EMT Chapter 31 – Birthing process

You are assessing a 25 year old woman who is 39 weeks pregnant. She is experiencing regular contractions that are approximately 3 minutes apart and states that her amniotic sac broke 2 hours ago. After taking the standard precautions, you should:
Assess her for crowning
Upon delivery of the baby’s head, you note that its face is encased in the unruptured amniotic sac. You should
puncture the sac and suction the baby’s mouth and nose.
If a baby is born at 7:52 p.m., the second APGAR score should be calculated at
7:57 p.m.
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General treatment guidelines when caring for a woman with traumatic vaginal bleeding includes
transporting to an appropriate facility
A placenta previa is MOST accurately defined as
development of the placenta over the cervical opening
Braxton-Hicks contractions are characterized by
alleviation of pain with movement or changing positions
The umbilical cord
carries oxygen to the baby via the umbilical vein.
The third stage of labor begins when the
the baby is expelled from the vagina
A nuchal cord is defined as an umbilical cord that
is wrapped around the baby’s neck.
Supine hypotensive syndrome occurs when
the pregnant uterus compresses the inferior vena cava
Which of the following statements regarding a breech presentation is MOST correct?
A breech presentation occurs when the buttocks are the presenting part.
In contrast to a placenta previa, a placenta abruptio occurs when
the placenta prematurely separates from the uterine wall.
You have just delivered a premature baby. Your assessment reveals that he is breathing adequately; however, his heart rate is 90 beats/min. You should
keep him warm and provide ventilatory assistance.
If a newborn has gasping respirations after being dried and suctioned
further stimulation is not likely to improve ventilation.
Which of the following statements regarding the placenta is MOST correct?
The placenta allows oxygen, carbon dioxide, and other products to transfer between the mother and fetus but does not allow blood to mix between the mother and fetus.
Which of the following is an indication of imminent birth?
Crowning of the baby’s head
The onset of labor begins with
contractions of the uterus
An abortion occurs when the fetus and placenta deliver before
20 weeks
During delivery, it is MOST important to position your partner at the mother’s head because
the mother may become nauseated and vomit.
The presence of thick meconium in the amniotic fluid indicates
that the baby’s airway may be obstructed.
The amniotic fluid serves to
insulate and protect the fetus.
You have just delivered a full-term infant. His respirations are rapid and irregular and he has a strong cry. What should you do next?
Assess the brachial or umbilical pulse.
During delivery of the baby’s head, you should suction the mouth before the nose because
suctioning the nose first may cause the baby to gasp and aspirate fluid.
An infant is considered to be premature if it
weighs less than 5 pounds or is born before 36 weeks’ gestation.
The leading cause of maternal death during the first trimester of pregnancy is
internal bleeding caused by a ruptured ectopic pregnancy
Upon delivery of an infant’s head, you note that the umbilical cord is wrapped around its neck. You should
attempt to slip the cord gently over the infant’s head
A 26-year-old woman complains of a stabbing pain in the right lower quadrant of her abdomen. She states that her last menstrual period was 7 weeks ago and that she had pelvic inflammatory disease approximately 3 months ago. You should be MOST suspicious that this patient is experiencing
an ectopic pregnancy
All of the following questions are pertinent to ask a mother when determining whether or not her baby will deliver within the next few minutes, EXCEP
Have you had a sonogram?
When the cervix begins to dilate
a mucus plug is expelled from the vagina
A mother who is pregnant with her first baby is typically in the first stage of labor for approximately
16 hours
When determining the frequency of contractions, you should
time the contractions from the start of one to the start of the next
After a baby is born, it is important to
ensure it is thoroughly dried and warm
A history of pelvic inflammatory disease or tubal ligations increases a woman’s risk for
an ectopic pregnancy
The ONLY indications for placing your gloved fingers in the vagina during delivery are
breeched presentation and prolapsed umbilical cord
You are assessing a 25-year-old woman who is 39 weeks’ pregnant. She is experiencing regular contractions that are approximately 3 minutes apart and states that her amniotic sac broke 2 hours ago. After taking the appropriate BSI precautions, you should
assess her for crowning.
A 35-year-old woman who is 30 weeks’ pregnant presents with a severe headache and swelling in her hands and feet. She is conscious and alert with a blood pressure of 148/94 mm Hg, a pulse of 100 beats/min, and respirations of 24 breaths/min. During transport, you should be MOST concerned with
the possibility that she may experience a seizure
You have just delivered a baby boy. His body is pink, but his hands and feet are blue. His heart rate is approximately 110 beats/min and his respirations are rapid and irregular. He has a weak cry when stimulated and resists attempts to straighten his legs. His APGAR score is
8
While examining a woman in labor, you see the umbilical cord protruding from the vagina. You should
push the infant’s head away from the cord
Following delivery of a full-term baby, you have properly cared for the baby and have clamped and cut the umbilical cord. During transport, you note that the mother is experiencing moderate vaginal bleeding. You should
firmly massage the uterine fundus with a circular motion
The term primipara refers to a woman who
has had only one live birth.
Following delivery of a pulseless and apneic infant that has a foul odor, skin sloughing, and diffuse blistering, you should
provide emotional support to the mother
You are assessing a 30-year-old woman who is 35 weeks’ pregnant. She tells you that her amniotic sac has not ruptured, but she is experiencing irregular contractions that “come and go.” Upon visual inspection, you note a small amount of brown mucus draining from her vagina. You should
administer oxygen and transport.
Which of the following occurs during true labor?
Uterine contractions become more regular
Signs and symptoms of pregnancy-induced hypertension (preeclampsia) include all of the following, EXCEPT
blood in the urine
Your 22-year-old patient is in active labor. Upon visual inspection, you note that the infant’s leg is protruding from the vagina. Appropriate management of this situation includes
placing the mother supine with her head down and pelvis elevated.
The vagina and the neck of the uterus comprise the
birth canal
A newborn infant will usually begin breathing spontaneously within _____ seconds following birth.
15-30
Which of the following statements regarding twins is MOST correct?
Most twins are born within 45 minutes of each other.
A 33-year-old woman who is 36 weeks’ pregnant is experiencing scant vaginal bleeding. During transport, you note that she suddenly becomes diaphoretic, tachycardic, and hypotensive. In addition to administering 100% oxygen, you should
place her in a left lateral recumbent position.
Compared to full-term infants, premature infants are at a higher risk for
infection
During your visual inspection of a 19-year-old patient in labor, you see the baby’s head crowning at the vaginal opening. What should you do?
apply gentle pressure to the baby’s head as it delivers.
A pregnant trauma patient may lose a significant amount of blood before showing signs of shock because
pregnant patients have an overall increase in blood volume.
Fetal complications associated with drug- or alcohol-addicted mothers include all of the following, EXCEPT: a) profound tachycardia b) premature delivery c) low birth weight d) respiratory depression
a) profound tachycardia
When preparing a pregnant patient for delivery, you should position her
on a firm surface with her hips elevated 2″ to 4″
A 30-year-old pregnant female is gravida-3 and para-2. This means that she has
given birth to 2 live babies
When the mother is experiencing a contraction, you should instruct her to:
take quick short breaths
APGAR
Summarizes the health of a newborn.
A=Appearance P=Pulse G=Grimace A=Activity R=Respirations
A precipitous labor and delivery is MOST common in women who
have delivered a baby before
Which of the following statements regarding gestational diabetes is correct: A. Diet and exercise are typically ineffective in controlling gestational diabetes. B. The onset of gestational diabetes typically manifests with hypoglycemia. C. Gestational diabetes results in permanent diabetes mellitus after delivery. D. In some cases, women with gestational diabetes require insulin injections.
D. In some cases, women with gestational diabetes require insulin injections.
Most medical models base a pregnant woman’s due date: A. two weeks after her last menstrual cycle. B. two weeks before her last menstrual cycle. C. on the last day of her last menstrual cycle.D. on the first day of her last menstrual cycle.
D. on the first day of her last menstrual cycle.
Eclampsia is MOST accurately defined as
Seizures that result from severe hypertension
Which of the following is NOT a component of the APGAR score? A.activity B.grimace C.pulse D.body size
D. body size
After the fetus has descended into the pelvis at the end of the third trimester, many mother experience:
Easier breathing
Common interventions used to stimulate spontaneous respirations in the newborn include all of the following, EXCEPT: A.thorough drying with a towel. B.suctioning of the upper airway. C.some form of tactile stimulation. D.positive-pressure ventilations.
D.positive-pressure ventilations
Abruprio placenta occurs when:
the placenta prematurely separates from the uterine wall
Spina bifida is a developmental defect in which:
a portion of the spinal cord or meninges protrudes outside of the vertebrae
Signs and symptoms of preeclampsia include:
Headache and edema
Preeclampsia MOST commonly occurs after the ___ week of gestation.
30th
Which of the following questions is of LEAST pertinence when determining whether a mother will deliver her baby within the next few minutes?
A”Have you had a sonogram?”
B”Is this your first baby?”
C”When are you due?”
D”Do you feel the urge to push?”
A”Have you had a sonogram?”
Which of the following is a normal physiologic change that occurs in the mother’s respiratory system during pregnancy?
increased respiratory rate and decreased respiratory reserve
The term “bloody show” is defined as:
the small amount of pink-tinged mucus that is discharged from the vagina after expulsion of the mucous plug
If a newborn’s heart rate is less than 60 beats/mins following delivery, you should:
provide ventilations for 30 seconds
pregnant women are advised to take iron supplements, such as prenatal vitamins, because:
pregnancy causes a decreased number of red blood cells, which predisposes the mother to anemia
The ONLY indications for placing your gloved fingers in the vagina during delivery are:
breech presentation and prolapsed umbilical cord
From what internal female organ is the fetus expelled during delivery?
uterus
Vigorous suctioning of a newborn’s airway is indicated if:
there is meconium in the amniotic fluid
By the 20th week of pregnancy, the uterus is typically at or above the level of the mother’s
belly button
Which of the following processes occurs during ovulation?
The inner lining of the uterus thickens in preparation for implantation.
in contrast to a full-term infant, a premature infant:
has an even proportionately larger head
Which of the following is NOT generally considered an obstetrical emergency?
return of contractions following delivery of the baby

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