Placental Delivery: A Quiz on Normal Placental Delivery

Question 1: Placental Separation

1. Definition: Placental separation is the process by which the placenta detaches from the uterine wall after the baby has been delivered.

2. Mechanism of Placental Separation:

• Primary mechanism: The uterus contracts after delivery, causing the placenta to detach from the uterine wall.
• Contributing factors:
  • The placenta shrinks in size.
  • Blood clots form behind the placenta, creating a cushion that facilitates separation.
  • Pulling on the umbilical cord after delivery helps detach the placenta from the uterine wall.

3. Types of Placental Separation:

• Baudelocque separation: The placenta separates from the center outward, with the maternal side facing outward.
  • Accounts for approximately 75% of cases.
  • More common, less prone to bleeding.
• Duncan separation: The placenta separates from the periphery inward, with the fetal side facing outward.
  • Accounts for approximately 25% of cases.
  • Less common, less prone to retained placenta or membranes.

Note:

• Placental separation is a natural process that occurs after the baby has been delivered.
• Monitoring and managing placental separation is crucial to prevent complications such as postpartum hemorrhage.

Question 2: Placental Delivery

1. Definition: Placental delivery is the process by which the placenta is expelled from the uterus after separation.

2. Types of Placental Delivery:

• Baudelocque delivery: The placenta is expelled with the maternal side facing outward.
• Duncan delivery: The placenta is expelled with the fetal side facing outward.

Note:

• Placental delivery typically occurs within 5-10 minutes after the baby has been delivered.
• If the placenta is not expelled, it can lead to retained placenta, which can cause postpartum hemorrhage.

Question 3: Post-Placental Delivery Care

1. Active Management of the Third Stage of Labor:

• Administer 10 IU of oxytocin intramuscularly after delivery.
• Controlled cord traction.
• Uterine massage after placental delivery.
• Frequent uterine checks to detect postpartum hemorrhage early.

2. Early Breastfeeding:

• Initiate breastfeeding within 30 minutes after delivery.
• Breastfeeding helps contract the uterus, reducing the risk of postpartum hemorrhage.

Note:

• Monitor the mother’s health after placental delivery to detect complications early.
• Seek medical attention if any concerns arise.

Question 4: Multiple Choice Questions

1. After delivery, which of the following signs indicates that the placenta has separated?

   • A. When pressing the fundus of the uterus with the palm of the hand, the umbilical cord retracts into the vagina.
   • B. The uterus becomes firm and globular.
   • C. A gush of blood is released from the vagina.
   • D. The uterus rises up in the abdomen.

   Answer: A. When pressing the fundus of the uterus with the palm of the hand, the umbilical cord retracts into the vagina.

   Explanation: When the placenta separates, the uterus contracts, pulling the umbilical cord inward towards the vagina.

2. The boundary between the placenta and the uterine wall where separation occurs is:

   • A. Between the chorion and the amnion.
   • B. Between the decidua basalis and the decidua capsularis.
   • C. Between the decidua basalis and the decidua parietalis.
   • D. Between the chorionic plate and the basal plate.

   Answer: C. Between the decidua basalis and the decidua parietalis.

   Explanation: The decidua basalis is the portion of the decidua that is attached to the placenta, while the decidua parietalis is the portion that lines the rest of the uterine wall.

3. The primary mechanism for placental separation is:

   • A. Gravity.
   • B. The shrinking of the placenta.
   • C. Uterine contraction.
   • D. The formation of blood clots behind the placenta.

   Answer: C. Uterine contraction.

   Explanation: Uterine contractions are the main factor that leads to placental separation.

4. Which sign helps detect postpartum hemorrhage early?

   • A. Heart rate above 90 beats per minute.
   • B. Decreased urine output.
   • C. Low blood pressure.
   • D. All of the above.

   Answer: A. Heart rate above 90 beats per minute.

   Explanation: Increased heart rate is an early sign of blood loss.

5. How soon after delivery should the mother start breastfeeding?

   • A. Within 30 minutes.
   • B. Within 1 hour.
   • C. Within 2 hours.
   • D. After the placenta has been delivered.

   Answer: A. Within 30 minutes.

   Explanation: Early breastfeeding helps the uterus contract, reducing the risk of postpartum hemorrhage.

6. If bleeding occurs after placental delivery, what should be done first?

   • A. Administer oxytocin.
   • B. Massage the uterus.
   • C. Check the pulse, blood pressure, and source of bleeding.
   • D. Call for help.

   Answer: C. Check the pulse, blood pressure, and source of bleeding.

   Explanation: Identifying the cause of bleeding is the first step in managing it.

7. Select the most accurate statement about Baudelocque placental separation:

   • A. Separation occurs from the center outward.
   • B. Separation occurs from the periphery inward.
   • C. It is less common than Duncan separation.
   • D. It is more prone to bleeding than Duncan separation.

   Answer: A. Separation occurs from the center outward.

   Explanation: Baudelocque separation occurs from the center of the placenta outward.

8. How many ways can the placenta be delivered after separation?

   • A. One way.
   • B. Three ways.
   • C. Two ways.
   • D. Four ways.

   Answer: C. Two ways.

   Explanation: There are two types of placental delivery: Baudelocque and Duncan.

9. The most important mechanism for controlling bleeding during placental delivery is:

   • A. The use of oxytocin.
   • B. Uterine massage.
   • C. Contraction of the interlacing muscle fibers in the uterine body.
   • D. Controlled cord traction.

   Answer: C. Contraction of the interlacing muscle fibers in the uterine body.

   Explanation: Uterine contraction is the primary mechanism for controlling bleeding after placental delivery.

10. Select the best course of action: if the membranes are not completely separated during placental delivery:

    • A. Gently lower the placenta into the palm of your hand and rotate it to separate the remaining membranes.
    • B. Pull on the umbilical cord to detach the remaining membranes.
    • C. Manually remove the remaining membranes with a forceps.
    • D. Wait for the membranes to separate on their own.

    Answer: A. Gently lower the placenta into the palm of your hand and rotate it to separate the remaining membranes.

    Explanation: Gentle rotation of the placenta can help separate the remaining membranes.

11. Determine the correct statement about the number of ways the placenta can separate and deliver:

    • A. Two types of separation and two types of delivery.
    • B. One type of separation and two types of delivery.
    • C. Two types of separation and one type of delivery.
    • D. One type of separation and one type of delivery.

    Answer: A. Two types of separation and two types of delivery.

    Explanation: There are two types of placental separation and two types of placental delivery.

12. Active management of the third stage of labor includes:

    • A. Administering 10 IU of oxytocin intramuscularly after delivery, controlled cord traction, and uterine massage after placental delivery.
    • B. Administering oxytocin intravenously, controlled cord traction, and uterine massage after placental delivery.
    • C. Administering oxytocin intramuscularly, controlled cord traction, and uterine massage before placental delivery.
    • D. Administering oxytocin intravenously, controlled cord traction, and uterine massage before placental delivery.

    Answer: A. Administering 10 IU of oxytocin intramuscularly after delivery, controlled cord traction, and uterine massage after placental delivery.

    Explanation: These measures help contract the uterus and control postpartum hemorrhage.

13. Baudelocque placental separation accounts for approximately:

    • A. 50%.
    • B. 60%.
    • C. 75%.
    • D. 90%.

    Answer: C. 75%.

    Explanation: Baudelocque separation accounts for approximately 75% of cases.

14. Duncan placental separation accounts for approximately:

    • A. 10%.
    • B. 15%.
    • C. 20%.
    • D. 25%.

    Answer: D. 25%.

    Explanation: Duncan separation accounts for approximately 25% of cases.

15. The average surface area of the placental villi is:

    • A. 12-14 square meters.
    • B. 5-7 square meters.
    • C. 2-4 square meters.
    • D. 1-2 square meters.

    Answer: A. 12-14 square meters.

    Explanation: The average surface area of the placental villi is approximately 12-14 square meters.

16. The uterine safety ring forms after placental delivery and lasts for:

    • A. 1 hour.
    • B. 2 hours.
    • C. 3 hours.
    • D. 4 hours.

    Answer: B. 2 hours.

    Explanation: The uterine safety ring forms after placental delivery and lasts for approximately 2 hours.

17. Choose the correct statement about the types of placental delivery:

    • A. Duncan delivery is more common and less prone to bleeding.
    • B. Baudelocque delivery is less common and more prone to bleeding.
    • C. Duncan delivery is more prone to retained placenta or membranes.
    • D. Baudelocque delivery is more common and less prone to bleeding.

    Answer: D. Baudelocque delivery is more common and less prone to bleeding.

    Explanation: Baudelocque delivery is more common and less prone to bleeding.

Note: This information is for general knowledge purposes and should not replace the advice of a medical professional.