Afghanistan Midwifery Exit Exam cheat sheet
Afghanistan Midwifery Exit Exam · Keep the key ideas within reach.
Antenatal Care and Midwifery Assessment
Naegele's rule: first day of last menstrual period minus 3 months plus 7 days plus 1 year gives estimated date of delivery.
WHO recommends a minimum of eight antenatal contacts; the first contact should occur before 12 weeks gestation.
Fundal height in centimeters approximates gestational age in weeks between 20 and 36 weeks; a lag of 3 cm or more warrants further assessment.
Normal fetal heart rate is 110-160 beats per minute; auscultate after 20 weeks or with Doppler from 10-12 weeks.
Gravida counts all pregnancies including the current one; para counts births at 20 weeks or more (or 500 g or more).
Rhesus-negative women without anti-D antibodies receive anti-D immunoglobulin at 28 weeks and within 72 hours of birth of an Rh-positive infant.
Daily elemental iron 60 mg plus 400 micrograms folic acid is standard antenatal supplementation; folic acid is most protective when started before conception.
Blood pressure of 140/90 mmHg or higher on two occasions at least 4 hours apart defines gestational hypertension in pregnancy.
Intrapartum Care and Labor Management
First stage latent phase: cervix dilates to 5 cm with irregular contractions; active phase: 5-10 cm with regular contractions and faster dilation.
In active first stage, cervical dilation of at least 1 cm per hour and descent of the fetal head are expected progress markers.
Second stage is complete cervical dilation to birth of the baby; nulliparous duration up to 3 hours and multiparous up to 2 hours are within WHO limits without intervention.
Partograph plotting of cervical dilation, descent, fetal heart rate, contractions, and maternal vital signs detects prolonged or obstructed labor.
Fetal heart rate is auscultated every 15-30 minutes in the first stage and every 5 minutes or after each contraction in the second stage.
The cardinal movements of labor are engagement, descent, flexion, internal rotation, extension, restitution, external rotation, and expulsion.
Active management of the third stage: prophylactic uterotonic, controlled cord traction, and uterine massage reduce postpartum hemorrhage.
Delayed cord clamping for 1-3 minutes after birth improves neonatal iron stores and hemoglobin.
Postpartum Care and Immediate Newborn Care
Normal postpartum blood loss is up to 500 mL after vaginal birth and up to 1000 mL after cesarean birth; greater volumes define postpartum hemorrhage.
The uterus should be firm and midline, with the fundus at or near the umbilicus in the first hours after birth.
Lochia progresses from rubra (days 1-3), to serosa (days 4-10), to alba (after day 10), lasting up to 6 weeks.
Breastfeeding should be initiated within the first hour of birth; exclusive breastfeeding is recommended for the first 6 months.
Newborn Apgar scores are assigned at 1 and 5 minutes for heart rate, respiratory effort, muscle tone, reflex irritability, and color.
Newborn axillary temperature should be 36.5-37.5 degrees Celsius; hypothermia is below 36.5 degrees Celsius.
Vitamin K 1 mg intramuscularly is given to all newborns within the first hour to prevent hemorrhagic disease of the newborn.
Postpartum visits are recommended within 24 hours, at day 3, day 7-14, and at 6 weeks for mother and baby.
Complications of Pregnancy, Labor, and the Puerperium
Postpartum hemorrhage first-line management: uterine massage, oxytocin 10 IU intramuscularly or intravenously, intravenous fluids, and tranexamic acid 1 g within 3 hours.
Preeclampsia with severe features: blood pressure of 160/110 mmHg or higher, platelets below 100,000, elevated liver enzymes, creatinine above 1.1 mg/dL, or pulmonary edema.
Magnesium sulfate for eclampsia: loading dose 4-6 g intravenously over 20 minutes, then 1-2 g per hour; monitor reflexes, respiration, and urine output; antidote is calcium gluconate 1 g intravenously.
Shoulder dystocia maneuvers include McRoberts position, suprapubic pressure, internal rotation, and delivery of the posterior arm.
Prolapsed cord management: call for help, relieve cord compression by elevating the presenting part, position knee-chest or Trendelenburg, and prepare for immediate delivery.
Ectopic pregnancy classic triad: amenorrhea, unilateral lower abdominal pain, and vaginal bleeding; treat with methotrexate or surgery.
Placenta previa presents with painless bright red vaginal bleeding; avoid digital vaginal examination until placenta location is known.
Postpartum endometritis is treated with intravenous clindamycin plus gentamicin, with or without ampicillin.
Newborn Health and Neonatal Resuscitation
Newborn resuscitation sequence: warm, dry, stimulate, position airway, clear secretions if needed, and assess breathing and heart rate within the first minute (golden minute).
Positive pressure ventilation is indicated for apnea, gasping, or heart rate below 100 beats per minute after initial steps.
Chest compressions are indicated when heart rate is below 60 beats per minute despite effective ventilation; ratio is 3 compressions to 1 breath.
Epinephrine 0.01-0.03 mg/kg intravenously or 0.05-0.1 mg/kg endotracheally is given if heart rate remains below 60 beats per minute after ventilation and compressions.
Initial oxygen for term newborns is 21 percent; for preterm under 35 weeks, start at 21-30 percent and titrate to target saturation.
Target preductal oxygen saturation is 85-94 percent at 5-10 minutes after birth; avoid hyperoxia.
Neonatal hypoglycemia is blood glucose below 45 mg/dL in the first 24 hours; feed or give intravenous dextrose if symptomatic or persistent.
Kangaroo mother care reduces mortality in low-birth-weight infants and supports thermoregulation and breastfeeding.
Reproductive and Sexual Health, Family Planning, and Safe Abortion Care
Combined oral contraceptive pills are taken daily with a 7-day hormone-free interval; missed pills require backup contraception per missed-pill rules.
Emergency contraception: levonorgestrel 1.5 mg within 72 hours, ulipristal acetate 30 mg within 120 hours, or copper intrauterine device within 5 days.
Copper intrauterine device is effective for up to 10-12 years and is also used for emergency contraception; it may increase menstrual bleeding.
Depot medroxyprogesterone acetate 150 mg intramuscularly every 3 months; return to fertility may be delayed up to 6-12 months after discontinuation.
Lactational amenorrhea method is effective only if exclusively breastfeeding, amenorrheic, and within 6 months postpartum.
Medical abortion with mifepristone 200 mg followed 24-48 hours later by misoprostol 800 micrograms is effective up to 10 weeks gestation.
Post-abortion care includes uterine evacuation when needed, contraception counseling, and screening for sexually transmitted infections.
Barrier methods such as condoms reduce risk of sexually transmitted infections as well as pregnancy.
Infection Prevention, Pharmacology, and Safe Medication Practice
WHO five moments for hand hygiene: before patient contact, before aseptic procedure, after body fluid exposure, after patient contact, and after contact with patient surroundings.
Hand hygiene with alcohol-based rub for 20-30 seconds; with soap and water for 40-60 seconds, and always when hands are visibly soiled.
Oxytocin is stored at 2-8 degrees Celsius and protected from light; it is used for labor induction and postpartum hemorrhage prevention.
Magnesium sulfate toxicity signs: loss of deep tendon reflexes, respiratory depression, oliguria; antidote is calcium gluconate.
High-alert medications in midwifery include oxytocin, magnesium sulfate, insulin, and concentrated potassium; require independent double-check.
Antibiotic prophylaxis for cesarean birth: single dose of cefazolin 2 g intravenously within 60 minutes before incision.
Sharps must be disposed of immediately in puncture-resistant containers; never recap needles by hand.
Medication rights: right patient, drug, dose, route, time, and documentation; verify allergies before administration.
Professional Ethics, Law, Communication, and Midwifery Scope of Practice
Informed consent requires disclosure of risks and benefits, comprehension, voluntariness, and decision-making capacity.
Confidentiality may be breached only when required by law, to prevent serious harm, or with the patient's consent.
Midwives practice within their defined scope; referral and consultation are required when care needs exceed competence or facility resources.
The four ethical principles are autonomy, beneficence, nonmaleficence, and justice.
Respectful maternity care includes freedom from abuse, discrimination, and neglect, and supports informed choice and privacy.
Documentation must be contemporaneous, accurate, legible, and include time, date, and signature; it is a legal record.
Mandatory reporting duties may include suspected child abuse, female genital mutilation, and certain communicable diseases, per national law.
Cultural safety and interpreter services support effective communication and equitable care for diverse populations.