Postpartum haemorrhage and emergencies: controlled cord traction: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Postpartum haemorrhage and emergencies: controlled cord traction

Sample item

A midwife has given oxytocin 10 IU intramuscularly within a minute of birth as part of active management of the third stage. Which condition must be met before she applies controlled cord traction?

AFundal pressure has first been used to push the placenta outBAt least 30 minutes have passed since the baby was bornCThe cord has been left unclamped for exactly three minutesDThe uterus is contracted, with counter-pressure held above the pubis

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. The uterus is contracted, with counter-pressure held above the pubis

Controlled cord traction is applied with a contraction, while the other hand steadies the uterus by pressing above the symphysis pubis. Pulling on the cord with a relaxed uterus, or pushing on the fundus, risks inversion or a torn cord. Waiting 30 minutes belongs to physiological management.

Option by option

A. Fundal pressure has first been used to push the placenta out
Pushing the fundus to expel the placenta can cause inversion and is not part of the technique.
B. At least 30 minutes have passed since the baby was born
A 30-minute wait is the physiological approach and is not the condition for cord traction.
C. The cord has been left unclamped for exactly three minutes
Cord clamping time does not decide when traction is safe.
D. The uterus is contracted, with counter-pressure held above the pubis (correct)
Correct. Traction only with a contracted uterus, guarded from above, prevents inversion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, The uterus is contracted, with counter-pressure held above the pubis. Controlled cord traction is applied with a contraction, while the other hand steadies the uterus by pressing above the symphysis pubis.

Why is "Fundal pressure has first been used to push the placenta out" not the answer?

Pushing the fundus to expel the placenta can cause inversion and is not part of the technique.

Why is "At least 30 minutes have passed since the baby was born" not the answer?

A 30-minute wait is the physiological approach and is not the condition for cord traction.

Why is "The cord has been left unclamped for exactly three minutes" not the answer?

Cord clamping time does not decide when traction is safe.

What concept does this question test?

It tests Postpartum haemorrhage and emergencies: controlled cord traction in OBG. Pulling on the cord with a relaxed uterus, or pushing on the fundus, risks inversion or a torn cord. Waiting 30 minutes belongs to physiological management.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Postpartum haemorrhage and emergencies: controlled cord traction?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.