FISDAP OB/GYN Emergencies 2 — Questions and Answers
Question 1: A 32-year-old woman at 38 weeks gestation presents with a sudden gush of fluid and you observe the umbilical cord protruding from the vagina. Your FIRST priority is to:
- Apply firm pressure to the cord to slow blood flow
- Elevate the presenting part off the cord and keep the cord moist (Correct answer)
- Clamp and cut the cord immediately
- Place the patient supine and transport rapidly
Correct answer: Elevate the presenting part off the cord and keep the cord moist
In cord prolapse, the EMT must manually elevate the presenting part off the cord to relieve compression while keeping the exposed cord moist and warm.
Question 2: A patient in active labor delivers the baby's head but the shoulders fail to deliver after 60 seconds. Which maneuver should the EMT attempt first for shoulder dystocia?
- Apply fundal pressure
- McRoberts maneuver with suprapubic pressure (Correct answer)
- Perform an episiotomy
- Rotate the fetus manually into a transverse lie
Correct answer: McRoberts maneuver with suprapubic pressure
McRoberts maneuver (hyperflexing the thighs against the abdomen) combined with suprapubic pressure is the first-line intervention for shoulder dystocia in the prehospital setting.
Question 3: A 26-year-old woman at 30 weeks gestation develops sudden severe headache, visual disturbances, and a blood pressure of 168/112 mmHg. This presentation is MOST consistent with:
- Placenta previa
- Eclampsia prodrome / severe preeclampsia (Correct answer)
- Abruptio placentae
- Normal third-trimester hypertension
Correct answer: Eclampsia prodrome / severe preeclampsia
Severe headache, visual changes, and BP ≥160/110 in a pregnant patient indicate severe preeclampsia or impending eclampsia, requiring urgent transport and seizure precautions.
Question 4: Which of the following BEST describes the management of a patient experiencing eclamptic seizures in the field?
- Restrain limbs, administer oral glucose, transport
- Protect airway, administer oxygen, position on left side, transport urgently (Correct answer)
- Administer aspirin and IV fluids, call medical control for magnesium order
- Perform a vaginal exam to assess dilation before transport
Correct answer: Protect airway, administer oxygen, position on left side, transport urgently
Field management of eclamptic seizures focuses on airway protection, supplemental oxygen, left lateral positioning to relieve aortocaval compression, and rapid transport.
Question 5: A neonate delivered in the field has a heart rate of 80 bpm, weak respiratory effort, and central cyanosis at 1 minute of life. The NEXT step after positioning and warming is:
- Begin chest compressions immediately
- Provide positive-pressure ventilation at 40–60 breaths/min (Correct answer)
- Administer epinephrine via umbilical route
- Stimulate vigorously by slapping the feet for 2 minutes
Correct answer: Provide positive-pressure ventilation at 40–60 breaths/min
A neonate with HR <100 bpm and inadequate respirations requires positive-pressure ventilation as the most critical resuscitation intervention.
Question 6: Postpartum hemorrhage is MOST commonly caused by which of the following?
- Cervical lacerations
- Uterine atony (Correct answer)
- Retained placenta fragments
- Coagulopathy
Correct answer: Uterine atony
Uterine atony (failure of the uterus to contract after delivery) accounts for approximately 80% of postpartum hemorrhage cases.
Question 7: When assessing a pregnant trauma patient, the EMT should prioritize which of the following positioning considerations?
- Supine with legs elevated 15 degrees
- Left lateral tilt of at least 15 degrees or manual uterine displacement to the left (Correct answer)
- Right lateral decubitus to optimize liver perfusion
- Reverse Trendelenburg to reduce aspiration risk
Correct answer: Left lateral tilt of at least 15 degrees or manual uterine displacement to the left
After approximately 20 weeks gestation, the gravid uterus compresses the inferior vena cava in the supine position; left tilt or manual displacement restores venous return.
FISDAP OB/GYN Emergencies 2
A 32-year-old woman at 38 weeks gestation presents with a sudden gush of fluid and you observe the umbilical cord protruding from the vagina.
Your FIRST priority is to: