AEMCA Obstetrics and Neonatology 3 — Questions and Answers
Question 1: A patient delivers a preterm infant at approximately 32 weeks. Beyond airway management and warmth, which additional measure is most important for this neonate?
- Wrap in a polyethylene plastic bag or thermal blanket to prevent heat loss (Correct answer)
- Administer prophylactic oxygen at 100%
- Stimulate aggressively by rubbing the trunk
- Delay cord clamping for at least 5 minutes
Correct answer: Wrap in a polyethylene plastic bag or thermal blanket to prevent heat loss
Preterm neonates are highly susceptible to hypothermia; wrapping in a polyethylene bag (without drying) is recommended to maintain temperature in infants under 32 weeks.
Question 2: Which finding BEST differentiates placental abruption from placenta previa in a third-trimester patient?
- Painful, dark red bleeding with a rigid abdomen (Correct answer)
- Painless bright red bleeding with a soft abdomen
- Rupture of membranes before bleeding
- Bleeding that worsens with digital examination
Correct answer: Painful, dark red bleeding with a rigid abdomen
Placental abruption classically presents with painful vaginal bleeding and uterine rigidity due to retroplacental hemorrhage, distinguishing it from the painless bleeding of previa.
Question 3: During a breech delivery, the infant's body delivers but the head does not. Which maneuver is used to deliver the aftercoming head?
- Mauriceau-Smellie-Veit maneuver (Correct answer)
- McRoberts maneuver
- Zavanelli maneuver
- Woods screw maneuver
Correct answer: Mauriceau-Smellie-Veit maneuver
The Mauriceau-Smellie-Veit maneuver uses the provider's fingers in the infant's mouth to flex the head while applying supraoccipital pressure to facilitate delivery.
Question 4: A patient at 36 weeks presents with generalized tonic-clonic seizure activity. She has no prior seizure history. What is the MOST likely diagnosis?
- Eclampsia (Correct answer)
- Epilepsy exacerbation
- Hypoglycemia-induced seizure
- Hypertensive encephalopathy unrelated to pregnancy
Correct answer: Eclampsia
New-onset seizures in a pregnant patient beyond 20 weeks with no prior history are eclampsia until proven otherwise.
Question 5: A neonate is apneic and limp at birth. After drying, warming, and stimulation for 30 seconds, there is still no respiratory effort. What is your next action?
- Begin positive-pressure ventilation with room air (or blended oxygen) (Correct answer)
- Begin chest compressions immediately
- Administer epinephrine and transport
- Insert an oropharyngeal airway and provide blow-by oxygen
Correct answer: Begin positive-pressure ventilation with room air (or blended oxygen)
Per NRP guidelines, apnea after initial steps requires immediate positive-pressure ventilation, ideally starting with 21% oxygen (room air) for term neonates.
Question 6: The normal fetal heart rate range monitored during field assessment of a pregnant patient is:
- 110–160 beats per minute (Correct answer)
- 80–110 beats per minute
- 160–200 beats per minute
- 60–80 beats per minute
Correct answer: 110–160 beats per minute
A normal fetal heart rate is 110–160 bpm; rates outside this range may indicate fetal distress and require rapid transport.
Question 7: A patient in active labor suddenly develops a prolapsed umbilical cord visible at the vaginal introitus. Your IMMEDIATE action is:
- Elevate the presenting part off the cord with a gloved hand and rapid transport (Correct answer)
- Attempt to push the cord back into the uterus
- Place the patient supine and administer high-flow oxygen only
- Clamp and cut the cord to prevent compression
Correct answer: Elevate the presenting part off the cord with a gloved hand and rapid transport
Manually elevating the fetal presenting part relieves cord compression and is the critical field intervention for umbilical cord prolapse while transporting emergently.
AEMCA Obstetrics and Neonatology 3
A patient delivers a preterm infant at approximately 32 weeks.
Beyond airway management and warmth, which additional measure is most important for this neonate?