Which of the following is not a part of active management of 3rd stage of labour (AMTSL)?

NORCET 3 - 2022 (Shift-1)

Obstetrics & Gynaecology

Easy

Appeared in: NORCET 3 - 2022 (Shift-1)

Explanation

Early cord clamping is not a component of modern AMTSL protocols.
Current evidence-based guidelines from organizations like the WHO recommend delayed cord clamping (DCC), which involves waiting 1–3 minutes after birth or until cord pulsations cease before clamping.
DCC is beneficial for the newborn as it improves iron stores and reduces the risk of anemia, and it does not increase the mother's risk of postpartum hemorrhage.
Therefore, early cord clamping is the procedure that is correctly identified as 'not' being part of AMTSL.

Option A: Fundal massage is a component of AMTSL, but it is performed after the placenta has been delivered to ensure the uterus remains firm and contracted to prevent atony and hemorrhage.
Option C: Administration of a uterotonic drug, with Oxytocin 10 IU being the drug of choice, is the first and most critical step of AMTSL. It is given within one minute of the baby's birth.
Option D: Controlled cord traction (CCT) is a standard technique in AMTSL used to facilitate the delivery of the placenta after it has separated, while applying counter-traction to prevent uterine inversion.

Visual 1: Diagram - An infographic illustrating the four steps of Active Management of the Third Stage of Labor: 1. Give Oxytocin, 2. Delayed Cord Clamping (showing a clock for 1-3 mins), 3. Controlled Cord Traction, 4. Uterine Massage after placental delivery.
Visual 2: Flowchart - A decision tree showing the process of AMTSL, starting from the birth of the baby and branching into the sequential steps, highlighting the timing for each action.

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 Labor (AMTSL) as background academic context rather than a clinical decision trigger.
AMTSL is a life-saving intervention proven to reduce the incidence of Postpartum Hemorrhage (PPH) by over 60%. PPH is a leading cause of maternal mortality globally, making proficiency in AMTSL a critical skill for all birth attendants.
Nurses play a vital role in ensuring all components of AMTSL are performed correctly and in a timely manner, including preparing and administering the uterotonic, timing the cord clamping, and assessing uterine tone post-delivery.
What if? - If a newborn requires immediate resuscitation due to distress, the principle of delayed cord clamping is overridden. In such an emergency, the cord is clamped and cut immediately to allow the neonatal team to begin life-saving measures without delay.

How to Approach the Question

This is a 'negative' question, asking what is NOT part of a standard procedure. The best approach is to recall the established components of the procedure in question.
First, identify the core topic: Active Management of the Third Stage of Labor (AMTSL).
Recall the key steps of AMTSL: 1) Uterotonic drug, 2) Controlled cord traction, and 3) Uterine massage after placental delivery.
Evaluate each option against this standard protocol.
Option A (Fundal massage), C (Oxytocin), and D (CCT) are all recognized components.
Option B (Early cord clamping) is contrary to current evidence-based guidelines, which advocate for delayed cord clamping. Therefore, this is the correct answer as it is 'not' part of AMTSL.

Concept Tested & Keywords

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