**Maternal-Newborn Boot Camp: High-Stakes Intrapartum
Assault**
---
1. 38 weeks, contractions q2min x 90 sec, FHR 90bpm for 8 minutes. Action?
A) O2 10L NRB, left lateral, IV fluids
B) Immediate C-section
C) Terbutaline 0.25mg SQ
D) Amnioinfusion
💫RATIONALE✔️✔️: Prolonged deceleration >2min but <10min = urgent intrauterine resuscitation. C-
section if fail to resolve.
💫ANSWER✔️✔️: A) O2 10L NRB, left lateral, IV fluids
---
2. Category III tracing: recurrent late decels with minimal variability. Next?
A) Operative vaginal delivery if cervix fully dilated
B) Continue monitoring
C) Discontinue oxytocin, intrauterine resuscitation
D) A and C
💫RATIONALE✔️✔️: Category III = abnormal. Stop pitocin, reposition, O2, fluids. Prepare for expedited
delivery.
💫ANSWER✔️✔️: D) A and C
---
3. Magnesium sulfate for eclampsia prophylaxis. Toxic sign?
A) Respiratory rate 10, absent DTRs
B) Urine output 100mL/hr
C) Patellar reflexes 2+
D) Serum Mg 4.5 mg/dL
,💫RATIONALE✔️✔️: Mg toxicity: RR <12, absent DTRs, then cardiac arrest. Antidote calcium gluconate.
💫ANSWER✔️✔️: A) Respiratory rate 10, absent DTRs
---
4. Rh-negative unsensitized mother, delivered Rh-positive infant. RhoGAM dose?
A) 300mcg IM within 72 hours
B) 50mcg IM
C) 600mcg IV
D) 150mcg IM at delivery only
💫RATIONALE✔️✔️: Standard 300mcg RhoGAM covers 15mL fetal RBCs. Given at 28 weeks and within
72h post-delivery if infant Rh+.
💫ANSWER✔️✔️: A) 300mcg IM within 72 hours
---
5. GBS positive, prolonged rupture >18 hours, febrile. Newborn management?
A) Sepsis workup, empiric ampicillin + gentamicin
B) Observe only
C) Oral antibiotics
D) Discharge with follow-up
💫RATIONALE✔️✔️: Maternal fever + GBS + prolonged rupture = high risk early-onset sepsis. Treat
neonate empirically.
💫ANSWER✔️✔️: A) Sepsis workup, empiric ampicillin + gentamicin
---
6. Preterm labor 32 weeks, intact membranes. Tocolysis first-line?
A) Nifedipine
B) Indomethacin
C) Magnesium sulfate
D) Terbutaline
💫RATIONALE✔️✔️: Nifedipine first-line for tocolysis (oral, effective, low maternal side effects). Mg for
fetal neuroprotection, not primary tocolytic.
💫ANSWER✔️✔️: A) Nifedipine
, ---
7. PPROM at 34 weeks, GBS unknown. Management?
A) Induce labor, give intrapartum penicillin
B) Expectant management until 37 weeks
C) C-section immediately
D) Discharge home
💫RATIONALE✔️✔️: PPROM ≥34 weeks: induce to prevent chorioamnionitis. GBS unknown → treat
empirically.
💫ANSWER✔️✔️: A) Induce labor, give intrapartum penicillin
---
8. Umbilical cord prolapse. Immediate nursing action?
A) Manual elevation of presenting part, knee-chest position
B) Push cord back
C) Oxytocin bolus
D) Amnioinfusion
💫RATIONALE✔️✔️: Relieve cord compression by elevating presenting part off cord. Emergency C-section.
💫ANSWER✔️✔️: A) Manual elevation of presenting part, knee-chest position
---
9. Shoulder dystocia. First maneuver?
A) McRoberts + suprapubic pressure
B) Zavanelli maneuver
C) Episiotomy
D) Fundal pressure
💫RATIONALE✔️✔️: McRoberts (hyperflex thighs) + suprapubic pressure is first-line, most effective, least
traumatic.
💫ANSWER✔️✔️: A) McRoberts + suprapubic pressure
---
10. Postpartum hemorrhage >1000mL after vaginal delivery. First medication?
A) Oxytocin 20-40 units in 1L LR at 250mL/hr
Assault**
---
1. 38 weeks, contractions q2min x 90 sec, FHR 90bpm for 8 minutes. Action?
A) O2 10L NRB, left lateral, IV fluids
B) Immediate C-section
C) Terbutaline 0.25mg SQ
D) Amnioinfusion
💫RATIONALE✔️✔️: Prolonged deceleration >2min but <10min = urgent intrauterine resuscitation. C-
section if fail to resolve.
💫ANSWER✔️✔️: A) O2 10L NRB, left lateral, IV fluids
---
2. Category III tracing: recurrent late decels with minimal variability. Next?
A) Operative vaginal delivery if cervix fully dilated
B) Continue monitoring
C) Discontinue oxytocin, intrauterine resuscitation
D) A and C
💫RATIONALE✔️✔️: Category III = abnormal. Stop pitocin, reposition, O2, fluids. Prepare for expedited
delivery.
💫ANSWER✔️✔️: D) A and C
---
3. Magnesium sulfate for eclampsia prophylaxis. Toxic sign?
A) Respiratory rate 10, absent DTRs
B) Urine output 100mL/hr
C) Patellar reflexes 2+
D) Serum Mg 4.5 mg/dL
,💫RATIONALE✔️✔️: Mg toxicity: RR <12, absent DTRs, then cardiac arrest. Antidote calcium gluconate.
💫ANSWER✔️✔️: A) Respiratory rate 10, absent DTRs
---
4. Rh-negative unsensitized mother, delivered Rh-positive infant. RhoGAM dose?
A) 300mcg IM within 72 hours
B) 50mcg IM
C) 600mcg IV
D) 150mcg IM at delivery only
💫RATIONALE✔️✔️: Standard 300mcg RhoGAM covers 15mL fetal RBCs. Given at 28 weeks and within
72h post-delivery if infant Rh+.
💫ANSWER✔️✔️: A) 300mcg IM within 72 hours
---
5. GBS positive, prolonged rupture >18 hours, febrile. Newborn management?
A) Sepsis workup, empiric ampicillin + gentamicin
B) Observe only
C) Oral antibiotics
D) Discharge with follow-up
💫RATIONALE✔️✔️: Maternal fever + GBS + prolonged rupture = high risk early-onset sepsis. Treat
neonate empirically.
💫ANSWER✔️✔️: A) Sepsis workup, empiric ampicillin + gentamicin
---
6. Preterm labor 32 weeks, intact membranes. Tocolysis first-line?
A) Nifedipine
B) Indomethacin
C) Magnesium sulfate
D) Terbutaline
💫RATIONALE✔️✔️: Nifedipine first-line for tocolysis (oral, effective, low maternal side effects). Mg for
fetal neuroprotection, not primary tocolytic.
💫ANSWER✔️✔️: A) Nifedipine
, ---
7. PPROM at 34 weeks, GBS unknown. Management?
A) Induce labor, give intrapartum penicillin
B) Expectant management until 37 weeks
C) C-section immediately
D) Discharge home
💫RATIONALE✔️✔️: PPROM ≥34 weeks: induce to prevent chorioamnionitis. GBS unknown → treat
empirically.
💫ANSWER✔️✔️: A) Induce labor, give intrapartum penicillin
---
8. Umbilical cord prolapse. Immediate nursing action?
A) Manual elevation of presenting part, knee-chest position
B) Push cord back
C) Oxytocin bolus
D) Amnioinfusion
💫RATIONALE✔️✔️: Relieve cord compression by elevating presenting part off cord. Emergency C-section.
💫ANSWER✔️✔️: A) Manual elevation of presenting part, knee-chest position
---
9. Shoulder dystocia. First maneuver?
A) McRoberts + suprapubic pressure
B) Zavanelli maneuver
C) Episiotomy
D) Fundal pressure
💫RATIONALE✔️✔️: McRoberts (hyperflex thighs) + suprapubic pressure is first-line, most effective, least
traumatic.
💫ANSWER✔️✔️: A) McRoberts + suprapubic pressure
---
10. Postpartum hemorrhage >1000mL after vaginal delivery. First medication?
A) Oxytocin 20-40 units in 1L LR at 250mL/hr
