Examination of the Placenta
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Questions and Answers

What is the average diameter of a mature placenta at term?

  • 22 cm (correct)
  • 17.5 cm
  • 20 cm
  • 25 cm

Which of the following describes the thickest measurement of the placenta at full term?

  • 2.0 cm
  • 1.5 cm
  • 2.5 cm (correct)
  • 3.0 cm

At what gestational age is the placenta completely formed and functioning?

  • 14 weeks
  • 8 weeks
  • 12 weeks (correct)
  • 10 weeks

Which characteristic is NOT a clinical feature of a normal placenta?

<p>Weighs 220 g at term (D)</p> Signup and view all the answers

What is one of the primary functions of the placenta?

<p>Respiration for the fetus (B)</p> Signup and view all the answers

What feature should be assessed regarding the umbilical cord during examination?

<p>The presence of Wharton's Jelly (D)</p> Signup and view all the answers

Which statement correctly describes the fetal surface of the placenta?

<p>It should be shiny, gray, and translucent. (C)</p> Signup and view all the answers

Which of the following is NOT typically assessed during a placental examination?

<p>Length of the fetal nails (C)</p> Signup and view all the answers

What should be inspected at the cut end of the umbilical cord before counting the vessels?

<p>The fused structure of the arteries (B)</p> Signup and view all the answers

What is an important finding when counting the vessels in the umbilical cord?

<p>Absence of one artery indicating renal agenesis (D)</p> Signup and view all the answers

Which irregularities should be looked for on the fetal side of the placenta?

<p>Presence of succenturate lobes or missing cotyledons (D)</p> Signup and view all the answers

When separating the amnion from the chorion, what should be ensured?

<p>That both are completely intact (B)</p> Signup and view all the answers

What should be done before assessing for blood loss in relation to cotyledons?

<p>Carefully replace broken fragments of cotyledon (D)</p> Signup and view all the answers

What action is recommended when there's suspicion of incomplete placenta or membranes?

<p>Keep the fragments for further inspection (D)</p> Signup and view all the answers

Why might placenta referral for examination be desirable?

<p>In cases of obstetric emergencies (D)</p> Signup and view all the answers

Which condition is listed as a reason to refer the placenta for examination?

<p>Fetal congenital malformation (D)</p> Signup and view all the answers

How does oxygen transfer from the mother to the fetus?

<p>Simple diffusion (D)</p> Signup and view all the answers

Which nutrient is NOT actively transferred from maternal to fetal blood?

<p>Fats (A)</p> Signup and view all the answers

What hormone is secreted by the placenta to maintain pregnancy?

<p>Human chorionic gonadotropin (HCG) (C)</p> Signup and view all the answers

Which substance is primarily excreted by the fetus?

<p>Urea (B)</p> Signup and view all the answers

What is the function of the placenta regarding glucose?

<p>Stores glucose as glycogen and reconverts it as needed (A)</p> Signup and view all the answers

Which of the following is true about the placental barrier?

<p>It allows the passage of certain drugs and chemicals (A)</p> Signup and view all the answers

What is one of the first steps in the placental examination process?

<p>Hold the placenta in both hands while delivering (A)</p> Signup and view all the answers

Which aspect of the placenta is NOT examined during the examination process?

<p>The maternal blood type (B)</p> Signup and view all the answers

Flashcards

Placenta Definition

A flat organ, about 17.5-20cm in diameter and 2.5cm thick, formed by the 12th week of pregnancy.

Mature Placenta

Fully formed and functioning placenta at 10-12 weeks after fertilization.

Placental Examination Objectives

To evaluate size, shape, consistency, and completeness; assess for accessory lobes, infarcts, hemorrhage, and tumors; check the umbilical cord for length, insertion, vessel number, thrombosis, knots, and Wharton's jelly; and assess the membranes' color and odor.

Normal Placenta Diameter

Around 22cm at full-term pregnancy.

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Umbilical Cord Vessels

A normal umbilical cord should have two arteries and one vein.

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Wharton's Jelly

A jelly-like substance in the umbilical cord.

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Maternal Placenta Surface

Dark red, divided into cotyledons; complete structure with no missing cotyledons.

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Placenta Respiration Function

Fetus obtains oxygen and removes carbon dioxide through the placenta due to the lack of lung function early in development.

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Placental Oxygen Transfer

Oxygen from the mother's blood moves to the fetus through simple diffusion, and carbon dioxide diffuses in the opposite direction.

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Nutrient Transfer

Nutrients like proteins, carbohydrates, and minerals are actively transported from the mother's blood to the fetal blood.

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Placental Glucose Storage

The placenta stores glucose as glycogen and converts it back to glucose as needed.

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Fetal Waste Removal

Fetal metabolic waste like carbon dioxide, bilirubin, urea, and uric acid is excreted through the placenta.

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Placental Protection

The placenta acts as a partial barrier to some harmful substances, but not all, like alcohol, toxins, and certain viruses.

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Placental Hormones

The placenta produces hormones like HCG, estrogen, progesterone, and HPL (human placental lactogen).

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Placenta Delivery Steps

Placenta delivery involves holding the placenta, twisting it, gently pulling it, examining for torn membranes, and placing it in a container.

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Placenta Examination Steps

Washing hands, wearing protective gear, explaining the procedure to parents, checking for lighting and ensuring a clean surface, preparing instruments if needed, laying the placenta correctly and examining its details are crucial.

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What can a two-vessel umbilical cord indicate?

The absence of one umbilical artery can be associated with renal agenesis (a condition where one or both kidneys fail to develop properly).

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What is the significance of a complete placental structure?

A complete placenta should have all its cotyledons neatly fitting together without gaps, forming a uniform circle. Any missing cotyledons, infarctions, or other irregularities should be noted.

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What are the key things to check in the fetal side of the placenta?

Inspect for irregularities such as succenturate lobes (accessory lobes), missing cotyledons, fatty deposits, or infarctions (areas of tissue death).

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What is the purpose of separating the amnion from the chorion?

To ensure both fetal membranes (amnion and chorion) are present. Look for a single hole where the baby passed through.

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What does a complete placenta look like on its maternal side?

The maternal surface should have distinct cotyledons, with no missing areas. Assess their size and check for any infarctions, blood clots, or calcification.

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When is referral of the placenta for examination DESIRABLE?

Referral is recommended for conditions such as prematurity, placental abruption, fetal congenital malformations, Rh isoimmunisation, morbidly adherent placenta, twins or other multiple pregnancies, abnormal placental shape, and two-vessel cord.

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What should be done with the placenta if it is suspected to be incomplete?

The placenta and membranes should be kept for further inspection and referred to the duty obstetrician for further assessment.

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What is the final step after examining the placenta?

Clean away all equipment and wash hands thoroughly to maintain a hygienic environment.

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Study Notes

Examination of the Placenta

  • Definition: A flat organ, approximately 17.5-20 cm in diameter and 2.5 cm thick, weighing about one-sixth of the infant's birth weight. It forms by the 12th week of pregnancy, originating from the trophoblastic layer of the fertilized ovum.

Mature Placenta

  • Fully formed and functional by 10-12 weeks after fertilization.
  • Weighs more than the fetus between 12-20 weeks due to fetal organs not being fully developed yet.
  • Gradually degenerates later in pregnancy as the fetus's organs take over their functions.

Objectives of Examination

  • Identify the size, shape, consistency, and completeness of the placenta.
  • Look for accessory lobes, placental infarcts, hemorrhages, and tumors.
  • Examine the umbilical cord for length, insertion, number of vessels, thrombosis, knots, and Wharton's jelly.
  • Assess the color and odor of the fetal membranes.

Clinical Characteristics of Normal Placenta

  • Diameter: 22 cm at term.
  • Thickness: 2-2.5 cm.
  • Weight: 470 g.
  • Umbilical cord: length 55-60 cm, diameter 2-2.5 cm, with 2 arteries and 1 vein, containing Wharton's jelly.

Surface of the Placenta

  • Maternal surface: Dark red, divided into cotyledons, should be complete with no missing ones.
  • Fetal surface: Shiny, gray, translucent, showing the color of underlying villous tissues.

Functions of Placenta

  • Respiration: The lungs do not function in the fetus, so the placenta facilitates oxygen exchange, taking oxygen from the mother's blood and releasing carbon dioxide. The same process happens for carbon dioxide as well.
  • Nutrition: Transports nutrients (proteins, carbohydrates, calcium, phosphorus, iron, minerals) from the mother to the developing fetus through the wall of the villi.
  • Storage: Stores glucose as glycogen for later use, with iron and fat-soluble vitamins also being stored.
  • Excretion: Removes waste products (carbon dioxide, bilirubin, urea, uric acid) from the fetus, as it cannot be fully eliminated by the fetus without function of the liver.
  • Protection: Provides limited barriers against infections. Some chemicals/viruses are not filtered, potentially leading to congenital anomalies.
  • Endocrine: Secretes hormones like HCG, estrogen, progesterone, and HPL.

Steps of Placental Examination

  • Delivery: Hold and gently turn placenta until membranes are twisted, and slowly pull until completely delivered. The membranes should be moved up and down.
  • Examination:
    • Wash hands, wear appropriate gear, and explain procedure to parents.
    • Adequately light the work area.
    • Prepare a flat surface to avoid spillage.
    • Prepare tools if needed (syringe, needle).
    • Lay out the placenta with maternal surface uppermost.
    • Note the size, shape, color, and odor.
    • Examine the umbilical cord (length, insertion, knots, thrombi, presence of vessels).
    • Identify vessel counts in the umbilical cord at its end.
    • If membrane tears, examine upper vagina and cervix using sterile gloves and sponge forceps to remove any pieces. Clean up any membrane pieces.

Referral of Placenta for Examination

  • Prematurity (30-36 weeks)
  • Placental abruption
  • Fetal congenital malformation
  • Rhesus (and other) isoimmunisation
  • Morbidly adherent placenta
  • Twins/multiple pregnancies
  • Abnormal placental shape
  • Abnormal umbilical cord (e.g., two-vessel cord)
  • Prolonged rupture of membranes >36 hours
  • Gestational diabetes
  • Maternal group B streptococcus
  • Pre-eclampsia/maternal hypertension
  • Maternal coagulopathy
  • Maternal substance abuse.

Disposal of Placenta

  • Place placenta in a yellow bag, then a yellow container.
  • If the woman wishes, the placenta can be taken home.

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Related Documents

Placenta Examination PDF

Description

This quiz focuses on the anatomy and clinical characteristics of the placenta. Participants will learn about its formation, examination objectives, and normal clinical features. Assess your knowledge on the structure and function of this crucial organ during pregnancy.

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