NARM Emergency and Complication Management 3 — Questions and Answers
Question 1: A client has a shoulder dystocia with the anterior shoulder impacted behind the pubic symphysis. After McRoberts maneuver and suprapubic pressure fail, what is the next maneuver?
- Zavanelli maneuver
- Rubin II or Woods screw maneuver (Correct answer)
- Kristeller expression
- Fundal pressure
Correct answer: Rubin II or Woods screw maneuver
Rubin II (internal rotation of the anterior shoulder toward the fetal chest) or the Woods screw maneuver (rotating the posterior shoulder) are the recommended next steps after McRoberts and suprapubic pressure fail.
Question 2: When managing a third-degree perineal laceration, which structure differentiates a third-degree from a second-degree tear?
- Vaginal mucosa
- Perineal skin
- External anal sphincter (Correct answer)
- Internal anal sphincter
Correct answer: External anal sphincter
A third-degree laceration involves the external anal sphincter, distinguishing it from a second-degree tear which involves the perineal muscles but not the sphincter.
Question 3: A newborn at 5 minutes of life has a heart rate of 105 bpm, weak cry, some flexion, grimace response to stimulation, and pink body with blue extremities. What is the Apgar score?
- 5
- 6
- 7 (Correct answer)
- 8
Correct answer: 7
Scoring: HR >100 (2) + weak cry (1) + some flexion (1) + grimace (1) + pink body/blue extremities (1) = 7.
Question 4: During a water birth, the midwife observes the infant born completely submerged and limp. What is the first action after lifting the infant from the water?
- Stimulate by rubbing the back and assess breathing (Correct answer)
- Immediately begin chest compressions
- Clamp and cut the cord before assessment
- Administer blow-by oxygen
Correct answer: Stimulate by rubbing the back and assess breathing
Initial newborn resuscitation begins with drying, stimulation, and assessment of breathing and heart rate before escalating to more aggressive interventions.
Question 5: A client develops sudden onset shortness of breath, hypotension, and altered mental status immediately following rupture of membranes at 38 weeks. What rare but catastrophic complication should be suspected?
- Pulmonary embolism
- Amniotic fluid embolism (Correct answer)
- Severe preeclampsia
- Tension pneumothorax
Correct answer: Amniotic fluid embolism
Amniotic fluid embolism (AFE) classically presents with sudden cardiovascular collapse, respiratory distress, and DIC following amniotomy or ROM, and has high maternal mortality.
Question 6: What is the maximum recommended dose of oxytocin for active management of the third stage of labor in a low-resource or home birth setting?
- 5 units IM
- 10 units IM (Correct answer)
- 20 units IM
- 40 units IV drip
Correct answer: 10 units IM
Ten units of oxytocin IM is the WHO-recommended standard dose for active management of the third stage of labor to prevent postpartum hemorrhage.
Question 7: A postpartum client presents 6 hours after birth with a firm, tender, fluctuant mass at the vaginal introitus extending to the right labia. What complication has occurred?
- Rectocele
- Vaginal hematoma (Correct answer)
- Bartholin gland abscess
- Periurethral laceration
Correct answer: Vaginal hematoma
A vaginal hematoma presents as a firm, tender, rapidly expanding mass in the vulvar or vaginal area postpartum, caused by bleeding into the tissue from injured vessels.
NARM Emergency and Complication Management 3
A client has a shoulder dystocia with the anterior shoulder impacted behind the pubic symphysis.
After McRoberts maneuver and suprapubic pressure fail, what is the next maneuver?