ITLS In Pregnancy 3 — Questions and Answers
Question 1: A 28-week pregnant trauma patient presents with uterine rigidity and severe abdominal pain after a fall. The fetal heart rate is 90 bpm. What is the priority intervention?
- Perform a field pelvic exam
- Immediate rapid transport to a trauma center (Correct answer)
- Place patient in Trendelenburg position
- Administer oral fluids
Correct answer: Immediate rapid transport to a trauma center
Fetal bradycardia with uterine rigidity suggests placental abruption requiring immediate surgical intervention only available at a hospital.
Question 2: Which physiologic change of pregnancy increases the risk of aspiration during airway management?
- Decreased gastric acid production
- Reduced lower esophageal sphincter tone (Correct answer)
- Increased gastric motility
- Elevated diaphragm position
Correct answer: Reduced lower esophageal sphincter tone
Progesterone reduces lower esophageal sphincter tone and slows gastric emptying, increasing aspiration risk in pregnant patients.
Question 3: What is the minimum gestational age at which fetal viability is generally considered possible in the US?
- 18 weeks
- 22–24 weeks (Correct answer)
- 28 weeks
- 32 weeks
Correct answer: 22–24 weeks
Fetal viability is generally considered possible at 22–24 weeks of gestation with advanced neonatal support.
Question 4: When placing IV access in a critically injured pregnant patient, which site is preferred?
- Femoral vein
- Saphenous vein
- Antecubital fossa or above (Correct answer)
- Foot dorsum
Correct answer: Antecubital fossa or above
IV access should be established above the diaphragm because the gravid uterus may compress the inferior vena cava, reducing flow from lower extremity IVs.
Question 5: Perimortem cesarean delivery (PMCD) should ideally be performed within how many minutes of maternal cardiac arrest for the best neonatal outcome?
- 2 minutes
- 5 minutes (Correct answer)
- 10 minutes
- 15 minutes
Correct answer: 5 minutes
PMCD performed within 5 minutes of maternal arrest gives the best chance of intact neonatal survival and may also improve maternal resuscitation.
Question 6: A pregnant trauma patient at 30 weeks reports she felt the baby 'stop moving' after a car crash 2 hours ago. Which assessment is most important in the field?
- Maternal blood pressure
- Fetal heart tones (Correct answer)
- Uterine fundal height
- Skin color of the patient
Correct answer: Fetal heart tones
Absent or abnormal fetal heart tones after trauma indicate possible fetal compromise requiring urgent hospital evaluation.
Question 7: Which mechanism of injury is most commonly associated with fetal death in blunt abdominal trauma?
- Uterine rupture
- Placental abruption (Correct answer)
- Direct fetal injury
- Maternal shock
Correct answer: Placental abruption
Placental abruption is the most frequent cause of fetal death in blunt abdominal trauma, occurring even without apparent external injury.
ITLS In Pregnancy 3
A 28-week pregnant trauma patient presents with uterine rigidity and severe abdominal pain after a fall.
The fetal heart rate is 90 bpm.
What is the priority intervention?