AEMCA Obstetrics and Neonatology 2 — Questions and Answers
Question 1: A pregnant patient at 34 weeks reports sudden, painless, bright red vaginal bleeding. Which condition should you suspect first?
- Placenta previa (Correct answer)
- Placental abruption
- Bloody show
- Uterine rupture
Correct answer: Placenta previa
Painless bright red bleeding in the third trimester is the classic presentation of placenta previa, where the placenta covers the cervical os.
Question 2: During a field delivery, the baby's head delivers but the shoulders do not follow with the next contraction. Your first maneuver should be:
- Apply suprapubic pressure while guiding the head downward (Correct answer)
- Apply fundal pressure
- Perform an episiotomy
- Attempt to rotate the infant 180 degrees
Correct answer: Apply suprapubic pressure while guiding the head downward
Shoulder dystocia is managed first with suprapubic pressure (not fundal) combined with downward traction on the fetal head to dislodge the anterior shoulder.
Question 3: A neonate delivered in the field has a heart rate of 80 bpm after 30 seconds of positive-pressure ventilation. What is your next step?
- Begin chest compressions at a 3:1 ratio with ventilations (Correct answer)
- Increase ventilation rate only
- Administer epinephrine IV
- Continue PPV alone for another 30 seconds
Correct answer: Begin chest compressions at a 3:1 ratio with ventilations
If neonatal HR remains below 100 bpm after 30 seconds of adequate PPV, chest compressions should be initiated at a 3:1 compression-to-ventilation ratio.
Question 4: A mother at 28 weeks gestation presents with a headache, visual disturbances, and BP of 158/106 mmHg. Which drug is appropriate for field management of severe hypertension in this patient?
- Labetalol or hydralazine per protocol (Correct answer)
- Furosemide
- Nitroglycerin sublingual
- Metoprolol
Correct answer: Labetalol or hydralazine per protocol
Labetalol and hydralazine are the preferred antihypertensive agents in obstetric emergencies when severe-range blood pressures require acute treatment.
Question 5: After delivery of the placenta, a patient has sustained heavy vaginal bleeding. The uterus feels soft and 'boggy.' Your priority intervention is:
- Uterine fundal massage and oxytocin if available (Correct answer)
- Immediate IV fluid bolus only
- Place patient in Trendelenburg position
- Apply direct pressure to the vaginal opening
Correct answer: Uterine fundal massage and oxytocin if available
A boggy, atonic uterus is the most common cause of postpartum hemorrhage; fundal massage stimulates contraction and oxytocin (if available) helps maintain tone.
Question 6: You are caring for a neonate born with meconium-stained amniotic fluid who is vigorous, crying, and has good muscle tone. Your management should be:
- Routine care; do not routinely suction the airway (Correct answer)
- Immediate endotracheal intubation for tracheal suctioning
- Bulb suction the oropharynx before delivering the shoulders
- Administer blow-by oxygen and transport without further intervention
Correct answer: Routine care; do not routinely suction the airway
Current NRP guidelines state that routine intubation for tracheal suctioning is NOT recommended for vigorous meconium-stained neonates; provide routine care.
Question 7: A gravid patient at 38 weeks is involved in a motor vehicle collision and is unresponsive. Which positioning change is critical during resuscitation?
- Left lateral uterine displacement to relieve aortocaval compression (Correct answer)
- Trendelenburg position to improve cerebral perfusion
- Right lateral tilt to facilitate airway management
- Supine with legs elevated 30 degrees
Correct answer: Left lateral uterine displacement to relieve aortocaval compression
The gravid uterus compresses the inferior vena cava and aorta in the supine position; manual left uterine displacement improves venous return and cardiac output.
AEMCA Obstetrics and Neonatology 2
A pregnant patient at 34 weeks reports sudden, painless, bright red vaginal bleeding.
Which condition should you suspect first?