RRB Nsg. Superintende…: During active labor, a woman experiences sudden respiratory distress, hypotension, and cyanosis. What is the…

RRB Nsg. Superintendent-2026 (Shift -2nd)

Obstetrics & Gynaecology

Medium

Appeared in: RRB Nsg. Superintendent-2026 (Shift -2nd)

Explanation

The patient's presentation of sudden respiratory distress, hypotension, and cyanosis during active labor is the classic triad for the initial phase of Amniotic Fluid Embolism (AFE).
AFE occurs when amniotic fluid enters the maternal circulation, triggering an intense inflammatory response.
This response leads to acute pulmonary artery vasoconstriction, causing right heart failure, profound hypoxemia (leading to cyanosis and respiratory distress), and subsequent left heart failure and cardiovascular collapse (hypotension).
While a consumptive coagulopathy is the third part of the classic AFE triad, it typically follows the initial cardiorespiratory collapse.

Option A: Placental abruption typically presents with painful vaginal bleeding, a rigid or 'board-like' abdomen, and signs of fetal distress. Sudden maternal respiratory collapse is not the primary feature.
Option C: Uterine inversion is a postpartum complication where the uterus turns inside out. It presents with severe postpartum hemorrhage, profound shock, and a palpable mass in the vagina or at the introitus. It occurs after the baby is delivered.
Option D: Cord prolapse is an obstetric emergency for the fetus, not the mother. It presents as an acute change in the fetal heart rate, typically severe bradycardia, and a pulsating umbilical cord may be felt in the vaginal canal. It does not cause maternal respiratory distress or hypotension.

Visual 1: Flowchart - Pathophysiology of Amniotic Fluid Embolism. This visual would illustrate the sequence of events from the entry of amniotic fluid into maternal circulation to cardiopulmonary collapse and coagulopathy.
Visual 2: Table - Differential Diagnosis of Obstetric Emergencies. This table would compare the signs, symptoms, and primary affected party (mother vs. fetus) for AFE, placental abruption, uterine inversion, and cord prolapse.

Clinical Relevance

Nursing practice connection: Use the key finding related to Differential diagnosis of acute intrapartum emergencies based on clinical presentation to guide bedside assessment, documentation, and the next nursing action.
Amniotic Fluid Embolism is a rare but often fatal complication of pregnancy. Nurses must be able to recognize the sudden onset of cardiorespiratory collapse to initiate life-saving measures immediately.
The nursing response is critical and involves activating the emergency response team, administering high-flow oxygen, preparing for advanced cardiac life support (ACLS), and managing massive hemorrhage.
Patient safety depends on rapid diagnosis and a coordinated, multidisciplinary team approach.

How to Approach the Question

First, analyze the clinical scenario and identify the key signs and symptoms presented by the patient: sudden onset, active labor, respiratory distress, hypotension, and cyanosis.
Next, consider each of the answer choices as a potential diagnosis.
Evaluate 'placental abruption'. This typically involves pain and bleeding. The patient's symptoms are primarily respiratory and cardiovascular, making this less likely.
Evaluate 'amniotic fluid embolism'. The classic presentation is sudden cardiorespiratory collapse. The patient's symptoms are a perfect match for the initial phase of AFE.
Evaluate 'uterine inversion'. This is a postpartum complication involving hemorrhage and a palpable mass. The patient is still in active labor, ruling this out.
Evaluate 'cord prolapse'. This is a fetal emergency causing bradycardia. It does not cause maternal respiratory collapse. Therefore, this is incorrect.

Concept Tested & Keywords

Concept Tested: Differential diagnosis of acute intrapartum emergencies based on clinical presentation.
Stem keywords: active labor, sudden respiratory distress, hypotension, cyanosis
Lead-in keywords: most likely diagnosis
Clinical cues: The combination of sudden respiratory, cardiovascular, and hematological collapse during labor is the key clinical cue.

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