AEMCA - Advanced Emergency Medical Care Assistant Obstetrics and Neonatology Questions and Answers

Question 1

You are called to a 34-year-old female, G3P2 at 38 weeks gestation, whose membranes have just ruptured. During assessment, you visualize the umbilical cord protruding from the vagina. The patient is anxious and states she feels contractions. What is the most critical immediate intervention?

Accepted Answer

Place the patient in a knee-chest position and manually elevate the presenting fetal part.

Answer

Umbilical cord prolapse is a true obstetrical emergency where the cord is compressed between the presenting part and the maternal pelvis, cutting off oxygen to the fetus. The single most important intervention is to relieve this pressure. This is achieved by placing the mother in a knee-chest or exaggerated Sims' position and inserting a sterile gloved hand into the vagina to manually lift the presenting part off the cord. Pushing the cord back in is not recommended and can cause vasospasm. While oxygen and transport are necessary, they are not the first critical action to relieve the life-threatening compression.

Question 2

A 29-year-old in her third trimester of pregnancy presents with sudden, painless, bright red vaginal bleeding. Her abdomen is soft and non-tender on palpation. Which of the following conditions is most likely?

Accepted Answer

Placenta previa

Answer

The classic presentation of placenta previa is painless, bright red vaginal bleeding in the second or third trimester. The uterus is typically soft and non-tender. In contrast, placental abruption usually presents with dark red bleeding, significant abdominal pain, and a rigid, tender uterus. Uterine rupture involves excruciating pain and signs of shock, while Braxton Hicks contractions do not cause significant bleeding.

Question 3

Following a field delivery of a vigorous, crying newborn at term, what are the appropriate initial steps of neonatal care?

Accepted Answer

Dry the infant, provide warmth with skin-to-skin contact, clear the airway only if necessary, and stimulate breathing.

Answer

For a vigorous newborn (good muscle tone, strong cry, term gestation), the initial steps focus on routine care to support the transition. This includes providing warmth (placing skin-to-skin with the mother is ideal), drying the infant to prevent heat loss, which also provides stimulation, and positioning the head to ensure an open airway. Suctioning is only indicated if there are signs of airway obstruction. Immediate cord clamping, PPV, and chest compressions are reserved for non-vigorous infants requiring resuscitation.

Question 4

When assessing a newborn's APGAR score, how is respiratory effort evaluated and scored?

Accepted Answer

A score of 1 is given for a slow or irregular cry; a score of 2 is for a vigorous cry.

Answer

The 'Respiration' component of the APGAR score is assessed based on the infant's breathing effort. A score of 0 is given for absent respirations (apnea). A score of 1 is for slow, weak, or irregular respirations. A score of 2 is awarded for a strong, vigorous cry. The other options describe the scoring for Heart Rate, Appearance (Color), and Reflex Irritability (Grimace), respectively.

Question 5

You have just assisted with a delivery in the patient's home. The placenta has delivered, but the mother is now experiencing heavy vaginal bleeding and the uterine fundus feels soft and 'boggy'. What is the primary and most important prehospital intervention for this condition?

Accepted Answer

Firmly massage the uterine fundus.

Answer

The patient's signs and symptoms are classic for uterine atony, the most common cause of postpartum hemorrhage (PPH). The primary, most effective, and immediate prehospital intervention is to perform a firm fundal massage. This action mechanically stimulates the uterus to contract, which constricts the blood vessels at the placental site and controls the bleeding. While oxygen, IV fluids, and positioning are important supportive measures, they do not address the underlying cause as directly as fundal massage.

AEMCA - Advanced Emergency Medical Care Assistant Practice Test

AEMCA - Advanced Emergency Medical Care Assistant Practice Test

AEMCA - Advanced Emergency Medical Care Assistant Obstetrics and Neonatology Questions and Answers