Complications of Pregnancy: Ectopic Pregnancy, Spontaneous Abortion, Placenta Previa, Abruption, and Uterine Rupture Practice Questions

25 multiple-choice questions on Complications of pregnancy: ectopic pregnancy, spontaneous abortion, placenta previa, abruption, and uterine rupture 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. The most common site of an ectopic pregnancy is the:

   1. A. Fallopian tube
   2. B. Ovary
   3. C. Cervix
   4. D. Abdominal cavity
   Show answer

   Answer: A. Fallopian tube

   About 95% of ectopic pregnancies implant in the fallopian tube, usually where scarring or a narrowing slows the egg. Ovarian and abdominal implantations occur but are rare.

2. A 32-year-old became pregnant by in vitro fertilization, and an ultrasound 2 weeks ago showed an intrauterine pregnancy. At 8 weeks she has sudden one-sided pelvic pain, pulse 126, and BP 86/52 mmHg. You should still consider:

   1. A. Normal round ligament stretch
   2. B. Bleeding from a threatened abortion
   3. C. A coexisting ectopic pregnancy
   4. D. Hyperemesis with dehydration
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   Answer: C. A coexisting ectopic pregnancy

   A confirmed intrauterine pregnancy does not exclude a second, ectopic implantation (heterotopic pregnancy), which is far more common after assisted reproduction, and one-sided pain with shock suggests rupture. Round ligament pain is brief and positional and never causes shock. A threatened abortion causes cramping and spotting with a closed cervix, not one-sided pain with hypotension. Hyperemesis causes vomiting and dehydration, not sudden pelvic pain. (ACOG Practice Bulletin 193; Caroline, ectopic pregnancy.)

3. For a woman in shock from a suspected ruptured ectopic pregnancy, the most important prehospital action is:

   1. A. A full vaginal exam to find the source
   2. B. Waiting on scene for fluids to work
   3. C. Rapid transport to a surgical facility
   4. D. Applying a pelvic binder for bleeding
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   Answer: C. Rapid transport to a surgical facility

   The bleeding is internal and needs surgery, so minimize scene time and start IV access en route, giving fluids or blood toward a permissive pressure per protocol. A pelvic binder treats pelvic fracture bleeding, not a ruptured tube.

4. A woman at 23 weeks delivers a fetus with no signs of life. Because of the gestational age, this loss is classified as:

   1. A. A complete spontaneous abortion
   2. B. An incomplete abortion
   3. C. A preterm live birth
   4. D. A fetal death, or stillbirth
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   Answer: D. A fetal death, or stillbirth

   Pregnancy loss after 20 weeks is a fetal death or stillbirth, while loss before 20 weeks is an abortion, spontaneous or induced. A preterm live birth requires signs of life such as breathing, heartbeat, or movement.

5. A woman at 10 weeks has mild cramping and light spotting. The cervix is reported closed by her obstetrician earlier today. This is classified as a:

   1. A. Inevitable abortion
   2. B. Threatened abortion
   3. C. Incomplete abortion
   4. D. Complete abortion
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   Answer: B. Threatened abortion

   Bleeding with a closed cervix in early pregnancy is a threatened abortion, and many such pregnancies continue. An inevitable abortion has a dilated cervix and cannot be stopped.

6. A woman at 12 weeks passed some tissue at home and still has heavy bleeding and cramping. This is most consistent with:

   1. A. Incomplete abortion
   2. B. Threatened abortion
   3. C. Missed abortion
   4. D. Complete abortion
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   Answer: A. Incomplete abortion

   When some products of conception remain in the uterus, bleeding continues because the uterus cannot contract fully. In a complete abortion all tissue has passed, and bleeding and cramps usually settle.

7. A woman at 14 weeks has vaginal bleeding, severe vomiting, and a BP of 158/100 mmHg on repeated readings. Preeclampsia this early in pregnancy should make you suspect:

   1. A. A molar pregnancy
   2. B. Threatened abortion
   3. C. Placenta previa
   4. D. Chronic hypertension
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   Answer: A. A molar pregnancy

   Preeclampsia normally appears after 20 weeks. Hypertension with bleeding and severe vomiting in the first trimester suggests gestational trophoblastic disease (a molar pregnancy), in which abnormal placental tissue produces very high hCG levels. A threatened abortion does not raise the blood pressure, and chronic hypertension does not explain the bleeding and vomiting.

8. A woman at 20 weeks has pelvic pressure and light spotting but no painful contractions. At the hospital, her membranes are found bulging through a dilated cervix. The most likely problem is:

   1. A. Placenta previa with bleeding
   2. B. Cervical insufficiency
   3. C. A concealed placental abruption
   4. D. A ruptured ectopic pregnancy
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   Answer: B. Cervical insufficiency

   Cervical insufficiency is painless, premature dilation of the cervix in the second trimester, often with only pressure and spotting, and it can lead to loss of the pregnancy. Abruption causes pain and a tender uterus, and a 20-week intrauterine pregnancy is not ectopic. Transport her lying down for obstetric evaluation.

9. The emotional care of a woman having a miscarriage should include:

   1. A. Telling her it was probably for the best
   2. B. Assuring her the fetus will survive
   3. C. Avoiding any mention of the pregnancy
   4. D. Acknowledging her loss without blaming
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   Answer: D. Acknowledging her loss without blaming

   Many women feel guilt after a pregnancy loss, so offer support, and avoid suggesting either cause or a hopeful outcome you cannot know. Saying it was for the best is meant to comfort but often deepens the grief.

10. Placenta previa is a condition in which the placenta:

    1. A. Separates early from the uterine wall
    2. B. Grows deeply through the uterine wall
    3. C. Lies over or near the cervical opening
    4. D. Implants outside the uterine cavity entirely
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    Answer: C. Lies over or near the cervical opening

    In previa, the placenta covers or lies close to the internal os, so cervical changes late in pregnancy tear its vessels. Early separation from a normally placed placenta is abruptio placentae, the condition most often confused with it.

11. A 33-year-old at 32 weeks has sudden painless, bright red vaginal bleeding. Her uterus is soft and nontender. The most likely cause is:

    1. A. Abruptio placentae
    2. B. Uterine rupture
    3. C. Preterm labor
    4. D. Placenta previa
    Show answer

    Answer: D. Placenta previa

    Painless bright red bleeding in the third trimester with a soft uterus is the classic sign of placenta previa. Abruption typically causes pain and a tender, firm uterus, often with darker blood.

12. For a woman at 34 weeks with suspected placenta previa and moderate bleeding, you should:

    1. A. Place a pad at the opening and transport
    2. B. Pack the vagina with gauze to slow the flow
    3. C. Perform a gentle exam of the cervix
    4. D. Have her push to speed the delivery
    Show answer

    Answer: A. Place a pad at the opening and transport

    Never place anything in the vagina with a suspected previa because it can cause torrential bleeding. Place a pad at the vaginal opening, position her on her left side, treat for shock, and transport.

13. Risk factors for abruptio placentae include:

    1. A. First pregnancy and young age
    2. B. Low maternal blood pressure
    3. C. Hypertension and cocaine use
    4. D. Gestational diabetes alone
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    Answer: C. Hypertension and cocaine use

    Chronic or pregnancy-induced hypertension, cocaine or methamphetamine use, smoking, abdominal trauma, and prior abruption raise the risk. A first pregnancy in a young woman is not a typical abruption profile.

14. A 31-year-old at 35 weeks with severe hypertension has sudden constant abdominal pain and a hard, tender uterus. There is minimal vaginal bleeding, yet she is pale with a pulse of 130. The most likely problem is:

    1. A. Bleeding placenta previa
    2. B. Concealed placental abruption
    3. C. Braxton Hicks contractions
    4. D. Round ligament strain from exertion
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    Answer: B. Concealed placental abruption

    Blood trapped behind the placenta can cause shock with little visible bleeding, so the amount at the vaginal opening underestimates the loss. Placenta previa bleeds outward, painlessly, with a soft uterus.

15. Which feature best distinguishes abruptio placentae from placenta previa?

    1. A. Abruption usually causes bright red blood
    2. B. Abruption usually causes abdominal pain
    3. C. Previa usually causes a rigid uterus
    4. D. Previa usually bleeds in the first trimester
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    Answer: B. Abruption usually causes abdominal pain

    Abruption typically brings pain and a tender, often rigid uterus, while previa bleeds painlessly with a soft uterus. Abruption blood is often dark and may be concealed behind the placenta; bright red bleeding fits previa better. A rigid, tender uterus is the abruption picture, not previa. Previa usually bleeds in the second half of pregnancy, as the lower uterus stretches and the cervix changes, not in the first trimester. (Caroline, third-trimester bleeding.)

16. A woman with abruptio placentae is at risk of what serious clotting complication?

    1. A. Hemophilia from factor VIII loss
    2. B. Thrombocytosis from marrow stimulation
    3. C. Heparin-induced thrombocytopenia
    4. D. Disseminated intravascular coagulation
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    Answer: D. Disseminated intravascular coagulation

    Placental tissue released during a large abruption can trigger disseminated intravascular coagulation, consuming clotting factors and causing uncontrolled bleeding. Hemophilia is an inherited disorder and is not caused by abruption.

17. The fetus is at risk in a large abruption mainly because:

    1. A. The mother develops high blood glucose
    2. B. The amniotic fluid becomes infected
    3. C. The detached area cannot exchange oxygen
    4. D. The umbilical cord wraps around the neck
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    Answer: C. The detached area cannot exchange oxygen

    Any part of the placenta that has separated stops delivering oxygen, and a large separation can quickly cause fetal hypoxia and death. Maternal shock worsens it further by reducing uterine blood flow.

18. A woman in active labor at term, who had a prior cesarean delivery, suddenly reports a tearing pain and her contractions stop. Fetal parts are easily felt through the abdomen, and she becomes hypotensive. You should suspect:

    1. A. Uterine rupture
    2. B. Placenta previa
    3. C. Normal transition
    4. D. Shoulder dystocia
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    Answer: A. Uterine rupture

    A prior uterine scar is the leading risk factor for rupture, which presents with sudden tearing pain, loss of contractions, easily felt fetal parts, and shock. Transition causes stronger, closer contractions, not their sudden end.

19. The prehospital care for suspected uterine rupture is to:

    1. A. Encourage her to push to finish delivery
    2. B. Treat for shock and transport rapidly
    3. C. Give oxytocin to contract the uterus
    4. D. Lay her supine with her legs raised
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    Answer: B. Treat for shock and transport rapidly

    Uterine rupture needs immediate surgery for both mother and fetus, so give oxygen, start IV access, treat shock, and transport without delay. Pushing can worsen the tear and the bleeding, and oxytocin can extend the rupture while the fetus remains inside. Lying supine lets the uterus compress the vena cava and worsens hypotension, so use left lateral positioning.

20. In placenta accreta, the placenta:

    1. A. Covers the cervical os during labor
    2. B. Separates from the uterus before delivery
    3. C. Is delivered before the infant is born
    4. D. Grows abnormally deep into the uterine wall
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    Answer: D. Grows abnormally deep into the uterine wall

    Accreta occurs when the placenta grows into the uterine wall and fails to separate after birth, causing severe postpartum hemorrhage. The risk is highest with a prior cesarean scar, especially when combined with previa.

21. A woman at 30 weeks had a brief episode of painless bright red bleeding last night that stopped on its own. She feels well, and her vital signs are normal. You should:

    1. A. Transport, as the next bleed may be heavier
    2. B. Advise rest at home, since the bleeding stopped
    3. C. Have her see her doctor at the next routine visit
    4. D. Reassure her it was normal bloody show
    Show answer

    Answer: A. Transport, as the next bleed may be heavier

    Painless bright red bleeding in the third trimester suggests placenta previa until an ultrasound proves otherwise; the first bleed often stops on its own, but later bleeds can be sudden and heavy, so she needs same-day obstetric evaluation. Rest at home does not prevent a recurrence and leaves her far from help if it happens. Waiting for a routine visit delays the diagnosis for days or weeks. Bloody show is a small amount of blood-streaked mucus at the onset of labor near term, not bright red bleeding at 30 weeks. (RCOG Green-top 27a; Caroline, placenta previa.)

22. A woman at 22 weeks has heavy vaginal bleeding, pulse 122, and BP 90/60 mmHg. Besides oxygen and IV access, which position is best?

    1. A. Supine with legs raised 12 inches
    2. B. Prone with a pillow under the hips
    3. C. Left lateral recumbent position
    4. D. Seated upright at 90 degrees
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    Answer: C. Left lateral recumbent position

    At 22 weeks the uterus can compress the vena cava, so placing her on her left side preserves venous return while treating shock. Lying supine with the legs raised still leaves the uterus pressing on the vena cava.

23. Placenta previa is more likely in a woman who has had:

    1. A. Gestational diabetes mellitus
    2. B. Only one prior pregnancy
    3. C. Low blood pressure
    4. D. Prior cesarean deliveries
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    Answer: D. Prior cesarean deliveries

    Uterine scars from cesarean delivery, multiple pregnancies, advanced maternal age, and smoking raise the risk of previa. Gestational diabetes affects fetal size and glucose, not where the placenta implants.

24. Vasa previa is dangerous mainly because bleeding in this condition comes from:

    1. A. Maternal uterine arteries
    2. B. The maternal cervix
    3. C. Fetal blood vessels
    4. D. Varicose veins in the vagina
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    Answer: C. Fetal blood vessels

    In vasa previa, unprotected fetal vessels cross the cervical opening and can tear when membranes rupture, so the blood lost is the fetus's own. Even a small volume can be fatal to the fetus.

25. You are treating a pregnant patient with third-trimester bleeding. Which finding most strongly suggests the need for immediate transport to a facility with obstetric surgery?

    1. A. Spotting with a stable pulse and BP
    2. B. Bleeding with signs of shock
    3. C. Mild cramping with a soft uterus
    4. D. Contractions every 15 minutes
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    Answer: B. Bleeding with signs of shock

    Any third-trimester bleeding is serious, and bleeding with tachycardia, hypotension, or altered mental status calls for rapid transport to a facility able to perform an emergency cesarean. Spotting with stable vital signs and mild cramping with a soft uterus still need evaluation, but they do not signal the immediate threat that shock does, and contractions every 15 minutes do not mean that delivery or hemorrhage is near.