Obstetrical Patient Management Flashcards

A 24-week gestation patient is in preterm labor during air transport. Terbutaline is ordered as a tocolytic. Which maternal side effect requires CLOSEST monitoring?

Answer: Tachycardia and hyperglycemia

Beta-2 agonist tocolytics like terbutaline cause maternal tachycardia and hyperglycemia, requiring continuous cardiac monitoring and glucose assessment.

During flight transport of a postpartum patient with uterine atony unresponsive to oxytocin, which second-line uterotonic is CONTRAINDICATED in a patient with asthma?

Answer: Carboprost (Hemabate)

Carboprost (15-methyl PGF2α) is contraindicated in patients with asthma because it can cause severe bronchospasm.

A neonate is born during air transport and has a heart rate of 50 bpm with no spontaneous respirations after 30 seconds of positive pressure ventilation. The NEXT step per NRP guidelines is:

Answer: Begin chest compressions with continued PPV at a 3:1 ratio

When HR remains <60 bpm after adequate PPV, NRP directs initiation of chest compressions coordinated with PPV at a 3:1 compression-to-ventilation ratio.

When transporting a patient with suspected ectopic pregnancy at 8 weeks who is hemodynamically unstable, which assessment finding BEST confirms rupture?

Answer: Referred shoulder pain (Kehr's sign) and peritoneal signs

Kehr's sign (referred shoulder pain from diaphragmatic irritation by hemoperitoneum) combined with peritoneal signs indicates ruptured ectopic with free abdominal bleeding.

A patient at 34 weeks is receiving magnesium sulfate for seizure prophylaxis. The flight nurse notes absent deep tendon reflexes and a respiratory rate of 10/min. The CORRECT immediate action is:

Answer: Stop magnesium and administer calcium gluconate IV

Absent DTRs with respiratory depression indicates magnesium toxicity; the antidote is calcium gluconate 1 gram IV given slowly to reverse neuromuscular blockade.

Which position is MOST appropriate for a term pregnant patient in hemorrhagic shock during aeromedical transport who cannot tolerate left lateral tilt?

Answer: Manual left uterine displacement while supine

Manual left uterine displacement while the patient remains supine effectively relieves aortocaval compression without requiring positional changes that complicate resuscitation.

During air transport of a 29-week gestation patient, the flight nurse administers betamethasone. This corticosteroid is given to:

Answer: Accelerate fetal lung maturity and reduce RDS risk

Antenatal betamethasone at 24–34 weeks gestation accelerates fetal lung surfactant production, significantly reducing the risk of neonatal respiratory distress syndrome.