AIIMS Delhi NO - 2018
Obstetrics & Gynaecology
Easy
Which injection and dose are given during the active management of the 3rd stage of labor?
Appeared in: AIIMS Delhi NO - 2018
Explanation
- The active management of the third stage of labor (AMTSL) is a crucial intervention to prevent postpartum hemorrhage (PPH), a leading cause of maternal death.
- The World Health Organization (WHO) and other major obstetric bodies recommend 10 international units (IU) of Oxytocin administered intramuscularly (IM) as the first-line uterotonic agent for AMTSL.
- Oxytocin works by stimulating strong, rhythmic contractions of the uterus.
- These contractions constrict the spiral arteries that supplied the placenta, leading to hemostasis and significantly reducing blood loss after delivery.
Why Other Options Were Wrong
- Option B: This dose is higher than the standard prophylactic dose recommended for AMTSL. While a 20-unit infusion might be used to treat established uterine atony, 10 units IM is the standard for routine prevention.
- Option C: Misoprostol is a second-line agent for PPH prevention. Oxytocin is the preferred first-line drug due to its superior efficacy and side-effect profile.
- Option D: Methotrexate is a folic acid antagonist used as a chemotherapeutic agent and to terminate ectopic pregnancies. It is a teratogen and is absolutely contraindicated for managing any stage of labor as it would be harmful to both mother and fetus.
Related Visual
Clinical Relevance
- Nursing practice connection: Knowing Pharmacological intervention during the active management of the third stage of labor (AMTSL) to prevent postpartum hemorrhage (PPH) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
- Postpartum hemorrhage (PPH) is the leading cause of maternal mortality globally. Correctly implementing AMTSL, including administering the right drug and dose, is a fundamental nursing competency that directly saves lives.
- Nurses are responsible for preparing and administering the Oxytocin injection, monitoring the mother for signs of placental separation, assessing uterine tone post-delivery, and quantifying blood loss.
- A key nursing responsibility is to ensure the 'five rights' of medication administration: right patient, right drug, right dose, right route, and right time.
How to Approach the Question
- First, identify the core concept of the question, which is the 'active management of the 3rd stage of labor'.
- Recall the standard protocol for AMTSL, which is a set of interventions designed to prevent PPH.
- Focus on the pharmacological component of AMTSL: the recommended uterotonic drug and its standard dose.
- Evaluate each option against this standard. Option A provides the correct drug (Oxytocin) and the standard prophylactic dose (10 units IM).
- Eliminate the other options by identifying why they are incorrect: Option B is an incorrect dose for prophylaxis, Option C is a second-line drug, and Option D is a completely inappropriate and contraindicated medication for this clinical scenario.
Concept Tested & Keywords
- Concept Tested: Pharmacological intervention during the active management of the third stage of labor (AMTSL) to prevent postpartum hemorrhage (PPH).
- Stem keywords: injection, dose, active management, 3rd stage of labor
- Lead-in keywords: Which
Question ID
QTtL6ADoRyjPe-9RzmA4eA
Reference Book
E6 Obstetrics Williams pp. 11-26, 83-95
E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 6-11
Practise the full AIIMS Delhi NO - 2018
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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