Which sign indicates placental separation?

Appeared in: BTSC Staff Nurse 30July-2025

Explanation

During the third stage of labor, after the baby's birth, the placenta detaches from the uterine wall.
As the placenta separates and moves into the lower uterine segment, the fundus of the uterus contracts, becomes firmer, and rises in the abdomen.
Simultaneously, the umbilical cord, which is attached to the descending placenta, appears to lengthen at the vaginal opening.
Other classic signs include a sudden gush of blood and the uterus changing to a globular shape.

Option A: A fetal cry is the sound a newborn makes after birth, indicating the initiation of breathing. It has no connection to the process of placental separation in the mother.
Option B: Maternal shivering, or postpartum chills, is a common physiological response after delivery. It can be caused by hormonal changes, fluid shifts, or anesthesia, but it is not a specific sign of placental separation.
Option C: Placental separation is associated with a sudden gush of blood, not decreased bleeding. The separation process releases blood that was trapped between the placenta and the uterine wall.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain The concept tested is the identification of the clinical signs that indicate the separation of the placenta 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. Prompt identification ensures readiness for placental delivery and allows for early detection of complications.
Failure of the placenta to separate can lead to a retained placenta, a major cause of postpartum hemorrhage (PPH). Nurses must monitor for these signs to intervene quickly and prevent excessive blood loss.
What if? - If more than 30 minutes pass after delivery without signs of placental separation, a 'retained placenta' is diagnosed. This is a medical emergency requiring manual removal of the placenta by a physician or trained provider to prevent life-threatening hemorrhage.

How to Approach the Question

This is a knowledge-based recall question.
First, identify the core concept: signs of placental separation.
Recall the physiological events of the third stage of labor. Remember that as the placenta detaches, it descends, causing changes in the uterus and cord.
Evaluate each option:
'Fetal cry' relates to the baby, not the placenta.
'Maternal shivering' is a common but non-specific postpartum symptom.

Concept Tested & Keywords

Concept Tested: The concept tested is the identification of the clinical signs that indicate the separation of the placenta during the third stage of labor.
Stem keywords: placental separation, sign
Lead-in keywords: Which
Negative lead-in flag: false

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

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

Practise the full BTSC Staff Nurse 30July-2025

Attempt every question from this paper in a timed mock, then review the full solution for each one.