Emergency and Complication Management Flashcards

A client at 39 weeks gestation presents with sudden onset of severe abdominal pain, rigid abdomen, and fetal heart tones that drop from 140 to 60 bpm. What is the most likely diagnosis?

Answer: Uterine rupture

Uterine rupture presents with sudden severe abdominal pain, a rigid abdomen, and acute fetal bradycardia due to fetal distress from disrupted placental perfusion.

During a home birth, the midwife notes the umbilical cord prolapsing past the presenting part with the cervix fully dilated and vertex at +2 station. What is the priority action?

Answer: Apply firm upward pressure on the presenting part while calling 911

With cord prolapse at +2 station, the most effective immediate action is to manually elevate the presenting part to relieve cord compression while arranging emergency transport.

A newborn is born limp and apneic at 1 minute of life. After 30 seconds of positive pressure ventilation, heart rate is 55 bpm. What is the next step?

Answer: Begin chest compressions at a 3:1 ratio with PPV

A heart rate below 60 bpm despite adequate PPV requires initiation of chest compressions at a 3:1 compression-to-ventilation ratio per NRP guidelines.

Which of the following is the FIRST-LINE treatment for eclamptic seizures in a laboring client?

Answer: Magnesium sulfate 4-6g IV loading dose

Magnesium sulfate is the first-line anticonvulsant for eclampsia and also prevents recurrent seizures, making it the preferred treatment over benzodiazepines or phenytoin.

A client delivers a 4,200g infant and subsequently develops a postpartum hemorrhage unresponsive to oxytocin and uterine massage. Which uterotonic should be considered next?

Answer: Carboprost (Hemabate)

Carboprost (Hemabate), a prostaglandin F2-alpha analog, is a second-line uterotonic for atony-related PPH unresponsive to oxytocin; it is contraindicated in asthma.

During auscultation of fetal heart tones in active labor, the midwife hears a rate of 180 bpm persisting for 15 minutes. What is the most common cause of fetal tachycardia in labor?

Answer: Maternal fever and chorioamnionitis

Maternal fever from chorioamnionitis is the most common cause of fetal tachycardia in labor, as the elevated maternal temperature directly increases fetal heart rate.

A client at 36 weeks presents with painless bright red vaginal bleeding without contractions. Fetal heart tones are 145 bpm. What should the midwife do FIRST?

Answer: Assess vital signs and call for emergency transport

Painless bright red bleeding at 36 weeks is a classic presentation of placenta previa; digital vaginal examination must be avoided and emergency transport is the priority action.