Active management of 3rd stage of labour includes?

IGNOU Post B. SC. Nursing entrance -2021

Obstetrics & Gynaecology

Easy

Appeared in: IGNOU Post B. SC. Nursing entrance -2021

Explanation

Active Management of the Third Stage of Labor (AMTSL) is a crucial intervention to prevent postpartum hemorrhage (PPH).
It consists of a package of three main steps: administration of a uterotonic drug, controlled cord traction (CCT), and uterine massage after placental delivery.
The correct option accurately lists the two most defining active components: the administration of Syntocinon (oxytocin, a uterotonic) and CCT.
These interventions work together to facilitate rapid placental separation and delivery, and to ensure the uterus contracts firmly to prevent excessive bleeding.

Option B: The dose of ergometrine is incorrect (0.02 mg instead of the standard 0.2 mg). Also, the intravenous (IV) route is not the standard of care due to the risk of severe hypertension; intramuscular (IM) is preferred.
Option C: This option is incomplete because it omits the administration of a uterotonic drug (like oxytocin), which is the single most important component of AMTSL for preventing PPH.
Option D: Uterine massage alone is not considered active management. It is a component of AMTSL, but it is performed after the placenta has been delivered to ensure the uterus remains contracted.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Active Management of the Third Stage of Labor (AMTSL) as background academic context rather than a clinical decision trigger.
AMTSL is a critical, evidence-based practice that significantly reduces the incidence of postpartum hemorrhage (PPH), a leading cause of maternal mortality worldwide.
Nurses play a vital role in AMTSL by preparing and administering the uterotonic drug promptly, assisting the provider with controlled cord traction, and performing regular fundal assessments and massage postpartum.
A key nursing responsibility is to palpate the abdomen to rule out the presence of an undiagnosed twin before administering the uterotonic, as the drug would cause severe distress to the second fetus.

How to Approach the Question

First, identify the core concept of the question, which is 'Active management of the 3rd stage of labour' (AMTSL).
Recall the standard components of AMTSL as defined by major health organizations like WHO.
The key components are: 1) administering a uterotonic drug, 2) performing controlled cord traction (CCT), and 3) massaging the uterus after the placenta is delivered.
Evaluate each option against these components.
Option A includes the uterotonic (Syntocinon) and CCT, the two main active interventions.
Option B has an incorrect drug dosage and route.

Concept Tested & Keywords

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