Which of the following is NOT a sign of placental separation during third stage of labour?

NIA - 29 January 2023

Obstetrics & Gynaecology

Easy

Appeared in: NIA - 29 January 2023

Explanation

A decrease in fundal height is incorrect because after the placenta separates, it descends into the lower uterine segment.
This descent pushes the contracted body of the uterus upward, causing the fundal height to actually increase and the fundus to become palpable at or above the umbilicus.
Therefore, a decrease in fundal height is the opposite of what is observed and is not a sign of placental separation.

Option A: This is a classic sign of placental separation. As the placenta detaches and moves down into the lower uterine segment and vagina, the length of the cord visible outside the introitus increases.
Option B: This is a classic sign of placental separation. When the placenta detaches from the uterine wall, the retroplacental blood that has collected is suddenly expelled.
Option C: This describes a key change and is a sign of placental separation. After the baby is delivered, the uterus is softer and more discoid. Once the placenta separates, the uterine body contracts firmly, becoming hard and globular. It also becomes more mobile and can be felt to be 'ballotable' or movable within the abdomen.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Signs of placental separation during the third stage of labor 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 and preventing postpartum hemorrhage (PPH).
Active Management of the Third Stage of Labor (AMTSL) involves administering a uterotonic, performing controlled cord traction only after signs of separation are present, and massaging the fundus after placental delivery.
Failure to wait for separation signs before applying cord traction significantly increases the risk of uterine inversion, a life-threatening obstetrical emergency.

How to Approach the Question

First, identify the negative keyword 'NOT' in the question stem. This means you are looking for the option that is false or is not a sign of placental separation.
Recall the physiological process of the third stage of labor, specifically what happens when the placenta detaches from the uterine wall.
List the three classic signs of placental separation: (1) a sudden gush of blood, (2) lengthening of the umbilical cord, and (3) the uterus becoming firm, globular, and rising in the abdomen.
Evaluate each option against your knowledge. Options A, B, and C are consistent with the known signs.
Analyze Option D. A 'decrease' in fundal height is the direct opposite of the uterus 'rising' in the abdomen. This contradiction makes it the correct answer to the 'NOT' question.

Concept Tested & Keywords

Concept Tested: Signs of placental separation during the third stage of labor.
Stem keywords: placental separation, third stage of labour, sign
Lead-in keywords: NOT
Negative lead-in flag: The question asks for the option that is NOT a sign of placental separation.

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

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

E6 Obstetrics Williams p. 48-69