Which of the following is not included in the active management of third stage of labor to prevent postpaum haemorrhage (PPH)?
**Core Concept**
The active management of the third stage of labor (AMTSL) is a crucial step in preventing postpartum hemorrhage (PPH). It involves a series of interventions aimed at reducing blood loss and promoting uterine contraction after delivery of the placenta.
**Why the Correct Answer is Right**
The AMTSL protocol typically includes administering uterotonic agents such as oxytocin or ergot alkaloids, controlled cord traction, and uterine massage. These measures help to promote uterine contraction, reduce bleeding, and prevent PPH. However, the use of **manual removal of placental tissue** is not recommended as part of the AMTSL protocol, as it may increase the risk of bleeding and complications.
**Why Each Wrong Option is Incorrect**
**Option A:** Oxytocin administration is a key component of AMTSL, as it helps to promote uterine contraction and reduce bleeding.
**Option B:** Controlled cord traction is also an essential part of AMTSL, as it helps to facilitate placental delivery and reduce bleeding.
**Option C:** Uterine massage is a recommended component of AMTSL, as it helps to promote uterine contraction and reduce bleeding.
**Clinical Pearl / High-Yield Fact**
The AMTSL protocol should be initiated immediately after delivery of the placenta, and all components should be performed in a coordinated and timely manner to prevent PPH.
**Correct Answer:** D. Manual removal of placental tissue.