Before making an attempt to expel the placenta Nurse should ensure that:

IGNOU PB Bsc Entrance-2023

Obstetrics & Gynaecology

Medium

Appeared in: IGNOU PB Bsc Entrance-2023

Explanation

The most critical prerequisite before attempting to assist with placental expulsion is to confirm its complete separation from the uterine wall.
Acting before separation can lead to life-threatening complications, most notably uterine inversion (the uterus turning inside out) and postpartum hemorrhage (PPH).
Nurses must vigilantly assess for the classic signs of placental separation: a sudden gush of blood, lengthening of the umbilical cord, and the uterus becoming firmer, more globular, and rising in the abdomen.
This principle applies to both active and expectant (physiological) management of the third stage of labor.

Option B: The mother is not required to hold her breath throughout the process. She may be asked to bear down (push) gently with a contraction to help expel the already-separated placenta.
Option C: Applying fundal pressure with fingers or the hand before the placenta has separated is a dangerous and contraindicated maneuver (known as the Kristeller maneuver). It can force a partial separation or cause uterine inversion.
Option D: This action is out of sequence. The nurse or provider holds and supports the placenta with one or both hands as it is being delivered from the vagina to prevent the membranes from tearing and to ensure it is delivered completely.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Management of the Third Stage of Labor in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Correctly identifying the signs of placental separation is a critical nursing skill to prevent postpartum hemorrhage (PPH), a leading cause of maternal mortality worldwide.
Mismanagement of the third stage, such as applying premature cord traction or inappropriate fundal pressure, can lead to uterine inversion, a life-threatening obstetric emergency requiring immediate intervention.
Active Management of the Third Stage of Labor (AMTSL), which includes administering a uterotonic, controlled cord traction, and uterine massage after delivery, is the evidence-based standard of care to reduce the risk of PPH.

How to Approach the Question

First, identify the core of the question: it asks for the essential prerequisite or safety check before a specific nursing action (expelling the placenta).
Recall the stages of labor. This question pertains to the third stage, which begins after the baby's birth and ends with the placenta's delivery.
Remember the key physiological event of this stage: the placenta must first detach (separate) from the uterine wall before it can be expelled.
Evaluate each option against this physiological principle. Option A directly addresses the need for separation and descent.
Analyze the other options for their timing and safety. Holding breath (B) is related to pushing but not the primary check. Applying pressure (C) is dangerous if done prematurely. Holding the placenta (D) is an action performed during expulsion, not before.
Conclude that ensuring separation is the foundational step that must precede any attempt at expulsion to ensure patient safety.

Concept Tested & Keywords

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 49-57

E6 Comprehensive Textbook of Community Health Nursing for BSc Nursing Students Part 2 — Subpart A (pp 1-275 of 550) p. 222-224