A resident is performing normal vaginal delivery. He is seen applying counterpressure above the pubic symphysis while gently pulling the umbilical cord. Which maneuver is being demonstrated?
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Gentle cord traction with uterine counterpressure during placental delivery = controlled cord traction.
Step 1: Understanding the Question:
The resident is managing the third stage of labor (delivery of the placenta). The specific technique of pulling the cord while pushing the uterus upward is described. Step 2: Detailed Explanation:
Controlled Cord Traction (CCT): Also known as the Brandt-Andrews maneuver. It is a core component of the Active Management of the Third Stage of Labor (AMTSL).
Procedure:
1. Wait for signs of placental separation (gush of blood, lengthening of the cord, uterus becoming globular and firm).
2. One hand is placed on the lower abdomen, applying suprapubic counterpressure in an upward and backward direction (guarding the uterus).
3. The other hand applies steady, gentle downward traction on the umbilical cord.
Purpose: This maneuver facilitates the delivery of the placenta and, most importantly, prevents uterine inversion, which can occur if the cord is pulled without supporting the uterus.
Why not others? Manual removal (C) involves inserting the whole hand into the uterus to peel the placenta away, which is only done if CCT fails after 30 minutes.
Step 3: Final Answer:
The technique shown is Controlled Cord Traction (Brandt-Andrews), used to safely deliver the placenta during the third stage of labor.
