FISDAP OB/GYN Emergencies 3 — Questions and Answers
Question 1: A 24-year-old woman with a positive pregnancy test presents with sharp left lower quadrant pain and vaginal spotting. Vital signs: BP 90/60, HR 118, pale and diaphoretic. The EMT should suspect:
- Threatened miscarriage
- Ruptured ectopic pregnancy (Correct answer)
- Placenta previa
- Ovarian torsion without vascular compromise
Correct answer: Ruptured ectopic pregnancy
Hypotension, tachycardia, peritoneal signs, and a positive pregnancy test with unilateral pelvic pain strongly suggest a ruptured ectopic pregnancy with hemoperitoneum.
Question 2: During a field delivery, the placenta has not delivered 30 minutes after the baby. The EMT should:
- Clamp the cord tightly and apply steady traction to deliver the placenta
- Monitor for hemorrhage, keep the cord clamped, and transport for hospital management (Correct answer)
- Manually explore the uterine cavity to remove the placenta
- Administer oxytocin IM per local protocol and then massage the fundus forcefully
Correct answer: Monitor for hemorrhage, keep the cord clamped, and transport for hospital management
Retained placenta beyond 30 minutes requires hospital management; the EMT should monitor for hemorrhage and transport without attempting manual removal.
Question 3: A term neonate is born covered in thick, green-tinged amniotic fluid and is not vigorous (limp, HR 60, no respiratory effort). The MOST appropriate initial prehospital action is:
- Deep suction the trachea with a bulb syringe before any stimulation
- Bring the neonate to the warmer, dry and stimulate, then assess for need for PPV (Correct answer)
- Intubate immediately before any other intervention
- Administer blow-by oxygen and transport without further intervention
Correct answer: Bring the neonate to the warmer, dry and stimulate, then assess for need for PPV
Current NRP guidelines state that even with meconium-stained fluid, initial steps are warmth, drying, and stimulation followed by assessment; routine intubation for meconium suctioning is no longer recommended for non-vigorous neonates without evidence of obstruction in many EMS systems.
Question 4: A woman at 36 weeks gestation presents with painless, bright-red vaginal bleeding. She denies contractions. This presentation is MOST consistent with:
- Abruptio placentae
- Placenta previa (Correct answer)
- Bloody show of early labor
- Vasa previa rupture
Correct answer: Placenta previa
Painless bright-red antepartum hemorrhage in the third trimester is the classic presentation of placenta previa, where the placenta overlies the cervical os.
Question 5: When managing a patient with placenta previa in the field, the EMT should:
- Perform a vaginal exam to estimate dilation
- Apply a sterile pad, do NOT perform a vaginal exam, and transport rapidly (Correct answer)
- Apply direct pressure inside the vagina to slow bleeding
- Attempt gentle manual removal of the placenta if visible
Correct answer: Apply a sterile pad, do NOT perform a vaginal exam, and transport rapidly
Vaginal examination in suspected placenta previa can cause catastrophic hemorrhage; the EMT should apply an external pad and transport immediately.
Question 6: A neonate delivered in the field has a 1-minute APGAR score of 4. Which component contributes MOST to the score if the baby is pink centrally, HR 90, weak cry, some flexion, and grimaces to stimulation?
- Color (2 points)
- Heart rate (2 points)
- Respiratory effort (0 points) (Correct answer)
- Muscle tone (1 point)
Correct answer: Respiratory effort (0 points)
A score of 4 in this scenario reflects: color=1 (acrocyanosis), HR=1 (60-100), respiratory effort=0 (weak/irregular cry scores 1 but no cry=0), tone=1, reflex=1; the weak/absent respiratory effort is the category contributing 0.
Question 7: Which of the following is the MOST reliable prehospital sign of imminent delivery?
- Contractions every 5 minutes lasting 45 seconds
- Crowning of the presenting part (Correct answer)
- Patient's report of urge to push
- Rupture of membranes within the last hour
Correct answer: Crowning of the presenting part
Crowning — visible bulging of the presenting part at the vaginal introitus — is the definitive sign that delivery is imminent and transport should be halted.
FISDAP OB/GYN Emergencies 3
A 24-year-old woman with a positive pregnancy test presents with sharp left lower quadrant pain and vaginal spotting.
Vital signs: BP 90/60, HR 118, pale and diaphoretic.
The EMT should suspect: