A woman delivers vaginally at term. At 20 minutes, the placenta has not delivered. The uterus is contracted and the cord has lengthened. On gentle fundal pressure, blood wells up around the placenta. Oxytocin 10 IU was given IM at delivery. What is the next immediate management step?
- A Controlled cord traction using Brandt-Andrews manoeuvre ✓
- B Bimanual compression of the uterus
- C Manual removal of placenta under anaesthesia
- D IV ergometrine 0.5 mg
Correct answer: A. Controlled cord traction using Brandt-Andrews manoeuvre
Explanation
The scenario describes a separated but undelivered placenta: contracted uterus, cord lengthening, and blood welling up are the signs of placental separation (Brandt's signs). Once separation is confirmed, controlled cord traction (Brandt-Andrews manoeuvre) is the correct next step to complete the third stage. Manual removal is reserved for retained placenta where separation has not occurred despite > 30 minutes or when there is haemorrhage. Bimanual compression is for postpartum haemorrhage after delivery.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.