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Study of Number of Cotyledons of Placenta in Different Gestational Age Groups of Healthy Pregnant Mother of Bangladesh

Received: 31 July 2024     Accepted: 21 August 2024     Published: 30 August 2024
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Abstract

Introduction: The placenta has drawn attention as an important indicator of intrauterine condition of fetus and maternal diseases. The study of number of cotyledons of placenta in different gestational age groups of healthy pregnant mother of Bangladesh is cross sectional descriptive study. Aim of the study: The aim of the study was to study the variation of number of cotyledons of placenta in deferent state of gestational ages of healthy pregnant mother. Methods: This cross sectional descriptive study was conducted in the Department of Anatomy, Mymensingh Medical College, Mymensingh, from January 2018 to December 2018. This study was performed on 80 human placentae. Result: The mean (± SD) number of cotyledon of the placenta was 18.56 (±2.15) in group A, 21.21 (±3.11) in group B and 23.75 (±3.45) in group C. The mean number of cotyledon of the placenta was maximum in group C (23.75) and was minimum in group A (18.56). It was also observed that the mean number of cotyledon of the placenta increased with gestational age. The mean difference of the number of placental cotyledons between groups A and C was statistically moderately significant (p < 0.05) but between A and B and B and C was statistically non-significant (p > 0.05). Conclusion: The placental examination becomes important as it will help in understanding the specific etiologies of adverse outcome. This study has shown that the mean number of cotyledon of the placenta increased with gestational age.

Published in American Journal of Health Research (Volume 12, Issue 4)
DOI 10.11648/j.ajhr.20241204.15
Page(s) 104-109
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Placenta, Cotyledons, Gestational Age, Healthy Pregnant Mother

1. Introduction
The placenta in Latin means cake that is floppy mass. Placenta is a vital organ for fetal development, derived from both fetal and maternal tissue, the maternal portion being the decidua basalis and fetal portion is chorion-frondosum . Placenta is a mirror which reflects intrauterine status of the fetus . Placenta is said to be a diary of intrauterine life . Only eutherian mammals possess placenta. The human placenta is discoid, because of its shape; haemochorial, because of direct contact of the chorion with the maternal blood and decidua, because some maternal tissue is shed at parturition. The placenta is attached to the uterine wall and establishes connection between the mother and fetus through the umbilical cord. The fact that maternal and fetal tissues come in direct contact without rejection suggest immunological acceptance of the fetal graft by the mother. The placenta at term is almost a circular disc with a diameter of 15-20 cm and thickness of about 3 cm at its center. It presents two surfaces, fetal and maternal, and peripheral margin. The fetal surface is covered by the smooth and glistening amnion with the umbilical cord attached at or near its center. At term, about four-fifths of the placenta is of fetal origin. The maternal surface is rough and spongy. The maternal surface is mapped out into 15-20 somewhat convex polygonal areas known as lobes or cotyledons which are limited by fissures. Each fissure is occupied by the decidual septum which is derived from basal plate . At approximately 40 days after conception; the trophoblast has invaded approximately 40-60 spiral arteries, of which 12-15 may be called major arteries. The pulsatile arterial pressure of blood that spurts from each of these major vessels pushes the chorionic plate away from the decidua to form 12-15 “tents” or maternal cotyledons. The remaining 24-45 tapped arterioles form minor vascular units that become crowded between the larger units. As the chorionic plate is pushed away from the basal plate, the anchoring villi pull the maternal basal plate up into septa (columns of fibrous tissue that virtually surround the major cotyledons). Thus at the center of each maternal vascular unit there is 1 artery that terminates in a thin walled sac, but there are numerous maternal veins that open through the basal plate at random. The human placenta has no peripheral venous collecting system. Within each maternal vascular unit is the fetal vascular “tree” with the tertiary free-floating villi (the major area for physiologic exchange) acting as thousands of baffles that disperse the maternal bloodstream in many directions . In normal pregnancies, the wall of the spiral arteries is invaded by trophoblastic cells and transformed into large, tortuous channels that carry a large amount of blood to the intervillous space and are resistant to the effects of vasomotor agents. Trophoblastic invasion begins from 16-20 weeks of gestation causing destruction of the muscularis layer of spiral arteries land is completed by 24 weeks’ time. These physiologic changes are restricted in patients with preeclampsia . The maternal cotyledons, or lobes, of the placenta are on the maternal side of the surface . Each cotyledon is a perfusion chamber partly or wholly separated from adjacent chambers by a wall of connective tissue, which may be lined by trophoblast cells. One or more maternal spiral arteries jet blood into the chamber. The fetal cotyledons comprise one or more fetal villous trees, containing a fetal artery and a vein, that are suspended into the maternal cotyledon. The number of maternal cotyledons in the placenta is highly variable. What determines the number is unknown, though it may depend on events in early gestation .
2. Objective
The objective of this study is to derive indices describing the relationship of the number of cotyledons of placenta with advancing gestational age. We also aim to compare these indices with national and international parameter.
3. Methodology & Materials
This cross sectional descriptive study was performed on 80 human placentae. This study was conducted in the Department of Anatomy, Mymensingh Medical College, Mymensingh, from January 2018 to December 2018. The specimens were collected from the Department of Gynaecology and Obstetrics, Mymensingh Medical College Hospital (MMCH), by purposive sampling technique. These specimens were collected of gestational age at 28 weeks and above from healthy pregnant mother excluding the following criteria- below 28 weeks of gestation, antepartum haemorrhage, multiple pregnancies, pre-eclamptic toxaemia, eclampsia, Rh-incompatibility, retained placenta, diabetes mellitus and pregnancy induced hypertension. It was performed on 80 human placentas to find out the variation in number of cotyledons of placenta of healthy Bangladeshi mother in relation to different gestational age. All patients’ information regarding the exclusion criteria were collected from the hospital records of MMCH. Just after delivery of the placenta and umbilical cord, they were kept in a bucket containing 10% formol saline. After dissecting the umbilical cord, each placenta was allotted an identification number tagged with a piece of waxed cloth. The collected specimens were divided into 3 groups e.g. A, B, and C according to the gestational age, on the basis of maturation of baby such as group A pre-term 28–36 weeks, group B term 37–40 weeks, group C late term above 40 weeks (Table 1) for convenience of differentiating the variation of number of cotyledons of placenta at different gestational age. Each formalin fixed placenta was taken on both hands. Then gentle pressure was applied on the fetal surface. As a result, the cotyledons (Figure 1) on the maternal aspect become prominent. Then counting was started from the right upper end of the placenta going leftward and again turning to the right in a manner of loop. This counting procedure was repeated until the left lower end of the placenta was reached. The total number of cotyledons was recorded (Figure 2) . The number of cotyledons of placenta was recorded in the pre designed data sheet, analyzed by SPSS program.
Table 1. Gestational Age Grouping of Samples for Morphological Study (n=80).

Group

Gestational Age in week

Number of specimen

A

28 – 36

20

B

37 – 40

42

C

Above 40 weeks

18

Total

80

Figure 1. Photograph of the Cotyledons (C) of Placenta.
Figure 2. Photograph of Showing the Procedure of Counting of Number of Cotyledons of Placenta.
4. Result
The maximum number of cotyledon of the placenta was 24 in Group A, 29 in group B, 30 in Group C. The minimum number of cotyledon of the placenta was 16 in Group A, 17 in Group B and 17 in Group C. The mean (± SD) number of cotyledon of the placenta was 18.56 (±2.15) in group A, 21.21 (±3.11) in group B and 23.75 (±3.45) in group C. The mean number of cotyledon of the placenta was maximum in group C (23.75) and was minimum in group A (18.56). It was also observed that the mean number of cotyledon of the placenta increased with gestational age. The mean difference of the number of placental cotyledons between groups A and C was statistically moderately significant (p < 0.05) but between A and B and B and C was statistically non-significant (p > 0.05). Above findings are shown in the table 2, table 3 and figure 3.
Table 2. Number of Cotyledons of Placenta in Different Gestational Age Groups.

Gestational Age Group

Number of Specimen (n = 80)

Number of Cotyledons Mean±SD (Minimum – Maximum)

A (28 to 36 weeks)

18

18.56±2.15 (16 – 24)

B (37 to 40 weeks)

42

21.21±3.11 (17 – 29)

C (Above 40 weeks)

20

23.75±3.45 (17 – 30)

Table 3. Comparison of number of cotyledons of placenta among the gestational age groups.

Comparison between gestational age groups

Mean Difference

Standard Error of Difference

t

p

Level of significance

A & B

-2.65873

0.69781

-2.01

0.05

Non-significant

B & C

-2.53571

0.90811

-0.429

0.67

Non-significant

A & C

5.19444

0.92219

3.325

0.002

Moderately significant

Figure 3. Bar Diagram Showing the Number of Cotyledons of Placenta in Different Gestational Age Groups.
5. Discussion
The maximum number of cotyledons of the placenta was 24 in Group A, 29 in group B, 30 in group C. The minimum number of cotyledons of the placenta was 16 in group A, 17 in group B and 17 in group C. The mean (± SD) number of cotyledons of the placenta was 18.56 (±2.15) in group A, 21.21 (±3.11) in group B and 23.75 (±3.45) in group C. The mean number of cotyledons of the placenta was maximum in group C (23.75) and was minimum in group A (18.56). It was also observed that the mean number of cotyledons of the placenta increased with age. The mean difference of the placental cotyledons between groups A and C was statistically moderately significant (p < 0.05) but A and B, B and C was statistically non-significant (p > 0.05).
Gunasegaran (2017) described that the average number of cotyledons of placenta at term was 15 – 20 . Sadler (2015) elaborated that the number of cotyledons of placenta at term was about 15 to 20 . Datta (2012) elaborated that the maternal surface of placenta was rough and irregular and was mapped into 15 to 30 polygonal areas known as the cotyledons which are limited by fissures . Dutta (2011) stated that the average number of cotyledons of the placenta at term was about 15 to 29 . Raghunath, Vijayalakshmi & Shenoy (2011) showed the average number of cotyledons was 18 and that study revealed a paucity of cotyledons in cases of pregnancy induced hypertension, low birth weight and prematurity . Begum (2010) made a study on 60 human placentas and revealed that the mean numbers of cotyledons of placenta were calculated as 16.90 in between 28 to 32 weeks, 19.31 in between 33 to 37 weeks and 20.24 in between 38 to above weeks of gestation . Kishwara (2009) stated that the mean±SD number of cotyledon in group A (n = 30, normal pregnant women) and group B (n = 30, pregnancy complicated by pre-eclampsia) was 15.77±2.80 and 14.30±2.47 respectively. Statistical analysis between group A and B was significant at P<0.05 . Majumder (2007) made a study on placenta of normal and hypertensive pregnancies and found that the mean±SD number of cotyledons per placenta in case of control group was 17±2 and hypertensive group was 16±2 . Sultana (2005) performed a study on 45 placentas (20 control group and 25 eclamptic mothers) and found the mean±SD number of cotyledons of placenta in eclampsia was 15.5±1.75 ranged 14 to 25. Whereas in control group the number of cotyledons of placenta ranged from 12 to 18 with a mean±SD number of cotyledons was 14.24 ± 1.66 . Dawn (2004) stated that the maternal surface showed dull red 15-20 lobes or maternal cotyledons which were separated by sulci. Each sulcus corresponds to decidual septum . Sing (2014) mention that the number of lobes generally varied from 15 to 20 . Kaufmann (1985) showed that the surface of the basal plate was incised by the placenta septa, which form deep clefts that subdivide the basal plate into 10–30 regions called maternal lobes or cotyledons. Histologically each maternal lobe was occupied by one to four fetal lobules . Boyd & Hamilton (1970) viewed that the number of slightly elevated convex areas called lobes (or if small, lobules) varied from 10 to 38. These lobes are separated, albeit incompletely, by grooves of variable depth, the placental septa. The lobes are also referred to as cotyledons .
Findings of the present study in all group was more or less similar to the findings of above mentioned authors.
6. Limitations of the Study
The study was conducted in a single hospital with a small sample size. So, the results may not represent the whole community.
7. Conclusion
The careful attention to sample collection, storage and processing are critical in order to reduce the number of variable that can influence data derived from the human placenta. This study considered the important factors that we have experienced during the course of our research. The placental examination becomes important as it will help in understanding the specific etiologies of adverse outcome. This study has shown that the mean number of cotyledon of the placenta increased with gestational age.
Abbreviations

MMCH

Mymensingh Medical College Hospital

Acknowledgments
I would like to express my sincere gratitude for the invaluable support and cooperation provided by the staff, participants, and my co-authors/colleagues who contributed to this study.
Author Contributions
Sanjib Kumar Bose: Conceptualization, Data curation, Methodology, Writing – original draft, Review & editing
Labiba Jabeen: Data curation, Investigation, Visualization
Rafuja Afrin Shanto: Investigation, Software, Resources
Afsana Khanam: Supervision, Validation, Visualization
Rawshon Ara Naznin: Funding acquisition, Project administration, Formal Analysis
Sharmin Akter Sumi: Project administration, Validation, Review & editing
Ethical Approval
The study was approved by the Institutional Ethics Committee.
Funding
No funding sources.
Conflicts of Interest
The authors declare no conflicts of interest.
References
[1] Harold Fox, Neil J (2007), Pathology of the placenta, 3rd ed. Philadelphia: Elsevier Saunders.
[2] Udainia A, Bhagwat SS, Mehta CD 2004, ‘Relation between placental surface area, infarction and fetal distress in pregnancy induced hypertension with its clinical relevance’, Journal of Anatomical Society of India, vol. 53, no. 1, pp. 27-30.
[3] Kurdukar MD, Deshpande NM, Shete SS, Zawar MP 2007, ‘Placenta in PIH’, Indian Journal of Pathology and Microbiology, vol. 50, no. 3, pp. 493-497.
[4] Dutta DC 2015, DC Dutta’s textbook of obstetrics including perinatology and contraception, 8th edn, Jaypee Brothers Medical Publishers Pvt. Ltd, New Delhi, pp. 28–45.
[5] Decherney AH, Nathan L, Laufer N, Roman AS 2018, Current diagnosis & treatment obstetrics & gynaecology, 12th edn, McGraw Hill Education, New York, pp. 108, 171–8.
[6] Robertson WB, Brosens I, Dixon HG 1967, ‘The pathological response of the vessels of the placental bed to hypertensive pregnancy’, J. Pathol. Bacteriol. Vol. 93, pp. 581-92.
[7] Benirschke K, Kaufman P, Baergen R 2000, The pathology of the human placenta, 4th edn, Springer, New York, pp. 12–4.
[8] Barker D, Osmond C, Grant S, Thornburg KL, Cooper C, Ring S et al. 2013, ‘Maternal cotyledons at birth predict blood pressure in childhood’, Placenta, Elsevier Ltd. Vol. 34, no. 2013, pp. 672-675.
[9] Kishwara S, Ara S, Rayhan KA, Begum M 2009, ‘Morphological changes of placenta in preeclampsia’, Bangladesh Journal of Anatomy, vol. 7, no. 2, pp. 49–54.
[10] Gunasegaran JP 2017, Textbook of histology, 3rd edn., Reed Elsevier India Pvt. Ltd., New Delhi, pp. 334 – 6.
[11] Sadler TW 2015, Langman’s medical embryology, 13th edn, Wolters Kluwer, Philadelphia, pp. 48, 109–19, 394.
[12] Datta AK 2014, Essentials of human embryology, 6th edn, Current Books International, Kolkata, pp. 21, 35, 57–68.
[13] Ragunath G, Vijayalakshmi Shenoy, V 2011, ‘A study of morphology & morphometry of the human placenta and its clinical relevance in a population in Tamil Nadu’, J. of clinical and diagnostic research, vol. 5, no. 2, pp. 282–6.
[14] Begum T 2010, Gross and histomorphological study of human placenta and umbilical cord in different gestational age group in Bangladesh, thesis, Mymensingh Medical College, Mymensingh.
[15] Majumdar S, Dasgupta H, Bhattacharya K, Bhattacharya A 2005, ‘A study of placenta in normal and hypertensive pregnancies’, Journal of the Anatomical Society of India, vol. 54, no. 2, pp. 1–9.
[16] Sultana S 2005, A comparative study of gross and histomorphological changes of human placenta and umbilical cord in normal and eclamptic pregnancy, thesis, Mymensingh Medical College, Mymensingh.
[17] Dawn CS 2004, Textbook of obstetrics and neonatology, 16th edn, Pratap Medical Publishers, Kolkata, pp. 46–50.
[18] Singh V 2017, Textbook of clinical embryology, 2nd edn, Elsevier Health Sciences, India, pp. 77–8.
[19] Kaufmann P 1985, ‘Basic morphology of the fetal and maternal circuits in the human placenta’, Contrib Gynecol Obstet, vol. 13, no. 1, pp. 5–17.
[20] Boyd JD, Hamilton WJ 1970, The human placenta, 1st edn, Heffer, England, pp. 143, 264.
Cite This Article
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    Bose, S. K., Jabeen, L., Shanto, R. A., Khanam, A., Naznin, R. A., et al. (2024). Study of Number of Cotyledons of Placenta in Different Gestational Age Groups of Healthy Pregnant Mother of Bangladesh. American Journal of Health Research, 12(4), 104-109. https://doi.org/10.11648/j.ajhr.20241204.15

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    Bose, S. K.; Jabeen, L.; Shanto, R. A.; Khanam, A.; Naznin, R. A., et al. Study of Number of Cotyledons of Placenta in Different Gestational Age Groups of Healthy Pregnant Mother of Bangladesh. Am. J. Health Res. 2024, 12(4), 104-109. doi: 10.11648/j.ajhr.20241204.15

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    AMA Style

    Bose SK, Jabeen L, Shanto RA, Khanam A, Naznin RA, et al. Study of Number of Cotyledons of Placenta in Different Gestational Age Groups of Healthy Pregnant Mother of Bangladesh. Am J Health Res. 2024;12(4):104-109. doi: 10.11648/j.ajhr.20241204.15

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  • @article{10.11648/j.ajhr.20241204.15,
      author = {Sanjib Kumar Bose and Labiba Jabeen and Rafuja Afrin Shanto and Afsana Khanam and Rawshon Ara Naznin and Sharmin Akter Sumi},
      title = {Study of Number of Cotyledons of Placenta in Different Gestational Age Groups of Healthy Pregnant Mother of Bangladesh
    },
      journal = {American Journal of Health Research},
      volume = {12},
      number = {4},
      pages = {104-109},
      doi = {10.11648/j.ajhr.20241204.15},
      url = {https://doi.org/10.11648/j.ajhr.20241204.15},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20241204.15},
      abstract = {Introduction: The placenta has drawn attention as an important indicator of intrauterine condition of fetus and maternal diseases. The study of number of cotyledons of placenta in different gestational age groups of healthy pregnant mother of Bangladesh is cross sectional descriptive study. Aim of the study: The aim of the study was to study the variation of number of cotyledons of placenta in deferent state of gestational ages of healthy pregnant mother. Methods: This cross sectional descriptive study was conducted in the Department of Anatomy, Mymensingh Medical College, Mymensingh, from January 2018 to December 2018. This study was performed on 80 human placentae. Result: The mean (± SD) number of cotyledon of the placenta was 18.56 (±2.15) in group A, 21.21 (±3.11) in group B and 23.75 (±3.45) in group C. The mean number of cotyledon of the placenta was maximum in group C (23.75) and was minimum in group A (18.56). It was also observed that the mean number of cotyledon of the placenta increased with gestational age. The mean difference of the number of placental cotyledons between groups A and C was statistically moderately significant (p  0.05). Conclusion: The placental examination becomes important as it will help in understanding the specific etiologies of adverse outcome. This study has shown that the mean number of cotyledon of the placenta increased with gestational age.
    },
     year = {2024}
    }
    

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    T1  - Study of Number of Cotyledons of Placenta in Different Gestational Age Groups of Healthy Pregnant Mother of Bangladesh
    
    AU  - Sanjib Kumar Bose
    AU  - Labiba Jabeen
    AU  - Rafuja Afrin Shanto
    AU  - Afsana Khanam
    AU  - Rawshon Ara Naznin
    AU  - Sharmin Akter Sumi
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    T2  - American Journal of Health Research
    JF  - American Journal of Health Research
    JO  - American Journal of Health Research
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    EP  - 109
    PB  - Science Publishing Group
    SN  - 2330-8796
    UR  - https://doi.org/10.11648/j.ajhr.20241204.15
    AB  - Introduction: The placenta has drawn attention as an important indicator of intrauterine condition of fetus and maternal diseases. The study of number of cotyledons of placenta in different gestational age groups of healthy pregnant mother of Bangladesh is cross sectional descriptive study. Aim of the study: The aim of the study was to study the variation of number of cotyledons of placenta in deferent state of gestational ages of healthy pregnant mother. Methods: This cross sectional descriptive study was conducted in the Department of Anatomy, Mymensingh Medical College, Mymensingh, from January 2018 to December 2018. This study was performed on 80 human placentae. Result: The mean (± SD) number of cotyledon of the placenta was 18.56 (±2.15) in group A, 21.21 (±3.11) in group B and 23.75 (±3.45) in group C. The mean number of cotyledon of the placenta was maximum in group C (23.75) and was minimum in group A (18.56). It was also observed that the mean number of cotyledon of the placenta increased with gestational age. The mean difference of the number of placental cotyledons between groups A and C was statistically moderately significant (p  0.05). Conclusion: The placental examination becomes important as it will help in understanding the specific etiologies of adverse outcome. This study has shown that the mean number of cotyledon of the placenta increased with gestational age.
    
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