1. Birth of
   the baby
   
   
2. Birth of
   the placenta
   
   
3. Local anesthesia for vaginal/
   perineal repair
   
   
4. Repair of the Perineum

Tutorial 2: Birth of the Placenta

Illustrations

• Anatomy of the Cotyledons
• Uterine vessels
• Diminution of uterus during third stage
• Process of placental separation during and after birth
• Change in uterine configuration after placental separation
• Uterine changes as the placenta descends
• Involution of the placental site
• Utero-Placental/Fetal Relationship
• Maternal and Fetal Placental Surfaces

Photographic examples of placentas and membranes

• Fetal Surface of a Normal, Healthy Placenta
• Maternal Surface of a Normal, Healthy Placenta
• Separation of Amniotic and Chorionic Membranes
• Circumvallate Placenta
• Inspection
• Umbilical vessels
• Battledore Insertion - Fetal Surface
• Heart shaped placenta, Battledore insertion of cord (at edge of placenta), long umbilical cord.
• Succinturiate Lobes
• Meconium stained fetal placental surface
• Meconium - maternal surface

Procedures for Birth of the Normal Placenta (models)

• Check for separation - ring forceps at introitus
• Check for separation: Abdominal hand over uterus, controlled cord traction
• Check for separation: Follow cord to cervical opening
• Birth maneuvers: Supra-pubic pressure
• Birth maneuvers: Controlled cord traction
• Birth Maneuvers: Lift placenta with ring forceps
• Birth maneuvers: Hands encompass placenta
• Birth maneuvers: Up and down with gentle rotation to deliver
• Birth maneuvers: Rotate placenta to create thick rope of trailing membranes
• Birth maneuvers: Grasp trailing membranes with ring forceps
• Birth maneuvers: Rotate ring forceps and gently lift up and down to tease out membranes
• Birth maneuvers: Fetal surface
• Birth maneuvers: Cord insertion
• Placental inspection: Location of tear in membranes
• Placental inspection: Characteristics of maternal surface

Back to beginning of Tutorial 2; Birth of the Placenta  |  Go to Birth of the Normal Placenta  |  Back to Psychomotor Skills for Intrapartum managment