Chapter 37 - Obstetrics and Care of the Newborn

Five minutes after delivering a baby, the mother states that she feels the sudden urge to push, just as a gush of blood comes from the vagina. Given that the mother is not delivering twins, what stage of labor should the EMT identify?

Placental

Why is the uterus essential to a healthy pregnancy?

Powerfully contracts to force the fetus from the mother's body

After successfully delivering a baby, the EMT notes that the protruding umbilical cord is lengthening and a small gush of blood came out of the vagina. What should the EMT do in response?

Prepare for delivery of the placenta

You have been called to a crisis shelter for a patient possibly having a baby. On scene you find an older female patient who is mentally retarded and cannot communicate with you. Staff states that the patient just came to the shelter and they know nothing about her, other than that she is pregnant. Assessment reveals crowning, and you proceed to deliver what appears to be a healthy baby boy. When assessing the mother after delivery, which one of the following signs should increase the EMT's suspicion that the woman may be carrying twins?

The mother's abdomen remains large after delivery of the baby

The EMT should use the sterile scissors found in the OB kit to cut which one of the following?

Umbilical cord

If the placenta attaches over the cervix, the patient and baby would be at risk for what condition?

Uterine tear

Which one of the following findings should be of greatest concern when assessing a 33-year-old female who is eight months pregnant?

Vaginal bleeding not associated with pain

The EMT shows she has a proper understanding of Braxton-Hicks contractions when she says:

Which one of the following findings should be of greatest concern when assessing a 33-year-old female who is eight months pregnant?

When faced with the possibility of delivering twins, the EMT must remember that:

a significant number of the second infants are born breech.

You have been called for a 35-year-old female who is experiencing vaginal spotting. The patient states that she has noted the discharge of blood from her vagina and is concerned because she is 36 weeks pregnant. She also states that she noted some abdominal pain, which she further describes as "sharp." Your assessment reveals bleeding as noted and tenderness on palpation just right to the midline of her abdomen. Her pulse is 122, respirations 22, blood pressure 118/82 mmHg, and oral temperature 97.3oF. Based on this presentation, what should you would:

administer high-concentration oxygen and immediately transport.

When treating a patient you believe to be suffering from an ectopic pregnancy, you know that the primary threat to the patient's life is:

hemorrhage

You arrive at the residence of a physician who informs you that his pregnant wife requires immediate transport to the hospital because she is bleeding and has a history of abruptio placenta. As a knowledgeable EMT, you should recognize that the greatest threat to the baby is

hypoxia

You arrive at the residence of a physician who informs you that his pregnant wife requires immediate transport to the hospital because she is bleeding and has a history of abruptio placenta. As a knowledgeable EMT, you should recognize that the greatest threat to the baby is:

hypoxia

A 31-year-old female in her third trimester of pregnancy lost her balance and fell down a flight of stairs. When treating her, the EMT should:

immobilize her, and then tilt the long spine board to the left

Assessment indicates that a newborn's respiratory rate is 40 breaths per minute and his heart rate is 80 beats per minute. The EMT should:

initiate PPV

A female patient who is eight and a half months pregnant states that she does not feel well. She denies chest pain, shortness of breath, and dizziness. She states that she did vomit earlier in the morning and still feels somewhat nauseated. She is alert and oriented and has a patent airway. She is breathing 18 times per minute and has a heart rate of 88 beats per minute. Her blood pressure is 116/70 mmHg. The most appropriate care for this patient should include:

oxygen at 15 lpm via nonrebreather face mask.

A 22-year-old female, who is eight months pregnant, calls 911 for vaginal bleeding. Your assessment reveals no threats to the ABCs, but she does have some evidence of blood in her underwear. The patient denies pain. Her vital signs are normal. Given these findings, the EMT should be suspicious of:

placenta previa

While delivering a baby in the field, the EMT notices that the baby is covered with a green-brown liquid. The EMT should immediately recognize that:

the baby was distressed and may be hypoxic.

Which one of the following shows that the EMT is correctly performing a uterine massage?

Both hands cup the uterus, with one of the hands positioned just above the symphysis pubis.

You are delivering a baby in the patient's house. As the baby's head appears at the vaginal opening, you notice that the amniotic membrane is still intact. Which one of the following should you do next?

Break open the amniotic sac with your fingers

A patient is 7 cm dilated and complaining of painful contractions. What stage of labor should the EMT identify?

First stage

You are assessing a 29-year-old who has signs of imminent delivery. Her past medical history includes HIV infection. In relation to a patient with no infectious disease, how will BSI precautions differ for this patient?

Gloves, a gown, and goggles must be worn for both the patient with HIV and the noninfectious patient.

You are assessing a female patient who informs you that she has been pregnant four times before but only delivered once. Which one of the following shows how you should document that information on the prehospital care report?

Gravida IV; Para I

The EMT should recognize that a newborn is stable when assessment shows:

HR of 120 bpm.

Which one of the following actions indicates that the EMT is properly suctioning the newborn?

He squeezes the bulb syringe prior to placing it in the baby's nose.

Which one of the following statements about the umbilical cord is true?

It contains one vein and two arteries.

The EMT shows he understands care of the post-delivery mother when he states:

"Allowing the baby to nurse immediately after delivery can help to control uterine bleeding."

The EMT shows that he can accurately differentiate placenta previa from abruptio placenta when he states:

"Bleeding associated with abruptio placenta is typically associated with abdominal pain; bleeding associated with placenta previa is painless."

A woman informs you that she is eight months pregnant and fatigues easily. She is apprehensive because when she lies down, she gets dizzy and feels as though she is going to vomit. Which one of the following is the best response?

"Check with your obstetrician, but you may want to rest and sleep on your left or right side."

An EMT has been called for a 16-year-old female with vaginal bleeding. On scene he finds out that the patient is pregnant and has been bleeding for three hours. Which one of the following statements indicates that the EMT is providing proper care?

"I am going to put this sanitary napkin between your legs to try to slow the bleeding."

You are transporting a female patient who is seven months pregnant. She has been diagnosed with preeclampsia and is currently hypertensive. Which one of the following statements made by the patient indicates she may be transitioning from preeclampsia to eclampsia?

"I am seeing spots in my eyes."

When assessing a 27-year-old patient who is eight months pregnant, which one of the following statements should the EMT be most concerned about?

"I have not been able to see the doctor this pregnancy."

The EMT shows she understands resuscitation of the newborn when she states:

"Interventions should be performed for 30 seconds followed by reassessment."

You are transporting a young female who just had a miscarriage at home. During the transport the woman weeps continually. Which one of the following is most appropriate for you to say?

"Is there anything that I can do to help you right now?"

An EMT is presenting a continuing education class on the care of the pregnant female. When discussing the amniotic sac, he is correct to emphasize which one of the following points?

"It protects and insulates the baby during pregnancy."

Which one of the following statements made by a pregnant patient in labor should be of most concern to the EMT?

"My water broke two days ago."

You have determined that you will need to perform a field delivery. What instructions provided to the patient show that the EMT is properly positioning the patient?

"Please lie on your back, draw your knees upward, and spread your legs apart."

As the head of a baby is delivered, the EMT identifies the presence of meconium. Which one of the following shows that the EMT is properly managing the situation?

"Stop pushing. I need to take time to suction the mouth and nose."

Which one of the following statements about the role and function of the cervix in pregnancy is true?

"The cervix becomes plugged with mucous to prevent contamination of the uterus."

Which one of the following statements about the placenta after the baby has been born is accurate?

"The placenta typically delivers itself within 20 minutes of the birth of the baby."

When asked, a young female with abdominal pain replies that she is not sure if she is pregnant or not. Which one of the following questions provides the best opportunity to determine if the patient is pregnant?

"When was your last menstrual period?"

Assessment of a newborn indicates that she has slow and irregular respirations with a weak cry. You should award her how many points according to the APGAR scoring system?

1

When faced with the possibility of delivering twins, which one of the following is it important for the EMT to remember?

A significant number of the second infants are born breech.

Assessment of a newborn indicates that his heart rate is 120 beats per minute. How many points should he be awarded according to the APGAR scoring system?

2

The EMT should recognize a full-term pregnancy in which one of the following patients?

21-year-old who is 39 weeks pregnant and feeling dizzy

Which one of the following patients should the EMT be most suspicious of having a spontaneous abortion?

21-year-old, six weeks pregnant, passing vaginal blood clots

The EMT is performing CPR on a neonate. Which one of the following is the correct compression-to-ventilation ratio?

3 compressions to every 1 ventilation

The EMT recognizes which one of the following to be a normal respiratory rate for a newborn?

56 breaths per minute

Which one of the following statements about a limb presentation is true?

A cesarean section birth will be required

At what point in the delivery process should the EMT first suction the baby?

After the head is delivered, but before the torso is out of the vaginal opening

You are in the process of a field delivery and have just delivered the baby's head. Which one of the following should you do next?

Check the neck for the umbilical cord

You arrive at the side of a pregnant patient in her third trimester who has been vaginally bleeding for several hours. Observation reveals several blood-soaked towels on the bed. She is alert and oriented with a patent airway and adequate breathing. Her pulse is 88 beats per minute and her blood pressure is 104/66 mmHg. As part of your care of the patient, which one of the following is most appropriate?

Collecting all towels with blood and transporting them with the patient

A patient has acute onset of right-sided abdominal pain, describes it as sharp, and rates it a 9/10. Her ABCs are intact, but her skin is cool and diaphoretic. She states that she has been going to the bathroom more and is worried because her father is a diabetic. Her last period was nine weeks ago and she has a history of irregular periods. Her heart rate is 122, respirations 20, blood pressure 138/68, and SaO2 at 97%. In this scenario, which one of the following is of most concern to the EMT?

Last period nine weeks ago

When cutting the umbilical cord, how should the baby be positioned?

Level with the vaginal opening

When should the EMT use the APGAR scoring system on a newborn?

One and five minutes after the baby has been delivered

After delivery, you note some blood oozing from the mother's vaginal canal. The sanitary pads that you placed between her legs continue to become soaked. Which one of the following should you do next?

Perform a uterine massage

Prior to delivery, the EMT prepares to create a sterile field around his patient's vaginal opening. Which one of the following describes the best way to do that?

Place a sheet from the OB kit under the patient's hips and another over her abdomen and legs.

You have been called to assist another crew with the birth of a baby. On scene another EMT informs you that the mother's perineum tore and is bleeding heavily. What should you do?

Place a sterile dressing between the mother's vagina and rectum.

Assessment of a pregnant patient in labor reveals what appears to be the baby's buttocks presenting at the vaginal opening. Which one of the following should the EMT do immediately?

Place the mother in a supine, head-down position with hips elevated and administer high-flow oxygen.

In which one of the following abnormal presentations is it permissible for the EMT to place a gloved hand into the vaginal canal?

Prolapsed umbilical cord

While en route for a pregnant patient who is seizing, an Emergency Medical Responder (EMR) contacts you via radio and reports that they are on scene and the patient is actively seizing. He also states that she is in her seventh month of pregnancy. Which one of the following instructions is it critical for the EMT say to the EMR?

Provide oxygen at 15 liters per minute

You have been dispatched to a residence for a female patient who is dizzy and "passing out." An Emergency Medical Responder meets you at the door and reports that the patient is lying in bed and is nine months pregnant. Her pulse rate is 112 and her blood pressure is 84/50 mmHg. Respirations are 24 per minute and she has a room air pulse oximetry reading of 97%. Which one of the following should you do as soon as you reach the patient's side?

Roll her onto her side

You are by the side of a 19-year-old female who is 36 weeks pregnant. When assessing this patient, which one of the following findings best indicates that she is in preterm labor?

Rupture of the amniotic sac

You have been called to a home for a female patient in labor. On scene the family tells you that the 37-year-old patient is 42 weeks pregnant and wanted to have her baby at home naturally. They tell you that she has been in labor for over 24 hours and suddenly began complaining of severe and tearing abdominal pain. What condition should the EMT suspect?

Ruptured uterus

While delivering a baby, you note that the umbilical cord is wrapped around the baby's neck. Which one of the following should you do immediately?

Slip the cord over the baby's shoulders

Despite positive pressure ventilation, a newborn's heart rate has fallen from 80 beats per minute to 40. He is breathing 40 breaths per minute, and he has a mottled appearance. Which one of the following should the EMT do immediately?

Start CPR.

You have been called to a residence for a 21-year-old female in labor. On location you immediately see that the head of the baby is out of the vagina. While delivering the head, the mother screams that she is having twins. The EMT should immediately:

call for another EMT crew

It has been 30 minutes and the placenta has yet to deliver. The EMT should:

continue to monitor the patient and baby.

As soon as the baby is delivered from the vaginal canal, it is critical that the EMT immediately:

dry and warm the newborn

The mother is 34 weeks along, and you are delivering the baby. As soon as the baby is completely delivered, you should immediately:

dry the baby with a warm towel

A 32-year-old female is complaining of the sudden inset of sharp pain to the left side of her abdomen. She denies any medical history and when asked, admits to being sexually active. Her last menstrual period was two months ago. As an EMT, you should immediately suspect:

ectopic pregnancy

A young female is complaining of sharp pain to the left lower quadrant of her abdomen. She states that her last period was seven weeks ago. With this information, the EMT should be suspicious of:

ectopic pregnancy

You have been called for a 27-year-old female who is 32 weeks pregnant. She states that she is experiencing uterine contractions but feels no pain with them, just a tightening in her abdomen. She states that these began three days ago and seem to be increasing in frequency today. She denies discharge or rupture of her membranes. Given this presentation, you should recognize:

probable false labor, but have the patient transported to the hospital for evaluation

After positive pressure ventilation, a newborn's heart rate improves from 80 to 120 beats per minute. The EMT should:

provide blow-by oxygen.