At the time of delivery umbilical cord lengthening and spurt of blood form vagina is suggestive of?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016

Obstetrics & Gynaecology

Easy

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016

Explanation

The combination of umbilical cord lengthening and a sudden gush of blood from the vagina are cardinal signs of placental separation.
This event occurs during the third stage of labor, after the fetus has been delivered.
The gush of blood results from the separation of the placenta from the uterine wall and the release of a retroplacental blood clot.
As the detached placenta descends into the lower uterine segment and vagina, the external portion of the umbilical cord appears to lengthen.
Another key sign is the uterus becoming firm, globular, and rising in the abdomen.

Option A: While the spurt of blood is caused by the dislodgement of the retroplacental hematoma, this is only one component of the entire physiological event. 'Placental separation' is the comprehensive and correct diagnosis for the collection of signs.
Option B: Uterine atony is the failure of the uterus to contract effectively after placental delivery, leading to postpartum hemorrhage. It is characterized by a soft, boggy uterus, which is the opposite of the firm, globular uterus seen with successful placental separation.
Option D: Placenta previa is an antepartum condition where the placenta is implanted in the lower uterine segment, covering or near the cervix. It typically causes painless, bright red vaginal bleeding before or during labor, not the specific signs of separation after the baby is delivered.

Clinical Relevance

Nursing practice connection: Knowing Signs of placental separation in the third stage of labor helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Recognizing the signs of placental separation is a critical nursing skill. It confirms that it is safe to apply controlled cord traction to deliver the placenta.
Applying cord traction before the placenta has separated can lead to severe complications, including uterine inversion (a medical emergency) or avulsion of the umbilical cord.
Nurses must actively manage the third stage of labor by administering uterotonics, watching for signs of separation, and then assisting with placental delivery to prevent postpartum hemorrhage.

How to Approach the Question

First, identify the key clinical signs presented in the question: 'umbilical cord lengthening' and 'spurt of blood from vagina'.
Situate these signs within the context of childbirth. These events happen after the baby is born, which is the third stage of labor.
Evaluate the options based on this timing. 'Placenta previa' is an antepartum (before delivery) complication, so it can be eliminated.
'Uterine atony' is a postpartum complication characterized by a soft, boggy uterus, which is contrary to the firming of the uterus that occurs with separation. So, this is unlikely.
'Hematoma dislodgement' describes the gush of blood but is only part of the overall process.
'Placental separation' is the physiological event that encompasses all the signs described: the gush of blood (from the retroplacental hematoma), cord lengthening (as the placenta descends), and the uterus becoming firm and rising. This is the most complete and accurate answer.

Concept Tested & Keywords

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E6 Obstetrics Williams pp. 68-95, 47-67