EXAMINATION OF PLACENTA

DEFINITION
Examination of placenta and its membranes thorough inspection and examination soon after
expulsion, for its completeness and normalcy.
PURPOSES
 A one-minute examination of the placenta performed in the delivery room provides
information that may be important to the care of both mother and infant
 To ensure that the entire placenta and membranes have been expelled and no part has been
retained.
 To make sure that placenta is of normal size, shape, consistency and weight.
 To detect abnormalities such as infarctions, calcification or additional lobes.
 To ascertain the length of the cord, number of blood vessels and site of insertion of the cord.
 To check weight of placenta and measure length of cord.
ARTICLES
 Placenta in a bowl
 Plastic apron
 A washable surface to lay the placenta for examination/Tray with yellow plastic sheet.
 A weighing machine
 Measuring Tape
 Kidney tray
 Bowl with cotton.
 Pair of clean gloves.
PRE PREPARATION:
•Ensure that there is adequate lighting to check the placenta.
•Prepare a flat surface with protection to avoid blood spillage.
•Prepare syringe and needle if cord samples are required
Steps of procedure for examination of placenta-
 Wear apron and gloves
 Keep placenta with cord in basin and take it to sink and wash thoroughly under tap water
 Now fill the basin with clean water and keep washed placenta with cord
 Place the placenta in clean surface
 Now hold the placenta for examination in the following sequence-
 Placenta at term
 Examination of cord
 Examination of fetal surface of placenta
 Examination of maternal surface of placenta.
PROCEDURE
 Wear gloves
 Clinical Characteristics of the Normal Placenta
 A fresh, term, healthy placenta diameter is 2.0 to 2.5 cm.
 It generally weighs approximately 500-600gms (1/6 of the baby’s birth weight).
 Using gloved hands hold the placenta by index finger of left hand than examining the
placenta by using the right hand. (Twisting the cord twice around the index fingers of left
hand will provide a firm grip).
 Identify the hole through which the baby was delivered.
 Insert right hand through the hole and spread out the fingers to view the membranes and the
blood vessels.
 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.
 The maternal surface of the placenta should be dark maroon in colour and should consist of
around 20 cotyledons. The structure should appear complete, with no missing cotyledons.
 Invert the placenta, expose the maternal surface and remove any clots present.
 Examine the maternal surface by 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).
 The fetal surface of the placenta should be shiny, gray and translucent enough that the colour
of the underlying maroon villous tissue may be seen.
 Fetal membranes are usually gray, wrinkled, shiny and translucent. It consist of two layers;
the amnion and the chorion
 Assess for presence of abnormalities such as infarctions, calcification or succenturiata lobes,
and any other abnormalities.
 Inspect the cut end of the umbilical cord for presence of three umbilical vessels.
 The normal cord contains two arteries and one vein. Measure the length of the umbilical cord
by holding it extended against a graduated surface/side of the weighing scale.
 Weigh the placenta by placing it on the weighing scale meant for the purpose.
 Place the placenta in the bin for proper disposal.
 Clean the area used for examination of the placenta and membranes, the weighing scale and
the bowl.
 Remove gloves and wash hands.
 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
AFTER CARE:
 Replace the articles and discard the placenta.
 Wash hand
 The findings of this assessment should be documented in the delivery records.
 The placenta should be submitted for pathologic evaluation if an abnormality is detected or
certain indications are present.
 Interpretations
Placental Size: -
 Placentas less than 2.5 cm thick are associated with intrauterine growth retardation of the
fetus.
•Placenta more than 4 cm thick has an association with maternal diabetes mellitus, fetal
hydrops and intrauterine fetal infections
  Placental Consistency and Surfaces-
A: Maternal Surface. In a term infant without anemia, the maternal surface of the placenta
should be dark maroon. In a premature infant, the placenta is lighter in color.
•Pallor of the maternal surface indicates the presence of fetal anemia, which may be a sign of
haemorrhage.
•Clots on the maternal surface, particularly adherent centrally located clots, may represent
placental abruption.
B: Fetal Surface
 A thick ring of membranes on the fetal surface of the placenta may represent a circumvallate
placenta which is associated with prematurity, prenatal bleeding, abruption, multiparity and
early fluid loss.
 A similar but thinner ring of membrane tissue represents a circummarginate placenta

Umbilical Cord
 •While opinions of authorities differ with regard to the limits of normal for cord length, 40 to
70 cm would appear to be a reasonable range.
 A short cord is associated with a less active fetus, fetal malformations, neuropathic diseases,
Down syndrome and Oligohydramnios.
 Cords of insufficient length may also result in breech and other fetal malpresentations.
 Cord Vessels
 The umbilical cord typically contains two arteries and a single vein.
 If only one artery and one vein are grossly visible, the fetal anomaly rate is nearly 50 percent.
These anomalies may affect the cardiovascular, genitourinary or gastrointestinal system and
other systems as well. Free Fetal Membranes
•Fetal membranes should be thin, gray and glistening. Thick, dull,
Discoloured or foul-smelling membranes indicate the possibility of infection.

REFERANCES
 JOSEPH F. YETTER et al, Examination of the Placenta.
 Maternity Guidelines –Checking the placenta after delivery.
• Dutta’s D.C. ‘a textbook of obstetrics’. 7th edition, Delhi: published by New Delhi book
agency; 2011, page no-216-218.

• Babu Molly” clinical case record for midwives.” 1st edition, Delhi: published by Kumar
publishing house; 2010, page no- 21-23.

• https://www.google.co.in.search placenta.

 
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