Quiz 11: The third stage of labour

Please choose the one, most correct answer to each question or statement.

The third stage of labour starts when:
- The cervix is fully dilated
- The anterior shoulder of the infant is delivered
- The infant is born
- The placenta is delivered
Which statement about the third stage of labour is correct?
- This stage of labour is potentially dangerous for the patient.
- Complications are uncommon during the third stage.
- After normal first and second stages of labour, complications are rare in the third stage.
- Postpartum haemorrhage during the third stage of labour is an uncommon cause of maternal death in developing countries.
The active management of the third stage of labour includes:
- Giving an oxytocic drug, after a second twin has been excluded, and then waiting for the uterus to contract
- Waiting for signs of placental separation and then pulling on the umbilical cord while pushing the uterus upwards
- Pulling on the umbilical cord while pushing the uterus upwards immediately after the infant has been delivered
- Giving oxytocin after the signs of placental separation have appeared and then pulling on the umbilical cord while pushing the uterus upwards
Which of the following is a contraindication to giving Syntometrine during the third stage of labour?
- An atonic uterus
- Hypotension after delivery
- Any of the hypertensive disorders of pregnancy
- Factors during pregnancy which result in a large uterus
Which oxytocic drug should be given if there is a contraindication to the use of Syntometrine?
- Ergometrine
- A combination of oxytocin and ergometrine
- Oxytocin
- Prostaglandin E2
Passive management of the third stage of labour includes:
- Giving an oxytocic drug and then waiting for the signs of placental separation
- Waiting for the signs of placental separation when the patient is then asked to bear down and spontaneously deliver the placenta
- Pulling down steadily on the umbilical cord and pushing the uterus up when the patient has a contraction
- Giving an oxytocic drug when the signs of placental separation appear so that the placenta can be spontaneously delivered
Which of the following signs do not confirm the diagnosis that the placenta has separated?
- Lengthening of the umbilical cord
- The fundus of the uterus moves from below to above the umbilicus
- A sudden gush of blood runs out of the vagina
- Suprapubic pressure does not result in shortening of the umbilical cord when the uterus is pushed upwards
What is an advantage of using the active method of managing the third stage of labour?
- Retained placenta is uncommon.
- An assistant is not needed.
- As the oxytocic drug is given after the delivery of the placenta, complications with a second twin are avoided.
- Blood loss during the third stage is reduced.
When should the umbilical cord be allowed to bleed before delivering the placenta?
- With a multiple pregnancy after the first infant has been delivered
- In a patient whose blood group is Rhesus negative and who has a single fetus
- If the placenta has still not separated 30 minutes after the infant was delivered
- With a retained placenta
How should a prolonged third stage of labour be managed if the active method had been used?
- Wait for a further 30 minutes for placental separation.
- A doctor should perform a manual removal of the placenta in theatre as an emergency procedure.
- As the active method of managing the third stage of labour has failed, the passive method should be used.
- Start an intravenous infusion with a side infusion containing 20 units of oxytocin, make sure that the uterus is well contracted and apply controlled cord traction.
When should the diagnosis of postpartum haemorrhage be made?
- After a blood loss of more than 250 ml within the first 12 hours after delivery of the infant
- After a blood loss of more than 750 ml within the first seven days after delivery of the infant
- Only after the patient has lost 1000 ml blood
- Any haemorrhage following the delivery of the infant which appears to be excessive must be regarded as a postpartum haemorrhage.
What is the management of a retained placenta following the active management of the third stage of labour, if a portion of the placenta is not palpable in the vagina or lower segment of the uterus?
- Pethidine and diazepam (Valium) must be given intravenously and a manual removal of the placenta done in the labour ward.
- An intravenous infusion with a side infusion containing 20 units of oxytocin should be started to ensure a well-contracted uterus and then the patient should be referred to hospital for a manual removal under general anaesthesia.
- Allow a further 30 minutes of observation before referring the patient.
- Apply fundal pressure together with traction on the cord to deliver the placenta.
What should be done if a severe haemorrhage occurs before the delivery of the placenta and the third stage of labour is being managed by the passive method?
- Wait until the signs of placental separation appear and then ask the patient to bear down.
- Pull on the umbilical cord while pushing upwards on the uterus to get the placenta to separate as soon as possible.
- A rapid intravenous infusion of 20 units oxytocin in 1000 ml Basol or normal saline must be started to ensure that the uterus is well contracted. The active method is then used to deliver the placenta.
- Give 1 mg konakion by intramuscular injection and call a doctor to take over the management of the patient.
What should be the first steps in the management of a postpartum haemorrhage when the placenta has already been delivered?
- Call for help and the uterus must immediately be rubbed up.
- A rapid intravenous infusion of 20 units of oxytocin should be started.
- The patient’s bladder must be emptied.
- The cause of the bleeding must be looked for.
Which sign suggests that the bleeding is caused by an atonic uterus?
- The vaginal bleeding consists of a continuous stream of bright red blood.
- The membranes are not complete.
- The vaginal bleeding is intermittent and consists of dark red clots.
- No uterus can be palpated on abdominal examination.
Which of the following is the most common cause of a postpartum haemorrhage due to an atonic uterus?
- Abruptio placentae
- The use of oxytocin during the first stage of labour
- Polyhydramnios
- A uterus full of blood clots
Which of the following statements about the placenta is correct?
- The uterus should be evacuated if the membranes are found to be incomplete.
- If a placental cotyledon is found to be missing when the placenta is examined, the uterus should be evacuated.
- A single retained cotyledon is unlikely to cause a postpartum haemorrhage.
- It is of no clinical value to examine the placenta after delivery to determine whether it is complete or not.
What clinical finding indicates that the bleeding is from a tear?
- The bleeding consists of a continuous stream of bright red blood.
- The uterus is atonic on abdominal examination.
- The patient is shocked and pale.
- Dark red clots of blood are passed when the uterus is rubbed up.
What is the probable diagnosis if a patient suddenly becomes shocked without any sign of vaginal bleeding during the third stage of labour, and on abdominal examination the uterus cannot be palpated?
- An atonic uterus
- A ruptured uterus
- An inverted uterus
- A cervical tear
Which of the following statements about the prevention of HIV infection is correct?
- Goggles should be worn by everyone involved with a delivery as the virus is present in both blood and liquor.
- Goggles are not necessary as the virus cannot cause infection by contamination of the eyes.
- Preventative measures are only needed with patients who are at high risk of HIV infection.
- Needles should be replaced in their sheath as soon as possible after use in order to prevent needle stick injuries.