9 to 10 11 and 12 70 - 90 two central vessels

26 - 34 capillary network

  • immature intermediate villi characterized by two large vessels surrounded by a capillary network
  • capillary network has few cords
  • blind ending capillary sprouts off the capillary network
Term Terminal villi
  • have an extensive surface area >10 m2
  • small calibre (40 – 100 µm)
Table data[2] Paper uses clinical gestational age (GA) table corrected also for post-conception (fertilization) age.

Historic Images

Decidua and villi location Chorionic villi
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References

  1. 1.0 1.1 Slator PJ, Hutter J, McCabe L, Gomes ADS, Price AN, Panagiotaki E, Rutherford MA, Hajnal JV & Alexander DC. (2018). Placenta microstructure and microcirculation imaging with diffusion MRI. Magn Reson Med , 80, 756-766. PMID: 29230859 DOI.
  2. Lisman BA, van den Hoff MJ, Boer K, Bleker OP, van Groningen K & Exalto N. (2007). The architecture of first trimester chorionic villous vascularization: a confocal laser scanning microscopical study. Hum. Reprod. , 22, 2254-60. PMID: 17545656 DOI.


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Practical 14: Implantation and Early Placentation | Villi Development | Maternal Decidua | Cord Development | Placental Functions | Diagnostic Techniques | Abnormalities