Sudden gush of blood or lengthening of the umbilical cord after the delivery of the infant indicates?

DSSSB Public Health Nurse - 2015

Obstetrics & Gynaecology

Easy

Appeared in: DSSSB Public Health Nurse - 2015

Explanation

The question describes the two classic signs of placental separation, which occurs during the third stage of labor.
After the baby is born, the uterus contracts significantly, reducing the surface area of the placental attachment site.
This size mismatch causes the placenta to buckle and shear off from the uterine wall (decidua).
As the placenta detaches, trapped blood is released, causing a sudden gush of blood.
The descent of the separated placenta into the lower uterine segment and vagina causes the external portion of the umbilical cord to lengthen.

Option A: Placenta accreta is a condition where the placenta attaches too deeply into the uterine wall, which prevents normal separation. This would lead to a retained placenta and potential for massive hemorrhage, not the classic signs of successful separation.
Option B: A retained placenta is the failure of the placenta to be expelled within a set time (e.g., 30 minutes) after the baby's birth. The signs in the question indicate that separation has occurred, which is a prerequisite for expulsion, not retention.
Option C: Abruptio placenta is the premature separation of the placenta before the delivery of the infant. The question explicitly states the signs occur after the infant's delivery.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Signs of Placental Separation in the Third Stage of Labor in the correct sequence, documenting the action clearly, and monitoring for the expected response.
A nurse's primary role during the third stage of labor is to monitor for signs of placental separation and assess for excessive bleeding.
Prompt recognition allows for timely intervention and active management, which significantly reduces the risk of postpartum hemorrhage (PPH).
The nurse should prepare for placental delivery by having a basin ready and ensuring uterotonic medications (like oxytocin) are available for administration after the placenta is delivered to ensure the uterus remains contracted.

How to Approach the Question

First, identify the key timing in the question stem: 'after the delivery of the infant'. This places the event in the third stage of labor.
Next, analyze the specific clinical signs described: 'sudden gush of blood' and 'lengthening of the umbilical cord'.
Recall the physiological events of the third stage of labor. These are the cardinal signs that the placenta has detached from the uterine wall.
Evaluate the options based on this understanding. 'Placental separation' directly matches the event described.
Differentiate from the other options by their definitions: Abruptio placenta is premature (before birth), placenta accreta is abnormal adherence (failure to separate), and retained placenta is failure of expulsion after separation.

Concept Tested & Keywords

Concept Tested: Signs of Placental Separation in the Third Stage of Labor
Stem keywords: Sudden gush of blood, lengthening of the umbilical cord, after the delivery, infant
Lead-in keywords: indicates
Clinical cues: Timing of event is post-delivery of the infant, which points to the third stage of labor.

Q4qDi3zwa23AdhbPtMxtkr

E6 Obstetrics Williams p. 13-28

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

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