During active management of the third stage of labour (AMTSL), the correct sequence of steps according to the WHO 2012 recommendation is:

• A Ergometrine 0.5 mg IM → CCT → uterine massage every 15 minutes
• B Oxytocin 10 IU IV → controlled cord traction (CCT) → uterine massage after placenta delivery ✓
• C Oxytocin 10 IU IM within 1 minute of birth → CCT if trained → sustained uterine massage
• D Misoprostol 600 µg sublingual → manual removal of placenta → CCT

Explanation

WHO 2012 AMTSL recommendation: administer oxytocin 10 IU IV (or IM) within 1 minute of birth, perform controlled cord traction (CCT) with counter-pressure, and massage the uterine fundus after placenta delivery to ensure sustained contraction. WHO 2012 updated AMTSL by removing routine sustained uterine massage as a required step before placenta delivery; uterine massage after placental expulsion is recommended only if oxytocin is unavailable. The 2012 revision also clarified that CCT should only be performed by trained providers. Ergometrine is a second-line agent and misoprostol is used when oxytocin is unavailable.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.