While assisting with the delivery of a term newborn, which intervention should a nurse anticipate to prevent postpartum haemorrhage during the third stage of labor?

Appeared in: JIPMER Pondicherry NO - 2022

Explanation

Administration of intravenous oxytocin is the cornerstone of Active Management of the Third Stage of Labor (AMTSL), the evidence-based approach to prevent postpartum hemorrhage (PPH).
Oxytocin is a uterotonic agent that stimulates strong and sustained contractions of the myometrium.
These powerful contractions compress the spiral arteries at the placental implantation site, achieving hemostasis and significantly reducing blood loss.
The World Health Organization (WHO) recommends oxytocin as the first-line uterotonic for PPH prevention.

Option B: Applying fundal pressure before the placenta has separated is contraindicated and dangerous.
Option C: The timing of cord clamping is primarily related to neonatal outcomes, not the prevention of maternal PPH. The most critical intervention for preventing PPH is the administration of oxytocin.
Option D: Terbutaline is a tocolytic, a drug that relaxes the uterus. Administering it would inhibit uterine contractions, leading to uterine atony and increasing the risk of severe hemorrhage.

Clinical Relevance

Nursing practice connection: Use the key finding related to Prevention of Postpartum Hemorrhage (PPH) and Active Management of the Third Stage of Labor (AMTSL) to guide bedside assessment, documentation, and the next nursing action.
Nurses are central to preventing PPH. Their responsibilities include preparing and administering oxytocin, assessing the uterus for firmness post-delivery, and identifying a boggy (atonic) uterus, which is a red flag for PPH.
Prompt initiation of uterine massage upon finding a boggy fundus is a critical, life-saving nursing intervention.
Accurate assessment and recording of blood loss after delivery are essential for early detection of PPH.

How to Approach the Question

First, identify the key elements of the question: the goal is to 'prevent postpartum haemorrhage' and the timeframe is the 'third stage of labor'.
Recall that the third stage of labor is the period from the birth of the baby until the delivery of the placenta.
Understand the primary cause of PPH: uterine atony, which is the failure of the uterus to contract effectively after childbirth.
Evaluate each option based on its physiological effect on the uterus.
Option A, Oxytocin, is a uterotonic, meaning it causes uterine contraction. This directly counteracts uterine atony.
Option D, Terbutaline, is a tocolytic, meaning it relaxes the uterus, which would worsen atony.

Concept Tested & Keywords

Concept Tested: Prevention of Postpartum Hemorrhage (PPH) and Active Management of the Third Stage of Labor (AMTSL).
Stem keywords: postpartum haemorrhage, third stage of labor, prevent
Lead-in keywords: which intervention
Clinical cues: third stage of labor

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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

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 50-58

E6 Obstetrics Williams p. 10-26

Practise the full JIPMER Pondicherry NO - 2022

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