Aims of Placenta Examination:

• To confirm the placenta and its membranes are complete.

• To identify any abnormalities in the placenta.

Requirements:

• Top Shelf:

  • Clean gloves.

  • Measuring jar.

  • Receiver for the placenta.

• Bottom Shelf:

  • Weighing scale.

  • Three buckets (for placenta, waste, and potentially contaminated materials).

  • Apron.

• At the Side:

  • Gum boots.

  • Hand washing equipment.

  • A flat, clean work surface.

Method/Procedure of Placenta Examination:

1. Remove any blood clots from the placenta and place them in the measuring jar.

2. Hold the placenta by the umbilical cord and carefully inspect it for any missing sections or holes. This is to rule out a succenturiate lobe (an extra lobe) or any sign that the baby may have passed through a tear in the membranes (which is rare but can happen in complicated births).

3. Observe the length of the umbilical cord. Examine the blood vessels to ensure there are three present—typically one vein and two arteries.

4. Note the insertion point of the umbilical cord on the placenta. Normally, it should be in the center. A cord inserted toward the edge is called battledore insertion.

Fetal Surface Examination:

1. Observe the fetal surface, which is normally white and shiny. The blood vessels (umbilical vein and arteries) should radiate outwards from the center of the cord insertion like the branches of a tree.

2. Check the membranes (amnion and chorion) to confirm they are complete.

   • The amnion reaches the umbilical cord; it is smooth, strong, and transparent, which makes it difficult to tear.

   • The chorion is thick, opaque, and more fragile and is found at the edge of the placenta.

Maternal Surface Examination:

1. Lay the placenta flat on the work surface with the lobes together to check for any missing lobes.

2. Note the color of the maternal surface, which should be a dark red color.

3. Observe for white patches, known as infarcts. Infarcts are areas of tissue death that may occur if blood flow to a portion of the placenta is interrupted.

4. Weigh the placenta. Typically, it should weigh approximately 1/6 of the baby’s weight at birth.

5. Dispose of the placenta in the designated placenta bucket and thoroughly disinfect the examination area.

6. Record all findings in the appropriate patient chart.

7. Report any observed abnormalities to the senior staff or in-charge.

Disposal of the Placenta:

• Ask the mother if she would like to take the placenta home, which is a cultural practice in some settings.

• If the mother does not want to take the placenta, dispose of it by taking it to the incinerator or placenta pit as per the facility’s policy.

MCQ Type Questions for Midwives:

Question 1:

What is the main purpose of performing an episiotomy during childbirth?

A) To reduce maternal distress

B) To prevent cerebral damage in premature babies

C) To quicken delivery in certain cases

D) To prevent excessive bleeding

Answer: C) To quicken delivery in certain cases

Explanation: Episiotomy is a surgical incision made on the perineum to enlarge the vaginal orifice prior to delivery of the baby. It is performed to expedite the delivery process in specific situations, such as maternal distress, fetal distress, cord prolapse, rigid perineum, forceps delivery, face-to-pubis delivery, and certain other conditions.

Question 2:

Which type of episiotomy incision is discouraged due to the risk of damage to the Bartholin’s glands?

A) Medial lateral

B) J-shaped

C) Lateral incision

D) Bilateral

Answer: D) Bilateral

Explanation: The “bilateral” episiotomy incision is done on either side and is similar to the lateral incision. However, it is discouraged because it can cause injury to the Bartholin’s glands, which are located on either side of the vaginal opening.

Question 3:

What is the primary purpose of controlled cord traction during the third stage of labor?

A) To expedite placental delivery

B) To prevent perineal tears

C) To encourage maternal pushing

D) To reduce postpartum hemorrhage

Answer: A) To expedite placental delivery

Explanation: Controlled cord traction is a method used during the third stage of labor to help deliver the placenta more efficiently by applying controlled downward traction on the umbilical cord. It aims to shorten the duration of the third stage and reduce the risk of postpartum hemorrhage.

Question 4:

What is the average volume of blood flow through the placental site before the baby is born?

A) 100-200ml/min

B) 300-500ml/min

C) 500-800ml/min

D) 1000-1200ml/min

Answer: C) 500-800ml/min

Explanation: The normal volume of blood flow through the placental site before the baby is born is approximately 500-800ml/min. This blood flow decreases significantly once the baby is delivered and the placental separation begins.

Question 5:

Which stage of labor involves the separation, descent, and expulsion of the placenta and membranes?

A) First stage

B) Second stage

C) Third stage

D) Fourth stage

Answer: C) Third stage

Explanation: The third stage of labor involves the separation, descent, and expulsion of the placenta and membranes after the delivery of the baby.

Question 6:

What is the main purpose of the placental examination after delivery?

A) To check the baby’s health status

B) To detect any abnormalities in the placenta

C) To ensure proper positioning of the baby

D) To assess maternal blood loss

Answer: B) To detect any abnormalities in the placenta

Explanation: The placental examination after delivery aims to assess the completeness of the placenta and membranes and to detect any abnormalities that may have occurred during pregnancy or delivery.

Question 7:

What is the recommended method of placental separation during the third stage of labor?

A) Mathew Dankan method

B) Active management with controlled cord traction

C) Passive management with maternal efforts

D) Schultze method

Answer: D) Schultze method

Explanation: The Schultze method is the recommended method of placental separation during the third stage of labor. It involves separation starting centrally, resulting in the formation of a retroplacental clot that aids in the separation process.

Question 8:

Which type of episiotomy incision is done by doctors and involves curving away from the anal sphincter?

A) J-shaped

B) Medial lateral

C) Bilateral

D) Lateral incision

Answer: A) J-shaped

Explanation: The J-shaped episiotomy incision is done by doctors and starts from the center of the fourchette, curving away from the anal sphincter.

Question 9:

What is the primary aim of uterine contractions during the third stage of labor?

A) To facilitate placental separation

B) To promote fetal descent

C) To prevent maternal discomfort

D) To dilate the cervix

Answer: A) To facilitate placental separation

Explanation: Uterine contractions during the third stage of labor help to facilitate placental separation and expulsion by reducing the area of the placental site and exerting pressure on the torn blood vessels.

Question 10:

Which stage of labor involves the arrest of hemorrhage?

A) First stage

B) Second stage

C) Third stage

D) Fourth stage

Answer: C) Third stage

Explanation: The third stage of labor involves the arrest of hemorrhage as the uterus contracts and closes the spiral arterioles after placental expulsion, reducing bleeding.

Question 11:

What is the main indication for performing an episiotomy in a forceps delivery?

A) To reduce fetal distress

B) To prevent cerebral damage in premature babies

C) To quicken delivery

D) To prevent excessive bleeding

Answer: C) To quicken delivery

Explanation: In a forceps delivery, an episiotomy may be performed to quicken delivery, allowing for easier extraction of the baby using forceps and reducing the risk of prolonged labor.

Question 12:

Which type of episiotomy incision is the commonest, safest, and recommended for use by midwives?

A) J-shaped

B) Medial lateral

C) Bilateral

D) Lateral incision

Answer: B) Medial lateral

Explanation: The medial lateral episiotomy is the commonest, safest, and recommended incision for use by midwives. It starts from the fourchette to the medial lateral direction of the perineum.

Question 13:

What is the typical healing time for an episiotomy?

A) 1-2 weeks

B) 2-4 weeks

C) 4-6 weeks

D) 6-8 weeks

Answer: C) 4-6 weeks

Explanation: The typical healing time for an episiotomy is around 4-6 weeks, depending on the size of the incision and the type of suture material used.

Question 14:

What is the average volume of blood flow through the placental site after the baby is born?

A) 100-200ml/min

B) 300-500ml/min

C) 500-800ml/min

D) 1000-1200ml/min

Answer: A) 100-200ml/min

Explanation: After the baby is born, the average volume of blood flow through the placental site reduces to approximately 100-200ml/min.

Question 15:

What is the primary aim of rubbing the fundus during the third stage of labor?

A) To assess the size of the uterus

B) To promote uterine contractions

C) To monitor the baby’s heart rate

D) To assess cervical dilation

Answer: B) To promote uterine contractions

Explanation: Rubbing the fundus during the third stage of labor helps to promote uterine contractions and assist in the expulsion of the placenta and membranes. It aids in preventing postpartum hemorrhage and achieving hemostasis.