CPC Maternal and Child Health 1 — Questions and Answers

Question 1: A community paramedic visits a 28-year-old patient at 32 weeks gestation who reports a sudden onset headache, visual changes, and upper right quadrant abdominal pain. Blood pressure is 158/106 mmHg. These findings are MOST consistent with:

Normal pregnancy hypertension that resolves with rest
Severe preeclampsia or HELLP syndrome requiring immediate emergency escalation (Correct answer)
Gestational migraine — a common third-trimester complaint
Indigestion related to the enlarged uterus compressing the stomach

Correct answer: Severe preeclampsia or HELLP syndrome requiring immediate emergency escalation

BP ≥160/110 mmHg with headache, visual changes, and right upper quadrant pain (hepatic capsule distension) in a pregnant patient indicates severe preeclampsia with possible HELLP syndrome — a life-threatening obstetric emergency requiring immediate transport.

Severe preeclampsia criteria (ACOG) include: BP ≥160/110 mmHg, thrombocytopenia (<100,000 platelets), renal insufficiency (creatinine >1.1), impaired liver function (2× upper normal transaminases) or severe RUQ pain, pulmonary edema, new-onset headache unresponsive to medication, or visual disturbances. HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe variant of preeclampsia that can progress to liver rupture, DIC, and maternal death. Community paramedics recognize this as an immediate life threat: activate 911, position patient left lateral (relieve aortocaval compression), provide oxygen, establish IV access, and transport to the nearest facility with obstetric capacity.

Question 2: The Edinburgh Postnatal Depression Scale (EPDS) is used by community paramedics during postpartum home visits to screen for:

Postpartum hemorrhage risk
Postpartum depression and anxiety in new mothers (Correct answer)
Infant developmental milestones
Gestational diabetes in the postpartum period

Correct answer: Postpartum depression and anxiety in new mothers

The EPDS is a validated 10-item self-report screening tool specifically designed to detect postpartum depression and anxiety. A score ≥13 suggests probable major depressive disorder requiring referral.

The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item questionnaire scored 0–30 that screens for postpartum depression (PPD) and anxiety in women within the first year after delivery. Cutoff scores: ≥10 = possible PPD requiring clinical assessment; ≥13 = probable major depressive episode requiring mental health referral; Question 10 (suicidal ideation) — ANY positive response requires immediate safety assessment. PPD affects 10–15% of new mothers. Community paramedics administer EPDS at 2-week and 6-week postpartum home visits, screen for PPD risk factors (prior psychiatric history, lack of social support, traumatic birth experience), and connect positive screens to OB provider, social work, and community mental health resources.

Question 3: A community paramedic is conducting a well-child home visit for a 9-month-old infant. Which developmental milestone should the infant TYPICALLY be demonstrating by this age?

Speaking 2-word phrases
Sitting without support and transferring objects between hands (Correct answer)
Walking independently
Pointing to named body parts

Correct answer: Sitting without support and transferring objects between hands

By 9 months, typical developmental milestones include sitting without support, transferring objects between hands, crawling or pulling to stand, and social behaviors like stranger anxiety. Walking and 2-word phrases occur at 12–24 months.

CDC developmental milestones by 9 months: Motor — sits without support, bears weight on legs when standing (with support), crawls or starts crawling, transfers objects hand to hand; Language — babbles with consonant sounds ('mama,' 'dada' — though not yet meaningful), responds to name; Social — shows stranger anxiety, plays peek-a-boo; Cognitive — looks for dropped objects (object permanence emerging). Red flags at 9 months warranting referral: not sitting with support, not babbling, no eye contact or social smile, not responding to name. Community paramedics use the CDC 'Learn the Signs. Act Early.' materials to assess and educate parents on developmental milestones during home visits.

Question 4: Safe sleep recommendations for infants to reduce the risk of Sudden Infant Death Syndrome (SIDS) include placing the infant:

Prone (on stomach) to prevent aspiration
Supine (on back) on a firm, flat surface, in their own sleep space, without soft bedding (Correct answer)
Side-lying with a rolled blanket for positioning
In the parents' bed for monitoring purposes

Correct answer: Supine (on back) on a firm, flat surface, in their own sleep space, without soft bedding

The 'Back to Sleep' (now 'Safe Sleep') guidelines recommend: supine (back) position, firm flat surface (not inclined), own sleep space (crib/bassinet), no soft bedding (pillows, bumpers, loose blankets), room-sharing without bed-sharing.

AAP Safe Sleep Guidelines (updated 2022): (A) Alone — in their own sleep environment; (B) on their Back — every time, for every sleep; (C) in a Crib/bassinet/play yard — firm, flat, non-inclined surface with fitted sheet only. Additional recommendations: room-sharing without bed-sharing (reduces SIDS risk by 50%), no soft bedding (pillows, bumper pads, weighted blankets, positioning wedges), no inclined sleepers (recalled due to deaths), breastfeeding recommended, avoid smoke exposure, offer pacifier at sleep onset. Community paramedics assess sleep environment during home visits and educate caregivers — especially in high-risk settings (preterm infants, low-income households, caregivers who smoke).

Question 5: A community paramedic conducts a home visit for a pregnant patient with gestational diabetes who has been monitoring her blood glucose. A fasting glucose consistently above 95 mg/dL or 1-hour post-meal glucose above 130 mg/dL indicates:

Normal values for gestational diabetes — no treatment change needed
Glucose targets not being met, requiring care team escalation for medication adjustment (Correct answer)
Probable type 1 diabetes onset during pregnancy
The patient is not performing glucose testing correctly

Correct answer: Glucose targets not being met, requiring care team escalation for medication adjustment

GDM management targets are: fasting BG <95 mg/dL and 1-hour post-meal BG <130 mg/dL (or 2-hour <120 mg/dL). Values consistently above these thresholds indicate inadequate glycemic control, requiring dietary adjustment or initiation/titration of insulin.

Gestational diabetes mellitus (GDM) glycemic targets (ACOG, ADA): Fasting: <95 mg/dL; 1-hour post-meal: <130–140 mg/dL (ACOG <130, ADA <140); 2-hour post-meal: <120 mg/dL. Consistent values above targets require escalation: dietary modification first (carbohydrate-controlled diet with RD consultation), then insulin therapy if dietary measures fail (insulin is preferred over oral agents in pregnancy). Uncontrolled GDM is associated with macrosomia, cesarean delivery, neonatal hypoglycemia, and increased long-term risk of type 2 diabetes in both mother and child. Community paramedics review glucose logs, assess diet adherence, and communicate with the OB/GYN care team.

Question 6: The Healthy People 2030 initiative includes which of the following as a goal directly relevant to community paramedicine's maternal and child health interventions?

Eliminating all childhood vaccine requirements
Reducing the infant mortality rate and increasing breastfeeding initiation and duration (Correct answer)
Transferring all prenatal care to paramedics
Achieving zero maternal mortality by 2025

Correct answer: Reducing the infant mortality rate and increasing breastfeeding initiation and duration

Healthy People 2030 targets include reducing infant mortality (MICH-01), increasing breastfeeding initiation (NWS-13), and reducing preterm birth rates — all directly supported by community paramedicine home visiting programs.

Healthy People 2030 MCH objectives directly supported by community paramedicine include: MICH-01 (Reduce the rate of infant deaths), MICH-08 (Increase the proportion of pregnant women who receive early prenatal care), NWS-13 (Increase proportion of infants who are ever breastfed), NWS-14 (Increase exclusive breastfeeding through 6 months), MICH-06 (Reduce preterm births). Community paramedics contribute through: prenatal home visits (identifying preeclampsia, GDM complications), postpartum visits (EPDS screening, breastfeeding support, safe sleep education, vaccine assessment), and well-child visits (developmental surveillance, immunization gap identification). The Nurse-Family Partnership and Early Head Start models demonstrate effectiveness in improving these outcomes.

CPC Maternal and Child Health 1

A community paramedic visits a 28-year-old patient at 32 weeks gestation who reports a sudden onset headache, visual changes, and upper right quadrant abdominal pain.
Blood pressure is 158/106 mmHg.
These findings are MOST consistent with: