Definite sign of placental separation in stage 3 of parturition is?

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021

Explanation

Lengthening of the cord is considered the most definite and reliable sign of placental separation.
This sign is a direct physical indication that the placenta has detached from the uterine wall and has descended into the lower uterine segment or vagina.
Unlike a gush of blood, which can be variable in timing and amount, the lengthening of the cord is an objective and consistent observation.

Option A: A gush of blood is a classic sign of placental separation, but it is not the most definite. The bleeding pattern can vary; it might be a slow trickle or be absent until the placenta is delivered (concealed hemorrhage).
Option C: Pain during the third stage is primarily due to uterine contractions that cause placental expulsion and control bleeding. It is not a specific sign of placental separation itself.
Option D: This is a subjective symptom that the mother might report. It is not an objective clinical sign that the healthcare provider can observe or measure.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Signs of placental separation in the third stage of labor as background academic context rather than a clinical decision trigger.
Accurate identification of placental separation is critical for the safe management of the third stage of labor.
Confirming separation before attempting to deliver the placenta (e.g., by controlled cord traction) is essential to prevent complications like uterine inversion or cord avulsion (snapping).
Failure to recognize the signs of separation can lead to a retained placenta, a major cause of postpartum hemorrhage (PPH).

How to Approach the Question

First, identify the core of the question: it asks for the 'definite' sign of placental separation.
The word 'definite' implies the most reliable, conclusive, and objective sign.
Evaluate each option based on this criterion.
A 'gush of blood' is a classic sign but can be variable or absent.
'Shooting pain' is non-specific to separation.
'Filling of placenta in vagina' is a subjective symptom.

Concept Tested & Keywords

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

E6 Physiology Guyton 4SAE Part 3 p. 67-69

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