On pushing the uterus upward, it doesn't move the cord with it. This condition is known as?

NORCET-7 Mains-2024

Obstetrics & Gynaecology

Easy

Appeared in: NORCET-7 Mains-2024

Explanation

Kustner's sign is a clinical maneuver performed to assess for placental separation after the delivery of the baby.
The test involves applying firm pressure with the side of the hand on the lower abdomen, just above the symphysis pubis, to push the uterus upward.
If the placenta has separated from the uterine wall, the umbilical cord will remain in place or may even descend slightly. This is a positive Kustner's sign.
If the placenta is still attached, pushing the uterus upward will cause the cord to retract back into the vagina. This is a negative Kustner's sign.

Option A: Palmer sign is a probable sign of early pregnancy, not a sign of placental separation in the third stage of labor.
Option C: Schroder's sign also indicates placental separation, but it describes the change in the uterus's shape and position (becoming firm, globular, and rising in the abdomen), not the movement of the umbilical cord.
Option D: Osiander sign is a probable sign of early pregnancy, related to increased blood flow to the uterus.

Visual 1: Diagram: Illustration of the Kustner's sign maneuver, showing the difference between a positive result (separated placenta, cord does not move) and a negative result (attached placenta, cord retracts).

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical 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 a critical nursing skill for managing the third stage of labor safely.
Confirming separation before applying controlled cord traction is essential to prevent complications such as uterine inversion or avulsion (tearing) of the umbilical cord, both of which can lead to severe postpartum hemorrhage.
Nurses monitor for a combination of signs (Kustner's, Schroder's, gush of blood, cord lengthening) to make a confident judgment about placental separation.

How to Approach the Question

First, analyze the question stem. It describes a specific clinical action ('pushing the uterus upward') and a resulting observation ('it doesn't move the cord with it').
Recognize that this scenario pertains to the third stage of labor, which involves the delivery of the placenta.
Recall the various signs associated with pregnancy and childbirth. The options include signs of early pregnancy and signs of placental separation.
Eliminate the options that are signs of early pregnancy. Palmer sign (uterine contractions) and Osiander sign (arterial pulsations) are observed in the first trimester.
Differentiate between the remaining options, which are signs of placental separation. The question specifically describes the lack of cord movement when the uterus is pushed up, which is the definition of Kustner's sign.
Confirm that Schroder's sign relates to the change in uterine shape and position, not the cord's movement, making Kustner's sign the best fit for the description.

Concept Tested & Keywords

Concept Tested: Clinical signs of placental separation in the third stage of labor.
Stem keywords: pushing uterus upward, cord, placental separation
Lead-in keywords: known as

Q-A8pwzCF8idPztNmJeTbV