Maternal health: active management of third stage of labour: practice question

A PSM question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

PSM · Maternal health: active management of third stage of labour

Sample item

A midwife has just delivered a baby at a primary health centre, and abdominal palpation confirms there is no second baby. What is the first step in the active management of the third stage of labour?

AControlled cord traction before giving any uterotonicBOxytocin 10 IU intramuscularly within one minute of birthCMisoprostol 600 micrograms sublingually as the preferred first drugDErgometrine 0.2 mg intravenously as routine

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Oxytocin 10 IU intramuscularly within one minute of birth

Active management of the third stage reduces postpartum haemorrhage. The steps are a uterotonic, ideally oxytocin 10 IU intramuscularly within a minute of delivery, controlled cord traction with counter-traction, and uterine massage after the placenta is delivered. Misoprostol is used where oxytocin is not available.

Option by option

A. Controlled cord traction before giving any uterotonic
Traction is applied only after the uterotonic has been given, otherwise uterine inversion or retained placenta is more likely.
B. Oxytocin 10 IU intramuscularly within one minute of birth (correct)
Correct. Oxytocin 10 IU IM is the first-line uterotonic and is given first.
C. Misoprostol 600 micrograms sublingually as the preferred first drug
Misoprostol is the alternative when oxytocin cannot be given.
D. Ergometrine 0.2 mg intravenously as routine
Routine intravenous ergometrine can cause hypertension and is not the first choice.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this PSM question

What is the answer to this PSM question?

The best answer is B, Oxytocin 10 IU intramuscularly within one minute of birth. Active management of the third stage reduces postpartum haemorrhage.

Why is "Controlled cord traction before giving any uterotonic" not the answer?

Traction is applied only after the uterotonic has been given, otherwise uterine inversion or retained placenta is more likely.

Why is "Misoprostol 600 micrograms sublingually as the preferred first drug" not the answer?

Misoprostol is the alternative when oxytocin cannot be given.

Why is "Ergometrine 0.2 mg intravenously as routine" not the answer?

Routine intravenous ergometrine can cause hypertension and is not the first choice.

What concept does this question test?

It tests Maternal health: active management of third stage of labour in PSM. The steps are a uterotonic, ideally oxytocin 10 IU intramuscularly within a minute of delivery, controlled cord traction with counter-traction, and uterine massage after the placenta is delivered. Misoprostol is used where oxytocin is not available.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Maternal health: active management of third stage of labour?

Practise biostatistics with small calculations until sensitivity, predictive values and risk measures are automatic. Then use the flashcards and the other PSM questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.