Cardiac Arrest and Trauma in Pregnancy, Preterm Labor, and Special Considerations Practice Questions

25 multiple-choice questions on Cardiac arrest and trauma in pregnancy, preterm labor, and special considerations 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. During CPR on a woman at 34 weeks, a crew member suggests tilting the backboard 30 degrees to her left instead of manually displacing the uterus. Manual displacement is preferred because tilting:

   1. A. Pushes the uterus onto the vena cava
   2. B. Makes chest compressions less effective
   3. C. Prevents defibrillation pads from sticking
   4. D. Is unsafe for the fetus during shocks
   Show answer

   Answer: B. Makes chest compressions less effective

   A lateral tilt reduces the force of compressions and lets the patient slide, so the AHA prefers continuous manual left uterine displacement with the patient flat and supine. A left tilt does move the uterus off the vena cava; the problem is compression quality, not caval pressure. Tilting has no effect on how pads adhere. Defibrillation is safe for the fetus in any position. (AHA 2020; AHA scientific statement 2015.)

2. Manual uterine displacement during maternal cardiac arrest is indicated when the fundus is at or above the level of the:

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

   Answer: B. Umbilicus

   When the fundus reaches the umbilicus, at about 20 weeks, the uterus is large enough to compress the vena cava and aorta. Waiting until the fundus nears the xiphoid would miss many patients who would benefit.

3. You are preparing to intubate a woman at 38 weeks in cardiac arrest. Because of airway edema in late pregnancy, you should have ready:

   1. A. A tube 0.5 to 1 mm smaller than usual
   2. B. A tube 1 mm larger to lower resistance
   3. C. A nasal tube to protect against reflux
   4. D. An uncuffed tube to avoid airway injury
   Show answer

   Answer: A. A tube 0.5 to 1 mm smaller than usual

   Pregnancy causes swelling of the upper airway mucosa, so obstetric airway guidelines advise a smaller tube (about 6.0 to 7.0 mm) along with a backup supraglottic airway. A larger tube is harder to pass through the edematous airway and causes more trauma. Nasal intubation in pregnancy risks heavy bleeding from engorged nasal mucosa, and it does not protect against reflux any better. A cuffed tube is needed precisely because of the high aspiration risk; an uncuffed tube leaves the airway unprotected. (AHA scientific statement 2015; OAA/DAS 2015.)

4. During CPR on a woman at 36 weeks, your partner moves his hands higher up the sternum because of the uterus. Under current AHA guidance, hand position for compressions should be:

   1. A. Higher, on the upper third of the sternum
   2. B. Over the left chest, beside the sternum
   3. C. Lower, directly over the xiphoid process
   4. D. The standard position used for any adult
   Show answer

   Answer: D. The standard position used for any adult

   Current AHA guidance found no evidence to support moving the hands higher in pregnancy, so compressions are done in the standard position on the lower half of the sternum, with manual left uterine displacement. Compressing over the xiphoid risks liver injury.

5. You reach a woman at 36 weeks within 3 minutes of a witnessed cardiac arrest at home. The nearest emergency department with obstetric backup is 8 minutes away. The best plan is to:

   1. A. Run the arrest on scene for 20 minutes first
   2. B. Hold ACLS drugs until she is at the hospital
   3. C. Start ACLS with LUD and transport early
   4. D. Pronounce death if no ROSC after 10 minutes
   Show answer

   Answer: C. Start ACLS with LUD and transport early

   A pregnant woman beyond about 20 weeks may need a resuscitative delivery that only the hospital can perform, so give high-quality CPR with continuous manual left uterine displacement and standard ACLS, notify the hospital, and transport early (with mechanical CPR if available) per protocol. Staying on scene for 20 minutes, as for many other adult arrests, uses up the window in which delivery helps the mother. ACLS drugs and doses are the same as for any adult and should not be held. Field termination rules for nonpregnant adults do not apply to a late-pregnancy arrest. (AHA 2020; AHA scientific statement 2015.)

6. You are preparing to manage the airway of a 29-year-old at 38 weeks in cardiac arrest. You should anticipate:

   1. A. An easy airway due to softened tissues
   2. B. Low aspiration risk from an empty stomach
   3. C. A difficult airway and rapid desaturation
   4. D. Slow desaturation from a larger blood volume
   Show answer

   Answer: C. A difficult airway and rapid desaturation

   Airway edema, a full stomach, and low oxygen reserve make the pregnant airway difficult, so give 100% oxygen and have the most experienced provider manage it. Pregnancy shortens, not lengthens, the time to desaturation.

7. A woman at 24 weeks with a fundus above the umbilicus is in cardiac arrest in the emergency department. The team plans a resuscitative hysterotomy within minutes even though the fetus may not survive, mainly because emptying the uterus:

   1. A. Relieves aortocaval compression for her
   2. B. Gives the fetus the best chance to survive
   3. C. Shortens the time to an advanced airway
   4. D. Reverses the cause of most maternal arrests
   Show answer

   Answer: A. Relieves aortocaval compression for her

   Delivery removes the uterus's weight from the aorta and vena cava, which improves venous return and the output of CPR, so it is done for the mother's sake even when the fetus is too young to survive. At 24 weeks the fetus may well not survive, so fetal benefit is not the main reason. The AHA advises considering it at about 4 minutes with delivery by about 5 minutes; ILCOR 2025 found no evidence for a precise time, so the point is to do it early when there is no ROSC. Airway management and compressions continue during and after the procedure and do not depend on delivery. Delivery does not by itself reverse hemorrhage, embolism, or cardiac causes; it improves the effectiveness of resuscitation while those are treated. (AHA 2020; ILCOR 2025.)

8. Why should you notify the receiving hospital early when transporting a pregnant woman in cardiac arrest?

   1. A. So the fetal monitor can be set up first
   2. B. So the ED can arrange a CT scan on arrival
   3. C. So the team can arrange an ICU bed first
   4. D. So obstetric and newborn teams are ready
   Show answer

   Answer: D. So obstetric and newborn teams are ready

   Resuscitative delivery and newborn resuscitation require obstetric, neonatal, and emergency teams at the bedside on arrival. A fetal monitor has no role during maternal cardiac arrest, and a CT scan or an ICU bed does not come before resuscitation and a possible hysterotomy in the emergency department.

9. Homicide of a woman during pregnancy or the year after birth is most often committed by:

   1. A. A stranger during a robbery or break-in
   2. B. A current or former intimate partner
   3. C. A relative who is not her partner
   4. D. A coworker or other acquaintance
   Show answer

   Answer: B. A current or former intimate partner

   Homicide is a leading cause of death during pregnancy and the postpartum year in the United States, and most of these killings are committed by a current or former partner. This is why IPV screening matters on every obstetric call.

10. A woman at 32 weeks was in a crash and has a chest injury with an SpO2 of 92% on room air. Her BP is normal. Regarding oxygen, you should:

    1. A. Accept 92%, because she is not in shock
    2. B. Aim for 90% or higher, as in other adults
    3. C. Hold oxygen until fetal heart tones are known
    4. D. Keep her SpO2 at or above about 95%
    Show answer

    Answer: D. Keep her SpO2 at or above about 95%

    Fetal oxygen delivery depends on maternal oxygenation, and small drops in maternal saturation reduce fetal oxygen substantially, so trauma and obstetric guidance call for supplemental oxygen to keep maternal SpO2 at or above about 95%. Accepting 92% because she is not in shock, or aiming for 90% as in other adults, leaves the fetus underoxygenated. Do not wait for fetal heart tones to treat maternal hypoxia; resuscitating the mother is the best fetal care.

11. A woman at 32 weeks in preterm labor received subcutaneous terbutaline at a clinic 20 minutes ago. She now has a pulse of 128, tremor, and palpitations, with no bleeding or abdominal pain. This is most likely:

    1. A. Magnesium toxicity from the tocolytic
    2. B. A beta-agonist effect of terbutaline
    3. C. A concealed abruption causing shock
    4. D. Hyperkalemia caused by terbutaline
    Show answer

    Answer: B. A beta-agonist effect of terbutaline

    Terbutaline is a beta-2 agonist that relaxes the uterus but also causes tachycardia, tremor, palpitations, hyperglycemia, and low potassium; monitor her, obtain an ECG, and watch for chest pain or pulmonary edema, which the FDA warns about. She received no magnesium, and magnesium toxicity causes weakness, lost reflexes, and slow breathing, not tremor and tachycardia. A concealed abruption causes pain and a tender, firm uterus, which she does not have. Beta-agonists drive potassium into cells and lower it; they do not cause hyperkalemia. (FDA 2011; ACOG PB 171.)

12. Preterm labor is labor that begins:

    1. A. Before 20 weeks of gestation
    2. B. After 42 weeks of gestation
    3. C. Before 37 weeks of gestation
    4. D. Before 40 weeks of gestation
    Show answer

    Answer: C. Before 37 weeks of gestation

    Regular contractions with cervical change before 37 weeks define preterm labor. Pregnancy loss before 20 weeks is spontaneous abortion, not preterm labor.

13. A woman at 31 weeks has regular contractions every 5 minutes and pelvic pressure. Delivery is not imminent. You should:

    1. A. Transport to a facility with a NICU
    2. B. Advise her to rest at home for a day
    3. C. Have her push to complete the birth
    4. D. Give oxytocin to strengthen labor
    Show answer

    Answer: A. Transport to a facility with a NICU

    Preterm labor needs hospital care where drugs may slow labor and give steroids for the fetal lungs, ideally where a neonatal intensive care unit is available. Advising rest at home delays treatment that can improve the outcome.

14. A woman at 33 weeks reports a gush of fluid from the vagina without contractions. This preterm rupture of membranes increases the risk of:

    1. A. Preeclampsia with seizures later
    2. B. Infection and preterm birth
    3. C. Uterine rupture in labor
    4. D. Amniotic fluid embolism
    Show answer

    Answer: B. Infection and preterm birth

    Once the membranes rupture, bacteria can ascend into the uterus, and labor often follows. Ruptured membranes do not cause preeclampsia, uterine rupture, or amniotic fluid embolism.

15. A woman at 30 weeks is found unresponsive with pinpoint pupils and respirations of 4/min after heroin use. You should:

    1. A. Withhold naloxone to protect the fetus
    2. B. Give flumazenil instead of naloxone
    3. C. Ventilate her and give naloxone
    4. D. Avoid ventilation until she is awake
    Show answer

    Answer: C. Ventilate her and give naloxone

    Maternal hypoxia is the greatest threat to the fetus, so support ventilation and give naloxone, titrated to breathing to limit withdrawal. Withholding naloxone out of fear for the fetus is a dangerous misconception.

16. A pregnant woman on methadone or buprenorphine treatment for opioid use disorder should generally be told that:

    1. A. Treatment is safer than abrupt withdrawal
    2. B. She should taper off it before delivery
    3. C. Treatment causes major fetal malformations
    4. D. Treatment prevents withdrawal in the newborn
    Show answer

    Answer: A. Treatment is safer than abrupt withdrawal

    Medication treatment stabilizes mother and fetus and lowers the risk of relapse and overdose, while abrupt withdrawal can cause fetal distress and relapse; ACOG recommends continuing it through pregnancy and after. Tapering off before delivery is not recommended because it raises the relapse and overdose risk. Methadone and buprenorphine are not associated with major malformations. Newborns of treated mothers may still have neonatal opioid withdrawal syndrome and should be observed. (ACOG Committee Opinion 711.)

17. A woman at 34 weeks was stabbed in the upper abdomen, above the top of the uterus. Compared with the same wound before pregnancy, it is more likely to injure:

    1. A. The uterus and the fetus directly below it
    2. B. The bladder, which rises with the uterus
    3. C. Nothing serious, since the uterus shields it
    4. D. Several loops of bowel crowded upward
    Show answer

    Answer: D. Several loops of bowel crowded upward

    In late pregnancy the enlarging uterus pushes the bowel up into the upper abdomen, so an upper abdominal stab or gunshot wound can injure multiple bowel loops along with the liver, spleen, or diaphragm. A lower abdominal wound mainly strikes the uterus, which tends to shield maternal organs but puts the fetus at high risk. Treat for shock and transport to a trauma center with obstetric care.

18. Heavy alcohol use during pregnancy can cause:

    1. A. Neonatal opioid withdrawal syndrome
    2. B. Large-for-dates infants
    3. C. Rh sensitization of the mother
    4. D. Fetal alcohol spectrum disorder
    Show answer

    Answer: D. Fetal alcohol spectrum disorder

    Alcohol crosses the placenta and can cause growth problems, facial anomalies, and lifelong neurodevelopmental disorders; no safe amount is known. It slows rather than speeds fetal growth, neonatal opioid withdrawal follows opioid exposure rather than alcohol, and Rh sensitization depends on blood type, not on what the mother drinks.

19. Smoking during pregnancy is associated with:

    1. A. Abruption and low birth weight
    2. B. Larger infants at birth than usual
    3. C. Lower risk of preterm labor
    4. D. Protection against placenta previa
    Show answer

    Answer: A. Abruption and low birth weight

    Nicotine and carbon monoxide reduce placental blood flow and oxygen delivery, raising the risks of abruption, previa, preterm birth, and low birth weight. Smokers have smaller, not larger, infants.

20. Intimate partner violence during pregnancy is important for you to recognize because:

    1. A. It is mostly limited to teenage mothers
    2. B. Abuse often starts or worsens in pregnancy
    3. C. Abusers tend to avoid the pregnant abdomen
    4. D. It seldom harms the fetus directly
    Show answer

    Answer: B. Abuse often starts or worsens in pregnancy

    Pregnancy is a time when abuse may begin or escalate, and homicide is a leading cause of pregnancy-associated death, so screen privately whenever injuries or the history raise concern. Abuse occurs at every age and in every background, not mainly among teenagers. Abusers often target the abdomen, breasts, and genitals during pregnancy. Blows to the abdomen can cause abruption, preterm labor, fetal injury, and fetal death. (ACOG Committee Opinion 518; CDC MMWR 2021.)

21. A woman at 28 weeks touched a frayed lamp cord at home and felt a brief shock through her hand. She feels fine and has no burns. The best advice is:

    1. A. Stay home, since she has no burn marks
    2. B. Watch for a burn to appear on her hand
    3. C. Go to the hospital for fetal monitoring
    4. D. Rest and see her obstetrician next month
    Show answer

    Answer: C. Go to the hospital for fetal monitoring

    Even a low-voltage shock that leaves the mother unhurt can pass through the uterus and amniotic fluid, which conduct current well, and may cause fetal arrhythmia or death. Pregnant women after any electrical injury past about 20 weeks are usually monitored. The lack of a skin burn does not show that the fetus was spared.

22. A woman at 28 weeks with a bruised abdomen tells you, "He pushed me down the stairs." Which entry is the best documentation?

    1. A. Patient was likely assaulted by her partner
    2. B. Patient states, "He pushed me down the stairs."
    3. C. Patient fell on the stairs, according to her partner
    4. D. Patient is a victim of domestic violence
    Show answer

    Answer: B. Patient states, "He pushed me down the stairs."

    Quoting the patient's own words, along with an objective description of the injuries, gives a record that can support later protection or prosecution. "Likely assaulted by her partner" is your conclusion, not an observation, and can be challenged. Recording the partner's version in place of hers misstates what the patient said. Labeling her a victim of domestic violence is also a conclusion; describe what she said and what you saw, and follow reporting laws. (ACOG Committee Opinion 518; EMS documentation guidance.)

23. A 15-year-old in labor is more likely than an adult to have:

    1. A. Gestational diabetes and macrosomia
    2. B. Postterm birth and large infants
    3. C. Late prenatal care and preeclampsia
    4. D. Placenta previa from prior cesareans
    Show answer

    Answer: C. Late prenatal care and preeclampsia

    Adolescents often have late or no prenatal care and a higher risk of preeclampsia, preterm birth, and low birth weight. Gestational diabetes, large infants, and postterm birth are more typical of older mothers, and placenta previa linked to prior cesareans is unlikely at 15, when few patients have had a cesarean. Youth does not protect against pregnancy complications.

24. A 43-year-old at 38 weeks is in labor with her first child. Compared with a younger woman, she is at higher risk of:

    1. A. A shorter and easier first stage of labor
    2. B. A lower rate of cesarean delivery
    3. C. Fewer chromosomal abnormalities
    4. D. Hypertension and gestational diabetes
    Show answer

    Answer: D. Hypertension and gestational diabetes

    Advanced maternal age raises the risk of hypertensive disorders, diabetes, placental problems, and chromosomal abnormalities. Labor is not easier or faster because of age.

25. A woman at 28 weeks was rescued from a house fire with smoke inhalation. Besides her airway, the fetus is especially threatened by:

    1. A. Carbon monoxide crossing the placenta
    2. B. Heat passing through the abdominal wall
    3. C. Carbon dioxide retained by the fetus
    4. D. Soot particles crossing the placenta
    Show answer

    Answer: A. Carbon monoxide crossing the placenta

    Carbon monoxide crosses the placenta and binds fetal hemoglobin even more tightly than maternal hemoglobin, so fetal levels can be higher and last longer; give 100% oxygen and consider a facility with hyperbaric capability. Carbon dioxide and soot are not the main threat: CO2 crosses the placenta easily in both directions, and soot particles stay in the mother's airway. Heat injury to the fetus through the abdominal wall is not the main danger.