Genital Integrity Awareness Week 2018


Registration and Sponsorship also at:

Genital Integrity Awareness Week 2018 takes place March 28-April 3 and we need your help to make this year's Washington D.C. event a powerful one! As advocates travel to D.C. to participate, and floods of tourists the world over gather in D.C. for the height of the annual Cherry Blossom Festival, we strive to have intact materials on hand to reach a large number of people at our nation's capitol. These are items that parents and professionals, young and old, from all backgrounds and locations in life will want to take home with them for further review. Making this happen takes a significant amount of planning, organization, and resources on the part of many people, and it also takes financial support.


If you have never been to GIAW in D.C., here's a quick snapshot of a day's event:

We are standing with a dozen others in front of the U.S. Capitol, with giant pro-intact signs that draw people in, and can be seen from the streets all around the Capitol's bus route. A group of 200 senior high students come up, interested in what we have to share. Teachers shuffle students along for group photos, and we have mere minutes to plant seeds of information, respond to quick questions, and get interesting materials into hands of these future parents -- materials they eagerly take with them because their curiosity is spiked! Students grab things to take back on the bus (bracelets, cards, stickers, buttons), and look things up on their phone on their way to their next destination... This happens every single hour. Multiple times a day. Sun-up to sun-down. The need is great for GIAW. The impact is monumental. And we need your support in this important effort.

We will also be hosting two booths with free materials on the West Lawn:

The Men's Health table includes a variety of restoration devices for men to hold, learn about, and explore their options; information on adult sexual health, and the impact that genital cutting and restoration has on adult men and their partners.

The Baby Health table includes instruments used in infant circumcision, information on the purposes of the foreskin, intact care materials, and resources for parents to pass on to friends and their home care provider. This table also has items for our young visitors because families who stop to talk often have children who want things of their own (child sized bracelets, stickers, bubbles, coloring pages, etc.).


Business Sponsors: Please include a note with your GIAW contribution and your organization name/URL that you'd like to have linked (website, Facebook page, etc.). With your support of $100 or more, we invite you to provide an image/logo or coupon to be shared with the community at large. Email this to SavingSons@gmail.com, or we will create one for you. Your business or group will be featured at at the main GIAW website, at DrMomma.org, and at SavingSons.org, as well as with social media circles of Peaceful ParentingSaving Our Sons, The Intact NetworkGIAW, Intact State Chapters, and be permanently linked at Genital Integrity Awareness Week and found on Google.

GIAW Sponsors:  2018  |  2017  |  2016  |  2015  |  2014  |  2013

Individuals: If you are sponsoring in honor of someone, we invite you to include a message with your gift and it will be included below. Individual sponsors will be listed by first name, last initial only for privacy.

Supporters: All supporting GIAW 2018 with your gift of any amount will receive commemorative vinyl decals with additional intact awareness stickers to plant in your area, if a mailing address is provided. For GIAW sponsors giving $25 or more, a registration pack (below) will be shipped, or can be picked up in DC.

Support on Etsy, or by PayPal, or by mail (below). Include a note with your address and selection choices, or email this to SavingSons@gmail.com

Registration and Thank You packs include: 
• 3 GIAW 2018 / Child Abuse Prevention Month vinyl decal stickers (3x3 inches)
• 1 GIAW 2018 commemorative button
• 1 #i2 lanyard of your choice (4 options to view here: Navy, Ocean, Violet, Hot Pink)
• 1 #i2 bracelet of your choice (view options)
• 25 set of stickers or cards of your choice (see sticker options here | see card options here)
* If attending GIAW and picking up in DC: #i2 water bottle 


On behalf of the next generation of babies to be born, and the adults they will become -
Thank you for supporting GIAW!




By Mail:
Saving Our Sons
P.O. Box 1302
Virginia Beach, VA 23451

PayPal Friends/Family To:
(no PayPal fee withdrawn)
SavingSons@gmail.com


GIAW 2018 Organization Sponsors
Please visit and support these intact-friendly businesses and groups!


Intact Australia
Homepage | Facebook | Intact Australia & New Zealand Group

Intact Connecticut
Facebook | Intact Connecticut Group

Made For You: By Anu
custom crochet for all your home and family needs
Contact | Facebook | Etsy

Babies Happen ~ Lindsey Ward
BabiesHappen.com | Facebook
• Birth and Postpartum Doula
• Stillbirthday Certified Birth and Bereavement Doula
• Placenta Preparation and Encapsulation Specialist
Serving the Virginia areas of Fauquier, Culpeper, Prince William, Stafford, Fairfax, Loudoun, and Clarke counties, Winchester, Manassas, Fairfax City, and Fredericksburg.

Intact Virginia
Facebook | Intact Virginia Group

Intact New Hampshire
Facebook | Intact New Hampshire Group

Peaceful Beginnings from Rosemary
Rosemary Romberg, author of Circumcision: The Painful Dilemma

NORM: National Organization of Restoring Men
NORM.org | Facebook | Twitter

Peaceful Pendants by Michelle
handcrafted jewelry of gemstone and clay
Contact via Facebook


Individual GIAW 2018 Supporters
Thank you greatly for your generosity and support!


✭ Tresyang D.
in memoriam of Lucila 

✭ Max R., Intact Australia

✭ Brian B., Intact Connecticut

✭ Michael Vier
"Thank you for all your hard work! If I were closer to D.C. I would be there."

✭ Janet M. - provided one of the traveling billboards for GIAW and beyond

✭ Amy E. - provided one of the traveling billboards for GIAW and beyond
"I wish I could attend these events! Maybe in the future.
Until then, may this sign go in my place.♥ "

✭ Ashley M.

✭ Daniel A.

✭ Robert J.

✭ Rodney D.

✭ Jennifer & Drew C., Intact Maryland

✭ Christina H., Intact Virginia

✭ Anu M., Intact Pennsylvania

✭ Michael M., Intact New Hampshire

✭ Eric S. and Holly M., Intact Houston

✭ David G.

✭ Jamie B., Intact Alabama

✭ Brittany W., Intact Nebraska

✭ Nancy J., Intact New Mexico

✭ Janice W.

✭ Leslie R.

✭ Alissa L.

✭ Cheryl S.

✭ James W.

✭ Ginger M.

✭ Melissa M.

✭ Rebekah J.

✭ Melissa D., Intact Michigan

✭ Danelle D., Intact Virginia

✭ Michelle M., Intact Rhode Island

✭ Teresa W.

✭ Austin H.

✭ Brian T.

✭ Melissa L.

✭ Cynthia M.

✭ Natalie W., Knoxville Wildtree | Facebook

✭ Danielle J., Intact Indiana

✭ Elana J., Intact Nebraska

✭ Mary L.

✭ Wren E.

✭ Jennifer R.

✭ Bret F. - provided all of Wednesday's #i2 GIAW Flags

✭ Samantha P. and Bill W. - provided all of Thursday's #i2 GIAW Flags

✭ Brittany W., Intact Nebraska - provided all of Friday's #i2 GIAW Flags

✭ Robbie J. & Holly M, Intact Houston - provided all of Saturday's #i2 GIAW Flags

✭ Maram H. & Robert B.- provided all of the GIAW MARCH flags needed for the Capitol to the White House!

✭ Robert J. - provided all of Sunday's #i2 GIAW Flags
"Let's make being intact the American Way!" -Robert

✭ Vivi M., Intact Cleveland - provided all of Monday's #i2 GIAW Flags

✭ Samantha A. - provided all of Tuesday's #i2 GIAW Flags





Allocation of GIAW 2018 Funds
(materials can only be ordered in the quantities we have funding for by March 28 - please help us reach our needed goal!) 

$800 new signage that will continue to be used throughout the year for rallies, expos, events, and future GIAW dates. We especially need a few of these to be new signs for kids to hold as ours are several years old and we have approximately 24 children attending GIAW with their families for most of the week this year. Children love to participate alongside their parents. 

$800 printed materials to give away at GIAW 2018. This week-long event functions as an expo, with booths of items that are entirely free for the public, meeting with people across the West Lawn from sun-up to sun-down each day for 7 days. Having enough professional literature on hand is crucial to GIAW's success. 

$300 Easter egg hunt on the West Lawn for children - we would like to ensure all children visiting the US Capitol can participate and that there will be enough to go around; we will also have child-sized advocacy bracelets, and a variety of #i2 themed stickers for children (Pokemon, Wonder Woman, and Intactosaurus). 

$200 flags for passing out along the march route, and giving away at the White House. Each flag will have intact information attached to it. These are *very* popular in DC and frequently chaperone groups who will not allow students to take other materials from GIAW leaders will allow them to accept and take home flags (getting intact material into their hands). 

$600 bracelets and buttons to give away throughout the week. These items are key in that they are the most requested items, especially by students - tomorrow's parents. We need materials that young people desire to hold onto, take home with them, and spark interest enough to check out the websites/share with friends. Awareness is key!

$60 two new full-color, full-page books of intact celebrities - one for the men's health booth, and one for the front West Wall of the Capitol where the most conversations take place.

$40 replacement plastibell, gomco, and mogen clamps for educational use (previously taken from an expo booth) 

$200 demonstration glans/foreskin models (in two skin shades) to highlight the normal adhesion of the foreskin to the glans/shaft in infancy, and the probing, severing, and cutting that must take place for infant circumcision to be achieved. These models are highly useful in one-on-one or small group education at expo booths.

If GIAW funds are raised beyond those needed, we will have intact material packs available to go home with people (U.S. advocates, leaders, teachers, and the international educators who visit the Capitol during GIAW and often ask for things to take back with them).  





Lanyard Options to Select From:
• Royal Blue: Genital Autonomy is a Human Right
• Violet: All Babies are Born Perfect
• Hot Pink: Foreskin is Fun & Functional
• Deep Aqua Blue: Boys are Not Born Broken

GIAW 2018 Buttons





*******

Words of Wisdom and Encouragement


"If for a while the harder you try, the harder it gets, take heart; so it has been with the best people who have ever lived." -Jeffrey R. Holland 

Be brave, my heart. <3 Have courage, my soul.

If you feel you don't fit in, in this world, it's because you're here to build a better one.

"Even after all this time, the sun never says to the earth, 'You owe me.'
Look what happens with a love like that - it lights the whole sky." -Hafiz, The Gift

May you always see the light, even in the darkness.

Surround yourself with people who love you for being you.

May the voices that cheer you on, always be louder than those that don't.

Wrong is wrong, even if everyone is doing it.
Right is right, even if only YOU are doing it.

Today, a caterpillar. Tomorrow, a butterfly.
Don't lose hope. You never know what tomorrow will bring.

"Let them judge you. Let them misunderstand you. Let them gossip about you. Their opinions aren't your problem. You stay kind, committed to LOVE, and free in your authenticity. No matter what they do or say, don't you dare doubt your worth or the beauty of your truth. Just keep on SHINING like you do." -Scott Stabile

"Hate has caused a lot of problems in this world, but it has not solved one yet." -Maya Angelou

"The coolest people I've ever met have the most colorful pasts. They've lived lives of risk, made bad choices, learned lessons, explored, and they're not afraid of being real. Tattered tapestries woven of similar threads, they're my kind of people - my favorite shades of crazy." -Stephen L. Lizotte

Self-help
How to stop time: kiss.
How to travel in time: read.
How to escape time: music.
How to feel time: write.
How to release time: breathe.

What's the greatest lesson a woman should learn? That since Day One she's already had everything she needs within herself. It's the world that convinced her she did not. -Rupi Kaur

Everyone wants to be the sun to lighten up someone's life; but why not be the moon to brighten in the darkest hour...

Now and then it's good to pause in our pursuit of happiness and just be happy.

"The best thing you can do as a father is make sure they see how you love their mother." -Matthew McConaughey

Sometimes it's okay if the only thing you did today was breathe.

People inspire you or they drain you. Pick them wisely. -Hans F. Hansen











Loveness in the Brokenness

By Kathleen Fleming, Majestic Unicorn



This was my hallway last Wednesday.

Broken. Sharp. Treacherous.

This was my hallway. It was my son who did this.

Sometimes, often really, things break - irreparably. And it takes your breath away...straight away. It took my breath away when my son stormed into the bathroom, frustrated, angry, fed-up for his very own, very significant to him, reasons. And when he chose to SLAM the bathroom door, causing the heavy mirror mounted to the front to slip out of the hardware holding it in place and crash onto the floor - a million, BROKEN pieces were left reflecting the afternoon light.

I was quiet.

I surveyed the damage and took a deep breath.

Put the dog outside so he wouldn't cut his feet, put the cat in the basement for the same reason.

I walked into the backyard and felt the hot tears streaming down my face. It's amazing how alone you can feel as a single parent in moments like these. I realized how scared and disappointed I felt. Did this really just happen? Yes. This was real. And as I stood and considered whether or not this was an indication of his developing character, I heard his tears through the window above me, coming from inside the bathroom. His soul hurt. This was not what he expected either. Hello, Anger - I don't remember inviting you into my house. Scary. Terrified. Ashamed. Worried. Scared.

Deep breath, #MamaWarrior. Deep breath.

That small, fragile soul needs you right now. He needs your very best. Your biggest compassion. Your most gentle and firm mama love and reassurance. More deep breaths. Go Mama. Go. Go now. Go open the front door, tiptoe through the broken glass, hear him hearing you coming, watch the bathroom door crack open, see the face you love most in the world red with worry and wet with tears, his voice is suddenly so small: "Mama, I'll never do it again, I am SO sorry." More tears. More weeping. Such uncertainty on his sweet face.

Go Mama. Get him. Go now. Scoop him into your lap. Yup, you're crying too. Damn this was big. Hold him tight. Watch how he curls into a ball in your arms so quickly. See how eager he is to be loved by you. To be reassured by you. See how small he still is. See how fragile that spirit is.

I love you.
You are safe.
I am right here.

The worst part is over now. I've got you. I'm here. I love you. Go Mama. Tell him about Anger. Tell him now. Anger is a really powerful feeling. You have a right to your Anger. Anger burns hot. It can purify. It can also destroy. He nods. He feels it. He's met Anger now. There's a better way to show your big feelings. We'll work on it together...tomorrow.

I'm here to help you. You are safe. You are never alone in your anger. You are never alone in your fears. I'm here. We're here together.

Now we will clean together.

And we cleaned up the broken pieces. We swept and we vacuumed. It was quiet work. It was careful work. It was thoughtful work.

Sometimes things break. Sometimes we break them. It's not the breaking that matters, the how or why. What matters is how we choose to respond to the broken-ness. Does it kill us? Does it throw us into a downward spiral of blame and punishment? OR does it help us remember how to love deepest? Does it push us towards compassion and over the hurdle of "rightness" and "wrongness" into LOVENESS? Yes. LOVENESS.

Go Mama. Go now. Get that baby of yours. Teach that. Show that. Live that. It's called LOVENESS. Go. Now.

Mother Love by Lulu, United Arab Emirates | Find more art by Lulu at Deviant Art


Related Reading: 

About the author.
Read more from Fleming at Majestic Unicorn and find her on Facebook here.

Tackling Distress Tantrums with Brain Research
DrMomma.org/2010/01/tackling-distress-tantrums-with-brain.html

When Things Get Physical: Hitting, Throwing, Kicking, Biting
DrMomma.org/2013/11/when-things-get-physical-hitting.html

Love Matters
DrMomma.org/2018/02/love-matters.html

Why Spanking is Never Okay
DrMomma.org/2010/09/why-spanking-is-never-okay.html

Peaceful Parenting Group
FB.com/groups/ExplorePeacefulParenting




Love, that is to nurse


No safer place in the world,
No better place to rest.
No calmer harbour can be found,
Than that of Mother’s breast.

No poetry brings it justice,
No rhyme or ancient verse.
One word only can love describe,
Love, that is to nurse. 💛

via PD Photography
MUA: @theminkzbox
Tribal Art: @kustom_stuff

The Breastfeeding Group




The Placenta Does Not Age or Fail Post-Dates


"A review of the available evidence indicates that the placenta does not undergo a true aging change during pregnancy. There is, in fact, no logical reason for believing that the placenta, which is a fetal organ, should age while the other fetal organs do not: the situation in which an individual organ ages within an organism that is not aged is one which does not occur in any biological system. The persisting belief in placental aging has been based on a confusion between morphological maturation and differentiation and aging, a failure to appreciate the functional resources of the organ, and an uncritical acceptance of the overly facile concept of 'placental insufficiency' as a cause of increased perinatal mortality."

Related:

Happy Pills! One way to encapsulate on your own: http://www.DrMomma.org/2010/08/happy-pills-placenta-encapsulation.html 

Ode to My Placenta: http://www.DrMomma.org/2017/09/ode-to-my-placenta.html

The First Forty Days: The Essential Art of Nourishing the New Mother: https://amzn.to/2QtlEQg

The Fourth Trimester: A Postpartum Guide to Healing Your Body, Balancing Your Emotions, and Restoring Your Vitality: https://amzn.to/2Pys7nU

Chocolate Placenta Truffles: http://www.DrMomma.org/2012/04/chocolate-placenta-truffles.html 

Placenta - the Forgotten Chakra: https://amzn.to/2PxY0g0

Lotus Birth: http://www.DrMomma.org/2010/08/lotus-birth.html

Fish Can't See Water: The Need To Humanize Birth: http://www.DrMomma.org/2009/08/fish-cant-see-water-need-to-humanize.html

The Lie of the Estimated Due Date (EDD): http://www.DrMomma.org/2009/06/lie-of-estimated-due-date-edd-why-your.html

Why Pregnancy Due Dates are Inaccurate: http://www.DrMomma.org/2009/09/why-pregnancy-due-dates-are-inaccurate.html

Fetal Lungs Protein Release Triggers Labor to Begin: http://www.DrMomma.org/2008/01/fetal-lungs-protein-release-triggers.html

Trusting Birth: 43 Weeks of Faith: http://www.DrMomma.org/2013/09/trusting-birth-43-weeks-of-faith.html

Placenta keychain (fun gift for the birth advocate in your life): https://amzn.to/2PxBF2n

Plush placenta (education, awareness raising, fun): https://amzn.to/2LaegmY

_______

Fox, Harold. Aging of the placenta. Archives of Disease in Childhood - Fetal and Neonatal Edition 1997;77:F171-F175. Full text: http://fn.bmj.com/content/77/3/F171

It is widely believed that during the relatively short duration of a normal pregnancy the placenta progressively ages and is, at term, on the verge of a decline into morphological and physiological senescence.1-3 This belief is based on the apparent convergence of clinical, structural, and functional data, all of which have been taken, rather uncritically, as supporting this concept of the placenta as an aging organ with, all too often, no distinction being made between time related changes and true aging changes. I will review some of these concepts and consider whether the placenta truly undergoes an aging process. For the purposes of this review an aging change is considered to be one which is intrinsic, detrimental, and progressive and which results in an irreversible loss of functional capacity, an impaired ability to maintain homeostasis, and decreased ability to repair damage.

Morphological changes

The placenta is unusual in so far as its basic histological structure undergoes a considerable change throughout its lifespan. For some time it has been customary to describe the appearances of the placental villi in terms of their changing appearance as pregnancy progresses, comparing, for instance, typical first trimester villi with those in third trimester placentas. It has often been implied that this changing appearance is an aging process, but it is now recognized that this temporal variability in villous appearances reflects the continual development and branching of the villous tree (fig 1) In recent years the relation between the growth of the villous tree and the villous histological appearances has been formally codified5-8with identification of five types of villi (fig 2).


Figure 1 Diagrammatic representation of a peripheral villous tree, showing a large central stem villus: the lateral branches from this are the mature intermediate villi from which the terminal villi protrude.


Figure 2  Representation of the peripheral branches of a mature villous tree together with typical cross sections of the five villous types. The figures are reproduced from Haines & Taylor. Textbook of Obstetrical and Gynaecological Pathology. 4th Edn. 1995, by kind permission of Churchill Livingstone and Professor P Kaufmann.

1 Mesenchymal villi 

These represent a transient stage in placental development and they can differentiate into either mature or immature intermediate villi. They comprise the first generation of newly formed villi and are derived from trophoblastic sprouts by mesenchymal invasion and vascularisation. They are found mainly in the early stages of pregnancy but a few may still be found at term They have complete trophoblastic mantles with many cytotrophoblastic cells and regularly dispersed nuclei in the syncytiotrophoblast: their loose, immature-type stroma is abundant and contains a few Hobauer cells, together with poorly developed fetal capillaries.

2 Immature intermediate villi 

These are peripheral extensions of the stem villi and are the predominant form seen in immature placentas. These villi have a well preserved trophoblastic mantle in which cytotrophoblastic cells are numerous; the syncytial nuclei are evenly dispersed and there are no syncytial knots or vasculo-syncytial membranes. They have an abundant loose stroma that contains many Hofbauer cells: capillaries, arterioles, and venules are present.

3 Stem villi 

These comprise the primary stems which connect the villous tree to the chorionic plate, up to four generations of short thick branches and further generations of dichotomous branches. Their principal role is to serve as a scaffolding for the peripheral villous tree, and up to one third of the total volume of the villous tissue of the mature placenta is made up of this villous type, the proportion of such villi being highest in the central subchorial portion of the villous tree. Histologically, the stem villi have a compact stroma and contain either arteries and veins or arterioles and venules; superficially located capillaries may also be present.

4  Mature intermediate villi 

These are the peripheral ramifications of the villous stems from which most terminal villi directly arise. They are large (60–150 μm in diameter) and contain capillaries admixed with small arterioles and venules, the vessels being set in a very loose stroma which occupies more than half of the villous volume. The syncytiotrophoblast has a uniform structure, no knots or vasculo-syncytial membranes being present. Up to a quarter of the villi in a mature placenta are of this type.

5 Terminal villi 

These are the final ramifications of the villous tree and are grape-like outgrowths from mature intermediate villi. They contain capillaries, many of which are sinusoidally dilated to occupy most of the cross sectional diameter of the villus. The syncytiotrophoblast is thin and the syncytial nuclei are irregularly dispersed. Syncytial knots may be present and vasculo-syncytial membranes are commonly seen. These terminal villi begin to appear at about the 27th week of gestation and account for 30–40 per cent of the villous volume, 50 per cent of the villous surface area, and 60 per cent of villi seen in cross section at term.

The pattern of development of the villous tree is therefore as follows: During the early weeks of pregnancy all the villi are of the mesenchymal type. Between the 7th and 8th weeks mesenchymal villi begin to transform into immature intermediate villi and these subsequently transform into stem villi. Development of additional immature intermediate villi from mesenchymal villi gradually ceases at the end of the second trimester, but these immature intermediate villi continue to mature into stem villi and only a few persist to term as growth zones in the centres of the lobules. At the beginning of the third trimester mesenchymal villi stop transforming into immature intermediate villi and start transforming into mature intermediate villi. The latter serve as a framework for the terminal villi which begin to appear shortly afterwards and predominate at term.

This progressive elaboration of the villous tree results in a predominance of terminal villi in the mature placenta. Such villi have been conventionally classed as “third trimester villi” and a comparison of their structure with the predominant type of villi in the first trimester— immature intermediate villi—has led many to suggest that as pregnancy progresses the villous trophoblast becomes irregularly thinned and the cytotrophoblast regresses, changes interpreted as being of an aging nature. The villous cytotrophoblast, which is a stem cell for the trophoblast, does not in reality regress, because the absolute number of these cells in the placenta is not decreased at term and in fact continues to increase throughout pregnancy. The apparent sparsity of these cells is due to their wider dispersion within a greatly increased total placental mass.9 10 The focal thinning of the villous syncytiotrophoblast apparent in many terminal villi has often been cited as evidence of syncytial senescence. These thinned areas are, in reality, the “vasculo-syncytial membranes”11 which, although formed in part by mechanical stretching of the trophoblast by ballooning capillary loops,12 never the less differ enzymatically and ultrastructurally from the non-membranous areas of the syncytium and are areas of the syncytiotrophoblast specifically differentiated for the facilitation of gas transfer.13 These membranes are therefore a manifestation of topographic functional differentiation within the trophoblast.

The interlinked, but separate, processes of maturation of the villous tree and functional differentiation of the trophoblast result in a predominant villous form that is optimally adapted for materno-fetal transfer diffusion mechanisms: the morphological changes substantially increase trophoblastic surface area14 and a significantly reduce the harmonic mean of the diffusion distance between maternal and fetal blood,15 with a resulting increase in the conductance of oxygen diffusion.16

It is not mere pedantry to distinguish between maturation, which results in increased functional efficiency, and aging, which results in decreased functional efficiency. In this respect it is worth noting that a proportion of placentas from women with severe pre-eclampsia look unusually mature for the length of the period of gestation: this is usually classed as “premature aging” but it would be more accurate to regard the changes as being due to accelerated maturation, this being a compensatory mechanism to increase the transfer capacity of the placenta in the face of an adverse maternal environment.

It has to be admitted that the control mechanisms of placental maturation are unknown. There are many agents thought to be of importance in the control of placental growth, including cytokines, growth factors, oncogenes, prostaglandins and leucotrienes,17-20 but it far from clear as to whether control of growth can be equated with control of maturation. However, villous development, certainly in the later stages of pregnancy, does seem to be driven principally by proliferation of endothelial cells and capillary growth.21 Vascular endothelial growth factors are present in placental tissue22 and the suggestion that hypoxia may stimulate angiogenesis,23 and thus have a significant role in placental development, would corroborate the accelerated placental maturation seen in some cases of maternal pre-eclampsia.

Placental growth 

It has long been maintained that placental growth and DNA synthesis cease at about the 36th week of gestation and that any subsequent increase in placental size is due to an increase in cell size rather than to an increase in the number of cells.24Simple histological examination of the term placenta will, however, serve to refute this view, because immature intermediate villi are often present in the centres of lobules and these clearly represent a persistent growth zone. Furthermore, total placental DNA content continues to increase in an almost linear manner until and beyond the 42nd week of gestation.25 This finding agrees with autoradiographic and flow cytometric studies that have shown continuing DNA synthesis in the term organ,26-28 and with morphometric investigations that have shown persistent villous growth, continuing expansion of the villous surface area, and progressive branching of the villous tree up to and beyond term.14 29

Placental growth certainly slows, but clearly does not cease, during the last few weeks of gestation, although this decline in growth rate is neither invariable nor irreversible, because the placenta can continue to increase in size if faced with an unfavourable maternal environment, such as pregnancy at high altitude, or severe maternal anaemia, while the potential for a recrudescence of growth is shown by the proliferative response to ischaemic syncytial damage. Those who contend that a decreased placental growth rate during late pregnancy is evidence of senescence often seem be comparing the placenta with an organ such as the gut, in which continuing viability depends on a constantly replicating stem cell layer producing short-lived postmitotic cells. A more apt comparison would be with an organ such as the liver, which is formed principally of long-lived postmitotic cells and which, once an optimal size has been attained to meet the metabolic demands placed on it, shows little evidence of cell proliferation while retaining a latent capacity for growth activity. There seems no good reason why the placenta, once it has reached a size sufficient to adequately meet its transfer function, should continue to grow, and the term placenta, with its considerable functional reserve capacity, has more than met this aim.

Functional activity 

There have been few vertical studies of placental function throughout pregnancy, but there is no evidence that any of the major indices of placental function decline—namely, proliferative, transfer, and secretory capacities.30 As already remarked, the diffusion conductance of the organ is increased, largely as a result of morphological changes, but there is considerable evidence that specific placental carrier mediated transfer systems are also augmented.20 The placental production of hormones continues unabated until term: the synthesis of human chorionic gonadotrophin declines towards the end of the first trimester but this is clearly due to a gene switch which results in progressively increasing secretion of human placental lactogen.

The placenta also retains its full proliferative capacity until term as shown by its ability to repair and replace, as a result of proliferation in the villous cytotrophoblastic cells, of a villous syncytiotrophoblast that has been ischaemically damaged in women with severe pre-eclampsia.13

Clinical factors 

The single most important factor leading to a belief in placental senescence has been the apparently increased fetal morbidity and mortality associated with prolonged pregnancy, this traditionally being attributed to “placental insufficiency” consequent on senescence of the organ.1 31 In the past it was thought that about 11% of pregnancies extended to or beyond the 42nd week of gestation32 33 : the introduction of a routine ultrasound examination in early pregnancy reduced the incidence of prolonged pregnancies to about 6%34 and it has even been claimed that with very accurate dating studies the incidence of truly prolonged gestations does not exceed 1%.35 This casts some doubt on the validity of a great deal of the historical information about the risks and ill effects of prolonged pregnancy, but it is never the less widely accepted that perinatal mortality increases after the 42nd week of gestation.36

Any increase in perinatal mortality after the 42nd week of gestation is due, in part, to the high incidence of fetal macrosomia: 10% of infants from prolonged pregnancies weigh over 4000 g and 1% over 4500 g and these fetuses are at particular risk of complications such as shoulder dystocia. The presence of this large number of macrosomic fetuses is a clear indication that, in this subset at least, the placenta continues to function well beyond the 40th week of gestation and remains capable of sustaining untrammelled fetal growth.

The classic clinical syndrome of the “postmature” infant1 31 is not commonly seen today but seems to be clearly related to the development of oligohydramnios. There is no doubt that amniotic fluid volume tends to decrease in a proportion of prolonged pregnancies39 and that oligohydramnios is associated with a high incidence of fetal heart rate decelerations.36 This has been attributed by some to cord compression,40 41 but one study, while confirming that cord compression is common in prolonged pregnancies, was unable to correlate such compression with fetal acidosis.42 It is often assumed, and indeed commonly stated, that the decline in amniotic fluid volume in these cases is an indication of “placental insufficiency” but, in reality, there is no evidence that in late pregnancy the placenta plays any part in the production of amniotic fluid or in the control of amniotic fluid volume. 43

The two most potent causes of increased morbidity in prolonged pregnancy are therefore clearly unrelated to any change in placental functional capacity. Examination of placentas from prolonged pregnancies shows no evidence of any increased incidence of gross placental abnormalities, such as infarcts, calcification, or massive perivillous fibrin deposition. The most characteristic histological abnormality, found in a proportion of cases but certainly not in all, is decreased fetal perfusion of the placental villi.13 The fetal villous vessels are normal in placentas from prolonged pregnancies44 and Doppler flow velocimetry studies have, in general but not unanimously, indicated that there is no increased fetal vascular resistance in such placentas.45-47 The decreased fetal perfusion is therefore probably a consequence of oligohydramnios, because umbilical vein flow studies have shown that fetal blood flow to the placenta is often reduced in cases of oligohydramnios.48

It has to be admitted that the pathophysiology of prolonged pregnancy has not been fully elucidated. It seems, however, quite clear that any ill effects which may befall the fetus in prolonged gestations can not be attributed to placental insufficiency or senescence.

Conclusions 

A review of the available evidence indicates that the placenta does not undergo a true aging change during pregnancy. There is, in fact, no logical reason for believing that the placenta, which is a fetal organ, should age while the other fetal organs do not: the situation in which an individual organ ages within an organism that is not aged is one which does not occur in any biological system. The persisting belief in placental aging has been based on a confusion between morphological maturation and differentiation and aging, a failure to appreciate the functional resources of the organ, and an uncritical acceptance of the overly facile concept of “placental insufficiency” as a cause of increased perinatal mortality.

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