Obstetrics Quiz

Question 1

What is the definition of a ‘term baby’

Answer 1

37-42 weeks

Question 2

What is a precipitate birth/delivery?

Answer 2

Usually a rapid labour and quick deliver (under 4 hours)

Question 3

Where would you transport a pre-term baby?

Answer 3

• between 32-36 weeks gestation consult with PIPER
• 20-32 gestation RWH, monash medical centre, mercy heidelberg as these have NICU facilities
• Rural - closest regional base hospital

Question 4

How much fluid would you administer to a pregnant woman with an antepartum haemorrhage?

Answer 4

• less than adequate perfusion (HR <50 or >100, BP <100) consider normal saline titrated to patient response
• max 40ml/kg
• if inadequate response, consult for a further 20ml/kg

Question 5

What are the signs and symptoms of pre-eclampsia?

Answer 5

• HA
• Cerebral irritability
• Agitation
• Visual disturbances (flashing lights)
• nausea and vomiting
• hyperreflexia
• heartburn/gastric pain/abdo pain
• SBP >140 + >90 diastolic

Question 6

What are the signs that the placenta is ready to be delivered?

Answer 6

• lengthening of the cord
• uterus becomes rounded, firmer, smaller
• trickle or gush of blood from the vagina
• cramping/contractions return

Question 7

What do you need to do with the placenta once it has been delivered?

Answer 7

• note the time of delivery
• place placenta and if any clots in a container/wrap in the towel and transport with mother and baby

Question 8

At what gestation would you apply a GTN patch if the mother was in labour?

Answer 8

• 20-34 weeks gestation
• consult for GTN patch to the abdomen

Question 9

How much time do you have to deliver a baby with shoulder dystocia? Why?

Answer 9

• 5-7 mins
• Compression of the cord on the pelvic rim

Question 10

When can a secondary PPH occur?

Answer 10

up to 6 weeks post partum

Question 11

Would you deliverthe placenta in a female with primary PPH?

Answer 11

• NO
• the risk of uterine inversion - they will still bleed

Question 12

What are the side effects of Misoprostol?

Answer 12

• hyper reflexia
• shivering
• abdo pain
• diarrhoea

Question 13

When would you commence ventilations in the non-vigorous newborn? How?

Answer 13

• within the first 60 seconds. 40-60 bpm with BVM, air only, no supplemental oxygen, apply PEEP 5cm
• After 30 seconds (and HR 60-100) ensure adequate mask seal/ventlation pressure and ADD oxygen 5L/min
• If HR <60 (after 30 seconds) CPR with 100% FiO2

Question 14

A baby who has a pink body and blue extremities, a pulse greater than 100, who is crying, flexing extremities has an APGAR score of what?

Answer 14

8

Question 15

When resuscitating a newborn, whos heart rate is between 60-100 (after 30 seconds ventilation) what should the paramedic do next?

Answer 15

• ensure adequate mask and seal (BVM), correct airway position (neutral, padding under shoulders), if HR between 60-100 add O2 5L/min via BVM

Question 16

What is restitution?

Answer 16

When the babies head rotates 90 degrees (to face the mothers thigh) indicating the the internal rotation of the shoulder is happening just before the birth of the body

Question 17

Is a cord prolapse more common in a breech presentation?

Answer 17

Yes

Question 18

How would you prevent hypothermia in the breech baby?

Answer 18

• maintain a warm environment
• use bubble wrap of the obstetric kit (dont rip it open) to wrap the baby if the body is exposed for an extended period of time
• cool air may stimulate the baby to breathe, which is not desirable if the head remains unborn

Question 19

What would you use Lovesett’s manoeuvre?

Answer 19

• in a breech presentation when the buttocks presents first (and the arms do not birth spontaneously)

Question 20

Define pre-term labour

Answer 20

• A woman who is in labour with a gestation between 24-<37 weeks

Question 21

What is McRobert’s manoeuvre?

Answer 21

• The hyperflexion pf the maternal hips (knees to nipples)
• Place the mother in the recumbent position, hips to the edge of the bed for better access to gentle downward traction
• assist the mother to grasp her knees and pull her knees/thighs back as faras possible onto her abdomen ( you may need an assistant)
• Used in birth where there is prolonged time between birthing the head and the body (after 30-60 seconds) = shoulder dystocia

Question 22

How long does a seizure last in the female with eclampsia? How would you manage this?

Answer 22

• typically no more than 90 seconds (provided not a history of epilepsy. Manage as per seizures)