All the following are signs of placental separation and descent EXCEPT?

AIIMS Bhuvneshwar NO- 2018

Obstetrics & Gynaecology

Easy

Appeared in: AIIMS Bhuvneshwar NO- 2018

Explanation

The correct option identifies an event that does not occur during placental separation.
During placental separation, the umbilical cord does not shorten; it visibly lengthens at the introitus as the placenta detaches from the uterine wall and descends into the vagina.
This apparent lengthening is a key clinical indicator that the placenta has separated and is ready for delivery.

Option A: Lengthening of the cord is a classic and expected sign of placental separation. As the placenta detaches and moves downward, more of the cord becomes visible outside the vagina.
Option C: A small, fresh gush of blood is a common sign of placental separation. It occurs when the placenta detaches from the uterine wall, causing blood from the placental site to be expelled.
Option D: The fundus becoming rounder (globular) and firmer is a definitive sign of placental separation. After the bulky placenta is no longer inside, the uterus contracts down, changing its shape and consistency.

Visual 1: Diagram - A two-panel diagram showing the uterus before and after placental separation. The 'before' panel shows a discoid uterus with the placenta attached high up. The 'after' panel shows a smaller, globular uterus, the placenta in the lower segment, a longer visible umbilical cord, and a small gush of blood.
Visual 2: Table - A summary table listing the signs of placental separation: 1. Sudden gush of blood, 2. Lengthening of the umbilical cord, 3. Uterus becomes firm and globular, 4. Uterus rises in the abdomen.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain The question tests the knowledge of the clinical signs indicating placental separation during the third stage of labor as background academic context rather than a clinical decision trigger.
Recognizing the signs of placental separation is critical for the safe management of the third stage of labor.
Nurses must wait for these signs before attempting controlled cord traction to deliver the placenta. Pulling on the cord of an unseparated placenta can cause life-threatening complications like uterine inversion, cord avulsion (snapping), or postpartum hemorrhage.
What if? If a gush of blood occurs but the cord does not lengthen and the uterus remains boggy (soft), it may indicate uterine atony with hemorrhage, not placental separation. In this case, the priority is to massage the fundus and administer uterotonics, not to pull on the cord.

How to Approach the Question

This is a negative lead-in (EXCEPT) question. The goal is to identify the false statement among the options.
First, recall the physiological process of the third stage of labor, specifically how the placenta separates and is expelled.
Evaluate each option against your knowledge of the signs of placental separation.
Option A (Lengthening of cord): This is a known sign. As the placenta descends, the cord appears longer.
Option C (Small fresh blood loss): This is a known sign, often described as a 'gush of blood'.
Option D (Fundus becoming rounder): This is a known sign. The uterus contracts and becomes globular.

Concept Tested & Keywords

Concept Tested: The question tests the knowledge of the clinical signs indicating placental separation during the third stage of labor.
Stem keywords: placental separation, descent, signs
Lead-in keywords: EXCEPT
Negative lead-in flag: This is a negative lead-in question, asking for the option that is NOT a sign of placental separation.

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