MATERNAL AND CHILD HEALTH PRACTICUM

CONDUCT OF DELIVERY, DELIVERY OF PLACENTA AND PLACENTAL

EXAMINATION
GROUP THREE MEMBERS

NAMES REG.NUMBERS

1. ABUBAKAR SADISU AHS/17/NUR/00103

2. ALHAJIJI TUKUR BELLO AHS/16/NUR/00427
3. SAHABI MATO IBRAHIM AHS/16/NUR/00454
4. ASMA’U LAGA ABDULLAHI AHS/16/NUR/00448
5. KHADIJAH ADAMU ABDULLAHI AHS/16/NUR/00406
6. ZAINAB SHEHU AHS/16/NUR/00474
7. ISINI PC LUKA AHS/17/NUR/00118
8. ID0WU ADEWOLE MERCY AHS/16/NUR/00415
9. AJIDE ELIZABETH TOLULOPE AHS/16/NUR/00418
10. RUTH ALABI OREOLUWAKITAN AHS/15/NUR/00076
11.FARIDA AHMAD AHS/17/NUR/00105
12.KHAIRIYYA IBRAHIM SAGAGI AHS/15/NUR/00273
13.VICTORY OLUWATOLA AHS/15/NUR/00267
 CONDUCT OF NORMAL LABOR AND DELIVERY
1. Admittance Procedures
2. Identification of Labor
◆ Contractions of True Labor
◆ Contractions of False Labor
Admittance Procedures
(1) Vital Signs and Review of Pregnancy Record
(2) Preparation of Vulva and Perineum
Scrubbing is directed from above, downward, and away from the introitus.
(3) Vaginal Examinations
It is important to avoid the anal region and not to withdraw the fingers from the
vagina until the examination is completed.
(4) Enema
(5) Laboratory investigations e.g hematocrit, or Hb concentration, urine specimen.
II. Management of First Stage of Labor
Average duration: nulliparous women - 8 hours
parous women - 5 hours
1. Monitoring Fetal Well-being During Labor
2. Maternal Monitoring Management During Labor
III. Management of Second Stage of Labor
1. Delivery of the Head
2. Delivery of Shoulders
3. Clamping the Cord
V. Management of Third Stage of Labor
As long as the uteurs remains firm and there is no unusual bleeding, watchful
waiting
until the placenta is separated.
No massage is practiced.
1. Signs of Placental Separation
2. Delivery of the Placenta
3. Active Management of the Third Stage
4. "4th Stage" of Labor
The hour immediately following delivery is critical.
VI. Lacerations of the Birth Canal
VII. Episiotomy and Repair
6. Pain after Episiotomy

DELIVERY OF PLACENTA

Introduction:

There are continuation of the processes and forces at working during the earlier
stages of a labor. It is an understanding of these changes that guides the
midwife’s practice. During the 3rd stage of labor separation and expulsion of the
placenta and membranes occurs as a result of interplay of mechanical and
haemostatic factors, the time at which placenta actually separate from the
uterine wall can vary, it may shears off during the final expulsive contractions
accompanying the birth of the baby or remain adherent for some considerable
time. The 3rd stage last between 5 and 15 minutes but any period up to I hour may
be considered to be within normal limits.
 1. Separation and descend of the placenta
(a) Mechanical factors
 Uterine muscle lies in its power of retraction
 During 2nd stage uterine county progressively empties, each ling the
retraction process to accelerate.
 By beginning of 3rd stage placenta site has already to diminish in size.
 Placenta is forced basic into the spongy layer of decidua.

Retraction of the oblique uterine muscles forced exerts pressure on the blood
vessel so that blood does not drain back into the maternal system.

- vessels becomes tense and congested

- Next contraction the distended veins burst & small amount of blood seeps
in between the thin septa of spongy layer and the placental surface,
stripping it from attachment.
- As the surface area for placental attachment begins to detach from uterine
wall.
- Separation usually begins centrally that a retro placental clot is formed. This
may further aid separation by exerting pressure at midpoint of placental
attachment so that the weight helps to strip the adherent lateral borders.
Placental descent fetal surface first.
- (Schultze)

Alternatively placental begins to detach at one of the lateral boarders.

- The blood escape so that separation is unaided by formation of a retro

placental clot. Placental descent slipping sideways, maternal surface
first (Duncan).
-When the separation has occurred the uterine full into the lower uterine
segment and finally into vagina.

Placental examination
Overview
Retained products of conception are one of the main causes of post
partum hemorrhage( PPH) aid infections. The placenta and membranes
should be examined carefully form irregularities and completeness as
soon as after birth.
= Purpose/Rational:
To ensure that part of placental membranes have been retained as this
may cause PPH & infection
(a) Placenta a fresh, term, healthy placenta is approximately 15-20cm in
diameter & 20-25cm thick, it generally weights approximately 5-
600gms (1/6 of the baby’s birth weight). However the measurement
can vary considerably depending on the number of variable
including: ethnicity, pathophysiology & baby weight.
(b) The maternal surface of placenta should be dark maroon in colour &
consist of around 20 cotyledons.
<= the fetal surface of placenta should be shiny, gray and translucent
so that the color of the underlying maroon villous tissue may be
seen.
 (c) Umblical cord => A term, typical UC is 55-60cm in length, with a
diameter of 2.0-2.5. The cord vessels are suspended in wharten’s
jelly. The normal cord contains two arteries and one veins.
(d) Membranes => consist of two layers amnion and chorion.
(e) Multiple pregnancy. The placenta and membranes for multiple births
are more complex as there are a variety of possible combinations of
placenta and membranes.
Procedure of placental examination
- Explain the procedure to the patients and obtain consent.
- Ensure there is adequate lighting to check the placenta.
- Prepare a flat surface with protection to avoid blood spillage.
- Prepare syringe & needles if cord samples are required .
- Wearing apron and gloves, lay the placenta fetal side uppermost, noting
the size, shape, smell and color.
- Examine the cord, noting length, insertion point presence of true clots
or thrombus.
- Inspect the umblical cord vessels at the cut end at the furthest point
from the placenta as the arteries can be fused around the insertion site
making it difficult to differentiate them.
- Lift the placenta up by the cord by doing this membrane can be
observed for completeness. There is usually a single hole where the
baby passes through the membranes.
- Return the placenta to the surface and spread out the membranes to
look for extra vessels, lobes or holes in the surface.
 - Separate the amnion from chorion by pulling the amnion back outer the
base of umblical cord to ensure both are present.
- Turn the placenta over to inspect maternal surfaces.
- Examine the cotyledons, ensuring all present noting the size any areas of
infarction, blood clots or calcification. Retain the clot to make an accurate
assessment of blood loss. The lobes of complete Placenta fit neatly
together without any gaps with edges forming a uniform circle. Broken
fragment making an accurate assessment e.g suceentarate lobes, missing
cotyledons, fatty deposits or infarction.
- Take cord samples if required.
- Weight the placenta if abnormally large/ small and record weight in
maternal health record.
- Swab the placental surface in case of suspected infection.
- Take a sample of placenta for chromosome analysis if required
through all layers.
- If the placenta is examined by students the supervising midwife must
also examine to ensure completeness and counter signed the records
to confirm this.
- Where there is suspicion that placenta or membrane are incomplete,
they should be kept for further inspection and discuss with the duty
obstetrician.
- Where there are missing lobes or other abdominal features of the
placenta, a photography should be taken and retained in the
maternal records.
- Inform the mother of your findings.
 - Complete documentation in the women’s health care records.
- Report any abnormality to appropriate medical professional.
(1) An excessively large or oedematous placenta (may appear to have
large, clear colored surfaces)may be associated with maternal
diabetes, hydrops or cardiac abnormality.
(2) One arterial vessel is associated with renal agenesis.

References

Black born, S (2008) Physiological 3rd stage of labor and birth at home.

Johnson, R & Taylor, W (2010) skills for midwifery practice.

MC Donald (2009) economist placenta and membrane Myles text book for
midwives