Chapter 34: Basic Obstetrics & Neonatal Care

A 26-year-old female who is 34 weeks pregnant is experiencing a seizure. Her husband tells you that her blood pressure has been high and that she had been complaining of a headache for the past few days. You should:

Select one:

A. administer oral glucose for presumed hypoglycemia and transport.

B. insert an oral airway and ventilate her with a bag-valve-mask.

C. elevate her legs to improve brain perfusion and keep her warm.

D. place her on her side, administer high-flow oxygen, and transport.

A history of pelvic inflammatory disease or tubal ligations increases a woman’s risk for:

Select one:

A. preeclampsia.

B. placenta previa.

C. gestational diabetes.

D. an ectopic pregnancy.

A mother who is pregnant with her first baby is typically in the first stage of labor for approximately:

Select one:

A. 10 hours.

B. 4 hours.

C. 16 hours.

D. 8 hours.

A nuchal cord is defined as an umbilical cord that:

Select one:

A. is wrapped around the baby’s neck.

B. is lacerated due to a traumatic delivery.

C. has separated from the placenta.

D. has abnormally developed blood vessels.

A pregnant trauma patient may lose a significant amount of blood before showing signs of shock because:

Select one:

A. pregnant patients can dramatically increase their heart rate.

B. blood is shunted to the uterus and fetus during major trauma.

C. pregnant patients have an overall increase in blood volume.

D. pregnancy causes vasodilation and a lower blood pressure.

By the 20th week of pregnancy, the uterus is typically at or above the level of the mother’s:

Select one:

A. xiphoid process.

B. superior diaphragm.

C. pubic bone.

D. belly button.

Common interventions used to stimulate spontaneous respirations in the newborn include all of the following, EXCEPT:

Select one:

A. some form of tactile stimulation.

B. thorough drying with a towel.

C. positive-pressure ventilations.

D. suctioning of the upper airway.

During your visual inspection of a 25-year-old woman in labor, you see the baby’s head crowning at the vaginal opening. What should you do?

Select one:

A. Apply gentle pressure to the baby’s head as it delivers.

B. Place your fingers in the vagina to assess for a nuchal cord.

C. Maintain firm pressure to the head until it completely delivers.

D. Tell the mother not to push and transport her immediately.

Following delivery of a full-term baby, you have properly cared for the baby and have clamped and cut the umbilical cord. During transport, you note that the mother is experiencing moderate vaginal bleeding. You should:

Select one:

A. elevate her legs 6 to 8 inches and cover her with a blanket.

B. carefully insert a sterile trauma dressing into her vagina.

C. place her legs together and position her on her left side.

D. firmly massage the uterine fundus with a circular motion.

From what internal female organ is the fetus expelled during delivery?

Select one:

A. Perineum

B. Uterus

C. Vagina

D. Cervix

If a baby is born at 7:52, the second Apgar score should be calculated at:

Select one:

A. 8:00.

B. 7:57.

C. 7:53.

D. 7:59.

The amniotic fluid serves to:

Select one:

A. transfer oxygen to the fetus.

B. insulate and protect the fetus.

C. remove viruses from the fetus.

D. assist in fetal development.

The presence of meconium in the amniotic fluid indicates:

Select one:

A. that the baby’s airway may be obstructed.

B. that full newborn resuscitation will be needed.

C. an expected finding in full-term infants.

D. that the fetus is at least 4 weeks premature.

Three days after delivering her baby, a 30-year-old woman complains of a sudden onset of difficulty breathing. Her level of consciousness is decreased and she is tachycardic. The EMT should suspect:

Select one:

A. pulmonary embolism.

B. spontaneous pneumothorax.

C. intrauterine bleeding.

D. acute pulmonary edema.

When determining the frequency of contractions, you should time the contractions from the:

Select one:

A. end of one to the end of the next.

B. end of one to the start of the next.

C. start of one to the end of the next.

D. start of one to the start of the next.

When preparing a pregnant patient for delivery, you should position her:

Select one:

A. in a supine position with her legs spread.

B. on a firm surface with her hips elevated 2 to 4 inches.

C. on her left side with the right leg elevated.

D. in a sitting position with her hips elevated 12 inches.

Which of the following questions is of LEAST pertinence when determining whether a mother will deliver her baby within the next few minutes?

Select one:

A. “Do you feel the need to push?”

B. “When are you due?”

C. “Is this your first baby?”

D. “Have you had a sonogram?”

You and your partner are both male and are attending to a 28-year-old female patient complaining of diffuse abdominal pain. The patient is 34 weeks pregnant with her first child. The patient refuses to allow you to examine her, and her husband informs you that their culture does not allow males to examine or care for pregnant women. You should:

Select one:

A. respect the patient’s wishes, ensure that the appropriate documentation is completed, and transport the patient.

B. inform the patient that by calling for an ambulance, she is agreeing to the care provided and continue with your assessment and management.

C. call for the police to ensure that patient assessment is carried out.

D. insist that the patient requires proper care and that requires an adequate physical assessment and that you cannot be responsible for the outcome.

You are attending to a 23-year-old female patient who is 16 weeks pregnant with her second child. The patient has apparently fallen and sustained an injury to her upper right arm. When you ask about the incident history, the patient is reluctant to explain what happened and becomes very quiet. Based on this information, you should:

Select one:

A. ask more detailed questions and press the issue until you have a more detailed understanding of the incident.

B. immediately remove the patient from the environment and transport.

C. continue your care in a private area, document any details regarding the scene and the incident, and reassure her as you provide care.

D. contact police and remain at the scene until they arrive and escort you to the hospital.

Your 22-year-old patient is in active labor. Upon visual inspection, you note that the infant’s leg is protruding from the vagina. Appropriate management of this situation includes:

Select one:

A. placing the mother supine with her head down and pelvis elevated.

B. gently pulling on the infant’s leg in an attempt to facilitate delivery.

C. placing the mother in a recumbent position and rapidly transporting.

D. carefully attempting to push the infant’s leg off of the umbilical cord.

What is a reason a fetus may be in trouble before the mother presents signs of shock?

Which of the following is not true regarding delivery with a nuchal cord?

Select One

A. gently slip the cord over the infant’s head or shoulder
B. clamp the cord and cut it before delivering the infant
C. clamp the cord, then suction the airway before cutting the cord
D. Clamp the cord and cut it, then gently unwind it from around the neck if wrapped around more than once

Which of the following refers to greenish or foul-smelling amniotic fluid?

Select One

A. nuchal rigidity
B. meconium staining
C. placenta previa
D. bloody show

Which of the following is not performed immediately following delivery of the infant?

Select One

A. wrap the infant in a towel and place it on one side with head lowered
B. be sure the head is covered and keep the neck in a neutral position
C. use a sterile gauze pad to wipe the infant’s mouth, then suction again
D. obtain an Apgar score

You may help control bleeding by massaging the _ after delivery of the placenta.

Select One

A. perineum
B. fundus
C. lower back
D. inner thighs

The Apgar score should be calculated at ___ minutes after birth.

Select One

A. 1 and 5
B. 3 and 7
C. 2 and 10
D. 4 and 8

Once the infant is delivered, feel for a brachial pulse or the pulsations in the umbilical cord. If the pulse rate is below beats/min, begin assisted ventilations.

Select One

A. 60
B. 80
C. 100
D. 120

When assisting ventilations in a newborn with a bag-mask device, the rate is breaths/min.

Select One

a. 20-30
b. 30-50
c. 35-45
d. 40-60

When performing CPR on a newborn, a compression to ventilation ratio of 3:1 should be used; this will yield a total of "actions" per minute.

Select One

A. 90
B. 100
C. 110
D. 120

You cannot successfully deliver a _ presentation in the field.

Select One

A. limb
B. breech
C. vertex
D. cephalic

Which of the following is not performed when caring for a mother with a prolapsed cord?

Select One

A. clamp and cut the cord
B. provide high-flow oxygen and rapid transport
C. use your fingers to physically hold the infant's head off the cord
D. position the mother to keep the weight of the infant off the cord

When handling a delivery involving a drug- or alcohol-addicted mother, your first concern should be for:

Select One

A. the mother's airway
B. your personal safety
C. the infant's airway
D. the need for CPR for the infant

Which of the following is not a stage of labor?

Select One

A. rupture of amniotic fluid
B. expulsion of the baby
C. delivery of the placenta
D. dilation of the cervix

The first stage of labor begins with the onset of contractions and ends when:

Select One

A. the infant is born
B. the cervix is fully dilated
C. the water breaks
D. the placenta is delivered

Which of the following is not a sign of the beginning of labor?

Select One

A. bloody show
B. contractions of the uterus
C. crowning
D. rupture of the amniotic sac

The second stage of labor begins when the cervix is fully dilated and ends when:

Select One

A. the infant is born
B. the water breaks
C. the placenta is delivered
D. the uterus stops contracting

The third stage of labor begins with the birth of the infant and ends with the:

Select One

A. release of milk from the breasts
B. cessation of uterine contractions
C. delivery of the placenta
D. cutting of the umbilical cord

The difference between preeclampsia and eclampsia is the onset of:

Select One

A. seeing spots
B. seizures
C. swelling in the hands and feet
D. headaches

You should consider the possibility of a(n) ___ in women who have missed a menstrual cycle and complain of a sudden stabbing and usually unilateral pain in the lower abdomen.

Select One

A. PID
B. ectopic pregnancy
C. miscarriage
D. placenta abruptio

Which of the following is not a reason for delivery of the fetus at the scene?

Select One

A. delivery can be expected within a few minutes
B. there is a natural disaster
C. there is severe inclement weather
D. the amniotic sac has ruptured

Which of the following statements regarding pregnancy is true?

Select One

A. a patient in the third trimester is at a decreased risk for aspiration
B. as the pregnancy continues, the patient will experience slower and deeper breathing
C. by the 20th week of pregnancy, the uterus is at or above the belly button
D. maternal blood volume increases up to 10% by the end of pregnancy

Low blood pressure resulting from compression of the inferior vena cava by the weight of the fetus when the mother is supine is called:

Select One

A. pregnancy-induced hypertension
B. placenta previa
C. placenta abruptio
D. supine hypotensive syndrome

__________ is a situation in which the umbilical cord comes out of the vagina before the infant.

Select One

A. eclampsia
B. placenta previa
C. abruptio placenta
D. prolapsed cord

Premature separation of the placenta from the wall of the uterus is known as:

Select One

A. eclampsia
B. placenta previa
C. abruptio placenta
D. prolapsed cord

__________ is a condition in which the placenta develops over and covers the cervix.

Select One

A. eclampsia
B. placenta previa
C. placenta abruptio
D. prolapsed cord

___________ is heralded by the onset of convulsions, or seizures, resulting from severe hypertension in the pregnant woman.

Select One

A. eclampsia
B. placenta previa
C. placenta abruptio
D. supine hypotensive syndrome

Which of the following is not considered a possible effect to the fetus when the mother is a known substance abuser?

Select One

A. low birth weight
B. spina bifida
C. prematurity
D. severe respiratory depression

You have been dispatched to the side of a highway where a woman is reported to be delivering a baby. As you approach the vehicle, you see her lying down in the back seat. Which of the following signs tell you that the birth is imminent?

Select One

a. her water has not broken
b. her contractions are 3-6 minutes apart
c. she is a primigravida
d. the infant is crowning

You have been dispatched to the side of a highway where a woman is reported to be delivering a baby. As you approach the vehicle, you see her lying down in the back seat. If the baby is crowning and the amniotic sac has not yet ruptured, you should:

Select One

A. leave it in place and wait for ALS
B. puncture the sac only after ordered to do so by medical control
C. puncture the sac, allow the fluid to drain, and leave the sac in place
D. puncture the sac away from the head and then push the sac away from the infant's face

You have been dispatched to the side of a highway where a woman is reported to be delivering a baby. As you approach the vehicle, you see her lying down in the back seat. As you perform a visual exam, you note crowning. This means that:

Select One

A. the baby is making a crowing-type of sound
B. the baby cannot be visualized
C. you can visualize the baby's head
D. the father is excited and needs care

You have been dispatched to the side of a highway where a woman is reported to be delivering a baby. As you approach the vehicle, you see her lying down in the back seat. Once the infant's head has been delivered:

Select One

A. suction the infant's nose, and then mouth
B. apply oxygen over the mother's vagina
C. suction the infant's mouth, then the nose
D. apply a nasal cannula at 3 L/min to the infant

You have been dispatched to the side of a highway where a woman is reported to be delivering a baby. As you approach the vehicle, you see her lying down in the back seat. Concerning the delivery of the placenta, which of the following are emergency situations?

Select One

A. more than 30 minutes have elapsed and the placenta has not delivered
B. there is more than 500mL of bleeding before delivery of the placenta
C. there is significant bleeding after delivery of the placenta
D. all of the above

Ovulation occurs approximately _ before menstruation.

Select One

A. 1 week
B. 2 weeks
C. 3 weeks
D. 4 weeks

Fertilization usually occurs when the egg is inside the:

Select One

A. ovary
B. uterus
C. fallopian tube
D. endometrium

Which of the following statements is false?

Select One

A. gestational diabetes will clear up in most women after delivery

B. the leading cause of abruptio placenta is an ectopic pregnancy

C. as pregnancy progresses, the uterus enlarges and rises out of the pelvis

D. some cultures may not permit male EMTs to examine a female patient

The "P" in Apgar stands for:

Select One

A. perfusion

B. pulse

C. pupils

D. position

Which of the following statements regarding multiple gestations is false?

Select One

A. you should consider the possibility of twins when the first infant is small and the mother's abdomen remains fairly large after the birth

B. you should record the time of birth on each twin separately

C. there is only one placenta with the birth of twins

D. the second baby will usually be born within 45 minutes of the first

An infant delivered before _ weeks is considered premature.

Select One

A. 36

B. 37

C. 38

D. 39

All of the following are correct regarding postterm pregnancy except:

Select One

A. infants can be larger, sometimes weighing 10lbs or more

B. there is an increased risk of meconium aspirations

C. postterm is considered past 2 weeks gestation

D. ultrasounds are not accurate at determining due dates

A patient presents with a sudden onset of shortness of breath three days following a delivery. What is likely the underlying cause of this condition?

Select One

A. pulmonary hypertension

B. pulmonary inflammation

C. pulmonary embolism

D. pulmonary fibrosis

After delivery, if the infant does not begin breathing after _ seconds, you should begin resuscitation efforts.

Select One

A. 5-10

B. 10-15

C. 15-20

D. 20-25

True or False

The small mucous plug from the cervix that is discharged from the vagina, often at the beginning of labor, is called a bloody show.

True or False

Crowning occurs when the baby's head obstructs the birth canal, preventing normal delivery.

True or False

Labor begins with the rupture of the amniotic sac and ends with the delivery of the baby's head.

True or False

A woman who is having her first baby is called a multigravida.

True or False

Once labor has begun, it can be slowed by holding the patient's legs together.

True or False

Delivery of the buttocks before the baby's head is called a breach delivery.

True or False

Massaging the abdomen after delivery helps to control bleeding.

True or False

The placenta and cord should be properly disposed of in a biohazard container after delivery.

True or False

The umbilical cord may be gently pulled to aid in delivery of the placenta.

True or False

A limb presentation occurs when the baby's arm, leg, or foot is emerging from the vagina first.

True or False

Multiple births may have more than one placenta.

True or False

Pregnant teenagers may not know that they are pregnant.

True or False

After delivery of the head, suction the nose first.

True or False

Abuse during the pregnancy increases the chance of miscarriage, premature delivery, and low birth weight.

True or False

If called to deliver an infant who may have died in the uterus, you could notice skin blisters and dark discoloration to the infant.

True or False

Most premature infants have vernix on their skin when delivered.

True or False

Excessive bleeding after birth is usually caused by the muscles of the uterus not fully contracting.

You assess an infant after delivery and note that the child has a loud cry and withdraws to pain. The heart rate is 94 beats/min, the extremities are cyanotic, respirations are rapid, and the infant strongly resists your attempts to straighten the knees. Determine the Apgar score.

Select One

A. 2

B. 10

C. 8

D. 4

You arrive at the scene of a home delivery. Upon entering the scene, the father appears upset and hands you a limp baby. The child has a weak cry, is completely cyanotic, and has a pulse of 70 beats/min. Respirations are slow.

Determine the Apgar score.

A. 3

B. 9

C. 2

D. 7

You arrive on scene to assist another crew with a delivery. Upon your arrival, the crew on scene informs you that the delivery has already taken place and that you are going to be responsible for care of the infant. As you approach, you hear a very loud cry. The infant appears completely pink and moves his foot away when you flick the sole of his foot. The pulse is 120 beats/min and respirations are rapiD. The infant has great muscle tone and resists your attempt to straighten the hips.

Determine the Apgar score.

A. 6

B. 10

C. 1

D. 8

During delivery, after the head has been delivered and the shoulder appears:

Select One

A. guide the head down slightly to deliver the shoulder

B. apply a nasal cannula to the infant

C. guide the head up slightly, to deliver the shoulder

D. pull gently

When giving chest compressions to an infant:

Select One

A. use the hands-encircling technique or the two-finger technique

B. press the palm of your had over the sternum, compressing 1" to 1 1/2" deep

C. compress at a rate of 60 to 80 times a minute

D. compress the sternum one quarter the depth of the chest

Which of the following would not be a typical question to ask when taking a history on a woman in labor?

Select One

A. are you having a boy or a girl?

B. when is your due date?

C. did your physician mention the possibility of any complications?

D. is this your first pregnancy?

Once the infant is completely delivered, you should:

Select One

A. dry and wrap the infant in a blanket

B. keep the infant at the level of the vagina until the umbilical cord is cut

C. use sterile gauze and wipe out the infant's mouth

D. all of the above

When cutting the umbilical cord:

Select One

A. place the clamps 7" to 10" apart

B. place the clamps 2" to 4" apart

C. tie the cord with shoelaces if you don't have any clamps

D. tie the cord with string if you don't have any clamps

When determining the duration of contractions, you should time the contractions from the:

Select one:

A. end of one to the end of the next.

B. end of one to the start of the next.

C. start of one to the end of the same.

D. start of one to the start of the next.

In contrast to a full-term infant, a premature infant:

has an even proportionately larger head.

is often covered with excess vernix material.

is one who is born before 38 weeks' gestation.

retains heat better because of excess body hair.

The leading cause of maternal death during the first trimester of pregnancy is:

A. blunt trauma to the abdomen during a motor vehicle crash.
B. unrecognized or untreated supine hypotensive syndrome.
C. massive brain damage secondary to a prolonged seizure.
D. internal bleeding caused by a ruptured ectopic pregnancy.

Which of the following processes occurs immediately following ovulation?

Certain female hormone levels decrease significantly in quantity.

The endometrium sheds its lining and is expelled from the vagina.

The inner lining of the uterus thickens in preparation for implantation.

Numerous follicles mature and release eggs into the fallopian tubes.

An abortion occurs when the fetus and placenta deliver before:

20 weeks.

24 weeks.

26 weeks.

28 weeks.

You have just delivered a full-term infant. His respirations are rapid and irregular, and he has a strong cry. What should you do next?

Allow the mother to hold her baby.

Clamp and cut the umbilical cord.

Check the pulse rate at the brachial artery.

Begin assisting the newborn's breathing.

Eclampsia is MOST accurately defined as:

high levels of protein in the patient's urine.

hypertension in the 20th week of pregnancy.

seizures that result from severe hypertension.

a blood pressure greater than 140/90 mm Hg.

CPR is in progress on a pulseless and apneic 29-year-old woman who is 37 weeks pregnant. When treating this patient, the EMT should:

deliver a compression rate of 120 to 140 per minute.

manually displace the patient's uterus to the left.

avoid defibrillation because it may harm the fetus.

perform compressions slightly lower on the sternum.

You are attending to a 26-year-old female patient who is at 37 weeks' gestation with her second pregnancy. The patient is in labor and delivery is imminent. The patient is on your stretcher. You should now:

move the stretcher to the ambulance and transport immediately.

open the OB kit and continue to prepare for the delivery.

encourage the patient to push.

hold the patient's legs together until you are ready for the delivery.

You are attending to a 28-year-old female patient in labor. Her newborn baby boy has just been delivered, and you have dried and wrapped the newborn in a clean blanket. The umbilical cord has stopped pulsating. Based on this information, you should now:

A. clamp the cord utilizing two clamps, placed approximately 6 inches from the newborn and 2 to 4 inches apart.

B. clamp the cord, utilizing one clamp approximately 6 inches from the newborn and cut it on the maternal side of the clamp.

C. pull the cord off of the newborn utilizing a consistent force and wrap in a clean towel.

D. wrap the cord in a clean towel and transport mother and newborn together.

During delivery, it is MOST important to position your partner at the mother's head because:

the mother may become nauseated and vomit.

the mother needs to be apprised of the situation.

she may need emotional support during the delivery.

mothers often need assisted ventilation during delivery.

If a pregnant patient requires spinal immobilization, you should secure her to the backboard and then:

place a folded towel behind her head to make it easier to breathe.

elevate the right side of the board with rolled towels or blankets.

raise the foot of the board 12 inches in order to maintain blood pressure.

elevate the head of the board 6 inches to prevent breathing impairment.