CEN Pediatric and Obstetric Emergencies 2 — Questions and Answers
Question 1: A pregnant patient at 36 weeks presents with sudden painless bright red vaginal bleeding. Which condition is most likely?
- Placental abruption
- Placenta previa (Correct answer)
- Uterine rupture
- Vasa previa
Correct answer: Placenta previa
Painless bright red vaginal bleeding in the third trimester is the hallmark presentation of placenta previa.
Question 2: A patient at 32 weeks gestation presents with sudden severe abdominal pain, rigid abdomen, and dark vaginal bleeding. Fetal heart tones are absent. Which complication is most likely?
- Placenta previa
- Placental abruption with fetal demise (Correct answer)
- Uterine rupture
- Vasa previa
Correct answer: Placental abruption with fetal demise
Painful dark vaginal bleeding with board-like rigidity and fetal demise indicates severe placental abruption with complete placental separation.
Question 3: A patient at 38 weeks is admitted in active labor. After a prolonged deceleration, the baby's head is not descending despite pushing. The fetal heart rate drops to 60 bpm. Which maneuver is first-line for shoulder dystocia?
- Fundal pressure (Kristeller maneuver)
- McRoberts maneuver with suprapubic pressure (Correct answer)
- Zavanelli maneuver
- Emergency C-section
Correct answer: McRoberts maneuver with suprapubic pressure
The McRoberts maneuver (hyperflexion of maternal hips) combined with suprapubic pressure is the first-line management for shoulder dystocia.
Question 4: A patient with preeclampsia at 34 weeks is being treated with IV magnesium sulfate. The nurse notes absent deep tendon reflexes and a respiratory rate of 10. Which action is immediately required?
- Increase the magnesium infusion rate
- Administer calcium gluconate IV and stop magnesium (Correct answer)
- Intubate the patient emergently
- Administer labetalol IV
Correct answer: Administer calcium gluconate IV and stop magnesium
Absent DTRs and respiratory depression are signs of magnesium toxicity; calcium gluconate is the antidote and the infusion must be stopped immediately.
Question 5: A woman delivers a baby and 20 minutes later has heavy vaginal bleeding (estimated 600 mL). The uterus is boggy on palpation. What is the first intervention?
- Administer 10 units oxytocin IM and perform uterine massage (Correct answer)
- Immediate surgical intervention
- IV fluid resuscitation with 2L normal saline
- Insert intrauterine balloon tamponade
Correct answer: Administer 10 units oxytocin IM and perform uterine massage
Uterine atony is the most common cause of postpartum hemorrhage and is initially treated with uterine massage and uterotonic medications (oxytocin).
Question 6: A newborn is delivered and does not cry, has poor muscle tone, and a heart rate of 60 bpm at 1 minute. After warming and stimulation, the HR remains <60. What is the next step?
- Administer epinephrine via endotracheal tube
- Perform positive pressure ventilation and begin chest compressions (Correct answer)
- Provide blow-by oxygen only
- Wait 2 more minutes before intervening
Correct answer: Perform positive pressure ventilation and begin chest compressions
Neonatal HR <60 bpm after initial resuscitation steps requires PPV and chest compressions at a 3:1 compression-to-ventilation ratio.
CEN Pediatric and Obstetric Emergencies 2
A pregnant patient at 36 weeks presents with sudden painless bright red vaginal bleeding.
Which condition is most likely?