Examination of the placenta to determine abnormalities

1. EXAMINATION OF THE
PLACENTA
BY
THOKOZIRE LIPATO

2. BROAD OBJECTIVE
• By the end of the lesson student should be able to demonstrate skills
and knowledge in the examination of the placenta

3. Specific Objectives
• Explain the procedure for examination of the placenta
• Differentiate between the normal and abnormal placenta
• Explain the interpretation of findings

4. INTRODUCTION
• Placenta is a fetal organ of pregnancy which is responsible for
providing nutrition and oxygen to the foetus as well as excretory
functions
• Placenta is formed by foetal and maternal components
• Term placenta weighs 470-500grams and measures 22cm with a
thickness of 2.0-2.5cm
• Placenta thickness is directly proportional to gestation age( 21mm
thickness at 21 weeks gestation.

5. EXAMINATION OF THE PLACENTA
• 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 infants
• The findings of this assessment should be documented in the delivery
records
• During the examination, the size, shape, consistency and
completeness of the placenta should be determined and the
presence of haemorrhage,tumors and nodules should be noted

6. EXAMINATION OF THE PLACENTA cont…
• The umbilical cord should be assessed for length, insertion, number
of vessels and knots
• The color and odor of the fetal membrane should be examined
• NOTE: Numerous common and uncommon findings of the placenta,
umbilical cord and membranes are associated with abnormal fetal
development and perinatal morbidity
• The placenta should be submitted for pathologic evaluation if an
abnormality is detected

7. CLINICAL CHARACTERISTICS OF A NORMAL
PLACENTA
• A fresh, term,healthy placenta is approximately 15-20cm in diameter,2.0 to
2.5 cm thick
• Maternal surface should be dark maroon in colour and should consist of
around 20 cotyledons
• The structure should appear complete with no missing cotyledons
• Fetal surface should be shiny,gray and transluscent enough that the colour
of the underlying maroon villous tissue may be seen
• The normal cord should contain two arteries and one vein, midwife should
count the number of vessels available
• Fetal membranes are usually grey, shiny and transluscent, consists of two
layers amnion and chorion

8. PROCEDURE: EXAMINATION OF THE PLACENTA
• Explain the procedure to the mother and guardian, ask them if they
wish to observe
• Ensure adequate lighting
• Prepare a flat surface with protection to avoid blood spillage
• Prepare syringe and needle if cord blood samples are required
• Wear protective gear
• Lay the placenta fetal side uppermost noting the size, shape,smell and
colour
• Examine the cord,noting length, insertion point and presence of true
knots

9. PROCEDURE: EXAMINATION OF THE PLACENTA
• Observe the fetal side for irregularities such as missing cotyledons,
fatty deposits of infarctions
• Lift the placenta up by holding the cord, by doing this the membranes
can be observed for completeness. There is usually a single hole
where the baby passes' through during delivery.
• Return the placenta to the surface and spread out the membranes to
look for extra vessels or holes.
• Separate the amnion from the chorion by pulling the amnion back
over the base of the umbilical cord to ensure both are present.

10. PROCEDURE: EXAMINATION OF THE PLACENTA
• Turn the placenta over to inspect the maternal surface
• Examine the cotyledons, ensure all are present
• Note size and any areas of infarction,blood clots or calcifications
• The lobes should fit neatly together without any gaps with edges
forming a uniform circle.
• Where there is suspicion of placenta/membranes incomplete, inform
the incharge/ doctor.
• Communicate the findings to the mother
• Document the findings

11. INTERPRETATIONS
• Placenta less than 2cm thick is associated with Intrauterine growth
retardation of the fetus
• Placenta more than 4 cm thick is associated with maternal diabetes
mellitus or Intrauterine fetal infections
• Maternal surface should be dark maroon, in Prematurity the placenta
is lighter in colour
• Pallor of the maternal surface = fetal anaemia
• Clots on maternal surface = Placenta abruption
• Thick ring of membranes on the fetal surface = Prematurity, perinatal
bleeding

12. INTERPRETATIONS
• Umbilical Cord= 40-70cm appear to be a reasonable range for cord
length.
• A short cord is associated with fetal malformation,neuropathic
diseases,Down Syndrome and oligohydraminios.
• Short cord may result in cord rupture, poor descent leading to
prolonged second stage of labour
• Cord vessels: if one vessel is missing the fetal anomaly rate is nearly
50%, These anomalies may affect the cardiovascular system,
genitourinary system and gastrointestinal system

13. INTERPRETATIONS
• Fetal membranes: should be thin, ray and glistering.
• Thick, dull, discoloured or foul smelling indicates the possibility of
infections.

14. Reference
• JosephF. Yetter et al Examination of the placenta
• Maternity guidelines- Checking the placenta after delivery

15. •
• END
• QUESTIONS