North American Registry of Midwives (NARM) Practice Exam

Once you are sure that the placenta has separated, what should be the next step in managing the delivery of the placenta?

1. Monitor maternal heart rate

2. Assess whether the uterus is contracted

3. Check for signs of hemorrhage

4. Administer oxytocin

The correct answer is: Assess whether the uterus is contracted

After confirming that the placenta has separated, assessing whether the uterus is contracted is a crucial next step. A well-contracted uterus plays a significant role in preventing postpartum hemorrhage, as it helps to constrict blood vessels at the site where the placenta was attached. If the uterus is not contracting effectively, this could lead to excessive bleeding, and timely intervention can be initiated to manage this risk. Understanding uterine tone is essential in the context of placental delivery; if the uterus is firm, it indicates good tone and reduces the risk of complications like hemorrhage. In cases where the uterus is found to be atonic (not contracted), it may require immediate action, such as medication to stimulate contraction or other interventions. While monitoring maternal heart rate, checking for signs of hemorrhage, and administering oxytocin all play important roles in overall postpartum care, the immediate priority after confirming placental separation is to ensure that the uterus is in a contracted state to minimize the risk of complications.