Ultrastructure of human amnion and amniotic plaques of normal pregnancy

The fine structure of amniotic and amniotic-plaque epithelia has been studied from normal term pregnancies. The columnar/cuboidal amniotic epithelial cells usually have apical or central nuclei, some free ribosomes, patches of granular endoplasmic reticulum, juxtanuclear Golgi complexes, rod-shaped mitochondria, lipid droplets and some glycogen granules. They have short, blunt microvilli which frequently branch and bathe in the amniotic fluid. The lateral plasma membranes enclose tortuous intercellular spaces which are always interrupted by variously folded processes and desmosomes. The epithelial cells rest on a basal lamina and exhibit highly folded basal processes. The amniotic epithelial cells are neither distinctly Golgi and fibrillar types nor "light" and "dark" in appearance. Amnion from near the umbilical cord contains many microscopic and several large plaques. Similar structures are not found on the reflected amnion. The microscopic plaques are whitish and translucent, whereas the large ones are opaque. The large plaques vary between 1-3 mm in diameter, and are over 15 cell layers thick. Each large plaque has a main central region and edges continuous with either the microscopic plaque or the simple amniotic epithelium. The main region shows four zones, namely, stratum basale, stratum spinosum, stratum granulosum and stratum corneum. Such zones are not distinct at the edges. The fine structure of basal cells compares with the amniotic epithelial cells, but the cells of spinosum and granulosum layers possess variable amounts of tonofibrils, keratohyalin granules, free ribosomes and other cytoplasmic organelles and inclusions. The corneum cells are keratinized and are frequently separated by intercellular spaces. They slough into the amniotic cavity singly or as a sheet, and contribute towards the composition of the amniotic fluid. The plaques are of amniotic origin, and are not formed by adhesion of either squamous cells or fetal skin cells (masses of keratinized squames). The present observations suggest that the occurrence of amniotic plaques is normal. The presence of plaques may not be necessarily associated with fetal abnormality. However, increase in numbers of plaques may be caused by conditions of fluid imbalance. The homology and significance of plaques in eutherian mammals have been discussed.