Prevention of postpartum hemorrhage can be achieved by all, except:

IGNOU PB Bsc Entrance-2022

Obstetrics & Gynaecology

Medium

Appeared in: IGNOU PB Bsc Entrance-2022

Explanation

The lithotomy position is a delivery posture where the woman lies on her back with her legs separated, flexed, and supported in raised stirrups.
This position is primarily used for the convenience of the healthcare provider, as it allows for maximum visualization and access to the perineum.
It does not have any physiological benefit in preventing PPH by enhancing uterine tone or reducing blood loss.
Some studies suggest that upright or lateral positions may be associated with a lower risk of perineal trauma compared to the lithotomy position.

Option A: This is incorrect because Active Management of the Third Stage of Labor (AMTSL) is the most effective and recommended intervention to prevent PPH caused by uterine atony.
Option B: This is incorrect because treating anemia during pregnancy is a crucial prophylactic measure. Anemic women are less able to tolerate even normal blood loss, making them more susceptible to severe complications from PPH.
Option C: This is incorrect because grand multiparity (a high number of previous pregnancies) is a significant risk factor for uterine atony. Therefore, preventing repeated pregnancies through family planning is a valid long-term strategy to reduce the risk of PPH.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Prevention of Postpartum Hemorrhage (PPH) as background academic context rather than a clinical decision trigger.
Nurses play a vital role in preventing PPH by ensuring AMTSL protocols are followed, accurately assessing blood loss, and frequently palpating the uterine fundus postpartum to check for firmness.
Early identification of risk factors such as grand multiparity, prolonged labor, or a large fetus allows the nursing team to be prepared for potential PPH.
A key nursing intervention is to monitor the patient's vital signs (pulse, blood pressure) closely in the immediate postpartum period, as a rising pulse and falling blood pressure are late signs of hypovolemia.

How to Approach the Question

First, identify that the question uses the word 'except'. This means you are looking for the option that is NOT a correct method for preventing PPH.
Read the question stem carefully: 'Prevention of postpartum hemorrhage can be achieved by all, except:'.
Evaluate each option to determine if it is a recognized method for preventing PPH or its complications.
Option A: Active management of the 3rd stage of labor is a well-known, primary intervention for PPH prevention. So, this is a correct preventive measure.
Option B: Treating anemia improves a woman's tolerance to blood loss, which is a key part of managing PPH risk. So, this is a correct preventive measure.
Option C: Preventing grand multiparity reduces a major risk factor for uterine atony. So, this is a correct preventive measure.

Concept Tested & Keywords

Concept Tested: Prevention of Postpartum Hemorrhage (PPH)
Stem keywords: Prevention, postpartum hemorrhage, PPH
Lead-in keywords: except
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: The question asks for the option that is NOT a method for preventing postpartum hemorrhage.

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 65-80

E6 Obstetrics Williams pp. 49-70, 12-27