In the third stage of labour, a patient experiences intermittent discomfort in the lower abdomen during expulsion of the placenta; it is due to ______.

Appeared in: RRB Nsg. Superintendent - 29 April 2025 (Shift-3rd)

Explanation

The third stage of labor is the period from the birth of the baby until the placenta is delivered.
During this stage, the uterus undergoes strong, intermittent contractions to cause the placenta to detach from the uterine wall.
These contractions continue to push the separated placenta down and out of the birth canal.
The patient experiences these rhythmic muscular contractions as intermittent cramping or discomfort in the lower abdomen.
This is a normal physiological process required for placental expulsion.

Option A: Pain from an episiotomy is somatic (related to skin and muscle), felt as a sharp, constant sensation in the perineum, not as intermittent visceral (organ-related) cramping in the lower abdomen.
Option B: The sensation of vaginal dilation or stretching is primarily felt in the perineal and pelvic floor area, not as cramping in the lower abdomen. The discomfort described points to the uterus, which is located in the lower abdomen.
Option C: A distended bladder causes a constant, suprapubic pain and can actually inhibit effective uterine contractions, potentially leading to a retained placenta and postpartum hemorrhage. It does not cause the intermittent, expulsive cramps.

Visual 1: Diagram illustrating the mechanism of placental separation: Show how the uterine wall contracts and thickens, reducing the surface area of the placental site and causing it to shear off.
Visual 2: Infographic of the four classic signs of placental separation (globular uterus, fundal rise, cord lengthening, gush of blood) with simple icons for each.

Clinical Relevance

Nursing practice connection: Use the key finding related to Physiology of the Third Stage of Labor to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary role in the third stage is to monitor for effective uterine contractions and signs of placental separation to ensure a safe delivery of the placenta.
Failure of the uterus to contract effectively (uterine atony) after placental separation is the most common cause of postpartum hemorrhage (PPH), a life-threatening complication.
Nursing interventions include palpating the fundus to assess its firmness, administering uterotonic medications (like oxytocin) as ordered to promote contractions, and closely monitoring for excessive bleeding.

How to Approach the Question

Identify the stage of labor mentioned in the question: 'third stage of labour'.
Recall the key physiological event of this stage: separation and expulsion of the placenta.
Analyze the description of the discomfort: 'intermittent' and in the 'lower abdomen'.
Correlate the symptom with the physiological process. The uterus is a muscle in the lower abdomen that contracts intermittently to expel its contents.
Evaluate the options. Episiotomy pain is perineal and constant. Vaginal dilation is a stretching sensation, not abdominal cramping. Bladder distention causes constant suprapubic pain and hinders contractions.
Conclude that uterine contractions are the only option that matches the location, nature (intermittent), and timing (placental expulsion) of the discomfort.

Concept Tested & Keywords

Concept Tested: Physiology of the Third Stage of Labor
Stem keywords: third stage of labour, intermittent discomfort, lower abdomen, expulsion of placenta
Lead-in keywords: due to

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