NORCET 9 Prelims-2025: An image shows a nurse applying pressure to the mother's lower abdomen during the third stage of labor. What…

NORCET 9 Prelims-2025

Obstetrics & Gynaecology

Medium

Appeared in: NORCET 9 Prelims-2025

Explanation

The image shows a hand applying upward pressure on the suprapubic region, which is the counter-traction component of Controlled Cord Traction (CCT).
This technique is also known as the Brandt-Andrews maneuver, a standard procedure in the active management of the third stage of labor.
The purpose of this upward pressure is to stabilize the uterus and provide counter-traction while the umbilical cord is gently pulled to deliver the placenta.
This is a critical safety measure to prevent uterine inversion, a life-threatening obstetric emergency.

Option A: Fundal pressure involves applying downward force on the top (fundus) of the uterus. The image clearly shows upward pressure on the lower segment of the abdomen.
Option C: Uterine massage is performed after the placenta has been delivered to stimulate uterine contraction (involution) and prevent postpartum hemorrhage.
Option D: Perineal massage is performed on the perineum (the tissue between the vaginal opening and the anus), not the abdomen.

Visual 1: Diagram - A side-by-side comparison showing the correct hand placement and force direction for the Brandt-Andrews maneuver versus the incorrect and dangerous fundal pressure maneuver.
Visual 2: Flowchart - The steps of active management of the third stage of labor: 1. Administer uterotonic, 2. Delayed cord clamping, 3. Controlled cord traction (with Brandt-Andrews maneuver), 4. Uterine massage after placental delivery.

Clinical Relevance

Nursing practice connection: Use the key finding related to Management of the Third Stage of Labor to guide bedside assessment, documentation, and the next nursing action.
Preventing uterine inversion is a critical nursing responsibility during the third stage of labor. The Brandt-Andrews maneuver is the key safety technique to achieve this.
Uterine inversion is an obstetric emergency where the uterus turns inside out, leading to severe pain, shock, and life-threatening postpartum hemorrhage.
Nurses must be able to differentiate between safe counter-traction and dangerous fundal pressure. Applying fundal pressure on an uncontracted uterus before placental separation can directly cause uterine inversion.

How to Approach the Question

First, carefully analyze the image. Note the precise location of the hand (lower abdomen, above the pubic bone) and the implied direction of pressure (upwards).
Next, identify the context provided in the question stem: 'third stage of labor'. This stage is primarily concerned with the delivery of the placenta.
Evaluate each option based on the visual evidence and your knowledge of obstetric procedures.
Option A (Fundal pressure): Recall that this is downward pressure on the top of the uterus. This contradicts the image.
Option B (Controlled cord traction): Recall that this involves pulling the cord while providing counter-pressure to the uterus. The action in the image perfectly matches the counter-pressure step (Brandt-Andrews maneuver).
Option C (Uterine massage): Recall this is done after the placenta is out. The question states it's during the third stage.

Concept Tested & Keywords

Concept Tested: Management of the Third Stage of Labor
Stem keywords: nurse, applying pressure, lower abdomen, third stage of labor
Lead-in keywords: What is the nurse doing?
Clinical cues: Image shows hand placement on the suprapubic region, indicating a specific obstetric maneuver.

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