FP-C Obstetric and Gynecological Emergencies 1 — Questions and Answers
Question 1: A 32-week pregnant patient presents with painless bright-red vaginal bleeding. Which condition should the flight paramedic suspect first?
- Placenta previa (Correct answer)
- Placental abruption
- Uterine rupture
- Ectopic pregnancy
Correct answer: Placenta previa
Placenta previa classically presents with painless bright-red vaginal bleeding in the second or third trimester.
Question 2: During a flight transport, a laboring patient delivers the head but the shoulders become impacted. What is the FIRST maneuver to attempt?
- McRoberts maneuver with suprapubic pressure (Correct answer)
- Zavanelli maneuver
- Woods screw maneuver
- Posterior arm delivery
Correct answer: McRoberts maneuver with suprapubic pressure
McRoberts maneuver (hyperflexion of maternal thighs) combined with suprapubic pressure is the first-line intervention for shoulder dystocia.
Question 3: A patient at 36 weeks gestation presents with severe hypertension (180/110 mmHg), headache, and visual disturbances. Which medication is most appropriate for acute BP management in-flight?
- Hydralazine or labetalol IV (Correct answer)
- Metoprolol PO
- Nifedipine sublingual
- Sodium nitroprusside infusion
Correct answer: Hydralazine or labetalol IV
IV hydralazine or labetalol are first-line agents for acute severe hypertension in preeclampsia, as they are safe in pregnancy and allow titrated control.
Question 4: Which magnesium sulfate finding during eclampsia management should prompt the flight paramedic to stop the infusion immediately?
- Loss of deep tendon reflexes (Correct answer)
- Blood pressure drop of 10 mmHg
- Respiratory rate of 14 breaths/min
- Urinary output of 35 mL/hr
Correct answer: Loss of deep tendon reflexes
Loss of deep tendon reflexes is an early sign of magnesium toxicity and warrants stopping the infusion before respiratory arrest occurs.
Question 5: A post-partum patient develops heavy vaginal bleeding unresponsive to fundal massage. What is the most common cause of postpartum hemorrhage?
- Uterine atony (Correct answer)
- Retained placenta
- Cervical laceration
- Coagulopathy
Correct answer: Uterine atony
Uterine atony accounts for approximately 80% of postpartum hemorrhage cases and is the most common cause.
Question 6: When transporting a patient with suspected placental abruption, which finding MOST suggests fetal compromise?
- Fetal bradycardia below 100 bpm (Correct answer)
- Maternal tachycardia of 110 bpm
- Rigid abdomen
- Dark vaginal bleeding
Correct answer: Fetal bradycardia below 100 bpm
Fetal bradycardia below 100 bpm is a direct indicator of fetal distress and signals compromised uteroplacental perfusion.
FP-C Obstetric and Gynecological Emergencies 1
A 32-week pregnant patient presents with painless bright-red vaginal bleeding.
Which condition should the flight paramedic suspect first?