Assessment of the Pregnant Patient: G/P Terminology, Gestational Age, Fundal Height, and Supine Hypotensive Syndrome Practice Questions

25 multiple-choice questions on Assessment of the pregnant patient: G/P terminology, gestational age, fundal height, and supine hypotensive syndrome for paramedic and EMT students, from Chapter 42 (Obstetrics). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. In obstetric history, the term gravida refers to the number of:

   1. A. Live children she currently has
   2. B. Times the woman has been pregnant
   3. C. Deliveries after 20 weeks of gestation
   4. D. Cesarean deliveries she has had
   Show answer

   Answer: B. Times the woman has been pregnant

   Gravida counts every pregnancy, including the current one, whatever the outcome. Deliveries after 20 weeks are counted by para, which is the term most often confused with gravida.

2. A woman is pregnant for the third time. She had one delivery at 39 weeks and one miscarriage at 9 weeks. Her obstetric history is written as:

   1. A. Gravida 3, para 1
   2. B. Gravida 2, para 1
   3. C. Gravida 3, para 2
   4. D. Gravida 2, para 2
   Show answer

   Answer: A. Gravida 3, para 1

   She has been pregnant three times, counting this one, and has delivered once after 20 weeks. The miscarriage at 9 weeks counts toward gravida but not para, so gravida 3, para 2 is wrong.

3. A woman at 34 weeks tells you she is gravida 2, para 1, and her first delivery was twins at 38 weeks. This history shows that para counts:

   1. A. Each baby delivered separately
   2. B. Births that reached 37 weeks
   3. C. Pregnancies, whatever their outcome
   4. D. Deliveries rather than infants
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   Answer: D. Deliveries rather than infants

   Para counts deliveries after 20 weeks, so a twin birth counts once and she is para 1. Counting each infant separately is the common error and would wrongly make her para 2 (the two living children are recorded under L in GTPAL). Para includes preterm deliveries after 20 weeks, not just births at term; term births are counted separately as T in GTPAL. Counting every pregnancy regardless of outcome is gravida, not para. (Caroline, obstetric history.)

4. A woman in labor tells you she has given birth six times before. Her history most increases her risk of:

   1. A. Preeclampsia, which is most common in later pregnancies
   2. B. Postpartum hemorrhage from a poorly contracting uterus
   3. C. A prolonged second stage lasting several hours
   4. D. Ectopic implantation of the current pregnancy
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   Answer: B. Postpartum hemorrhage from a poorly contracting uterus

   A uterus stretched by many pregnancies (grand multiparity) contracts less well after delivery, so atony and postpartum hemorrhage are more likely; labor is also often fast. Preeclampsia is most common in a first pregnancy, and a woman with many prior births usually has a short, not prolonged, second stage.

5. A 24-year-old primigravida at 39 weeks has regular contractions every 6 minutes. She has no urge to push, there is no crowning, and the hospital is 20 minutes away. Given how a first labor usually progresses, you should:

   1. A. Prepare to deliver on scene right now
   2. B. Have her push to speed up the labor
   3. C. Wait at home until contractions are closer
   4. D. Transport her and reassess on the way
   Show answer

   Answer: D. Transport her and reassess on the way

   A first labor usually lasts many hours, and contractions 6 minutes apart without an urge to push or crowning mean delivery is not imminent, so transport and watch for signs of second stage en route. Preparing to deliver on scene is right only when signs of imminent birth, such as crowning or a strong urge to push in a multipara, are present. Pushing before the cervix is fully dilated exhausts the mother and can cause cervical swelling or tearing. Waiting at home delays care and risks an unattended birth if labor speeds up. (Caroline, stages of labor; ACOG/SMFM Obstetric Care Consensus No. 1 on labor duration.)

6. A woman's last menstrual period began on March 10. Using Nagele's rule, her estimated due date is about:

   1. A. December 17
   2. B. December 10
   3. C. January 17
   4. D. November 17
   Show answer

   Answer: A. December 17

   Nagele's rule adds 7 days to the first day of the last period and subtracts 3 months: March 10 plus 7 days is March 17, minus 3 months gives December 17. December 10 forgets to add the 7 days.

7. A pregnancy is considered term, with the infant ready for birth, beginning at:

   1. A. 32 weeks of gestation
   2. B. 34 weeks of gestation
   3. C. 37 weeks of gestation
   4. D. 42 weeks of gestation
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   Answer: C. 37 weeks of gestation

   Birth from 37 weeks on is term, and birth before 37 weeks is preterm. A pregnancy past 42 weeks is postterm, which carries its own risks for the placenta and fetus.

8. At about 12 weeks of gestation, the uterine fundus can usually first be felt at the level of the:

   1. A. Symphysis pubis
   2. B. Umbilicus
   3. C. Xiphoid process
   4. D. Costal margin
   Show answer

   Answer: A. Symphysis pubis

   The uterus rises out of the pelvis at about 12 weeks, reaches the umbilicus near 20 weeks, and approaches the xiphoid by about 36 weeks. A fundus at the umbilicus therefore suggests roughly 20 weeks, not 12.

9. Between about 20 and 36 weeks, fundal height measured in centimeters from the symphysis pubis roughly equals the:

   1. A. Months of gestation
   2. B. Weeks remaining until the due date
   3. C. Weeks of gestation
   4. D. Fetal length in centimeters
   Show answer

   Answer: C. Weeks of gestation

   A fundal height of 28 cm suggests about 28 weeks, which helps you estimate gestational age when the patient is unsure. The centimeter count matches the weeks directly, not months, not the weeks left until the due date, and not the length of the fetus. The rule becomes less reliable after 36 weeks as the fetus drops into the pelvis.

10. A woman who does not know how far along she is has a fundus about two finger widths below the xiphoid process. You should estimate her gestation as about:

    1. A. 12 to 14 weeks
    2. B. 34 to 36 weeks
    3. C. 20 to 22 weeks
    4. D. 26 to 28 weeks
    Show answer

    Answer: B. 34 to 36 weeks

    A fundus near the xiphoid means a near-term pregnancy, so you should prepare for a possibly viable newborn. A fundus at the umbilicus would point to about 20 weeks.

11. A 26-year-old at 35 weeks becomes dizzy and pale while lying flat on her back for an ECG. BP falls from 118/74 to 88/56 mmHg. The most likely cause is:

    1. A. Concealed bleeding from placental abruption
    2. B. Vasovagal reaction to the ECG electrodes
    3. C. Pulmonary embolism from a pelvic vein clot
    4. D. Compression of the vena cava by the uterus
    Show answer

    Answer: D. Compression of the vena cava by the uterus

    Supine hypotensive syndrome occurs when the heavy uterus compresses the vena cava and cuts venous return. Its link to the supine position and quick relief on turning point away from abruption, which would bring pain, uterine tenderness, or bleeding.

12. A woman at 39 weeks with regular contractions notices a small amount of pink, blood-tinged mucus on her underwear. This most likely represents:

    1. A. Placenta previa needing rapid transport
    2. B. A placental abruption with hidden bleeding
    3. C. Bloody show as the cervix begins to open
    4. D. Rupture of the membranes with meconium
    Show answer

    Answer: C. Bloody show as the cervix begins to open

    As the cervix effaces and dilates, the mucus plug loosens with a little blood from small cervical vessels. This bloody show is a normal sign that labor is progressing. Bright red bleeding that soaks pads, or dark blood with pain and a rigid uterus, would suggest previa or abruption instead.

13. A woman at 30 weeks shows you her prenatal record, which reads G4 T1 P1 A1 L2. Which history does this describe?

    1. A. 2 term births, 1 abortion, 1 living child
    2. B. 1 term birth, 1 preterm birth, 2 losses
    3. C. 4 prior births, of which 2 children are alive
    4. D. 1 term birth, 1 preterm birth, 1 early loss
    Show answer

    Answer: D. 1 term birth, 1 preterm birth, 1 early loss

    G4 counts four pregnancies including the current one, so she has had three before: one term birth (T1), one preterm birth (P1), and one loss before 20 weeks (A1), and both born children are living (L2). Two term births would be written T2, and one living child L1. Two losses would be A2 and would need a fifth pregnancy. Gravida counts pregnancies, not births, so G4 does not mean four prior births. (Caroline, GTPAL obstetric history.)

14. Supine hypotensive syndrome becomes a concern once the uterus is large enough to compress the vena cava, generally after about:

    1. A. 20 weeks of gestation
    2. B. 8 weeks of gestation
    3. C. 12 weeks of gestation
    4. D. 38 weeks of gestation
    Show answer

    Answer: A. 20 weeks of gestation

    By about 20 weeks the fundus reaches the umbilicus and the uterus is heavy enough to compress the vena cava when the woman lies supine. Waiting until 38 weeks to position her would miss many patients at risk.

15. In the GTPAL system for recording obstetric history, the letter A stands for:

    1. A. Apgar scores of prior newborns
    2. B. Abortions, spontaneous or induced
    3. C. Assisted or instrument deliveries
    4. D. Antepartum hemorrhage episodes
    Show answer

    Answer: B. Abortions, spontaneous or induced

    GTPAL records gravida, term births, preterm births, abortions (any pregnancy loss before 20 weeks, spontaneous or induced), and living children. Apgar scores describe a newborn's condition, not the mother's history.

16. Fetal heart tones at 38 weeks are 92 beats/min while the mother's pulse is 90. The best interpretation is:

    1. A. The fetus has a normal rate for term
    2. B. The fetus is tachycardic and stressed
    3. C. You may be counting the maternal pulse
    4. D. The fetus is preparing to be delivered
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    Answer: C. You may be counting the maternal pulse

    The normal fetal heart rate is about 110 to 160 beats/min, so a rate that matches the mother's pulse suggests you are hearing maternal vessels; palpate her radial pulse while listening. A rate of 92 is below the normal range, so it is not normal for term. If the fetal rate truly is near 90, it is bradycardia, which signals distress, not tachycardia. The fetal heart rate does not slow to prepare for birth. (Caroline, fetal heart tones.)

17. When you take the history of a woman in labor, which question most directly helps you judge whether delivery is imminent?

    1. A. What is your blood type and Rh factor?
    2. B. How many babies have you had, and how fast?
    3. C. When did you first feel the baby move?
    4. D. Have you had an ultrasound during this pregnancy?
    Show answer

    Answer: B. How many babies have you had, and how fast?

    Prior births, and how quickly they went, are among the best predictors of a rapid delivery. The timing of first fetal movement helps date the pregnancy, and blood type and ultrasound history matter for later care, but none of them tells you much about the next hour.

18. A woman at 39 weeks reports a sudden gush of clear fluid from the vagina 1 hour ago. You should document this as:

    1. A. Loss of the mucous plug
    2. B. Urinary incontinence alone
    3. C. Onset of the third stage
    4. D. Rupture of the membranes
    Show answer

    Answer: D. Rupture of the membranes

    A gush or steady leak of fluid suggests the amniotic sac has ruptured; note the time, color, and odor. The mucous plug, or bloody show, is a small blood-tinged discharge, not a gush of fluid.

19. Amniotic fluid that is greenish brown suggests:

    1. A. Meconium passed by the fetus
    2. B. Normal fluid near term
    3. C. A maternal bladder infection
    4. D. Bleeding from placenta previa
    Show answer

    Answer: A. Meconium passed by the fetus

    Greenish or brownish fluid means the fetus passed meconium, often a sign of stress, and the newborn may need airway support. Normal amniotic fluid is clear or slightly straw colored.

20. A woman at 30 weeks has irregular, mild tightening that eases when she rests and drinks water. Her cervix is not dilating. This most likely represents:

    1. A. Onset of true preterm labor
    2. B. A placental abruption
    3. C. Uterine rupture
    4. D. Braxton Hicks contractions
    Show answer

    Answer: D. Braxton Hicks contractions

    Braxton Hicks contractions are irregular, do not grow stronger, and ease with rest and hydration. True labor brings regular contractions that become longer, stronger, and closer together.

21. When you time contractions, frequency is measured from the:

    1. A. End of one to the start of the next
    2. B. Start of one to the end of the same
    3. C. Start of one to the start of the next
    4. D. Peak of one to the end of the next one
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    Answer: C. Start of one to the start of the next

    Frequency runs from the beginning of one contraction to the beginning of the next, while duration runs from the start to the end of the same contraction. Measuring from the end of one to the start of the next records the rest period instead.

22. Why is a field digital vaginal examination of a pregnant woman generally avoided?

    1. A. Paramedics cannot legally touch the perineum
    2. B. It can cause bleeding with a low placenta
    3. C. It cannot tell whether the cervix is dilating
    4. D. It is painful but carries no other risk
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    Answer: B. It can cause bleeding with a low placenta

    If the placenta lies over or near the cervix, a digital exam can provoke severe hemorrhage, and it also adds infection risk, so field assessment relies on inspection. The exam is avoided because of these risks, not because of a legal bar on examining the perineum; crowning, for example, is checked by inspection during a contraction. A digital exam can detect cervical dilation, which is why it is done in the hospital; in the field the information does not change care enough to justify the risks. The exam carries real risks of bleeding and infection, not just discomfort. (Caroline, assessment of the pregnant patient.)

23. A woman at 36 weeks has new swelling of her face and hands. Before anything else, you should check her:

    1. A. Blood pressure
    2. B. Blood glucose
    3. C. Temperature
    4. D. Pupil reactivity
    Show answer

    Answer: A. Blood pressure

    Facial and hand edema can be a sign of preeclampsia, so blood pressure is the key next measurement. Ankle swelling alone is common in late pregnancy, but swelling of the face and hands deserves attention.

24. A 19-year-old with abdominal pain says she cannot be pregnant. She is sexually active and her last period was 7 weeks ago. You should:

    1. A. Rely on her report and move on
    2. B. Delay care for a urine test
    3. C. Ask her parents to confirm it
    4. D. Treat her as possibly pregnant
    Show answer

    Answer: D. Treat her as possibly pregnant

    Any woman of childbearing age with abdominal pain or bleeding should be considered possibly pregnant until proven otherwise. A missed period and sexual activity make pregnancy likely whatever her belief.

25. In late pregnancy, a maternal pulse of 125 beats/min and a BP of 100/60 mmHg after a fall should be interpreted as:

    1. A. An expected change of pregnancy
    2. B. Possible significant blood loss
    3. C. A sign of preeclampsia
    4. D. Supine hypotensive syndrome
    Show answer

    Answer: B. Possible significant blood loss

    A modest rise in heart rate is normal, but a rate of 125 with soft pressure suggests hemorrhage, which pregnancy can mask until late. Blaming tachycardia on pregnancy is the dangerous error.