Obstetrics and Neonatal Exam

Scenario: You respond to a 30-year-old female, 36 weeks pregnant, complaining of a sudden onset of severe, constant abdominal pain with dark red vaginal bleeding. Her abdomen is rigid and tender to palpation. She denies a recent fall or trauma. Vitals are BP 90/60 mmHg, P 124, R 22, SpO2 96% on room air. What is the most likely obstetric emergency, and what is the primary management goal?

• Administer high-flow oxygen and monitor for crowning

• Ectopic Pregnancy; Rapid transport and IV access

• Abruptio Placentae; Rapid transport in the left lateral recumbent position and treat for shock

• Spontaneous Abortion; Provide emotional support and save all expelled tissue

Scenario: You are transporting a 25-year-old female who is 38 weeks pregnant. She is lying supine on the stretcher when she suddenly becomes dizzy, pale, and her blood pressure drops from 120/80 mmHg to 94/56 mmHg. What is the most appropriate initial intervention?

• Begin assisted ventilations with a bag-valve mask

• Shift the patient to the left lateral recumbent position

• Perform chest compressions and prepare the AED

• Administer a crystalloid fluid bolus intravenously

Scenario: A 28-year-old female, 40 weeks pregnant, is actively pushing. You visualize the top of the baby's head, but it quickly retracts back into the perineum between contractions ("turtle sign"). What is your immediate priority action to manage this complication?

• Apply gentle, steady traction to the baby's head

• Instruct the mother to stop pushing and have her attempt the McRoberts maneuver

• Insert your fingers into the vagina to push the baby's head back to relieve pressure

• Prepare for a breech delivery by lowering the mother's head

Scenario: You arrive to a home delivery in progress. The baby's head has delivered, but you note the umbilical cord is wrapped tightly around the baby's neck (nuchal cord). What is the most appropriate initial action?

• Clamp and cut the cord immediately before the next contraction

• Attempt to slip the cord gently over the baby's head or shoulder

• Push the baby's head back into the vagina until advanced medical personnel arrive

• Apply high-flow oxygen to the mother via non-rebreather mask

Scenario: A woman has just delivered a healthy newborn. The placenta has not delivered, and the mother has significant, steady vaginal bleeding. You have performed fundal massage, but the bleeding continues. The mother is pale and dizzy. What is the most appropriate immediate action to manage the postpartum hemorrhage?

• Place the mother in the Trendelenburg position

• Wait 30 minutes for the placenta to naturally detach

• Continue fundal massage and allow the baby to nurse at the breast

• Pack the vagina with sterile dressings to absorb the blood

Scenario: You are called for a 17-year-old female who reports sudden, painless, bright red vaginal bleeding. She states she is 34 weeks pregnant and woke up to find her sheets saturated. Vitals are stable. This presentation is most consistent with:

• Abruptio Placentae

• Uterine Rupture

• Placenta Previa

• Ectopic Pregnancy

Scenario: You are attending a delivery in the back of the ambulance. The baby's feet and buttocks are presenting first. What is the initial modification to your normal delivery procedure?

• Apply firm pressure to the mother's abdomen to encourage descent

• Attempt to turn the baby by placing two fingers into the vagina

• Allow the baby to deliver up to the head, creating an airway if necessary

• Immediately clamp and cut the cord after the buttocks deliver

Scenario: A 35-year-old female, 30 weeks pregnant, presents with a severe headache, blurred vision, and swelling in her hands and face. Her blood pressure is 160/110 mmHg. She has no history of seizures. What condition should you suspect, and what is the primary concern?

• Placenta Previa; Life-threatening hemorrhage

• Preeclampsia; Potential progression to eclampsia and seizures

• Abruptio Placentae; Fetal distress and maternal shock

• Spontaneous Abortion; Sepsis due to retained products

Scenario: You are managing a 20-year-old female, 41 weeks pregnant, with her second baby. Contractions are 2 minutes apart and lasting 60 seconds. She feels an urge to push. Upon visualization, you see no crowning. What is the most appropriate management?

• Tell her to push hard with every contraction to speed delivery

• Prepare for transport, encouraging her to pant or breathe deeply during contractions

• Place your hand on her abdomen and apply firm downward pressure

• Have her walk around to see if it lessens the frequency of contractions

Scenario: Which finding indicates that the delivery of the baby is imminent and you should prepare for an emergency field delivery?

• The mother's water just broke

• Contractions are 5 minutes apart

• Crowning is noted upon inspection of the perineum

• The mother reports a bloody show