What are the signs of placental seperation?

1. Uterine contraction.
2. The fundus of the uterus rises in the abdomen, when the placenta moves from the upper segment of the uterus to the lower segment and vagina.
3. Lengthening of the umbilical cord. This sign is most easily seen if the cord is clamped with forceps at the vulva. Any lengthening of the umbilical cord above the forceps is then easily noticed.
4. An amount of blood suddenly escapes from the vagina.

Separation of the placenta can now be confirmed by applying suprapubic pressure. The placenta has definitely separated if the umbilical cord does not shorten when the uterus is pushed up (no cord retraction).

Information from this website: Ebwhealthcare.com

When Should You hurry and cut the cord ?

In the delivery of multiple births.

I found this information from this website very helpful. Ebwhealthcare.com

It also states that You Should Not hurry to cut the cord if the mother is Rh Neg. I Am Rh Negative so this was helpful to know.  Here is what the link says.

1. "The umbilical cord must not be allowed to bleed after the delivery of the first infant in a multiple pregnancy. In identical twins with a single placenta (monochorionic placenta), the undelivered second twin may bleed to death if the umbilical cord of the firstborn infant is allowed to bleed.
2. The umbilical cord should be allowed to bleed if the patient’s blood group is Rhesus negative (Rh negative) with a single fetus. This will reduce the risk of fetal blood crossing the placenta to the mother’s circulation and, thereby, sensitising the patient. Nevertheless, anti-D immunoglobulin must always be given to these patients.
3. Allowing the umbilical cord to bleed during the third stage of labour reduces the placental volume and, thereby, speeds up the separation of the placenta. As a general rule, the umbilical cord should be allowed to bleed once a multiple pregnancy has been excluded."

How to cut the umbilical cord ?

Cutting The Cord Video

In this video, it appears it is cut after the cord has stopped pulsing but before the delivery of the placenta. 


Information from this website: About.com

Here's How:

1. Be sure the cord has stopped pulsing for most births.
2. Ensure that there are two clamps on the cord.
3. Hold the section of cord to be cut with a piece of gauze under it.
4. Using sterile scissors cut between the two clamps.
5. Dab excess blood.
6. Place scissors away.

Tips:

1. The gauze keeps excess blood from splattering.
2. Remind everyone that mom and baby can't feel the cord being cut.
3. The cord is thicker and harder to cut, more like meat gristle. Don't be surprised.

How to examine the placenta after birth ?

Below information found at this website: Ebwhealthcare.com


Every placenta must be examined for:

1. Completeness.
   Make sure that both the placenta and the membranes are complete after the delivery of the placenta:
   
   • The membranes are examined for completeness by holding the placenta up by the umbilical cord so that the membranes hang down. You will see the round hole through which the infant was delivered. Examine the membranes carefully to determine whether they are complete.
   • The placenta is now held in both hands and the maternal surface is inspected after the membranes are folded away. A missing part of the placenta, or cotyledon, is thus easily noticed.
2. Abnormalities.
   • Cloudy membranes, or a placenta that smells offensive, suggests the presence of chorioamnionitis.
   • Clots of blood which adhere to the maternal surface suggest that abruptio placentae has occurred.
3. Size.
   The weight of the placenta increases with gestational age and is usually 1/6 the weight of the infant, i.e. 450–650 g at term.
   If the placenta is abnormally large, the following possibilities must be considered:
   
   • A heavy, oedematous placenta is suggestive of congenital syphilis.
   • A heavy, pale placenta is suggestive of Rhesus haemolytic disease.
   • A placenta which is heavier than would be expected for the weight of the infant, but with a normal appearance, is suggestive of maternal diabetes.
   • A placenta which is lighter than would be expected for the weight of the infant, is suggestive of fetal intra-uterine growth restriction (IUGR).
4. Umbilical cord.
   Two arteries and a vein should be seen on the cut end of the umbilical cord. If only one umbilical artery is present, the infant must be carefully examined for other congenital abnormalities.
   

Infarcts can be recognized as firm, pale areas on the maternal surface of the placenta. Calcification on the maternal surface is normal.

All placentas must be carefully examined for completeness and abnormalities after delivery.

More Links

Placenta Pics 

Placental Exam

Gross Examination