EXAMINATION OF PLACENTA

EXAMINATION OF PLACENTA – Examination of the Placenta, Membranes and the Umbilical Cord (MATERNAL AND CHILD HEALTH NURSING)

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. 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 accessory lobes, placental infarcts, hemorrhage, tumors and nodules should be noted. The umbilical cord should be assessed for length, insertion, number of vessels, thromboses, knots and the presence of wharton’s jelly. The color, luster and odor of the fetal membranes should be evaluated, and the membranes should be examined for the presence of large (velamentous) vessels. Tissue may be retained because of abnormal lobation of the placenta or because of placenta accreta, placenta increta or placenta percreta 

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 or certain indications are present

EXAMINATION OF THE PLACENTA, MEMBRANES AND THE UMBILICAL CORD

Examine the placenta and the membranes for completeness as follows:

Maternal surface of the placenta

• Hold the placenta in the palms of the hands, keeping the palms flat and the maternal surface facing you. Look for the following:

All the lobules must be present

The lobules should fit together

There should be no irregularities in the margins

• After rinsing the maternal side carefully with water, it should shine because of the decidual covering
• If any of the lobes are missing or the lobules do not fit together, suspect that some placental fragments may have been left behind in the uterus

Fetal surface

• Hold the umbilical cord in one hand and let the placenta and membranes hand down like an inverted umbrella
• The umbilical vessels will be seen passing from the cord and gradually fading into the edge of the placenta
• Look for free-ending vessels and holes which may indicate that a succenturiate lobe has been left behind in the uterus
• Look for the insertion of the cord, particularly the velamentous insertion (the point where the cord is inserted into the membranes and from where it travels to the placenta)

Membranes

• The chorion is the layer in contact with the uterus. It is rough and thick
• The amnion is the inner layer. It is thin and shiny
• The amnion can be peeled up to the level of insertion of the cord
• Both the layers can be seen at the edge of the hole where the membranes rupture and the fetus comes out
• If the membranes are ragged, place them together and make sure that they are complete

UMBILICAL CORD

The umbilical cord should be inspected. It has two arteries and one vein. If only one artery is found, look for congenital malformations in the baby