ACNM May 2000


DSM PathWorks, Inc.
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American College of Nurse-Midwives
Workshop #23: The Placenta: To Know Me Is To Love Me
May 12th, 2000
Anchorage, Alaska: During the workshop, questions were asked regarding umbilical cord coiling, neonatal blood gases, umbilical vein as conduit for coronary artery bygass grafting, and RhoGam for RH incompatibility. Click here for the results of the MedLine search.
: Below are the questions and answers for the quiz distributed during the workshop.

	1. 400 grams, 18 x 18 x 3 cm
	2. 470 GRAMS, 20 x 20 x 2 CM (Schuler-Maloney, pg. 61)
	3. 550 grams, 24 x 20 x 1.4 cm
	4. 350 grams, 20 x 14 x 2 cm

	1. right twisted umbilical cord
	2. velamentously inserted umbilical cord
	3. MARGINALLY INSERTED UMBILICAL CORD (Schuler-Maloney, pg. 61)
	4. a cord that has been torn off the fetal surface during manual placental removal

	1. Decidua vera: D - decidua in late pregnancy lining uterus and overlying membranes
	2. Decidua capsularis: B - decidua attached to the membranes
	3. Decidua parietalis: C - decidua lining the uterus
	4. Decidua basalis: A - decidua underlying the placenta (Schuler-Maloney, pg. 70)

	1. prenatal meconium discharge
	2. hemosiderin pigment associated with old hemorrhage
	3. severe ascending infections
	4. ALL OF THE ABOVE (Schuler-Maloney, pg. 40)

E. There are twice as many veins as arteries on the fetal surface of the placenta.

F. Right twisted umbilical cords out number left twisted umbilical cords because more people are right handed.

G. Under which circumstances is the Wharton's jelly more likely to be shrunken, contracted (lesser diameter umbilical cord)? (circle all that apply)

	1. with preterm delivery
	2. AT TERM (Schuler-Maloney, pg. 61)
	3. POSTDATES
	4. in association with polyhydramnios
	5. IN ASSOCIATION WITH OLIGOHYDRAMNIOS

H. Single umbilical artery (SUA/two vessel umbilical cord), is most often associated with which of the following congenital anomalies?

	1. tracheo-esophageal fistula
	2. sirenomelia
	3. renal dysplasia or agenesis
	4. OVER 100 MALFORMATIONS ARE ASSOCIATED WITH SUA AND NO ONE ANOMALY PREDOMINATES (Schuler-Maloney, pg. 66)

	1. meconium may be discharged in response to fetal distress
	2. meconium may not be discharged in response to fetal distress
	3. meconium is thought to be a contributing cause to the development of cerebral palsy
	4. ALL OF THE ABOVE (Schuler-Maloney, pg. 158-159)

	1. THE PLACENTAL PARENCHYMA IS TORN AND FRAGMENTED AT THE SITE OF ABRUPTION (Schuler-Maloney, pp. 3, 81)
	2. the placental maternal surface may show nothing
	3. the placental maternal surface may show adherent rubbery red to stringy brown blood clot
	4. is often due to damaged endometrial spiral artery
	5. the placental parenchyma overlying the abruption often infarcts

	1. they are both anorexic drugs
	2. they are both vasoconstrictors
	3. they are both associated with a higher incidence of abruptio placentae
	4. THEY ARE BOTH RESPONSIBLE FOR DOUBLING THE PROPORTION OF LOW BIRTH WEIGHT BABIES IN A POPULATION (Slotkin)
	5. they are both associated with higher incidence of risky behavior such as co-abuse of other drugs, no prenatal care, low socioeconomic status

M. Placental triage is an important part of health care for the child, mother and future children.

	Schuler-Maloney D, Lee S: The Placenta: To Know Me Is To Love Me. A reference guide for gross placental examination, published 1998 by DSM PathWorks, Inc., St. Mary's, IA
	Slotkin TA: Fetal Nicotine or Cocaine Exposure: Which one is worse? Journal of Pharmacology and Experimental Therapeutics, 1998, Vol. 285, No. 3, pp. 931-945.

NANN Sept 2000

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ACNM May 2000