INTR0DUCTION

DEFINITION :
A thorough inspection and examination of the placenta and membranes, soon after
expulsion, for its completeness and normalcy.

PURPOSES:

1. To ensure that the entire placenta and membranes have been expelled and no part has
been retained.
2. To make sure that placenta is of normal size, shape, consistency and weight.
3. To detect abnormalities such as infarction, calcifications or additional lobes.
4. To ascertain the length of the cord, number of blood vessels and site of insertion of
the cord.
5. To check weight of placenta and measures length of cord.

ARTICLES :
1. Placenta in a bowl.
2. Mackintosh
3. Measuring tape
4. Pin (to measure thickness of placenta )
5. Cotton thread (to measure diameter of placenta and length of cord.
6. Weighing machine
7. Gloves
8. Kidney tray
9. Cotton swab
10.Yellow beg

PROCEDURE

NURSING ACTION RATIONALE

1) Don gloves.
2) Using gloved hands hold the placenta
by the cord allowing the membranes to
hang (twisting the cord twice around
the fingers will provide a firm grip.
3) Identify the hole through which the
baby was delivered.
4) Insert hand through the hole and spread
out the fingers to view the membranes
and the blood vessels.
5) Remove the hand from inside the
membranes and lay the placenta on a
flat surface with the fetal surface up.
identify the site of cord insertion
Protects nurse from contamination.
Hanging membrane will provide a better
view to check its completeness.
If the membranes are not pieces, a single
round hole can be identified clearly.
The position of cord insertion and the
course of blood vessels can be noted in
this position.
Normally the cord is inserted in the
placenta .lateral or velamentous insertion
may be noted.

6) Examine the two membranes, amnion Amnion is shiny and chorion is

and chorion for completeness and shaggy.Amnion can be peeled from the
presence of abnormal vessel indicating chorion upto the umbilical cord.
Succenturiate lobe.

7)Invert the placenta, expose the maternal

and remove any clots present.
Ensures that no part of the placenta or
8)Examine the maternal surface by membranes is left inside the uterus.
spreading it in the palms of your two
hands and placing the cotyledons in close
approximation (any broken fragments
must be replaced before accurate
assessment is made)

9) Assess the presence of abnormalities

such as infarction, calcifications or
succenturiate lobes.

10 Inspect the cut end of the umbilical Two arteries and one vein should
cord for presence of three umbilical normally be seen. Absence of an artery
vessels.Measure the length of the cord by may be associated with renal
holding it extended against a graduated abnormalities.
surface/side of the weighting scale. (the
 length of the cord on the baby may be
added to get the total length where Average length of the cord is 50 cm.
applicable).
Weight the placenta by placing it on the
weighing scale meant for the purpose.
Place the placenta in the bin for proper Normally the placenta weighs about 1/6 th
disposal. of the baby’s weight.
Clean the area used for examination of the
placenta and membranes, the weighing
scale and the bowl. Acts as a communication between staff
Remove gloves and wash hands. members.
6) Record in the patient’s chart, the
findings of placental examination and
weight of the placenta, length of the
cord and any special observation made.

MATURE PLACENTA:
a. Round flat with discoid shape.
b. Diameter 15-20 cm
c. Thickness 2 to 2.5 cm at centre thinning towards periphery.
d. Weight 1/6 of baby weight.

CORD AND AMNIOTIC BAG:

a. Cord attached to the centre of fetal surface of placenta.

b. Diameter of cord 1-2.5 cm
c. Average length 30 to 100 cm.
d. Covering of cord from outside to inside be amnion, mucoid embryonic connective
tissue and Wharton’s jelly.
e. Amniotic membrane /bag by holding the placenta from its cord and inserting hand
into the ruptured bag of membranes.
f. Blood vessels, 2 arteries and 1 vein.
g. Knots –false knots (formed of Wharton’s jelly).
True knots cyst (abnormal cord).

SURFACES :
a) Fetal surface (smooth shining)
b) Maternal surface (rough, shiny and dull red colour)
PLACENTAL LOBES/COTYLEDONS:15-20 in number

ABNORMALITIES OF THE CORD:

o Short cord: Length <30 cm.

o Long cord: Length >100 cm.
o Single umbilical artery.
o True knots.
o Rarities (tumours cysts,oedema and haematomas)
o Vasa previa.
o Velamentous placenta: cord is inserted into the membranes of placenta only.
o Battledore placenta: cord is inserted at the edge or margin of the placenta.

ABNORMALITIES OF THE PLACENTA:

o Edema of placenta: occurs in case of maternal nephritis,heart disease.

o Excessive infarct area.
o Syphilitic placenta: one or more separate placental lobes away from main placenta.
o Extrachorial placenta : fetal surface as a thick white ring which gives the impression
of depressed central portion.
o Bipartite placenta: placenta determines 2 parts of it.with single cord.
o Membranecae : unduly large and thin placenta.

POINTS TO BE REMEMBER:

 Do examination after removing all clots.

 Examine placenta and cord .report the findings
 If required label and send it for histopathology.

After care of articles :

 Dispose the placenta in yellow bag.

 Replace all articles.
 Clean all articles.