ITLS In Pregnancy 2 — Questions and Answers
Question 1: When performing CPR on a pregnant patient in cardiac arrest, what modification is most critical?
- Increase compression depth to 3 inches
- Manually displace the uterus to the left (Correct answer)
- Perform compressions at a rate of 120/min
- Place hands higher on the sternum
Correct answer: Manually displace the uterus to the left
Manual left uterine displacement relieves aortocaval compression and improves cardiac output during CPR.
Question 2: At approximately what gestational age does the fundus reach the umbilicus?
- 16 weeks
- 20 weeks (Correct answer)
- 24 weeks
- 28 weeks
Correct answer: 20 weeks
The fundal height in centimeters approximates gestational age in weeks, reaching the umbilicus at roughly 20 weeks.
Question 3: Which breathing change is normal in pregnancy that may mimic respiratory distress?
- Decreased respiratory rate
- Hyperventilation with reduced PaCO2 (Correct answer)
- Increased PaCO2 above 45 mmHg
- Cheyne-Stokes respirations
Correct answer: Hyperventilation with reduced PaCO2
Progesterone-driven hyperventilation lowers maternal PaCO2 to 28–32 mmHg, which is normal in pregnancy.
Question 4: A term pregnant patient is involved in a motor vehicle crash. She has no abdominal pain but vaginal bleeding is present. What condition should be highest on the differential?
- Placenta previa
- Abruptio placentae (Correct answer)
- Uterine rupture
- Vasa previa
Correct answer: Abruptio placentae
Abruptio placentae (placental abruption) is the most common serious obstetric complication following blunt abdominal trauma.
Question 5: In a trauma patient at 36 weeks gestation, which finding best indicates significant hemorrhage despite vital signs appearing normal?
- Mild tachycardia (HR 95)
- Fetal heart rate of 170 bpm (Correct answer)
- Respiratory rate of 18
- Blood pressure of 110/70
Correct answer: Fetal heart rate of 170 bpm
Fetal tachycardia (>160 bpm) can be an early indicator of maternal hypovolemia even before maternal vital signs deteriorate.
Question 6: Which of the following is a late sign of hypovolemic shock specifically relevant to pregnant trauma patients?
- Fetal heart rate changes
- Maternal hypotension (Correct answer)
- Maternal tachycardia
- Uterine irritability
Correct answer: Maternal hypotension
Pregnant patients can compensate for up to 1,500 mL blood loss before maternal hypotension appears, making it a late sign.
Question 7: What is the recommended oxygen saturation target when providing supplemental oxygen to a critically injured pregnant patient?
- Above 88%
- Above 92%
- Above 95% (Correct answer)
- Above 98%
Correct answer: Above 95%
Maintaining SpO2 above 95% helps ensure adequate fetal oxygenation, as fetal hemoglobin has a different oxygen dissociation curve.
ITLS In Pregnancy 2
When performing CPR on a pregnant patient in cardiac arrest, what modification is most critical?