Which of the following are the components of Active Management of Third Stage of Labour for management of PPH?

NHM MP Staff Nurse-2019

Obstetrics & Gynaecology

Easy

Appeared in: NHM MP Staff Nurse-2019

Explanation

This option correctly identifies all three essential components of the Active Management of Third Stage of Labour (AMTSL).
AMTSL is a sequence of interventions including the administration of a uterotonic drug (10 IU oxytocin), the application of controlled cord traction (CCT), and uterine massage after the placenta is delivered.
This combination is an evidence-based practice recommended by the WHO to significantly reduce the risk of postpartum hemorrhage (PPH).

Option A: This option is incomplete. It omits the administration of a uterotonic drug like oxytocin, which is the first and most critical step to initiate uterine contractions for placental separation.
Option B: This option is highly incomplete and dangerous. Performing controlled cord traction without first administering a uterotonic to ensure placental separation can lead to uterine inversion, a life-threatening emergency.
Option D: This option is incorrect because Option C provides a complete and accurate list of the components of AMTSL.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Components of Active Management of Third Stage of Labour (AMTSL) as background academic context rather than a clinical decision trigger.
AMTSL is a high-impact, low-cost intervention that reduces the incidence of PPH by over 60% and is a standard of care in most delivery settings.
Nurses are pivotal in implementing AMTSL. They must ensure all three components are performed correctly and in the right sequence. Forgetting to apply suprapubic counter-traction during CCT can lead to uterine inversion.
What if oxytocin is not available due to storage issues? The nurse should be prepared to administer an alternative uterotonic as per protocol, such as misoprostol (600 mcg orally) or ergometrine (if the patient is not hypertensive), and continue to monitor uterine tone and blood loss vigilantly.

How to Approach the Question

First, identify the core concept of the question, which is the components of Active Management of Third Stage of Labour (AMTSL).
Recall the three key interventions that constitute the AMTSL protocol. A helpful mnemonic is 'O-C-M': Oxytocin, Cord traction, and Massage.
Systematically evaluate each option to see if it includes all three essential components.
Option A is missing Oxytocin. Option B is missing Oxytocin and Massage. Option C includes all three.
Therefore, select the option that provides the most complete and accurate description of the standard AMTSL protocol.

Concept Tested & Keywords

Concept Tested: Components of Active Management of Third Stage of Labour (AMTSL)
Stem keywords: Active Management of Third Stage of Labour, AMTSL, PPH, components
Lead-in keywords: Which of the following
Negative lead-in flag: false

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E6 Comprehensive Textbook of Community Health Nursing for BSc Nursing Students Part 2 — Subpart A (pp 1-275 of 550) p. 222-224

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