Chapter 36 | OB/GYN Emergencies Flashcards
• Anatomy and physiology of the female reproductive system • Physiologic changes in pregnancy • Care of the mother and baby during labor and delivery • Care of the neonate • Postdelivery care of the mother • Complications of labor and delivery • Emergencies in pregnancy • Gynecologic emergencies
1
Q
Define:
labia
A
soft tissues that protect the entrance to the vagina
2
Q
Define:
perineum
A
surface area between the vagina and anus
3
Q
Define:
mons pubis
A
soft tissue that covers the pubic symphysis
4
Q
Define:
vagina
A
birth canal
5
Q
Define:
ovaries
A
female reproductive organs which produce ova
6
Q
Define:
fallopian tubes
A
narrow tube that connects the ovary to the uterus
7
Q
Define:
uterus
A
muscular abdominal organ where the fetus develops
(aka “the womb”)
8
Q
Define:
cervix
A
lower neck of the uterus at the entrance to the birth canal
9
Q
Define:
ovulation
A
phase of the female reproductive cycle in which an ovum is released from the ovary
period when female is fertile
10
Q
Define:
embryo
A
gestating baby from fertilization to eight weeks of development
11
Q
Define:
fetus
A
gestating baby from eight weeks of development to birth
12
Q
Define:
placenta
A
organ of pregnancy where exchange of oxygen, nutrients, and wastes occurs between a mother and fetus
13
Q
Define:
umbilical cord
A
fetal structure containing the blood vessels that carry blood to and from the placenta
14
Q
Define:
amniotic sac
A
the “bag of waters” that surrounds the developing fetus
15
Q
List:
stages of female reproductive cycle
A
- menstruation (period)
- ovulation (fertility)
16
Q
Define:
menstruation
A
the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina
17
Q
Define:
fertilization
A
the union of a human egg and sperm to form a zygote, occurring primarily in the ampulla of the fallopian tube
18
Q
Define:
supine hypotensive syndrome
A
condition in pregnant women which causes weight of infant and placenta to compress inferior vena cava
leads to heart not getting enough blood back from body
19
Q
Define:
GP
(acronym and meaning)
A
- gravity: number of pregnancies
- parity: number of births
(scored like G3P2)
20
Q
Define:
EDD
(abbreviation)
A
expected due date
21
Q
Define:
crowning
(childbirth)
A
appearance of baby’s head through birth canal
22
Q
Define:
cephallic presentation
(childbirth)
A
normal birth presentation where the baby’s head appears first
23
Q
Define:
breech presentation
(childbirth)
A
protrusion of fetus’s butt first (instead of head) through birth canal
24
Q
Define:
limb presentation
(childbirth)
A
protrusion of infant’s limb from the vagina before the appearance of any other body part
25
# Fill in the blank:
The first stage of labor begins when **[BLANK]**.
The first stage of labor begins when **mother experiences regular contractions**.
26
# Fill in the blank:
The second stage of labor begins when **[BLANK]**.
The second stage of labor begins when **the cervix is fully dilated**.
27
# Fill in the blank:
The third stage of labor begins when **[BLANK]**.
The third stage of labor begins **after the baby is born**.
28
# Fill in the blank:
The third stage of labor ends when **[BLANK]**.
The third stage of labor ends when **the placenta is delivered**.
29
# Define:
Braxton-Hicks contractions
irregular prelabor contractions of the uterus
| often mistaken for true labor reactions
30
# Define:
lightening
| (childbirth)
sensation of the fetus moving from high in the abdomen to low in the birth canal
31
# Define:
APGAR
| (acronym)
* **a**ppearance
* **p**ulse
* **g**rimace
* **a**ctivity
* **r**espirations
| scoring system used to evaluate neonates
32
# Define:
neonate
infant from birth to 1 month of age
33
# Describe:
primary treatment for neonate with *pulse below 100 bpm*
ventilate with BVM
34
# Describe:
primary treatment for neonate with *pulse below 60 bpm*
begin CPR
35
# Explain:
how to suction a delivered baby
use **bulb syringe** to suction *mouth and then nose*
| to prevent aspiration of amniotic fluid
36
# Fill in the blank:
The normal gestation time for a human baby is **[BLANK]** weeks.
The normal gestation time for a human baby is **40** weeks.
37
# Fill in the blank:
A human baby born under **[BLANK]** weeks is considered premature human baby.
A human baby born under **37** weeks is considered premature human baby.
38
# Fill in the blank:
A fetus can survive if born after **[BLANK]** weeks.
A fetus can survive if born after **27** weeks.
39
# Fill in the blank:
You should take an APGAR score at **[BLANK]** minutes.
You should take an APGAR score at **1, 5, and 10** minutes.
40
# Define
merconium staining
amniotic fluid that is greenish- or brownish-yellow rather than clear as a result of fetal defecation
| baby was basically swimming in its own shit
41
# Fill in the blank:
Merconium staining is a possible indication of **[BLANK]**.
Merconium staining is a possible indication of **maternal or fetal distress during labor**.
42
# Fill in the blank:
The umbilical cord clamps should be placed **[BLANK]** inches apart.
The umbilical cord clamps should be placed **3** inches apart.
43
# Answer:
Where should you (or the dude) cut the umbilical cord?
| (and what might you wait for?)
in between the umbilical cord clamps
| **after** it stops pulsating to avoid the yucky
44
# Define:
stillbirth
**birth of fetus that died** in the womb *after 20 weeks* of pregnancy
45
# Define:
miscarriage
pregnancy loss *before 20 weeks*
46
# Define:
ectopic pregnancy
pregnancy in which the fertilized egg implants outside the uterus
| extremely life-threatening
47
# Define:
pre-eclampsia
**pregnancy condition characterized by high BP**, peripheral edema, and protein in urine
48
# Define:
eclampsia
occurrence of **seizures** during pregnancy in a patient with pre-eclampsia
49
# True or false:
A miscarriage may be physically painful.
true
| may cause cramping and abdominal pain
50
# Define:
The Bradley Method
| (childbirth)
giving birth "all natural, no epidural"
51
# Define:
HypnoBirth
meditative exercises aimed at delivering baby in **relaxed state**
52
# Define:
lamaze
birthing method that uses **breathing techniques**, movement, and other support practices to facilitate drug-free labor and delivery
53
# Define:
multiple birth
birth of more than one baby during a single delivery
54
# Define:
premature infant
any newborn born **before the 37th week** of pregnancy
| or weighing less than 5.5 pounds (2.5 kg) at birth
55
# Define:
merconium
**fetal stool** that stains amniotic fluid greenish- or brownish-yellow in color
56
# Define:
placenta previa
a condition in which the **placenta is formed in an abnormal location** (low in the uterus and close to or over the cervical opening) that will not allow for a normal delivery of the fetus
| a cause of excessive prebirth bleeding
57
# Define:
placenta abruptio
condition in which the **placenta separates from the uterine wall**
| a cause of excessive prebirth bleeding
58
# Define:
abortion
spontaneous (miscarriage) or induced **termination of pregnancy**
59
# Define:
spontaneous abortion
delivery of fetus and placenta *before the 20th week* of pregnancy
| commonly called a **miscarriage**
60
# Define:
induced abortion
expulsion of a fetus as a result of **deliberate actions taken to terminate the pregnancy**
61
# Define:
nuchal cord
when the **umbilical cord becomes wrapped around the fetal neck** 360 degrees
62
# Answer:
You’re assessing the one-minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: heart rate 130, pink body and hands with cyanotic feet, weak cry, flexion of the arms and legs, active movement, and crying when stimulated.
**What is your patient’s APGAR score?**
8
## Footnote
* A - 1
* P - 2
* G - 2
* A - 2
* R - 1
63
# Answer:
You’re assessing the one-minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: heart rate 101, cyanotic body and extremities, no response to stimulation, no flexion of extremities, and strong cry.
**What is your patient’s APGAR score?**
4
## Footnote
* A - 0
* P - 2
* G - 0
* A - 0
* R - 2
64
# Answer:
You’re assessing the one-minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: weak cry, some flexion of the arm and legs, active movement and cries to stimulation, heart rate 145, and pallor all over the body and extremities.
**What is your patient’s APGAR score?**
6
## Footnote
* A - 0
* P - 2
* G - 2
* A - 1
* R - 1
65
# Choose:
A newborn’s five-minute APGAR score is 5.
**Which of the following interventions will you provide to this newborn?**
## Footnote
**A.** Routine post-delivery care
**B.** Continue to monitor and reassess the APGAR score in 10 minutes.
**C.** Some resuscitation assistance such as oxygen and rubbing baby’s back and reassess APGAR score.
**D.** Full resuscitation assistance is needed and reassess APGAR score.
**C**
66
# Choose:
A newborn’s five-minute APGAR score is 5. When would you reassess the APGAR score?
## Footnote
**A.** 2 minutes after the previous APGAR assessment
**B.** 15 minutes after the previous APGAR assessment
**C.** 5 minutes after the previous APGAR assessment
**D.** No reassessment of the APGAR score is needed
**C**
| APGAR is recorded at 1, 5, and 10 minutes from birth
67
# Answer:
You’re assessing the five-minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: pink body and hand with cyanotic feet, heart rate 109, grimace to stimulation, flaccid, and irregular cry.
**What is your patient’s APGAR score?**
5
## Footnote
* A - 1
* P - 2
* G - 1
* A - 0
* R - 1
68
# Answer:
You’re assessing the five-minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: heart rate 97, no response to stimulation, flaccid, absent respirations, cyanotic throughout.
**What is your patient’s APGAR score?**
1
## Footnote
* A - 0
* P - 1
* G - 0
* A - 0
* R - 0
69
# Choose:
A newborn’s one-minute APGAR score is 8. Which of the following interventions will you provide to this newborn?
## Footnote
**A.** Routine post-delivery care
**B.** Full resuscitation assistance is needed and reassess APGAR score
**C.** Continue to monitor and reassess the APGAR score in 10 minutes
**D.** Some resuscitation assistance such as oxygen
**A**
70
# Answer:
A neonatal patient has a pink color, a pulse rate of 102, and a respiration rate of 27. She grimaces in response to stimuli, has limited muscle movement.
**What is your patient’s APGAR score?**
7
## Footnote
* A - 2
* P - 2
* G - 1
* A - 1
* R - 1
71
# Answer:
A newborn has a strong cry and is actively moving his blue extremities when stimulated. Vital signs are HR of 140, RR of 48.
**What is your patient’s APGAR score?**
9
## Footnote
* A - 1
* P - 2
* G - 2
* A - 2
* R - 2
72
# Choose:
What is a typical one-minute APGAR score for a newborn?
## Footnote
**A.** APGAR 8-10
**B.** APGAR 9-10
**C.** APGAR 7-8
**D.** APGAR 6-9
**C**
73
# Answer:
After assisting in the delivery of a newborn, the infant is pale, limp, and bradycardic. However, the infant shows some respiratory effort.
**What is your patient’s APGAR score?**
2
## Footnote
* A - 0
* P - 1
* G - 0
* A - 0
* R - 1
74
# Answer:
You just delivered a baby boy. His body is pink, but his hands and feet are blue. The patient's pulse is 110, and his respirations are rapid and irregular. He has a weak cry when stimulated and resists attempts to straighten his legs.
**What is your patient’s APGAR score?**
7
## Footnote
* A - 1
* P - 2
* G - 1
* A - 2
* R - 1
75
# Answer:
A newly delivered infant has a pink trunk and blue hands and feet, a pulse rate of 60, and does not respond to your attempts to stimulate her. She also appears to be limp and taking slow, gasping breaths.
**What is your patient’s APGAR score?**
3
## Footnote
* A - 1
* P - 1
* G - 0
* A - 0
* R - 1
76
# Answer:
One minute after birth, your newborn patient is actively crying in response to your bulb syringe. His body is pink, and he is moving his extremities which are blue. His heart rate is 110.
**What is your patient’s APGAR score?**
9
## Footnote
* A - 1
* P - 2
* G - 2
* A - 2
* R - 2
77
# Answer:
You have just delivered a newborn. The baby appears pink with blue extremities, pulse rate is 95, baby is grimacing but not crying, respiratory effort is absent, and has only some flexion of extremities.
**What is your patient's APGAR score?**
4
## Footnote
* A - 1
* P - 1
* G - 1
* A - 1
* R - 0
78
# Choose:
Starting at which number on the APGAR score should you need to start resuscitation efforts?
## Footnote
**A.** APGAR 5
**B.** APGAR 6
**C.** APGAR 7
**D.** APGAR 9
**B**
79
# Choose:
The nine months of pregnancy are divided into three-month trimesters. **During the second trimester, the:**
## Footnote
**A.** fetus is being formed, and there is little uterine growth.
**B.** uterus grows very rapidly, while the woman's blood volume, cardiac output, and heart rate increase.
**C.** uterus is often seen reaching up to the epigastrium.
**D.** uterus develops to full size.
**B**
## Footnote
*During the second trimester, the uterus grows very rapidly, while the woman's blood volume, cardiac output, and heart rate increase.*
80
# Choose:
You are assessing a pregnant patient who thinks that she is going into labor.
**The first stage of labor begins with:**
## Footnote
**A.** conception.
**B.** the nine-month point.
**C.** regular contractions of the uterus.
**D.** the cervix being fully dilated.
**C**
## Footnote
*The first stage of labor starts with regular contractions of the uterus. This can occur earlier or later than nine months. It ends with full dilation of the cervix.*
81
# Choose:
The third stage of labor begins with:
## Footnote
**A.** the birth of the baby.
**B.** delivery of the afterbirth.
**C.** dilation of the cervix.
**D.** full growth of the uterus.
**A**
82
# Choose:
The process by which the cervix gradually widens and thins out is called:
## Footnote
**A.** delivery.
**B.** dilation.
**C.** staining.
**D.** contraction.
**B**
83
# Fill in the blanks:
You are assisting in the delivery for a 26-year-old patient who is about to have her third child. She states that she has had prenatal care and is not aware of any complications. The baby is due next week. Greenish or brownish-yellow fluid is being expelled from the amniotic sac.
This is called **[BLANK]** and could indicate **[BLANK]**.
This is called **merconium staining** and could indicate **potential fetal distress**.
84
# Choose:
When your 22-year-old patient, who is in labor, suddenly states, "I need to go to the bathroom right now!" this most likely means that the:
## Footnote
**A.** birth will be delayed.
**B.** uterus is almost dilated.
**C.** birth moment is nearing.
**D.** baby is in distress.
**C**
## Footnote
When a mother in labor states that she feels the need to move her bowels, the birth moment is nearing because the fetus is pressing on her bowel in the process of moving down the birth canal. This does not indicate that the baby is in distress.
85
# Choose:
*You are treating an 21-year-old pregnant woman who is full-term and in labor.*
**When you are timing the *duration of a contraction,* time it from the:**
## Footnote
**A.** start of the pain until the delivery of the infant.
**B.** beginning of the contraction to when the uterus relaxes.
**C.** end of a contraction to the beginning of the next one.
**D.** peak of the contraction to the end of the contraction.
**B**
86
# Fill in the blanks:
Delivery is said to be imminent when the contractions last **[BLANK]** seconds and are **[BLANK]** minutes apart.
Delivery is said to be imminent when the contractions last **30** seconds and are **2-3** minutes apart.
87
# Choose:
The EMT's primary roles at a normal childbirth scene are to determine whether the delivery will occur at the scene and, if so, to:
## Footnote
**A.** determine whether the delivery can be delayed.
**B.** assist the mother as she delivers the infant.
**C.** carefully deliver the infant.
**D.** immobilize the patient.
**B**
## Footnote
*The EMT's primary roles at a normal childbirth scene are to determine whether the delivery will occur at the scene and, if so, to assist the mother as she delivers the child. If delivery is imminent, do not delay it. There is no need to immobilize the patient during emergency childbirth.*
88
# Choose:
The sterile obstetrical kit is usually in a sealed container. It should be checked regularly, although the seal is rarely broken. **The kit does *not* contain:**
## Footnote
**A.** a rubber bulb syringe for suctioning.
**B.** several individually wrapped sanitary napkins.
**C.** heavy, flat twine to tie the cord.
**D.** cord clamps or hemostats.
**C**
## Footnote
*The sterile obstetrical kit does not contain heavy, flat twine to tie the cord. Occasionally, in an off-duty situation, you may be required to improvise using heavy, flat twine or new shoelaces to tie the cord.*
89
# Choose:
When you are evaluating the mother for a possible home delivery, you should ask:
## Footnote
**A.** whether pregnancy problems run in the family.
**B.** the frequency and duration of contractions.
**C.** whether the mother feels that she needs to urinate.
**D.** the father's blood type and medical history.
**B**
## Footnote
*When evaluating the mother for a possible home delivery, the EMT should ask about the frequency and duration of contractions. It is normal if the mother feels the need to urinate, but if she has to move her bowels, this is a signal that the infant is moving down the birth canal. The father's blood type is not important to field care but would be important to hospital care if a transfusion becomes necessary.*
90
# Choose:
An important part of assessment of your 29-year-old patient, who you suspect is going to deliver soon, is to examine for crowning. **It is important to ask the patient whether you can examine for crowning if she:**
## Footnote
**A.** is straining during contractions.
**B.** is in her ninth month of pregnancy.
**C.** is pregnant for the first time.
**D.** It is not important to ask permission to examine the patient.
**A**
## Footnote
*It is important to ask the mother whether you can examine for crowning if she is straining during contractions. If there is crowning, birth will probably occur too soon for transport. EMTs do not automatically examine every woman in her ninth month for crowning, and you would need the patient's permission to do so.*
91
# Choose:
You are treating a 26-year-old female who is eight months pregnant. She states that she is having contractions every 15 minutes or so that last for about 20 seconds. She is not exactly sure what labor pain is like because this is her first pregnancy. Her vital signs are pulse of 96, blood pressure of 130/70, respirations of 22, and Sp02 of 98%.
**What should you do next?**
## Footnote
**A.** Administer oxygen and transport immediately.
**B.** Prepare for a home delivery immediately.
**C.** Ask whether her water broke and prepare for a quiet ride to the hospital.
**D.** Tell her to call you back when the contractions are more frequent.
**C**
## Footnote
*You should ask the mother whether her water broke and prepare for a quiet ride to the hospital. This is her first pregnancy and only an eight-month term, so this may be false labor or the beginning of labor.*
92
# Choose:
If you determine that delivery is imminent because of the presence of crowning and other signs, you should:
## Footnote
**A.** contact medical direction.
**B.** transport as quickly as possible.
**C.** ask the mother to go to the bathroom first.
**D.** ask the mother to hold her legs closed.
**A**
## Footnote
*If you determine that the delivery is imminent because of the presence of crowning and other signs, you should contact medical direction or follow your local protocol.
Do not ask the mother to go to the bathroom first, as the infant could be expelled into the toilet. Do not attempt to hold back a delivery by asking the mother to hold her legs closed.*
93
# Fill in the blank:
When a full-term pregnant woman in a supine position complains of dizziness and you note a drop in her blood pressure, this could be due to a condition called **[BLANK]**.
this could be due to a condition called **supine hypotension syndrome**.
## Footnote
*This is a condition in which the heavy mass created by the weight of the uterus, coupled with weight of the infant, placenta, and amniotic fluid, compresses the inferior vena cava, reducing return of blood to the heart and reducing cardiac output, thus resulting in low blood pressure.*
94
# Choose:
To counteract the pressure of the uterus on the inferior vena cava, you should:
## Footnote
**A.** raise the patient's legs.
**B.** transport the patient on her left side.
**C.** raise the patient's head.
**D.** apply a pelvic binder.
**B**
95
# Choose:
You are preparing for a home delivery for a 32-year-old woman who is full-term about to give birth to her third child. **During the delivery, you will need all of the following infection control gear *except*:**
## Footnote
**A.** surgical gloves.
**B.** a mask.
**C.** eye protection.
**D.** a Tyvek suit.
**D**
| Tyvek suit is not needed for protection against blood spraying
96
# Choose:
During the delivery, you should encourage the mother to:
## Footnote
**A.** breathe rapidly and deeply.
**B.** hold her breath every 2 minutes.
**C.** close her mouth and breathe through her nose.
**D.** breathe deeply through her mouth.
**D**
## Footnote
*During delivery, encourage the mother to breathe deeply through her mouth. She may feel better if she pants, although she should be discouraged from breathing rapidly and deeply enough to bring on hyperventilation.*
97
# Choose:
When supporting the baby's head during a delivery, the EMT should do all of the following *except*:
## Footnote
**A.** pulling on the baby's shoulders when they appear.
**B.** applying gentle pressure to control the delivery.
**C.** placing one hand below the baby's head.
**D.** spreading the fingers evenly around the baby's head.
**A**
## Footnote
*Do not pull on the baby's shoulders or any other part of the baby. When supporting the baby's head during a delivery, the EMT should apply gentle pressure to control the delivery, place one hand below the baby's head, and spread the fingers evenly around the baby's head.*
98
# Choose:
You are assisting a 23-year-old female who is about to deliver. She states that her water did not break. **If the amniotic sac has not broken by the time the baby's head is delivered, you should:**
## Footnote
**A.** stop the delivery and transport immediately.
**B.** use your finger to puncture the membrane.
**C.** contact medical direction immediately.
**D.** delay the delivery until it breaks.
**B**
## Footnote
*If the amniotic sac has not broken by the time the baby's head is delivered, use your finger to puncture the membrane. Then pull the membranes away from the baby's mouth and nose.*
99
# Choose:
If you cannot loosen or unwrap the umbilical cord from around the infant's neck, you should:
## Footnote
**A.** stop the delivery and transport immediately.
**B.** tell the mother to push more forcefully.
**C.** clamp the cord in two places and cut between the clamps.
**D.** contact medical direction for advice.
**C**
## Footnote
*If you cannot loosen or unwrap the umbilical cord from around the infant's neck, you should clamp the cord in two places and cut between the clamps. Thus, the child will not strangle, and the cord will not tear.*
100
# Choose:
Most babies are born:
## Footnote
**A.** face down and then rotate to either side.
**B.** face up and then rotate to either side.
**C.** feet and buttocks first and do not rotate.
**D.** face up and do not rotate.
**A**
101
# Choose:
When suctioning a newborn:
## Footnote
**A.** compress the bulb syringe while it is inside the baby's mouth.
**B.** compress the bulb syringe before placing it in the baby's mouth.
**C.** suction the nose and then the mouth.
**D.** insert the syringe about 22 inches into the baby's mouth.
**B**
## Footnote
*When suctioning a newborn, compress the syringe before placing it in the baby's mouth to avoid blowing fluids into the baby's airway.*
102
# Choose:
To assess the newborn, the EMT should do all of the following except:
## Footnote
**A.** noting ease of breathing.
**B.** checking movement in the extremities.
**C.** noting skin coloration.
**D.** checking the response to a sternal rub.
**D**
## Footnote
*To assess the newborn, the EMT does not check
the response to a sternal rub because it could injure the child. A general evaluation usually calls for noting ease
of breathing, heart rate, crying (vigorous crying is a good sign), movement (the more active, the better), and skin color (blue coloration at the hands and feet may or may not disappear, but it should not spread to other parts of the body).*
103
# Choose:
If assessment of the infant's breathing reveals shallow, slow, or absent respirtions, the EMT should:
## Footnote
**A.** provide oxygen by nonrebreather mask.
**B.** use a gentle but vigorous rubbing of the infant's back.
**C.** provide artificial ventilations at 40-60 per minute.
**D.** provide artificial ventilations at 20-30 per minute.
**C**
## Footnote
*If assessment of the infant's breathing reveals shallow, slow, or absent respirations, the EMT should provide artificial ventilations at 40-60 per minute. Do not use an oxygen mask.*
104
# Choose:
In a normal birth, the infant must be breathing on his or her own:
## Footnote
**A.** before you clamp and cut the cord.
**B.** before transportation to the hospital.
**C.** before considering ventilation.
**D.** to use an oral airway.
**A**
105
# Fill in the blank:
The first umbilical cord clamp should be placed about **[BLANK]** inches from the baby.
The first umbilical cord clamp should be placed about **10** inches from the baby.
| the far one
106
# Fill in the blank:
The second umbilical cord clamp should be placed about **[BLANK]** inches from the baby.
The second umbilical cord clamp should be placed about **7** inches from the baby.
| the close one
107
# Fill in the blank:
If the placenta does not deliver within **[BLANK]** minutes of the baby's birth, transport the mother and baby to a medical facility without delay.
If the placenta does not deliver within **20** minutes of the baby's birth, transport the mother and baby to a medical facility without delay.
108
# Choose:
During the delivery of a full-term newborn, the mother sustains a tear in her perineum. **The EMT should:**
## Footnote
**A.** massage the uterus for at least 15 minutes.
**B.** apply a sanitary napkin and gentle pressure.
**C.** transport the patient on her left side immediately.
**D.** contact medical direction immediately.
**B**
## Footnote
*It is not uncommon for part of the mother's perineum to tear during a delivery. If this occurs, apply a sanitary napkin and apply gentle pressure. Let the mother know that torn tissue is normal and that the problem will be cared for quickly at the medical facility.*
109
# Choose:
You are assisting in the delivery for a 26-year-old female who was told by her doctor that the infant is in the breech position.
**Which of the following is an appropriate action to take for a breech presentation?**
## Footnote
**A.** Place the mother on her left side.
**B.** Provide low-concentration oxygen.
**C.** Pull on the baby's legs to deliver.
**D.** Initiate rapid transport upon recognition.
**D**
## Footnote
*Initiate rapid transport on recognition of a breech presentation. Never pull on the baby's legs. Provide high concentration oxygen. Place the mother in a head-down position with the pelvis elevated.*
110
# Choose:
During the examination of a 29-year-old woman with labor pains, you see the umbilical cord presenting first. **You should:**
## Footnote
**A.** gently push up on the baby's head or buttocks to take pressure off of the cord.
**B.** use two gloved fingers to check the cord for a pulse and keep the cord cool.
**C.** raise the mother's head and lower her buttocks to lessen pressure on the birth canal.
**D.** attempt to push the cord back if it is not wrapped around the baby's neck.
**A**
## Footnote
*If you see the umbilical cord presenting first, gently push up on the baby's head or buttocks to take pressure off the cord. This may be the only chance that the baby has for survival, so continue to push up on the baby until you are relieved by a physician. All patients with prolapsed cords require rapid transport.*
111
# Choose:
*You are about to assist in the delivery for a full-term 33-year-old female. When you check for crowning, you do not see the head, but you do see one foot.*
**When a baby's limb presents first, you should:**
## Footnote
**A.** push gently on the extremity to prevent it from advancing.
**B.** pull gently on the limb to encourage delivery.
**C.** administer low-concentration oxygen to the mother.
**D.** begin rapid transport of the patient immediately.
**D**
## Footnote
*When a baby's limb presents first, the EMT should begin rapid transport of the patient immediately. Do not try to replace the limb into the vagina.*
112
# Choose:
You are assisting in the delivery for a 28-year-old female who is full-term; she tells you that this is her third child. She said that she may be having twins.
**When you are assisting with the delivery of twins:**
## Footnote
**A.** the afterbirth will be delivered after each individual infant.
**B.** clamp the cord of the first baby before the second baby is born.
**C.** labor contractions will stop after the first clelivery.
**D.** transport the mother immediately.
**B**
## Footnote
*When assisting with the delivery of twins, clamp the cord of the first baby before the second baby is born. Labor contractions will continue after the first baby is born.*
113
# Choose:
Newly born infants lose heat rapidly. Heat loss not only affects their comfort but also can:
## Footnote
**A.** increase their glucose level.
**B.** affect their ability to carry oxygen in their blood.
**C.** cause them to develop a fever.
**D.** decrease their ability to shiver.
**B**
## Footnote
*Newly born infants lose heat rapidly. This heat loss affects their comfort and decreases their glucose level, which affects their ability to carry oxygen in their blood and increases their shivering.*
114
# Choose:
When oxygen is administered to an infant, it should be given by:
## Footnote
**A.** a nonrebreather mask.
**B.** flowing it past the baby's face.
**C.** a pediatric nasal cannula.
**D.** a transport ventilator.
**B**
## Footnote
*When oxygen is administered to an infant, it should be given by flowing it past the baby's face. Use humidified oxygen, if available, so that it doesn't dry out the baby's respiratory tract.*
115
# Choose:
If you suspect meconium staining when the infant is born:
## Footnote
**A.** contact medical direction for advice.
**B.** avoid stimulating the infant before suctioning the oropharynx.
**C.** suction the infant's nose, then the mouth.
**D.** provide oxygen to the mother.
**B**
## Footnote
*If you suspect meconium staining when the infant is born, avoid stimulating the infant before suctioning the oropharynx. This reduces the risk of aspiration.*
116
# Fill in the blank:
A condition in which the placenta is formed low in the uterus and close to the cervical opening, preventing normal delivery of the fetus, is called **[BLANK]**.
is called **placenta previa**
## Footnote
*A condition in which the placenta is formed low in the uterus and close to the cervical opening, preventing normal delivery of the fetus, is called placenta previa.*
117
# Choose:
You are treating a 22-year-old female who is eight months pregnant and just had a seizure.
**Which of the following is *true* of seizures in pregnancy?**
## Footnote
**A.** They are usually associated with low blood pressure.
**B.** They tend to occur early in pregnancy.
**C.** They pose a threat to the mother but not to the fetus.
**D.** They are usually associated with extreme swelling of the extremities.
**D**
## Footnote
*Seizures in pregnancy are usually associated with extreme swelling of the extremities. In addition, the patient will have elevated blood pressure. Seizures tend to occur late in pregnancy and pose a threat to both the mother and the fetus.*
118
# Choose:
You are assessing a 19-year old woman who is about eight months pregnant and states that she fell down the stairs.
**The greatest danger associated with blunt trauma to the pregnant woman's abdomen and pelvis is:**
## Footnote
**A.** cramping abdominal pains.
**B.** spontaneous abortion.
**C.** massive bleeding and shock.
**D.** elevated blood pressure.
**C**
## Footnote
*Massive bleeding and shock are the gravest dangers associated with blunt trauma to the pregnant woman's abdomen or pelvis. Perform a patient assessment, and treat her injuries as you would those of any trauma patient.*
119
# Choose:
Which of the following is *true* about the physiology of a pregnant woman?
## Footnote
**A.** Her vital signs may be interpreted as suggestive of shock when they are actually normal.
**B.** She has a pulse rate that is 10-15 beats per minute slower than that of the nonpregnant female.
**C.** A woman in later pregnancy may have a blood volume that is up to 48% lower than what she would have in her nonpregnant state.
**D.** Assessing for shock is easier in the pregnant patient than in a nonpregnant patient.
**A**
## Footnote
*Because of the physiology of a pregnant woman,
her vital signs may be interpreted as suggestive of shock when they are actually normal. The pregnant woman has a pulse rate that is 10-15 beats per minute faster than her nonpregnant counterpart and a blood volume as much as 48% higher than what she would have in her nonpregnant state. Shock is more difficult to assess in the pregnant patient, and it is the most likely cause of prehospital death from injury to the uterus.*
120
# Choose:
You are called to the scene of a 35-year-old woman who has a complaint of abdominal pain. She tells you that she also has unexpected vaginal bleeding.
**Which of the following is *true* of the treatment necessary for this patient?**
## Footnote
**A.** Massage the abdomen vigorously.
**B.** Assume that the woman is pregnant and transport.
**C.** Treat her as if she has a potentially life-threatening condition.
**D.** Determine the cause before beginning treatment.
**C**
## Footnote
*If vaginal bleeding is associated with abdominal pain, treat the patient as if she has a potentially life-threarening condition. The most serious complication of vaginal bleeding is hypovolemic shock due to blood loss.*
121
# Define:
pallor
unhealthy **pale** appearance
122
# Choose:
A patient calls 911 due to severe cramping pelvic pain, menorrhagia, lightheadedness, and tachycardia. She notes that her usually regular period was absent this past month.
**At what average age does her current condition become possible?**
## Footnote
**A.** 8
**B.** 20
**C.** 13
**D.** 18
**C**
## Footnote
*This patient is likely experiencing an ectopic pregnancy; reproductive maturity (the age when an organism can reproduce) is generally reached at or around the age of 13 in females. Males can reproduce beginning at ages 10 to 12. Also to note, sexual abuse should be a suspicion when a 13-year-old is pregnant due to the age. Be sure to document thoroughly and, if at all possible, have a female crew caring for the patient for sensitivity.*
123
# Define:
menorrhagia
heavy or prolonged menstrual bleeding
124
# Choose:
You are on scene with a 15-day-old infant. The mother states that she has been nursing him but he's not acting right. He is difficult to awaken, pale, he has dry mucous membranes, and sunken fontanelles. She thinks he hasn't had a wet diaper in 18 hours.
**What do you suspect is the problem?**
## Footnote
**A.** Sepsis
**B.** Jaundice
**C.** Dehydration
**D.** Apnea
**C**
125
# Choose:
A 20-year-old female presents with severe lower abdominal pain with abnormal vaginal bleeding and vomiting. When interviewed, she states she shouldn't be pregnant because she uses an intra-uterine device to prevent unwanted pregnancy.
**Which of the following should be considered until proven otherwise?**
## Footnote
**A.** An ectopic pregnancy
**B.** A miscarriage
**C.** Uterine cancer
**D.** Pelvic inflammatory disease
**A**
## Footnote
*An ectopic pregnancy is often a surprise to the patient. The signs and symptoms of a ectopic pregnancy normally begins after the 10th week of gestation and can become life threatening. Therefore, sudden onset abdominal pain that presents with any amount of vaginal bleeding in a women of child bearing age should be considered a true medical emergency and monitored closely. These patients may become shocky and decompensate quickly. The use of condoms, IUD's, surgical birth control (tube tying), and oral contraceptives do not exclude pregnancy or ectopic pregnancy!*
126
# Choose:
You are called to see a woman who has just delivered her baby and placenta. You note that she is bleeding profusely from her vagina, although she is stable in all of her vital signs. Visual inspection of her vagina shows no tears. She states milk is leaking from her nipples and wants to breastfeed her baby immediately.
**You should:**
## Footnote
**A.** Let her breastfeed the baby.
**B.** Tell her to wait until the doc OKs it.
**C.** Have her apply a tight bra to her breast.
**D.** Place a large towel against the vagina.
**A**
## Footnote
*Let her do this. This will stimulate release of pituitary oxytocin, contracting her uterus and limiting her bleeding.*
127
# Choose:
To prevent excess shifts of blood between the placenta and newborn, the newborn should be kept at which of the following levels until the umbilical cord is clamped or has stopped pulsating?
## Footnote
**A.** on the mom's chest
**B.** level with the vagina
**C.** at a level higher than the vagina
**D.** at a level lower than the vagina
**B**
## Footnote
*Keeping the newborn close to or at the level of the vagina is important until the umbilical cord is clamped. A common mistake is placing the newborn on the mother's chest directly after delivery, reducing the amount of blood in the newborn's circulation as gravity pulls it to the placenta.*
128
# Choose:
You are called to see a pregnant woman who is unresponsive. Her family states she has not had a convulsion. She is not bleeding.
**After initial vitals are documented, what is your best *next* step?**
## Footnote
**A.** Listen for fetal heart tones.
**B.** Check for patellar reflexes and clonus.
**C.** Get a blood sugar determination.
**D.** Try to awaken her with an ammonia inhalant.
**C**
