Which is not included in active management of 3rd stage in labor to prevent PPH?
**Core Concept**
Active management of the third stage of labor (AMTSL) is a vital intervention to prevent postpartum hemorrhage (PPH), a leading cause of maternal morbidity and mortality worldwide. AMTSL involves a series of steps to ensure a controlled delivery of the placenta and minimize bleeding.
**Why the Correct Answer is Right**
Proper uterine massage and controlled cord traction are essential components of AMTSL. Uterine massage helps to massage the uterus and promote contraction, while controlled cord traction facilitates the delivery of the placenta. Both techniques are crucial in reducing the risk of PPH. In contrast, the other options are not directly included in the active management of the third stage of labor.
**Why Each Wrong Option is Incorrect**
* **Option A:** Uterine incision is not a standard step in AMTSL. It is a surgical intervention that may be required in cases of uterine atony or other complications, but it is not a routine part of AMTSL.
* **Option B:** Oxytocin augmentation is a vital component of AMTSL, as it helps to stimulate uterine contractions and reduce bleeding. However, the question is asking which is "not included," so this option is incorrect because it is actually included in AMTSL.
* **Option C:** The use of uterotonic agents like oxytocin or ergot alkaloids is an essential part of AMTSL, as they help to stimulate uterine contractions and reduce bleeding. Like oxytocin augmentation, this option is actually included in AMTSL.
**Clinical Pearl / High-Yield Fact**
Remember the "3 Ps" of AMTSL: **P**lace the mother on her back, **P**lace a pad on the perineum, and **P**ull on the cord gently while simultaneously giving a uterotonic agent like oxytocin. This mnemonic helps to ensure that all essential steps of AMTSL are performed.
**Correct Answer:** A.