EXAMINATION OF THE PLACENTA.pptx

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