CFRN Obstetrical Patient Management 3 — Questions and Answers
Question 1: A 30-week pregnant trauma patient is transported after a motor vehicle collision. Which assessment finding would MOST directly indicate fetal compromise?
- Maternal tachycardia >110 bpm
- Uterine tenderness on palpation
- Fetal heart rate of 90 bpm for 5 minutes (Correct answer)
- Decreased maternal oxygen saturation to 94%
Correct answer: Fetal heart rate of 90 bpm for 5 minutes
Sustained fetal bradycardia (FHR <110 bpm) is a direct indicator of fetal compromise requiring immediate intervention.
Question 2: When performing neonatal resuscitation after an unexpected delivery during air transport, what is the INITIAL step after ensuring warmth and stimulation?
- Initiate chest compressions if heart rate <100 bpm
- Assess respiratory effort and heart rate (Correct answer)
- Administer epinephrine via umbilical vein
- Place an endotracheal tube immediately
Correct answer: Assess respiratory effort and heart rate
After warmth and stimulation, the NRP algorithm requires assessment of respiratory effort and heart rate to guide subsequent resuscitation steps.
Question 3: A patient with known placenta previa at 35 weeks presents with painless vaginal bleeding during transport. Which assessment is CONTRAINDICATED?
- Abdominal palpation
- External fetal monitoring
- Digital cervical examination (Correct answer)
- IV access and fluid resuscitation
Correct answer: Digital cervical examination
Digital cervical examination is absolutely contraindicated in placenta previa because it can disrupt the placenta and cause catastrophic hemorrhage.
Question 4: During aeromedical transport at altitude, a pregnant patient's oxygen requirements increase due to physiologic changes. Which of the following is a NORMAL respiratory adaptation of pregnancy that affects transport management?
- Decreased tidal volume due to diaphragmatic compression
- Increased functional residual capacity (FRC)
- Chronic compensated respiratory alkalosis (Correct answer)
- Decreased minute ventilation
Correct answer: Chronic compensated respiratory alkalosis
Pregnancy causes chronic respiratory alkalosis (decreased PaCO2 ~30 mmHg) due to progesterone-driven hyperventilation, which must be considered during ventilator management.
Question 5: A 38-week patient in the transport environment is found to have a category III fetal heart rate tracing. This classification indicates:
- Normal fetal status requiring routine monitoring
- Indeterminate status needing increased surveillance
- Abnormal status associated with fetal acidemia requiring immediate action (Correct answer)
- Fetal tachycardia only, no intervention needed
Correct answer: Abnormal status associated with fetal acidemia requiring immediate action
Category III FHR tracings are abnormal, associated with fetal acidemia, and require immediate evaluation and interventions such as repositioning, oxygen, and expedited delivery.
Question 6: When transporting a patient with severe preeclampsia, the MINIMUM acceptable urine output to monitor renal perfusion is:
- 10 mL/hr
- 25 mL/hr (Correct answer)
- 50 mL/hr
- 100 mL/hr
Correct answer: 25 mL/hr
A urine output of at least 25 mL/hr (0.5 mL/kg/hr) indicates adequate renal perfusion in the preeclamptic patient during transport.
Question 7: A patient at 26 weeks gestation develops sudden dyspnea, hypoxia, and cardiovascular collapse during transport. Amniotic fluid embolism (AFE) is suspected. What is the PRIORITY intervention?
- Immediate intubation and high-flow oxygen (Correct answer)
- Administer epinephrine and prepare for ECMO
- Perform emergency cesarean section in the aircraft
- Administer magnesium sulfate to prevent seizures
Correct answer: Immediate intubation and high-flow oxygen
In AFE, immediate airway management with intubation and high-flow oxygen is the priority to address the severe hypoxia and cardiovascular collapse.
CFRN Obstetrical Patient Management 3
A 30-week pregnant trauma patient is transported after a motor vehicle collision.
Which assessment finding would MOST directly indicate fetal compromise?