CMS CMS Obstetric Complications & Emergency Management 1 — Questions and Answers
Question 1: A patient at 32 weeks presents with painless, bright-red vaginal bleeding. Which condition is most likely?
- Placenta previa (Correct answer)
- Placental abruption
- Vasa previa
- Bloody show
Correct answer: Placenta previa
Placenta previa classically presents with painless, bright-red vaginal bleeding in the second or third trimester due to the placenta overlying the cervical os.
Question 2: Which triad of findings is characteristic of severe preeclampsia requiring immediate intervention?
- BP ≥160/110 mmHg, severe headache, visual disturbances (Correct answer)
- BP ≥140/90, proteinuria, mild edema
- BP ≥130/80, nausea, hyperreflexia
- BP ≥150/100, epigastric pain, normal labs
Correct answer: BP ≥160/110 mmHg, severe headache, visual disturbances
Severe-range preeclampsia features BP ≥160/110 plus severe symptoms such as severe headache, visual changes, or epigastric pain, mandating magnesium sulfate and delivery planning.
Question 3: A patient experiences sudden, severe 'tearing' abdominal pain with fetal heart rate decelerations at 38 weeks. She has a prior uterine scar. The most likely diagnosis is:
- Uterine rupture (Correct answer)
- Placental abruption
- Cord prolapse
- Severe preeclampsia
Correct answer: Uterine rupture
Uterine rupture presents with sudden severe abdominal pain, loss of fetal station, and fetal distress, and is a life-threatening emergency requiring immediate cesarean.
Question 4: Magnesium sulfate is administered in severe preeclampsia primarily to:
- Prevent eclamptic seizures (Correct answer)
- Lower blood pressure acutely
- Improve fetal lung maturity
- Treat the underlying cause of preeclampsia
Correct answer: Prevent eclamptic seizures
Magnesium sulfate is the drug of choice for seizure prophylaxis in severe preeclampsia; antihypertensives are used separately for blood pressure control.
Question 5: Which clinical finding most reliably distinguishes placental abruption from placenta previa?
- Painful uterine contractions with dark vaginal bleeding (Correct answer)
- Painless bright-red vaginal bleeding
- Decreased fetal movement only
- Hyperemesis with spotting
Correct answer: Painful uterine contractions with dark vaginal bleeding
Placental abruption typically presents with painful, board-like uterine rigidity and dark vaginal bleeding, in contrast to the painless bleeding of placenta previa.
Question 6: A patient in active labor has a sudden variable deceleration with cord palpable in the vagina. The priority nursing action is:
- Elevate the presenting part off the cord and call for emergency cesarean (Correct answer)
- Position patient in left-lateral and apply oxygen only
- Administer tocolytics to stop contractions
- Perform amnioinfusion immediately
Correct answer: Elevate the presenting part off the cord and call for emergency cesarean
Cord prolapse requires immediate manual elevation of the presenting part to relieve compression while emergency cesarean is prepared.
CMS CMS Obstetric Complications & Emergency Management 1
A patient at 32 weeks presents with painless, bright-red vaginal bleeding.
Which condition is most likely?