Expanded Nursing Uganda Explanation
Examination of placenta should be reviewed through safe maternal and newborn assessment, early recognition of danger signs, respectful communication and timely referral. Connect the definition to vital signs, bleeding, fetal or newborn wellbeing, patient education and local protocol requirements.
01 Examination of the Placenta:
Aims of Placenta Examination:
- To determine the completeness of the placenta and the membranes.
- To detect any abnormalities.
Requirements :
- Top shelf: Clean gloves.
- Measuring jar.
- Placenta in a receiver.
- Bottom shelf: Weighing scale.
- 3 buckets.
- Apron.
- At the side: Gum boots.
- Hand washing equipment.
- A flat work surface.
02 Method/Procedure of Placenta Examination:
- Remove all clots and place them in a measuring jar.
- Hold the placenta by the cord and inspect for extra holes, ruling out the presence of a Succenturiate lobe or the passage of the baby.
- Observe the length of the cord and check the blood vessels. Normally, there should be three blood vessels present (one vein and two arteries).
- Note the insertion of the cord. It should be centrally inserted. If it is inserted towards the edge, it is known as battledore insertion.
- Observe the color of the fetal surface, which should normally be white and shiny. Branches of the umbilical vein and arteries should be seen radiating from the center of insertion outwards.
- Check the membranes, consisting of the amnion and the chorion, for completeness. The amnion reaches the umbilical cord, is smooth, tough, and transparent, making it difficult to tear.
- The chorion is thick, opaque, and friable and is found at the edge of the placenta.
- Lay the placenta flat on the examining surface, putting the lobes together, and observe for any missing lobe.
- Note the color of the maternal surface, which should normally be dark red.
- White patches found on the maternal surface are called infarcts.
- Weigh the placenta (approximately 1/6 of the baby’s weight at birth).
- Place the placenta in a designated placenta bucket and disinfect the examination area.
- Record the findings in the appropriate chart.
- Report any abnormalities to the in-charge.
03 Disposal of the Placenta:
- Inquire from the mother if she would like to take the placenta home.
- If the mother declines, dispose of the placenta by taking it to the incinerator or placenta pit.
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.
04 MCQ Type Questions for Midwives:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
05 Nursing Uganda Clinical Lens
Use Examination of placenta as a practical nursing topic, not only a memorized definition. Read the topic through the safety of two patients: the mother and the fetus or newborn.
- What to understand first: define examination of placenta, identify the normal or expected pattern, then explain what changes when the patient is unwell.
- Why it matters in care: the nurse must recognize risk early, explain findings clearly, document accurately and know when to escalate.
- How to revise it: connect each point to assessment, nursing diagnosis or care problem, intervention, rationale and evaluation.
06 Assessment Guide
- Maternal vital signs, bleeding, pain, contractions, uterine tone and danger signs.
- Fetal or newborn wellbeing, feeding, temperature, breathing and activity.
- History of pregnancy, parity, medications, allergies, investigations and referral risks.
07 Nursing Priorities, Rationales and Outcomes
- Recognize danger signs early and escalate without delay.
- Provide respectful communication, privacy, infection prevention and clear documentation.
- Teach the mother what to monitor at home and when to return urgently.
The rationale for these priorities is patient safety: nursing actions should prevent deterioration, reduce discomfort, support recovery and create clear evidence for the next caregiver.
- Expected outcome: Mother and baby remain stable, danger signs are acted on early, and the family understands follow-up instructions.
08 Patient Teaching and Revision Check
- Explain examination of placenta in simple language the patient or caregiver can repeat back.
- Teach warning signs, medicine or follow-up instructions, hygiene or lifestyle points where relevant.
- For exams, prepare a short answer using: definition, causes or risk factors, signs, assessment, management, complications and prevention.
- For ward practice, document baseline findings, actions taken, patient response and the plan for review.
Illustrations and Diagrams (5)
Related Video Lectures
Watch nursing lecture videos on YouTube for this topic. Opens in a new tab.
Watch on YouTubeExternal link: YouTube may use its own cookies and terms. Nursing Uganda is not affiliated with YouTube.