CPM Emergency Obstetric Complications 2 — Questions and Answers
Question 1: HELLP syndrome is characterized by which diagnostic triad?
- Hypertension, edema, and proteinuria
- Hemolysis, elevated liver enzymes, and low platelet count (Correct answer)
- Headache, epigastric pain, and leg edema
- Hypotension, elevated creatinine, and low hemoglobin
Correct answer: Hemolysis, elevated liver enzymes, and low platelet count
HELLP syndrome is defined by Hemolysis, Elevated Liver enzymes, and Low Platelets, representing a severe variant of preeclampsia with significant maternal and fetal morbidity.
Question 2: The Zavanelli maneuver for shoulder dystocia involves:
- Hyperflexion of maternal thighs to widen the pelvic outlet
- Lateral rotation of the posterior shoulder toward the fetal back
- Cephalic replacement into the vagina followed by emergency cesarean section (Correct answer)
- Delivery of the posterior arm to release the anterior shoulder
Correct answer: Cephalic replacement into the vagina followed by emergency cesarean section
The Zavanelli maneuver involves returning the fetal head to its pre-restitution position and replacing it back into the vagina, followed by immediate emergency cesarean section, and is used only as a last resort.
Question 3: A client experiences sudden severe dyspnea, cardiovascular collapse, and coagulopathy immediately after delivery of a healthy infant. The MOST likely diagnosis is:
- Massive postpartum hemorrhage with hypovolemic shock
- Acute pulmonary embolism from deep vein thrombosis
- Amniotic fluid embolism (Correct answer)
- Uterine inversion with vagal response
Correct answer: Amniotic fluid embolism
Sudden cardiovascular collapse with respiratory distress and coagulopathy at the time of delivery or immediately postpartum is the classic presentation of amniotic fluid embolism, a rare but catastrophic obstetric emergency.
Question 4: Bimanual uterine compression is performed to:
- Assess fetal position and presentation during active labor
- Mechanically compress the uterus between an internal vaginal hand and an external abdominal hand to control hemorrhage (Correct answer)
- Facilitate delivery of the placenta through sustained downward traction
- Identify retained placental fragments by palpating the uterine cavity
Correct answer: Mechanically compress the uterus between an internal vaginal hand and an external abdominal hand to control hemorrhage
Bimanual compression controls postpartum hemorrhage from uterine atony by mechanically compressing the uterine body between one fist placed in the anterior vaginal fornix and one hand on the abdomen.
Question 5: A laboring client at 41 weeks develops persistent fetal bradycardia with a heart rate of 88 bpm for 7 minutes that does not resolve with maternal position change. The MOST appropriate action is:
- Continue monitoring with reassessment in 15 minutes
- Change position, administer oxygen, establish IV access, and initiate emergency transport (Correct answer)
- Perform amnioinfusion to relieve possible cord compression
- Apply additional external monitoring for more accurate assessment
Correct answer: Change position, administer oxygen, establish IV access, and initiate emergency transport
Persistent fetal bradycardia below 110 bpm for more than 2 minutes that is unresponsive to position change indicates significant fetal compromise requiring immediate preparation for emergency transport.
Question 6: The antidote for magnesium sulfate toxicity is:
- Naloxone (Narcan) 0.4 mg IV push
- Calcium gluconate 10 mL of 10% solution IV (Correct answer)
- Atropine 0.5 mg IV to reverse bradycardia
- Epinephrine 1 mg IV for cardiovascular collapse
Correct answer: Calcium gluconate 10 mL of 10% solution IV
Calcium gluconate reverses magnesium toxicity by competitively blocking magnesium's effects at the neuromuscular junction, and should be kept at bedside whenever magnesium sulfate is administered.
Question 7: A third-degree perineal laceration is defined as one that extends through the:
- Vaginal epithelium and perineal skin only
- Perineal body muscles but not involving the anal sphincter
- External anal sphincter complex (Correct answer)
- Internal anal sphincter and rectal mucosa
Correct answer: External anal sphincter complex
A third-degree laceration involves disruption of the external anal sphincter complex and requires careful layered repair to prevent long-term fecal incontinence.
CPM Emergency Obstetric Complications 2
HELLP syndrome is characterized by which diagnostic triad?