Chorionic villi

They are an essential element in pregnancy from a histomorphologic perspective, and are, by definition, a product of conception. Branches of the umbilical arteries carry embryonic blood to the villi. After circulating through the capillaries of the villi, blood returns to the embryo through the umbilical vein. Thus, villi are part of the border between maternal and fetal blood during pregnancy.

Structure

Villi can also be classified by their relations:

• Floating villi float freely in the intervillous space. They exhibit a bi-layered epithelium consisting of cytotrophoblasts with overlaying syncytium (syncytiotrophoblast).
• Anchoring (stem) villi stabilize the mechanical integrity of the placental-maternal interface.

Development

The chorion undergoes rapid proliferation and forms numerous processes, the chorionic villi, which invade and destroy the uterine decidua and at the same time absorb from it nutritive materials for the growth of the embryo. They undergo several stages, depending on their composition.

Until about the end of the second month of pregnancy, the villi cover the entire chorion, and are almost uniform in size—but after then, they develop unequally.

Microanatomy

The chorionic villi form the principal exchange surface between the maternal and fetal circulations. Maternal blood flows through the intervillous space and directly bathes the external surface of the villi, while fetal blood remains within capillaries in the villous cores. The two circulations therefore normally remain anatomically separate.

The surface of each villus is formed by the syncytiotrophoblast, a continuous, terminally differentiated, multinucleated epithelium without lateral cell boundaries. Its maternal-facing surface bears numerous microvilli that increase the area available for exchange. Beneath it are individual mononuclear villous cytotrophoblasts, which serve as progenitor cells and fuse with the overlying syncytiotrophoblast. Cytotrophoblasts form a conspicuous, nearly continuous layer early in pregnancy but become sparse and discontinuous as gestation advances.

The villous core consists of fetal connective tissue containing capillaries, fibroblasts and fetal macrophages known as Hofbauer cells. Near term, many fetal capillaries are positioned immediately beneath attenuated areas of syncytiotrophoblast. These thin regions, termed vasculosyncytial membranes, minimize the diffusion distance between maternal and fetal blood. The exchange barrier at these sites consists principally of syncytiotrophoblast, closely approximated basement membranes, and fetal capillary endothelium.

Syncytial knots are localized aggregates of syncytiotrophoblastic nuclei protruding from the villous surface. They become more frequent with advancing gestational age and are therefore commonly encountered in mature term placentas. Their presence alone is physiological; only a diffuse or excessive increase relative to gestational age may indicate abnormal villous maturation or maternal vascular malperfusion.