Chapter 32- Obstetrics and Neonatal Care

In which of the following situations would a baby MOST likely be born with respiratory depression and require aggressive resuscitation?

The mother recently ingested narcotics.

Which of the following statements regarding twins is correct?

There are two placentas if only one umbilical cord is attached to the first placenta.

At what period during pregnancy are the fetal lungs capable of producing pulmonary surfactant?

Weeks 25 to 27

Compared to the umbilical arteries, the umbilical vein is:

a large, thin-walled vessel.

The APGAR score is:

a method of assessing the newborn's response to resuscitation.

In addition to appropriate airway management and high-flow oxygen, the MOST appropriate care for a pregnant woman in shock includes:

adequate fluid resuscitation and immediate transport.

After providing 30 seconds of positive-pressure ventilations to a premature newborn, your partner assesses the infant's heart rate and finds that it is 50 beats/min. You should:

advise your partner to initiate chest compressions

Positive-pressure ventilations may be difficult to perform on a premature infant because:

alveolar surface tension is increased due to surfactant deficiency

A 20-year-old female presents with lower abdominal pain and scant vaginal bleeding. She is conscious and alert with a blood pressure of 124/64 mm Hg and a pulse rate of 120 beats/min and strong. When asked, she states that her last menstrual period was approximately 2 months ago. You should suspect:

an ectopic pregnancy

In newborns, the saphenous veins are located:

anterior to the medial malleolus of the ankle

After stopping the ambulance en route to the hospital to assist your partner with the delivery of an infant, you should resume transport after delivery has occurred and:

any needed newborn resuscitation has occurred.

You arrive at the scene of a 29-year-old woman in active labor. She tells you that her amniotic sac broke about 2 hours ago. You should:

ask her if the fluid was clear or if it was dark and odorous.

It is MOST important to suction the newborn's mouth before the nose because:

aspiration may occur if the newborn gasps when the nose is suctioned.

A 29-year-old female in her second trimester of pregnancy is found semiconscious by her sister. The patient is diaphoretic and breathing shallowly at a rate of 28 breaths/min. Her blood glucose level reads 40 mg/dL. You should:

assist ventilations, start an IV of normal saline, and give 25g of dextrose slowly.

The passageway for the downward movement of an ovum from the ovary, and for upward movement of sperm from the uterus, is called the:

fallopian tube

Gestation refers to the process of:

fetal development after fertilization of an egg

The uppermost portion of the uterus is called the:

fundus

As the baby's head delivers, you note that the umbilical cord is loosely wrapped around its neck. You should:

gently slip the cord over the infant's head or shoulder.

Minimum standard precautions when delivering a baby include:

gloves, gown, and facial protection.

Which of the following is a LATE sign of preeclampsia?

hyperactive reflexes

When assessing a 30-year-old female in her second trimester of pregnancy, the MOST important clinical sign of preeclampsia for the AEMT to recognize is:

hypertension

Descent of the fetal head to the pelvic inlet (lightening) occurs:

in the third trimester of pregnancy.

During the third trimester of pregnancy, you should expect the patient's heart rate to:

increase by 10 to 20 beats/min.

The MOST serious risk to a fetus associated with premature rupture of the amniotic sac is:

infection

During a breech delivery, the baby's legs and trunk deliver; however, the head does not deliver spontaneously. You should:

keep the infant's mouth and nose away from the vaginal wall.

In addition to moving the presenting part of the baby off a prolapsed umbilical cord, you should:

keep the protruding cord moist and give the mother high-flow oxygen.

During the delivery of a baby, you note a gush of brown amniotic fluid. This indicates:

meconium staining.

Vaginal bleeding during the first and second trimesters of pregnancy is MOST commonly caused by a(n):

miscarriage

Vaginal bleeding during the first and second trimesters of pregnancy is MOST commonly caused by a/an:

miscarriage

The thick, muscular layer of the uterus is called the:

myometrium

A nulliparous woman has:

never delivered a viable baby

An embryo is referred to as a fetus beyond the ______ week of gestation.

ninth

Major events that typically occur during the first trimester of pregnancy include all of the following EXCEPT:

notable movement of the fetus by the mother.

Major events that typically occur during the first trimester of pregnancy include all of the following, EXCEPT:

notable movement of the fetus by the mother.

The precursor to a premature egg, which is produced by the ovary, is called a(n):

oocyte

The precursor to a premature egg, which is produced by the ovary, is called a/an:

oocyte

After administering 30 seconds of free-flow oxygen to a newborn with central cyanosis, you note that the cyanosis is not improving. You should:

perform positive-pressure ventilation with 100% oxygen.

The follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are key hormones in the development of a mature egg. On a monthly basis, FSH and LH are released by the:

pituitary gland

During your visual inspection of a 30-year-old female in labor, you see the infant's leg protruding from the vagina. In addition to administering high-flow oxygen to the mother and transporting immediately, you should:

place the mother supine with her head down and hips elevated

Delivery of an infant at the scene should occur in all of the following situations, EXCEPT when:

the amniotic sac ruptured within the last 60 minutes.

As the baby begins to deliver, you note that it presents in a vertex position. This means that:

the head is the presenting part

In the prehospital setting, the end of the first stage of labor is typically determined by:

the presence of crowning

Following delivery of an infant that is 34 weeks' gestation, you should:

thoroughly dry and warm the newborn

The MOST important prehospital treatment for an abnormal fetal presentation is to:

transport the mother as soon as possible

An infant born with a nuchal cord has:

umbilical cord wrapped around the neck

Following a rapid delivery, your 28-year-old patient's uterus has inverted. The MOST appropriate initial management for this condition is to:

use the palm of your hand and make one attempt to replace the uterus.

A 21-year-old female in her third trimester of pregnancy was involved in a motor-vehicle crash. She was unrestrained and struck a telephone pole while traveling approximately 40 MPH. She complains of severe abdominal pain and vaginal bleeding and has signs of shock. While palpating her abdomen, you can feel a fetal body part through the abdominal wall. On the basis of the mechanism of injury and the patient's clinical presentation, you should suspect a/an:

uterine rupture

Vigorous or deep oropharyngeal suctioning of the newborn immediately following birth may result in:

vagal-induced bradycardia and apnea.

The external female genitalia are referred to as the:

vulva

The release of oxytocin from the pituitary gland:

will help contract the uterus and slow postpartum bleeding.

A 24-year-old female, in her second trimester of pregnancy, presents with what she describes as "mild" contractions. After further questioning, she tells you that there is no regular pattern to the contractions and that they have not increased in intensity since they began. She denies vaginal bleeding or any other symptoms. This patient is MOST likely experiencing:

Braxton-Hicks contractions

Under which circumstances is it necessary to insert your gloved fingers into the mother's vagina?

Breech position and prolapsed umbilical cord

Immediately following delivery, which of the following findings would necessitate further assessment and potential treatment of the newborn?

Brown amniotic fluid

How would you classify a woman who has been pregnant twice, had a miscarriage with her first pregnancy, and is now in active labor?

Gravida 2, para 0

How would you classify a woman who has been pregnant twice, had a miscarriage with her first pregnancy, and is now in active labor?

Gravida 2, para 0`

What is the pathophysiology of gestational diabetes?

Increased insulin secretion and decreased cellular sensitivity to insulin.

What is the function of human chorionic gonadotropin (hCG)?

It stimulates progesterone release and maintains the pregnancy.

What effects could gestational diabetes have on the fetus?

Large body size and hypoglycemia

Newborn bradycardia exists when the heart rate falls below ______ beats/min and is almost always secondary to ____________.

100, systemic hypoxia

Once the amniotic sac has ruptured, it is optimal that the fetus be delivered within:

24 hours

A premature infant is one that is born before:

36 weeks or weighs less than 5 pounds

A baby is born at 34 weeks' gestation. Its body is cyanotic and it has weak muscle tone. Further assessment reveals that the infant has a weak cry, a heart rate of approximately 90 beats/min, and irregular respirations of approximately 12 breaths/min. What is this infant's Apgar score?

4

After determining that a newborn's airway is patent and breathing is adequate, you assess the heart rate and find that it is 90 beats/min. You should:

begin assisting ventilations with a bag-mask device.

After drying, warming, and suctioning the mouth and nose of an infant following birth, you note that the baby's respirations are gasping, and irregular. You should:

briefly flick the soles of the feet or gently rub the back or trunk.

In utero, the ductus arteriosus functions:

by connecting the left pulmonary artery and the aorta and diverting oxygenated blood away from the lungs.

If fetal distress occurs in utero, it is usually caused by:

compromised blood flow in the placenta or umbilical cord.

Upon delivery of the baby's head, you note the presence of meconium on its face. After suctioning the mouth and nose, you complete the delivery. Your assessment reveals that the infant is vigorous, crying loudly, and has good muscle tone. Appropriate management includes:

continuing your assessment as usual and providing prompt transport.

Following delivery of the placenta, your patient continues to experience vaginal bleeding. She is becoming diaphoretic and her pulse is weak and rapid. In addition to administering 100% oxygen and providing rapid transport, you should:

cover the vagina with a sanitary pad, keep her warm, and infuse 20 mL/kg boluses of an isotonic crystalloid to maintain perfusion.

When assessing the heart rate of a pregnant patient in her second trimester, you should expect her systolic blood pressure to:

decrease by 10 to 15 mm Hg.

When administering crystalloid solutions to the newborn, you should:

deliver the fluid over 5 to 10 minutes.

After 30 seconds of positive-pressure ventilations and chest compressions on a depressed newborn, your reassessment reveals that the infant's heart rate is 80 beats/min. You should:

discontinue chest compressions and continue positive-pressure ventilations.

The functional layer of the uterus that is shed from the vagina if fertilization of an egg does not occur is called the:

endometrium.

The MOST effective way to improve the cardiac output of an uninjured hypotensive woman in her third trimester of pregnancy is to:

ensure that she is placed on her left side

The MOST effective way to improve the cardiac output of an uninjured hypotensive woman in her third trimester of pregnancy is to:

ensure that she is placed on her left side.

An umbilical catheter that is inserted too far may:

enter the portal venous system and injure the liver.

When evaluating a woman in labor, who is gravida 5 and para 4, you should:

expect a relatively short second stage of labor

You are dispatched to a residence for a 33-year-old pregnant female with vaginal bleeding. The patient's husband tells you that she is 37 weeks' pregnant and has not had any problems with this pregnancy. Your assessment reveals the presence of bright red vaginal bleeding and mild abdominal cramping. The patient is conscious and alert with a blood pressure of 94/64 mm Hg and a pulse rate of 110 beats/min. You should be MOST suspicious for a:

placenta previa

The quickest and most effective way to prevent newborn hypothermia in the prehospital setting is to:

preheat the back of the ambulance and quickly dry the newborn after birth.

Oogenesis is defined as the:

process that results in a mature egg

Oogenesis is defined as the:

process that results in a mature egg.

A 34-year-old female in her second trimester of pregnancy presents with a generalized motor seizure. Her husband tells you that her obstetrician recently diagnosed her with preeclampsia. You should:

protect her airway from injury, maintain her airway and administer O2, and be prepared to suction her mouth

As soon as the entire infant is born, you should:

provide warmth, maintain a patent airway, and resuction.

The ductus arteriosus constricts in response to:

pulmonary vessel dilation and an increase in blood oxygen levels.

When assessing a woman in labor, the AEMT's only sources of information regarding the stage of labor that she is in is/are:

questioning the patient and visually inspecting for crowning

You are assisting in the delivery of a baby in a patient's residence. In between uterine contractions, you should encourage the mother to:

relax and breathe deeply.

Massaging the uterine fundus, or having the infant breastfeed following birth, may slow post-partum bleeding by:

releasing oxytocin and promoting contraction of the uterus.

During pregnancy, the mother may experience a relative respiratory alkalosis when her:

respiratory rate increases

Once the gravid uterus grows superiorly and puts pressure on the diaphragm, the mother's:

respiratory rate increases to compensate for decreased tidal volume

It is MOST important for your partner to remain at the mother's head during delivery because:

she may become nauseated and vomit

When a pregnant woman's system is stressed due to shock, her body will:

shunt blood away from the uterus and fetus

A 29-year-old female has experienced a spontaneous abortion during the latter part of her first trimester. She is conscious and alert, with a blood pressure of 100/60 mm Hg and a heart rate of 100 beats/min and strong. In addition to providing emotional support and administering oxygen, you should:

start a large-bore IV of normal saline and transport

After the baby's head delivers, you should tell the mother to:

stop pushing so you can suction the infant's mouth and nose.

Clinical signs of fetal distress include:

sustained bradycardia

Clinical signs of fetal distress include:

sustained bradycardia.