PCP Obstetric and Gynecological Emergencies 2 — Questions and Answers
Question 1: A prolapsed umbilical cord is managed prehospital by:
- Pushing the cord back into the uterus
- Elevating the presenting part off the cord and rapid transport (Correct answer)
- Clamping and cutting the cord immediately
- Placing the patient in high Fowler's position
Correct answer: Elevating the presenting part off the cord and rapid transport
Manually elevate the presenting fetal part to relieve cord compression, place the patient in knee-chest or Trendelenburg position, and transport rapidly.
Question 2: Supine hypotensive syndrome in a pregnant patient is caused by:
- Vasovagal response to pain
- Aortocaval compression by the gravid uterus (Correct answer)
- Dehydration from morning sickness
- Hyperventilation syndrome
Correct answer: Aortocaval compression by the gravid uterus
The gravid uterus compresses the inferior vena cava and aorta when the patient is supine, reducing venous return and cardiac output.
Question 3: Placental abruption (abruptio placentae) classically presents with:
- Painless, bright red vaginal bleeding
- Painful, dark vaginal bleeding with a rigid uterus (Correct answer)
- Green-tinged amniotic fluid
- Excessive fetal movement
Correct answer: Painful, dark vaginal bleeding with a rigid uterus
Placental abruption presents with painful uterine contractions, a rigid/board-like uterus, and dark vaginal bleeding from premature placental separation.
Question 4: At what gestational age is a fetus generally considered viable outside the womb?
- 16–18 weeks
- 20–22 weeks
- 24–28 weeks (Correct answer)
- 32–34 weeks
Correct answer: 24–28 weeks
Viability is generally considered to begin at 24–28 weeks gestation with intensive neonatal care.
Question 5: After a normal delivery, the umbilical cord should be clamped and cut:
- Immediately after the baby is delivered
- After the placenta delivers
- After the baby takes its first breath and pulsations in the cord slow or stop (Correct answer)
- Only if the newborn is not breathing
Correct answer: After the baby takes its first breath and pulsations in the cord slow or stop
Delayed cord clamping (after pulsations slow) is recommended to allow placental blood transfer to the newborn.
Question 6: Which of the following medications is used prehospital to prevent eclamptic seizures?
- Diazepam
- Magnesium sulfate (Correct answer)
- Phenytoin
- Lorazepam
Correct answer: Magnesium sulfate
Magnesium sulfate is the drug of choice for prophylaxis and treatment of eclamptic seizures.
PCP Obstetric and Gynecological Emergencies 2
A prolapsed umbilical cord is managed prehospital by: