LESSON PLAN

ON
ABNORMALITIES OF PLACENTA & CORD

SUBMITTED BY SUBMITTED TO
TAMIL SELVI C MRS VAHITHA S
MSC NURSING I YEAR LECTURER
COLLEGE OF NURSING COLLEGE OF NURSING
JIPMER JIPMER

SUBMITTED ON

08/06/2021
Subject : Obstetrical and Gynaecological Nursing
Topic : Abnormalities of the Placenta & Cord
Date :
Time :
Group : B.Sc Nursing IV year
Size of the group :
Method of Teaching :
Duration : 1 hour
AV Aids :
Name of the Student : Tamil Selvi. C M.Sc Nursing I year, College of Nursing, JIPMER.

Name of the Evaluator : Mrs Vahitha S, Lecturer, College of Nursing, JIPMER.

 GENERAL OBJECTIVE
At the end of the session students will be able to gain knowledge regarding abnormalities of placenta and its significance, abnormalities of cord
and its significance

SPECIFIC OBJECTIVE
At the end of the session the students will be able to
- Describe normal placenta and cord
- Enlist the abnormalities of placenta
- Explain the abnormalities of placenta and its significance
- Explain the abnormalities of umbilical cord and its significance

SPECIFIC TIME CONTENT TEACHING / AV AIDS EVALUATION

OBJECTIVE LEARNING
ACTIVITY
Describe 5 mts INTRODUCTION Discussion
normal The placenta is a complex organ, which originates from the trophoblastic
placenta and layer of the fertilized ovum. When fully developed it serves as the interface
cord between the mother and the developing fetus carrying out functions that the fetus
is unable to perform for itself during intrauterine life. The survival of the fetus
depends upon the placenta’s integrity and efficiency.
The placenta begins to form at implantation.
. The structure of the placenta is complete by the twelfth week. The placenta
continues to grow wider until 20 weeks, when it covers about half of the uterine
surface. It then continues to grow thicker. In each of the 15 to 20 cotyledons, the
chorionic villi branch out, and a complex system of fetal blood vessels forms.
Each cotyledon is a functional unit.
At term the placenta is discoid in shape, about 20 cm in diameter and 2.5
cm thick at its Centre and weighing approximately 470 g.
It has two surfaces
- Maternal surface (ie the basal plate) – rough and spongy
- Fetal Surface – smooth & shiny.

UMBILICAL CORD
The umbilical cord, which extends from the fetal surface of the placenta to
the umbilical area of the fetus, is formed by the 5th week of pregnancy. It
originates from the duct that forms between the amniotic sac and yolk sac. The
umbilical cord or funis forms the connecting link between the fetus and placenta
through which the fetal blood flows to and from the placenta. It extends from the
fetal umbilicus to the fetal surface of the placenta.
 The constituents of the umbilical cord when fully formed are
i) Covering epithelium
ii) Wharton’s jelly
iii) Blood vessels – 2 umbilical arteries
1 umbilical vein
Explain the 30 mts ABNORMALITIES OF THE PLACENTA AND CORD Lecture cum List out the
abnormalities There is a marked variationin the morphology including size, shape and weight discussion abnormalities of
of placenta of the placenta. Variations of the cord is also quite common. placenta
and its PLACENTAL ABNORMALITIES
significance 1) PLACENTA SUCCENTURIATE
MORPHOLOGY
One or more small lobes of placenta, size of a cotyledon may be placed at
varying distances from the main placenta and joined to it by blood vessels
that run through the membranes to connect it.
The accessory lobe is developed from the activated villi on the chorionic
villi on the chorionic leave. In the absence of communicating blood vessels it
is called Placenta spuria.
The incidence of placenta succenturiata is 3%.
DIAGNOSIS
The diagnosis is made following inspection of the placenta after its
expulsion.
1) With intact lobe – presence of extra lobes which is attached to the main
lobes by the communicating blood vessels.
2) With missing lobes
a) There is a gap in the chorion
b) Torn ends of blood vessels are found on the margin of the gap.
CLINICAL SIGNIFICANCE
 If the succenturiate lobe is retained following birth of the placenta it may
lead to
1) Postpartum haemorrhage- primary or secondary
2) Sub involution
3) Uterine sepsis
4) Polyp formation
TREATMENT
Whenever the diagnosis of missing lobe is made, exploration of the uterus
and removal of the lobe under general anaesthesia is to be done.
PLACENTA EXTRACHORIALIS
Two types are described under this
1) Circumvallate placenta
2) Placenta marginata
DEVELOPMENT
This occurs due to the smaller chorionic plate than the basal plate.
Recurrent marginal haemorrhage is thought to be the same.
The chorionic plate does not extend to the placental margin. The
membranes (amnion and chorion) are folded, rolled back upon itself to form a
ring which is reflected centrally. This leaves a rim of bare placental tissue.
MORPHOLOGY
CIRCUMVALLATE PLACENTA
1) The fetal surface is divided into a central depressed zone surrounded by a
thickened white ring which is usually complete. The ring is situated at
the varying distances from the margin of the placenta. The ring is
composed of double fold of amnion and chorion with degenerated
decidua (vera) and fibrin in between.
2) Vessels radiate from the cord insertion as far as the ring and then
 disappear from view.
3) The peripheral zone outside the ring is thicker and the edge is elevated
and rounded.
PLACENTA MARGINATA
A thin fibrous ring is present at the margin of the chorionic plate where the
fetal vessels appear to terminate.
CLINICAL SIGNIFICANCE
There is increased chance of
1) Abortion
2) Hydrorrhea gravidarum ( excessive watery vaginal discharge)
3) Antepartum haemorrhage
4) Growth retardation of the baby
5) Preterm delivery
6) Retained placenta or membranes
PLACENTA MEMBRANECEA
The placenta is unduly large and thin. The placenta not only develops from
the chorion frondosum but also from the chorion leave so that the whole of the
ovum is practically covered by the placenta.
CLINICAL SIGNIFICANCE
1) Encroachment of some part over the lower segment leads to placenta
previa.
2) Imperfect separation in the third stage leads to postpartum haemorrhage.
3) Chance of retained placenta is more and manual removal becomes
difficult.
PLACENTA BILOBATE (BIPARTITE PLACENTA OR DUPLEX
PLACENTA)
Rarely placenta may develop as separate and nearly equally sized discs. The
 umbilical cord is attached into a connecting chorionic bridge or into the
intervening membranes inbetween the two placental lobes.
Multi lobed placenta may develop having three or more lobes of equal size.
CLINICAL SIGNIFICANCE
- The clinical implications are similar to that of placenta succenturiata.
- The risks of placenta previa and accrete are high.
PLACENTA FENESTRATA
This is due to missing of central portion of the placental disk. Clinically it
may be mistaken as if the central cotyledon is retained inside the uterus.
CORD ABNORMALITIES
BATTLE DORE PLACENTA
Explain 10 mts The cord is attached to the margin of the placenta. If associated with low Lecture cum List out the
abnormalities
implantation of the placenta, there is chance of cold compression in vaginal discussion abnormalities of
of umbilical
cord and its delivery leading to fetal anoxia or death. cord
clinical
VELAMENTOUS INSERTION OF THE CORD
significance
In this type the cord is attached to the membranes. The branching vessels
traverse between the membranes for a varying distance before they reach and
supply the placenta.
If the leash of blood vessels happens to traverse through the membranes
overlying the internal or infront of the presenting part, the condition is called vasa
previa.
Rupture of the membranes involving the overlying vessels leads to vaginal
bleeding. This may result in fetal exsanguination and even death.
MANAGEMENT
In the presence of fetal bleeding, urgent delivery is essential either vaginally
or by caesarean section.
The baby’s hemoglobin should be estimated and if necessary blood
transfusion to be done.
ABNORMAL LENGTH
The cord may be unduly long or absent.
SHORT CORD
The short cord may be true (less than 20 cm or 8”) or commonly relative due to
entanglement of the cord round any fetal part. In exceptional circumstances, the
cord may be absent and the placenta may be attached to the liver as in
exomphalos.
CLINICAL SIGNIFICANCE
In either variety it may cause
i) Failure of external version
ii) Prevent descent of the presenting part especially during labour.
iii) Premature separation of a normally situated placenta.
iv) Favour malpresentation.
v) Fetal distress in labour.
LONG CORD
The clinical significance of a long cord is that there is an increased chances of
i) Cord prolapse
ii) Cord entanglement round the neck or the body.
The condition may produce sufficient compression on the cord
vessels so as to produce fetal distress or rarely death.
iii) True knot is rare
Even with true knot fetal vessels are protected from compression by
wharton’s jelly.
False knots are the result of accumulation of wharton’s jelly or due to
varices.
SINGLE UMBILICAL ARTERY
 - It is present in about 1- 2% of cases.
- It may be due to failure of development of one artery or due to its atrophy
in later months.
- It is more common in twins and in babies born of women with diabetes,
epilepsy, oligohydramnios, hydramnios, preeclampsia and antepartum
haemorrhage.
- It is frequently associated with congenital malformation of the fetus (20 –
3 mts 25%), renal and genital anomalies, trisomy 18 are common.
- There is increased chance of abortion, fetal aneuploidy, prematurity,
IUGR and increased perinatal mortality.

Summarise 3 mts SUMMARY

the content. So far we have discussed about the overview of placenta, abnormalities of
placenta and its significance, management, abnormalities of cord and its clinical
significance.

5 mts RECAPITUALIZATION
- Describe placenta
- Enumerate the placental abnormalities
- What are the implications of abnormalities of placenta?
List out the abnormalities of umbilical cord.
2 mts CONCLUSION
Development of the placenta requires complex processes involving
enzymes, hormones and growth factors which remodel maternal tissue in addition
to constructing new tissue specifically for the sustenance of the fetus. The
placenta acts as a life support system for the developing embryo and fetus until
birth.
BIBLIOGRAPHY
1. Dutta D .C. Textbook of obstetrics, 9th edition, Jaypee brothers medical publishers. Pg no 25, 204 – 206
2. Lowdermilk, Perry, Cashion, maternity & Women’s health care. 11 th edition, Elsevier Publication. Pg No- 277
3. Marshall A, Myles Textbook for midwives, 16th edition, Churchill livingstone Elsevier. Pg no 153 – 154.
4. Pilliteri A, Maternal and child health Nursing: care of the child bearing and childrearing family, 6 th edition, wolters kluwers & Lippincott
Williams & wilkins Pg no 648
5. Susan A. Orshan, Maternity, Newborn & women’s health Nursing: comprehensive care across the life span, wolters kluwers & Lippincott
Williams & wilkins Pg no 648.