Signs of placental separation are?
a. Slight gush of vaginal bleeding
b. Permanent lengthening of the cord
c. Uterus becomes soft & non-ballotable
d. Slight bulging in the suprapubic region

1. A

   A, B, and C only

2. B

   A, C, and D only

3. C

   A, B, D only

4. D

   B, C, and D only

Appeared in: MNS 2024

Explanation

• The correct option combines the three accurate signs of placental separation: a slight gush of blood, permanent lengthening of the cord, and a suprapubic bulge.
• A sudden gush of vaginal blood occurs as the placenta detaches from the uterine wall, releasing trapped blood from the placental bed.
• The umbilical cord appears to lengthen as the separated placenta descends from the fundus into the lower uterine segment and vagina.
• A slight bulge in the suprapubic region appears as the detached placenta occupies the lower uterine segment, which also causes the uterine fundus to rise and become firm and globular.
• Statement C is incorrect; after separation, the uterus becomes firm, globular, and ballotable. A soft uterus is a sign of uterine atony, a dangerous complication.

Why Other Options Were Wrong

• Option A: This option is incorrect because it includes statement C, 'Uterus becomes soft & non-ballotable,' which is a false sign of placental separation. The uterus should become firm.
• Option B: This option is incorrect because it includes the false statement C ('Uterus becomes soft & non-ballotable') and omits the correct statement B ('Permanent lengthening of the cord').
• Option D: This option is incorrect because it includes the false statement C ('Uterus becomes soft & non-ballotable') and omits the correct statement A ('Slight gush of vaginal bleeding').

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Signs of Placental Separation as background academic context rather than a clinical decision trigger.
• Recognizing the signs of placental separation is a critical nursing skill for managing the third stage of labor safely.
• Prompt identification allows the nurse or midwife to determine if the placenta is ready for delivery, either by maternal effort or by controlled cord traction, which helps prevent postpartum hemorrhage (PPH).
• Failure to recognize these signs, or misinterpreting them, can lead to mismanagement, such as pulling on a non-separated placenta, which can cause uterine inversion—a life-threatening emergency.

How to Approach the Question

• This is an analytical question that requires you to evaluate multiple statements.
• First, read the question stem carefully to understand what is being asked: 'Signs of placental separation'.
• Evaluate each statement (a, b, c, d) individually based on your knowledge of the physiology of the third stage of labor.
• Recall the classic signs: a gush of blood, lengthening of the cord, and a change in the uterus's shape and position (becomes firm, globular, and rises).
• Identify statement 'c' as incorrect. A soft uterus is a sign of atony, a complication, whereas a firm, contracted uterus is the normal physiological state after separation.
• Confirm that statements 'a', 'b', and 'd' are all correct signs.

Concept Tested & Keywords

• Concept Tested: Signs of Placental Separation
• Stem keywords: placental separation, signs
• Lead-in keywords: are
• Negative lead-in flag: false

Question ID

QhSkiPMZJYALJFlrbW_nH9

Copy ID

Reference Book

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 48-56

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