Maternity Nursing Q 14

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The following are signs that the placenta has detached, except?

  

     A. Lengthening of the cord

     B. Uterus becomes more globular

     C. Sudden gush of blood

     D. Mother feels like bearing down

    

    

Correct Answer: D. Mother feels like bearing down

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Placental detachment does not require the mother to bear down. A normal placenta will detach by itself without any effort from the mother.

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Option A: The most reliable sign is the lengthening of the umbilical cord as the placenta separates and is pushed into the lower uterine segment by progressive uterine retraction. Placing a clamp on the cord near the perineum makes it easier to appreciate this lengthening. Never place traction on the cord without countertraction on the uterus above the symphysis; otherwise, one may mistake cord lengthening due to impending prolapse or inversion for that of uncomplicated placental separation.

Option B: The uterus takes on a more globular shape and becomes firmer. This occurs as the placenta descends into the lower segment and the body of the uterus continues to retract. This change may be clinically difficult to appreciate.

Option C: As the placenta detaches, the spiral arteries are exposed in the placental bed; massive hemorrhage would occur if not for the structure of the uterus. The vessels supplying the placental bed traverse a latticework of crisscrossing muscle bundles that occlude and kink-off the vessels as they contract and retract following the expulsion of the placenta.

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