Which of the following interventions is not recommended in active management of IIIrd stage of labour?
## Core Concept
The active management of the third stage of labor (AMTSL) is a series of steps designed to facilitate the delivery of the placenta and prevent postpartum hemorrhage. It involves the administration of a uterotonic agent, controlled cord traction, and uterine massage.
## Why the Correct Answer is Right
The recommended steps in AMTSL include:
- Administration of a uterotonic agent (usually oxytocin) to help contract the uterus and reduce bleeding.
- Controlled cord traction to help deliver the placenta.
- Uterine massage if the uterus is not well contracted.
## Why Each Wrong Option is Incorrect
**Option A:** Administering a uterotonic agent is a recommended step in AMTSL to prevent postpartum hemorrhage by inducing uterine contractions.
**Option B:** Controlled cord traction is also recommended as it helps in the delivery of the placenta.
**Option D:** Uterine massage is sometimes performed if the uterus is not well contracted after delivery of the placenta to help it contract down.
## Clinical Pearl / High-Yield Fact
A key clinical pearl is that delayed cord clamping for at least 30 seconds to 1 minute is now recommended for most births, as it has been shown to improve neonatal outcomes. However, this is not directly related to the interventions listed but is an important consideration in the management of the third stage of labor.
## Correct Answer Line
**Correct Answer: D. uterine massage.**