AEMCA Obstetrics and Neonatology 5 — Questions and Answers
Question 1: After a normal delivery, how long should you wait before clamping the umbilical cord in a term, vigorous neonate when time permits?
- At least 30–60 seconds to allow placental transfusion (Correct answer)
- Immediately after delivery to prevent blood loss
- Only after the placenta delivers spontaneously
- 10 minutes to maximize iron stores
Correct answer: At least 30–60 seconds to allow placental transfusion
Delayed cord clamping for at least 30–60 seconds in vigorous term neonates improves iron stores and reduces the risk of anemia, per current guidelines.
Question 2: A patient at 31 weeks has a gush of clear fluid from the vagina without contractions. Your HIGHEST priority assessment concern is:
- Inspect for cord prolapse before providing any treatment (Correct answer)
- Determine whether she had intercourse in the last 24 hours
- Check fundal height to estimate gestational age
- Administer oxygen and obtain IV access
Correct answer: Inspect for cord prolapse before providing any treatment
Premature rupture of membranes with fluid gush requires immediate inspection for umbilical cord prolapse, which is a life-threatening emergency.
Question 3: Which of the following BEST describes the purpose of the initial 'golden minute' in neonatal resuscitation?
- Complete initial steps and begin PPV if the neonate is not breathing or HR is below 100 bpm within 60 seconds (Correct answer)
- Administer epinephrine and establish IV access within 60 seconds of delivery
- Perform APGAR scoring and make transport decisions within the first minute
- Allow the neonate time to transition without intervention before assessing
Correct answer: Complete initial steps and begin PPV if the neonate is not breathing or HR is below 100 bpm within 60 seconds
The golden minute emphasizes rapid completion of warming, drying, stimulation, and airway positioning, then beginning PPV promptly if needed.
Question 4: A gravida 4, para 3 patient reports contractions every 3 minutes. She had her last delivery in 45 minutes. This history is MOST significant because:
- Multiparity and rapid prior deliveries increase the risk of precipitous delivery in the field (Correct answer)
- She is at low risk because she has delivered before without complications
- Multiparity reduces uterine contraction efficiency, prolonging labor
- Her previous deliveries increase risk for placenta previa
Correct answer: Multiparity and rapid prior deliveries increase the risk of precipitous delivery in the field
A history of rapid prior deliveries (precipitous labor) and multiparity significantly increase the likelihood of an imminent field delivery.
Question 5: During a field delivery, the amniotic sac has not ruptured and the infant delivers inside the intact membranes ('en caul'). You should:
- Puncture and peel away the membranes from the infant's face immediately (Correct answer)
- Leave the membranes intact and transport to allow hospital delivery
- Clamp and cut the membranes as you would the umbilical cord
- Administer oxygen to the mother to improve fetal oxygenation through the intact sac
Correct answer: Puncture and peel away the membranes from the infant's face immediately
An en caul delivery requires the provider to immediately puncture and remove the membranes from the infant's face to allow breathing.
Question 6: A neonate delivered at term has central cyanosis but is vigorous with a strong cry and HR of 130 bpm at 3 minutes of life. Your BEST action is:
- Provide supplemental oxygen and reassess; SpO2 targets guide oxygen titration (Correct answer)
- Begin positive-pressure ventilation immediately
- Begin chest compressions due to cyanosis
- No intervention; central cyanosis is normal at 3 minutes
Correct answer: Provide supplemental oxygen and reassess; SpO2 targets guide oxygen titration
Central cyanosis persisting beyond the first minutes with a vigorous neonate warrants supplemental oxygen titrated to NRP SpO2 targets (60–65% at 1 min, rising to 85–95% by 10 min).
Question 7: Which maternal position is MOST appropriate during transport of a 36-week patient in preterm labor who is hemodynamically stable?
- Left lateral recumbent to relieve aortocaval compression (Correct answer)
- Supine with legs elevated to improve cardiac output
- Fowler's position at 45 degrees to ease breathing
- Right lateral recumbent to facilitate venous return
Correct answer: Left lateral recumbent to relieve aortocaval compression
The left lateral recumbent position prevents the gravid uterus from compressing the inferior vena cava and aorta, optimizing maternal cardiac output and fetal perfusion.
AEMCA Obstetrics and Neonatology 5
After a normal delivery, how long should you wait before clamping the umbilical cord in a term, vigorous neonate when time permits?