PATHOLOGICAL CONDITIONS

1. Hydatidiform Mole

During the early weeks of placental development, the chronic villi undergo cystic degeneration. As a result, the embryo dies due to lack of nourishment, and this is considered an abnormal pregnancy.

2. Infarcts or Premature Degeneration

These are areas of enclosed chronic villi, appearing red in the early stage and white later with a solid cartilaginous consistency. They are produced by increased concentration of tissue Thromboplastin and always appear on the maternal surface.

• They are associated with the normal degenerative process of the placenta at term but can be severe in cases of hypertension, syphilis, and P.E.T. (Pre-Eclampsia Toxemia) diseases.

3. Edema

This results in a large, pale, water-logged placenta weighing as much as half the weight of the fetus. It is associated with hydrops fetalis and is due to hemolytic disease of the newborn caused by Rhesus ISO-immunization. Other associated conditions include Diabetes and Syphilis.

EXAMINATION OF THE PLACENTA AND MEMBRANES

Reasons for Examination of the Placenta

1. To determine whether the placenta and the membranes have been completely delivered. If any part (like a cotyledon or a Succenturiate lobe) is retained in the uterus, there is a high risk of hemorrhage and infection.

2. To determine the weight, general appearance, and consistency of the placenta to provide information about the baby.

3. To check for specific abnormalities, either structural (e.g., abnormal position of the insertion of the cord, presence of more or fewer blood vessels) or diseases (e.g., infarcts, edema).

4. To remove blood clots from the placenta so that it can be weighed to estimate blood loss.

5. In the case of twins, to find out whether the twins were monozygotic (sharing one placenta) or dizygotic (if each had one placenta).

Method of Examination

The duty of a midwife as regards the management of labor is not complete until the placenta and membranes have been examined.

1. General Inspection: The placenta is held by the cord, and the membranes are left to hang to see if there is a hole where the baby passed. It is then placed on a flat surface, and the length of the cord is noted, along with any abnormality.

2. The Fetal Surface: Inspected to see the insertion of the cord and to see if the blood vessels terminate at the edge of the placenta. Also note if the membranes are complete and no blood vessels run through to the edge.

3. The Maternal Surface: All clots are removed and placed in a measuring jar. The cotyledons are inspected to see if they are complete. The placenta is held in a cupped hand so that cotyledons can be fitted into one another to confirm that none are missing. If the placenta is abnormally big or small, it should be weighed and kept for doctor’s inspection.