ATLS 11 Trauma in Pregnancy Study Guide | Practice
Questions, Answers & Detailed Rationales | Exam Prep
2026/2027
Question 1: Which of the following physiologic changes of
pregnancy most significantly increases the risk of airway
management difficulty in the trauma patient?
A. Decreased functional residual capacity
B. Increased mucosal vascularity and edema of the upper airway
C. Delayed gastric emptying
D. Increased cardiac output
CORRECT ANSWER: B. Increased mucosal vascularity and edema
of the upper airway
Rationale: Pregnancy induces physiologic hyperemia and edema of the
upper airway mucosa, which can reduce the caliber of the glottic opening
and make visualization of the vocal cords and endotracheal intubation more
challenging. While decreased functional residual capacity and delayed
gastric emptying also contribute to airway risk, the direct mechanical
difficulty is primarily due to edema and vascular engorgement.
Question 2: In a pregnant trauma patient at 32 weeks gestation,
which of the following is the primary reason for performing manual
left uterine displacement during resuscitation?
A. To prevent preterm labor
B. To relieve aortocaval compression and improve venous return
C. To facilitate fetal monitoring
D. To reduce the risk of placental abruption
CORRECT ANSWER: B. To relieve aortocaval compression and
improve venous return
Rationale: After 20 weeks of gestation, the gravid uterus can compress the
inferior vena cava and aorta when the patient is supine. This compression
reduces venous return and cardiac output, potentially worsening maternal
hypotension. Manual left uterine displacement relieves this compression
and improves the efficacy of resuscitation efforts.
Question 3: A 28-year-old woman at 34 weeks gestation is involved
in a motor vehicle collision. She is hypotensive and tachycardic.
,Which of the following statements regarding fetal assessment is
most accurate?
A. Fetal heart tones should be obtained before addressing maternal
hypotension
B. The best initial treatment for fetal distress is optimal maternal
resuscitation
C. Fetal monitoring should only be initiated after delivery
D. Abnormal fetal heart tones are an indication for immediate cesarean
section regardless of maternal status
CORRECT ANSWER: B. The best initial treatment for fetal distress
is optimal maternal resuscitation
Rationale: Maternal resuscitation is fetal resuscitation. The fetus depends
entirely on maternal circulation for oxygen and nutrient delivery. Placental
blood flow has no autoregulation, so maternal hypotension directly
compromises fetal oxygenation. Stabilizing the mother is the most effective
initial intervention for fetal distress.
Question 4: Which of the following is the most common cause of
fetal death in pregnant trauma patients?
A. Direct fetal head injury
B. Maternal death or shock
C. Uterine rupture
D. Pelvic fracture
CORRECT ANSWER: B. Maternal death or shock
Rationale: The most common causes of fetal death in trauma are maternal
death, maternal shock, and placental abruption. Direct fetal injury is
relatively uncommon due to the protective cushioning of amniotic fluid and
the uterine wall. Maternal shock leads to inadequate uteroplacental
perfusion and fetal hypoxia.
Question 5: A pregnant trauma patient at 30 weeks gestation has a
fibrinogen level of 180 mg/dL. Which of the following statements
best explains why this value warrants concern?
A. Normal pregnancy fibrinogen levels are lower than in non-pregnant
patients
B. Fibrinogen levels are normally doubled in pregnancy, so this value may
,indicate consumptive coagulopathy
C. Fibrinogen levels are unrelated to pregnancy physiology
D. This value is within normal limits for pregnancy and requires no concern
CORRECT ANSWER: B. Fibrinogen levels are normally doubled in
pregnancy, so this value may indicate consumptive coagulopathy
Rationale: Pregnancy induces a hypercoagulable state with fibrinogen levels
approximately double those of non-pregnant patients. A fibrinogen level
that would be normal in a non-pregnant patient may indicate disseminated
intravascular coagulation (DIC) in a pregnant patient, especially after
placental abruption or severe hemorrhage.
Question 6: Which of the following is the correct technique for
manual left uterine displacement in a supine pregnant trauma
patient?
A. Pushing the uterus downward toward the pelvis
B. Grasping the uterus with two hands and lifting it toward the left and
anteriorly
C. Applying firm pressure to the fundus to compress the uterus
D. Placing the patient in the Trendelenburg position instead
CORRECT ANSWER: B. Grasping the uterus with two hands and
lifting it toward the left and anteriorly
Rationale: Manual left uterine displacement is performed by grasping the
gravid uterus with both hands and displacing it toward the patient's left side
and anteriorly (toward the ceiling). This relieves compression of the inferior
vena cava and aorta against the vertebral column while maintaining spinal
precautions if needed.
Question 7: A 26-year-old woman at 36 weeks gestation presents
after a fall. She has abdominal tenderness and vaginal bleeding.
Which of the following findings most strongly suggests placental
abruption?
A. Fetal heart rate of 140 beats per minute with variability
B. Uterine tenderness and contractions
C. Maternal hemoglobin of 11 g/dL
D. Negative Kleihauer-Betke test
CORRECT ANSWER: B. Uterine tenderness and contractions
, Rationale: Placental abruption classically presents with vaginal bleeding,
abdominal pain, and uterine tenderness. However, up to 20% of abruption
cases may have concealed hemorrhage with no external bleeding. Uterine
tenderness and contractions are common findings. Fetal distress may be
the only presenting sign in some cases.
Question 8: Which of the following statements regarding radiation
exposure in the pregnant trauma patient is correct?
A. All radiographic studies are contraindicated regardless of maternal
condition
B. Clinically indicated imaging should not be withheld due to fear of fetal
radiation exposure
C. CT scans should never be performed in pregnancy
D. The fetus is most vulnerable to radiation effects during the third
trimester
CORRECT ANSWER: B. Clinically indicated imaging should not be
withheld due to fear of fetal radiation exposure
Rationale: The fundamental principle is that necessary diagnostic imaging
should not be withheld from a pregnant trauma patient if it is clinically
indicated for the diagnosis of potentially life-threatening maternal injuries.
The most vulnerable period for radiation effects on the fetus is between 2
and 15 weeks gestation. Cumulative exposure below 5 rads has not been
shown to adversely affect pregnancy outcomes.
Question 9: A pregnant trauma patient at 28 weeks gestation
requires emergency intubation. Which of the following is the most
appropriate consideration?
A. Use a larger endotracheal tube than usual due to increased airway
diameter
B. Anticipate a potentially difficult airway due to edema and use a smaller
endotracheal tube
C. Delay intubation until after fetal monitoring is established
D. Avoid preoxygenation to prevent fetal oxygen toxicity
CORRECT ANSWER: B. Anticipate a potentially difficult airway due
to edema and use a smaller endotracheal tube
Rationale: Pregnancy-related airway edema and vascular engorgement can
narrow the airway and make intubation more difficult. A smaller
Questions, Answers & Detailed Rationales | Exam Prep
2026/2027
Question 1: Which of the following physiologic changes of
pregnancy most significantly increases the risk of airway
management difficulty in the trauma patient?
A. Decreased functional residual capacity
B. Increased mucosal vascularity and edema of the upper airway
C. Delayed gastric emptying
D. Increased cardiac output
CORRECT ANSWER: B. Increased mucosal vascularity and edema
of the upper airway
Rationale: Pregnancy induces physiologic hyperemia and edema of the
upper airway mucosa, which can reduce the caliber of the glottic opening
and make visualization of the vocal cords and endotracheal intubation more
challenging. While decreased functional residual capacity and delayed
gastric emptying also contribute to airway risk, the direct mechanical
difficulty is primarily due to edema and vascular engorgement.
Question 2: In a pregnant trauma patient at 32 weeks gestation,
which of the following is the primary reason for performing manual
left uterine displacement during resuscitation?
A. To prevent preterm labor
B. To relieve aortocaval compression and improve venous return
C. To facilitate fetal monitoring
D. To reduce the risk of placental abruption
CORRECT ANSWER: B. To relieve aortocaval compression and
improve venous return
Rationale: After 20 weeks of gestation, the gravid uterus can compress the
inferior vena cava and aorta when the patient is supine. This compression
reduces venous return and cardiac output, potentially worsening maternal
hypotension. Manual left uterine displacement relieves this compression
and improves the efficacy of resuscitation efforts.
Question 3: A 28-year-old woman at 34 weeks gestation is involved
in a motor vehicle collision. She is hypotensive and tachycardic.
,Which of the following statements regarding fetal assessment is
most accurate?
A. Fetal heart tones should be obtained before addressing maternal
hypotension
B. The best initial treatment for fetal distress is optimal maternal
resuscitation
C. Fetal monitoring should only be initiated after delivery
D. Abnormal fetal heart tones are an indication for immediate cesarean
section regardless of maternal status
CORRECT ANSWER: B. The best initial treatment for fetal distress
is optimal maternal resuscitation
Rationale: Maternal resuscitation is fetal resuscitation. The fetus depends
entirely on maternal circulation for oxygen and nutrient delivery. Placental
blood flow has no autoregulation, so maternal hypotension directly
compromises fetal oxygenation. Stabilizing the mother is the most effective
initial intervention for fetal distress.
Question 4: Which of the following is the most common cause of
fetal death in pregnant trauma patients?
A. Direct fetal head injury
B. Maternal death or shock
C. Uterine rupture
D. Pelvic fracture
CORRECT ANSWER: B. Maternal death or shock
Rationale: The most common causes of fetal death in trauma are maternal
death, maternal shock, and placental abruption. Direct fetal injury is
relatively uncommon due to the protective cushioning of amniotic fluid and
the uterine wall. Maternal shock leads to inadequate uteroplacental
perfusion and fetal hypoxia.
Question 5: A pregnant trauma patient at 30 weeks gestation has a
fibrinogen level of 180 mg/dL. Which of the following statements
best explains why this value warrants concern?
A. Normal pregnancy fibrinogen levels are lower than in non-pregnant
patients
B. Fibrinogen levels are normally doubled in pregnancy, so this value may
,indicate consumptive coagulopathy
C. Fibrinogen levels are unrelated to pregnancy physiology
D. This value is within normal limits for pregnancy and requires no concern
CORRECT ANSWER: B. Fibrinogen levels are normally doubled in
pregnancy, so this value may indicate consumptive coagulopathy
Rationale: Pregnancy induces a hypercoagulable state with fibrinogen levels
approximately double those of non-pregnant patients. A fibrinogen level
that would be normal in a non-pregnant patient may indicate disseminated
intravascular coagulation (DIC) in a pregnant patient, especially after
placental abruption or severe hemorrhage.
Question 6: Which of the following is the correct technique for
manual left uterine displacement in a supine pregnant trauma
patient?
A. Pushing the uterus downward toward the pelvis
B. Grasping the uterus with two hands and lifting it toward the left and
anteriorly
C. Applying firm pressure to the fundus to compress the uterus
D. Placing the patient in the Trendelenburg position instead
CORRECT ANSWER: B. Grasping the uterus with two hands and
lifting it toward the left and anteriorly
Rationale: Manual left uterine displacement is performed by grasping the
gravid uterus with both hands and displacing it toward the patient's left side
and anteriorly (toward the ceiling). This relieves compression of the inferior
vena cava and aorta against the vertebral column while maintaining spinal
precautions if needed.
Question 7: A 26-year-old woman at 36 weeks gestation presents
after a fall. She has abdominal tenderness and vaginal bleeding.
Which of the following findings most strongly suggests placental
abruption?
A. Fetal heart rate of 140 beats per minute with variability
B. Uterine tenderness and contractions
C. Maternal hemoglobin of 11 g/dL
D. Negative Kleihauer-Betke test
CORRECT ANSWER: B. Uterine tenderness and contractions
, Rationale: Placental abruption classically presents with vaginal bleeding,
abdominal pain, and uterine tenderness. However, up to 20% of abruption
cases may have concealed hemorrhage with no external bleeding. Uterine
tenderness and contractions are common findings. Fetal distress may be
the only presenting sign in some cases.
Question 8: Which of the following statements regarding radiation
exposure in the pregnant trauma patient is correct?
A. All radiographic studies are contraindicated regardless of maternal
condition
B. Clinically indicated imaging should not be withheld due to fear of fetal
radiation exposure
C. CT scans should never be performed in pregnancy
D. The fetus is most vulnerable to radiation effects during the third
trimester
CORRECT ANSWER: B. Clinically indicated imaging should not be
withheld due to fear of fetal radiation exposure
Rationale: The fundamental principle is that necessary diagnostic imaging
should not be withheld from a pregnant trauma patient if it is clinically
indicated for the diagnosis of potentially life-threatening maternal injuries.
The most vulnerable period for radiation effects on the fetus is between 2
and 15 weeks gestation. Cumulative exposure below 5 rads has not been
shown to adversely affect pregnancy outcomes.
Question 9: A pregnant trauma patient at 28 weeks gestation
requires emergency intubation. Which of the following is the most
appropriate consideration?
A. Use a larger endotracheal tube than usual due to increased airway
diameter
B. Anticipate a potentially difficult airway due to edema and use a smaller
endotracheal tube
C. Delay intubation until after fetal monitoring is established
D. Avoid preoxygenation to prevent fetal oxygen toxicity
CORRECT ANSWER: B. Anticipate a potentially difficult airway due
to edema and use a smaller endotracheal tube
Rationale: Pregnancy-related airway edema and vascular engorgement can
narrow the airway and make intubation more difficult. A smaller
