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2 min Introduces self INTRODUCTION:
and the topic to Good morning, I am
the group. Nidhi Sharma, student
of M.Sc. (N) 2nd Year
today I am here to
present a topic which
is very important as it
allows us to examine
the placenta for any
abnormality so that it
can be managed to
initial stages.
The placenta is a
temporary organ that
connects the
developing fetus via
the umbilical cord to
the uterine wall to
allow nutrient uptake,
thermo-regulation,
waste elimination,
and gas exchange via
the mother's blood
supply; to fight
against internal
infection; and to
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produce hormones
which support
pregnancy.
1 min Defines placenta. DEFINITION OF PLACENTA: Student teacher Define placenta.
Placenta is a choriodecidual structure (forms from chorion, defines placenta with
maternal decidua and maternal blood), which helps in the help of ppt.
maintenance of pregnancy and development of fetus. The placenta
is partly fetal and partly maternal in origin. It connects closely with
mother’s circulation to carry out functions, which the fetus is
unable to perform for itself during intrauterine life. The survival of
the fetus depends on the integrity and efficiency of the placenta.
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2 min Defines placental DEFINITION OF PLACENTAL EXAMINATION: Student teacher Define placental
examination. Placental examination is an important procedure of Labour room defines placental examination
which is done to identify any abnormalities, lesions and prepare examination with the
material for histological examination. help of ppt.
or

It is thorough inspection of placenta after delivery to check for its

completeness and abnormalities.
2min Describes about AIMS OF PLACENTAL EXAMINATION: Student teacher List down the
the aims of  Identification of risk of retained products of conception describes about the aims of placental
placental  To check for any variations in placenta or cord which may aims of the placental examination.
examination. indicate either congenital anomalies in baby or may complicate examination with the
labour/ postpartum period help of ppt.

2 min Enlists about the ARTICLES REQUIRED FOR EXAMINATION OF PLACENTA, Student teacher List down the
articles required MEMBRANES AND CORD: enlists the articles articles required
for examination required for for examination
of placenta, S.NO. ARTICLES RATIONALE examination for of placenta,
membranes and 1. Placenta with cord-1  For examination placenta, membranes membranes and
cord. 2. Sink with tap water  For cleaning placenta of and cord. cord.
fresh blood and blood
clots
3. Gloves- 1 pair  To protect hands of the
examiner
4. Mask  To protect face of the
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examiner from spilled
blood
5. Plastic apron- 1  To protect clothing of the
examiner
6. Basin  To keep placenta with
cord for examination
7. Mackintosh  To spread on table so as to
prevent soiling on table
8. Bowl with cotton  To separate the
balls- 2 or 3 membranes
9. Weighing scale  To measure the weight of
placenta
10. Inch tape/ Scale  To measure the length and
diameter
11. Yellow poly bag  To discard the placenta
10 min Explains about STEPS OF PROCEDURE FOR EXAMINATION OF PLACENTA: Student teacher Redemonstrate
the steps of 1. Wear the Personal Protective Equipments. explains about the the steps of
procedure for 2. Keep placenta with cord in the basin and take it to the sink steps of the examination
examination of and wash thoroughly under running water. procedure with the placenta.
placenta. 3. Fill basin with clean water and wash until all the blood clots help of placenta.
are removed.
4. Hold placenta by the cord thus allowing the membranes to
hang.
5. Spread out the hand inside the membranes through the
hole from which the baby was delivered. This aids in
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inspection of membranes. If the membranes are complete,
strip the amnion from the chorion and see if both
membranes are present.
6. Spread the mackintosh on the table surface and lay the
placenta on a flat surface.
7. Examine for both the maternal and fetal surfaces one after
the other in a good light.
8. MATERNAL SURFACE:
I. Take the placenta in both cupped hands and check for the
completeness of placenta. Broken pieces of cotyledons
must be replaced before assessing the maternal surface.
II. Place the placenta on the mackintosh and count the lobes
also called cotyledons of placenta which normally
numbered to be 16-20. These cotyledons are separated by
sulci (furrows) in to which decidua dips down to form septa.
III. Normally maternal surface is dark red in colour but white
patches/ infarctions may be seen on maternal surface that
may be due to the disposition of lime salts. The edges of the
maternal surface form a uniform circle.

9. FETAL SURFACE:
It is white and shiny surface. Branches of umbilical veins and
arteries are visible spreading out from the insertion of the
umbilical cord.
IV. Separate amnion and chorion using the probe. Peel off
amnion from the fetal surface till the insertion of cord to
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see the chorionic plate from which the placenta develops.
V. Note the insertion of the umbilical cord. It is normally
central but it may be laterally inserted.
VI. Measure the length of the umbilical cord. It is normally 50
cm and ranges from 30-100 cms. A cord measuring less
than 40 cm is considered as short. A very long cord may
lead to true knots in the cord and it may become wrapped
around the neck or body of the fetus resulting in occlusion
of the blood vessels during labour.
VII. Clean the stump of the cord and look for vessels. It has two
arteries and one vein. Note for the knots in the cord.
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VIII. Note for the false knots in the cord, it is comprised of
Whartson’s jelly, a gelatinous substance formed from
mesoderm.
10. Weigh the empty basin and then again weigh the basin with
placenta in it and calculate the actual weight of placenta.
Weight of the placenta is about 1/6th of the baby weight at
term. Weight of placenta may also be affected by the time
of clamping. Early clamping of cord results in more
placental weight while late clamping leads to less placental
weight, owing to amount of blood retained in placenta.
11. Record the findings of examination of placenta and
membranes and an estimate of blood loss in mother’s note
12. Discard placenta in yellow bag after the procedure is over.
Discarded placenta is sent for incineration.
13. Perform the aftercare of articles and replace all the articles
to utility.
2 min Describe about ANATOMICAL VARIATIONS OF THE PLACENTA AND CORD: Student teacher Explain the
the anatomical  Placenta succenturiate: A small extra lobe is present, describes about the anatomical
variations of the separate from main placenta and joined to it by blood anatomical variations variations of the
placenta and vessels, which run through the membrane to reach it. of the placenta and placenta and
cord. Risks associated with placenta succenturiate : cord. cord.
 Increased risk of PPH due to retained placental
tissues.
 Increased incidence of vasa previa
 Subinvolution
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 Uterine sepsis
 Polyp formation

 Circumvallate placenta: An opaque ring is seen on fetal

surface. The ring is situated at varying distance from the
margin of placenta. The ring is composed of a double fold of
amnion and chorion with degenerated decidua vera and
fibrin in between, vessels radiate from the cord insertion as
far as the ring and then disappear from view, the peripheral
zone outside the ring is thicker and the edge is elevated and
rounded.
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 Bipartite placenta: 2 complete and separate lobes are
present, each with a cord leaving it. The cord joins a short
distance from the 2 parts of the placenta.

 Tripartite placenta: Similar as bipartite placenta but with 3

distinct lobes.
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 Battledore insertion of cord: Cord attached at the very
edge of the placenta. If associated with low implantation of
the placenta, there is chance of cord compression in vaginal
delivery leading to fetal anoxia or even death; otherwise it
has got little clinical significance.

 Velamentous insertion of cord: the cord is attached to the

membranes. The branching vessels traverse between the
membranes for a varying distance before they reach and
supply the placenta. If the leash of blood vessels happens to
traverse through the membranes overlying the internal os,
in front of the presenting part, the condition is vasa previa.
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2 min Elucidates about ABNORMALITIES OF CORD: Student teacher Describe the
the abnormalities  Short cord: Length less than 40 cm. May lead to dystocia, elucidates the abnormalities of
of cord. premature separation of placenta and foetal distress. abnormalities of cord cord.
 Long cord: Excessive long cord may lead to cord prolapsed, with the help of ppt
cord loops around the neck, looped or knotted cord.
 Single umbilical artery: It may indicate child born of a
diabetic mother, congenital malformations (especially
genital and renal) of foetus.
 Missing a blood vessel: May indicate congenital anomaly of
gastrointestinal and genitourinary system.

2 min Summarization of Summarization of the

the topic. topic:
Today, we’ve learnt
about placental
examination that It is
the procedure done
to evaluate any
variations in normal
placenta and umbical
cord, aims of
placental
examinations
procedure of
placental examination
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and finally the after
care of the procedure.

2 min Conclusion of the Conclusion of the

topic. topic:
Placental examination
is an integral
procedure in
obstetrics and
gynaecology so that
any variations can be
identified in the initial
life of the baby so as
to prevent further
complications to baby
and mother.