CPM Emergency Obstetric Complications 1 — Questions and Answers
Question 1: Which maneuver is the first-line intervention for shoulder dystocia?
- McRoberts maneuver with suprapubic pressure (Correct answer)
- Zavanelli maneuver with immediate surgical backup
- Woods screw internal rotation maneuver
- Delivery of the posterior arm
Correct answer: McRoberts maneuver with suprapubic pressure
The McRoberts maneuver (hyperflexion of maternal thighs) combined with suprapubic pressure is the first-line intervention for shoulder dystocia, resolving the majority of cases without further maneuvers.
Question 2: According to standard obstetric guidelines, postpartum hemorrhage is defined as blood loss exceeding:
- 250 mL after vaginal delivery
- 500 mL after vaginal delivery or 1,000 mL after cesarean (Correct answer)
- 750 mL regardless of delivery route
- 1,000 mL after vaginal delivery
Correct answer: 500 mL after vaginal delivery or 1,000 mL after cesarean
PPH is defined as blood loss greater than 500 mL after vaginal delivery or greater than 1,000 mL after cesarean section, or any blood loss causing hemodynamic instability.
Question 3: A client at 38 weeks gestation develops sudden severe headache, visual disturbances, and epigastric pain at a planned homebirth. The MOST appropriate immediate action is:
- Administer oral antihypertensive and recheck BP in 30 minutes
- Place client in left lateral position and continue monitoring
- Initiate emergency transport to the hospital immediately (Correct answer)
- Perform fundal massage and assess for bleeding
Correct answer: Initiate emergency transport to the hospital immediately
Severe headache, visual disturbances, and epigastric pain together are warning signs of impending eclampsia, requiring immediate emergency transport to a facility capable of managing this obstetric emergency.
Question 4: Uterine atony, the most common cause of postpartum hemorrhage, is best described as:
- Premature separation of the placenta from the uterine wall
- Failure of the uterus to contract adequately after delivery of the placenta (Correct answer)
- Incomplete expulsion of placental fragments
- Lacerations of the cervix causing excessive bleeding
Correct answer: Failure of the uterus to contract adequately after delivery of the placenta
Uterine atony is the failure of the uterus to contract and retract after placental delivery, accounting for approximately 70–80% of all postpartum hemorrhage cases.
Question 5: When a prolapsed umbilical cord is identified at a homebirth, the CPM's priority intervention is:
- Attempt to manually replace the cord back into the uterus
- Apply warm moist dressings to the cord and observe for spontaneous resolution
- Elevate the presenting part off the cord and initiate emergency transport immediately (Correct answer)
- Position the client prone and perform emergency fundal pressure
Correct answer: Elevate the presenting part off the cord and initiate emergency transport immediately
Relieving pressure on the prolapsed cord by manually elevating the presenting part while initiating immediate emergency transport is the priority, as this is a life-threatening emergency requiring emergent cesarean.
Question 6: Which of the following presentations is MOST consistent with placental abruption?
- Painless bright red vaginal bleeding in the third trimester
- Painful dark red vaginal bleeding with uterine rigidity (Correct answer)
- Mucus-tinged show with irregular contractions
- Gradual onset of mild uterine contractions with slight spotting
Correct answer: Painful dark red vaginal bleeding with uterine rigidity
Placental abruption classically presents with painful, dark red vaginal bleeding accompanied by a rigid, board-like uterus due to retroplacental hematoma formation.
Question 7: A client delivers a 4,300g infant and has excessive vaginal bleeding. Uterine massage reveals a firmly contracted uterus. The next priority assessment is:
- Repeat oxytocin dose for suspected uterine atony
- Retained placenta evaluation with manual exploration
- Inspect the birth canal for genital tract lacerations (Correct answer)
- Assess for uterine inversion by measuring fundal height
Correct answer: Inspect the birth canal for genital tract lacerations
When the uterus is firmly contracted but bleeding persists, lacerations of the cervix, vagina, or perineum are the most likely source and must be identified and repaired.
CPM Emergency Obstetric Complications 1
Which maneuver is the first-line intervention for shoulder dystocia?