What Is a Post-Birth Placental Exam?

A new mother doesn't even realize her doctor is examining the placenta because she has a new baby.

Rune Hellestad / Getty Images

For many parents, their newborn baby is the only thing they’re thinking about after giving birth, but there's reason to think about the placenta as well.

"Parents might often be distracted—for good reason—by the time the placenta comes out," says Ericka C. Gibson, MD, an OB/GYN and the physician program director for perinatal safety and quality for Kaiser Permanente in Atlanta, Georgia. “They want to bond with their baby and the placenta becomes very very secondary at that point.”

It’s understandable that you might not even think twice about the placenta that nourished your baby inside your body all those long months. Fortunately, your healthcare provider is paying attention to it—and there's an entire exam just for that one organ. Ahead, learn more about what a placental exam actually entails, why it's essential, and what medical professionals can learn from studying a placenta after birth.

What Is a Placental Exam?

The placenta is an organ that grows inside your uterus when you become pregnant. It provides oxygen and nutrients to your growing baby via the umbilical cord. A typical placenta is about 22 cm in diameter, about 2 cm thick, and weighs about a pound.

Just as your baby has to come out at some point, so does the placenta. Usually, the placenta is delivered within 30 minutes after the baby is born, according to Dr. Gibson. That’s when it’s time for the post-birth placental exam.

A placental exam is essentially what it sounds like: your healthcare provider will peer closely at your placenta after you deliver it to make sure nothing’s amiss. By examining your placenta, your physician can make sure that nothing was left behind in your uterus that could cause complications. They will also note any abnormalities in the umbilical cord or at the umbilical cord insertion site within the placenta.

Why Is a Placental Exam Important?

One of the most crucial things that your doctor is looking for during a placental exam is a complete placenta. You might not even realize if small amounts have been left behind in your uterus without an examination, notes Michael Tahery, MD, an OB/GYN and urogynecologist in Los Angeles and Glendale, California.

“Sometimes the placenta fragments, and if it does, that [excess] portion can lead to an increased risk of hemorrhage or lead to an increased risk of infection,” says Dr. Tahery.  

If it does appear that some pieces of the placenta are still in the uterus, your healthcare provider may need to go in and remove any of that remaining placental tissue manually or possibly via a dilation and curettage (D&C).

One potential culprit for missing pieces of placenta is a condition known as placenta accreta, a complication that arises when the placenta grows deeply into the uterine wall, so bits of the organ remain attached while the rest of the placenta is delivered. Placenta accreta, which occurs in about 1 in every 2500 pregnancies, can sometimes cause significant blood loss after delivery. Usually, surgery to remove the remainder of the placenta is necessary—and in some severe cases, a hysterectomy may also be required to remove the uterus and the rest of the placenta.

What Doctors Look for During a Placental Exam

The placenta is a two-sided organ, and your doctor will check out both sides—the side that was attached to your uterus and the side that was facing your baby.

The Parent's Side of the Placenta

When it’s inside you, the placenta is connected to the top or side of your uterus. It tends to be a deep red color, with knobby or bumpy surface of the lobes, which are known as cotyledons.

Your doctor will examine this side of the placenta to make sure that there aren’t any abnormalities and that it’s not missing any pieces.

“It’s not something that happens often, but it happens frequently enough that it’s part of our routine examination,” explains Dr. Gibson.

The Baby’s Side of the Placenta

Next up, it’s time to look at the baby’s side of the placenta.

“We also look at the placental membranes, again trying to ensure no membranes were stuck inside the uterus,” says Erin Higgins, MD, an OB/GYN with the Cleveland Clinic.

They’ll check out the color and surface of the membranes, making sure there aren’t any nodules or lesions that look suspicious.

Then they’ll examine the umbilical cord. The umbilical cord tethers your baby to your placenta, so your healthcare provider will check the cord for the number of vessels, length, and any knots, cysts, or other abnormalities. A normal umbilical cord consists of three vessels: two arteries and a vein.

Your physician will also eyeball the spot where the cord was inserted into the placenta. There can be rare occurrences like a velamentous cord insertion, when the umbilical cord inserted itself into the amniotic membrane, rather than the middle of the placenta. Research suggests the insertion site can affect a baby’s birth weight, so this could be useful information if your baby has a lower-than-expected birth weight.

What Happens to the Placenta After the Exam?

Normally, the post-birth placental exam is a pretty short affair, according to Dr. Gibson. If the placenta checks out just fine, the physician will just discard the placenta—or offer if to you if you’ve expressed your wishes to see or keep it. But if something looks concerning, your healthcare provider won’t discard the placenta or pass it to you.

“An abnormal-appearing placenta or certain antepartum/intrapartum complications will prompt a physician to send the placenta to pathology for a microscopic exam,” says Dr. Higgins. In other words, if any complications happen prior to (antepartum) or during childbirth (intrapartum), your doctor may send your placenta to the pathology department for a more detailed inspection.

The pathologist will notify your doctor about the results of their examination of the placenta.

A Word From Verywell

Most of the time, nothing is abnormal with the placenta after childbirth. But the post-childbirth placental exam is still important, just in case. It doesn’t take very long, and you might not even realize it’s happening while you’re admiring your new baby. If you have any questions about your placenta, don't hesitate to have a conversation with your healthcare provider.

7 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  4. Brigham and Women’s Hospital. Placenta Accreta

  5. Barker D, Osmond C, Grant S, et al. Maternal cotyledons at birth predict blood pressure in childhood. Placenta. 2013;34(8):672-675.doi: 10.1016/j.placenta.2013.04.019

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  7. Brouillet S, Dufour A, Prot F, et al. Influence of the umbilical cord insertion site on the optimal individual birth weight achievement. BioMed Research International. 2014;2014:e341251. https://doi.org/10.1155/2014/341251

By Jennifer Larson
Jennifer Larson is a seasoned journalist who regularly writes about hard-hitting issues like Covid-19 and the nation's ongoing mental health crisis, as well as healthy lifestyle issues like nutrition and exercise. She has more than 20 years' of professional experience and hopes to log many more.

Originally written by Robin Elise Weiss, PhD, MPH
Robin Elise Weiss, PhD, MPH is a professor, author, childbirth and postpartum educator, certified doula, and lactation counselor.
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