Definition
A thorough inspection and examination of the placenta and membranes, soon after expulsion, for its completeness and normalcy.
Purposes
- To ensure that the entire placenta and membranes have been expelled, and no part has been retained.
- To make sure that placenta is of normal size, shape, consistency, and weight.
- To detect abnormalities, such as infarctions, calcification or additional lobes.
- To ascertain the length of the cord, number of blood vessels and site of insertion of the cord.
- To check weight of placenta and measure length of cord.
Articles
- Placenta in a bowl.
- A washable surface to lay the placenta for examination.
- Kidney tray.
- A weighing machine.
- Measuring tape.
- Pair of clean gloves.
Procedure
| Nursing Action | Rationale | |
| 1. | Don gloves. | Protects nurse from contamination. |
| 2. | Using gloved hands hold the placenta by the cord allowing the membranes to hang (twisting the cord twice around the fingers will provide a firm grip). | Hanging membranes will provide a better view to check its completeness. |
| 3. | Identify the hole through which the baby was delivered. | If the membranes are not torn into pieces, a single round hole can be identified clearly. |
| 4. | Insert hand through the hole and spread out the fingers to view the membranes and the blood vessels. | The position of cord insertion and the course of blood vessels can be noted in this position. |
| 5. | Remove the hand from inside the membranes and lay the placenta on a flat surface with the fetal surface up. Identify the site of cord insertion. | Normally the cord is inserted in the center of placenta. Lateral or velamentous insertion may be noted. |
| 6. | Examine the two membranes amnion and chorion for completeness and presence of abnormal vessels indicating succenturiate lobe. | Amnion is shiny and chorion is shaggy. Amnion can be peeled from the chorion up to the umbilical cord. |
| 7. | Invert the placenta, expose the maternal surface and remove any clots present. | |
| 8. | Examine the maternal surface by spreading it in the palms of your two hands and placing the cotyledons in close approximation (any broken fragments must be replaced before accurate assessment is made). | Ensures that no part of the placenta or membranes is left inside the uterus. |
| 9. | Assess for presence of abnormalities, such as infarctions, calcification or succenturiate lobes. | |
| 10. | Inspect the cut end of the umbilical cord for presence of three umbilical vessels. | Two arteries and one vein should normally be seen. Absence of an artery may be associated with renal abnormalities. |
| 11. | Measure the length of the umbilical cord by holding it extended against a graduated surface/side of the weighing scale (the length of the cord on the baby may be added to get the total length where applicable). | Average length of the cord is 50 cm. |
| 12. | Weigh the placenta by placing it on the weighing scale meant for the purpose. | Normally the placenta weighs about one-sixth of the baby’s weight. |
| 13. | Place the placenta in the bin kept for the purpose. | For proper disposal. |
| 14. | Clean the area used for examination of the placenta and membranes, weighing scale, and bowl. | Keeps area and article clean and safe for next use. |
| 15. | Remove gloves and wash hands. | Completes the procedure. |
| 16. | Record in the patient’s chart, the findings of placental examination and weight of the placenta, length of the cord, and any special observations made. | Acts as a communication between staff members. |
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Annamma Jacob, Manual of Midwifery and Gynaecological Nursing, 4th Edition, 2023, Jaypee Publishers, ISBN: 978-9356961593
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
