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Afghanistan Midwifery Exit Exam study materials
Afghanistan Midwifery Exit Exam study resources

Afghanistan Midwifery Exit Exam practice questions

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Question 1Antenatal Care and Midwifery Assessment

At what gestational age does the fundus of the uterus first become palpable abdominally above the symphysis pubis?

  1. About 28 weeks
  2. About 12 weeks Correct answer.
  3. About 36 weeks
  4. About 20 weeks

Explanation

The uterus remains a pelvic organ until roughly 12 weeks of gestation, when the fundus rises above the symphysis pubis. Thereafter fundal height increases approximately 1 cm per week until term.

Question 2Antenatal Care and Midwifery Assessment

A woman at 34 weeks reports that fetal movements have noticeably decreased over the past two days. What is the most appropriate immediate action?

  1. Reassure her that movements naturally reduce near term
  2. Tell her to lie on her back and count for one hour
  3. Advise her to return in one week for routine review
  4. Arrange a formal fetal movement count and urgent assessment Correct answer.

Explanation

Reduced fetal movements warrant prompt evaluation because they can signal fetal compromise. Assessment includes auscultation, cardiotocography, and ultrasound as indicated. Reassurance without assessment risks missing fetal hypoxia.

Question 3Antenatal Care and Midwifery Assessment

Which measurement is used to define the symphysio-fundal height recorded at each antenatal visit after 24 weeks?

  1. Distance from symphysis pubis to uterine fundus in centimetres Correct answer.
  2. Distance from umbilicus to xiphisternum in centimetres
  3. Distance from anterior superior iliac spine to fundus in centimetres
  4. Distance from symphysis pubis to umbilicus in centimetres

Explanation

Symphysio-fundal height is the distance in centimetres from the upper border of the symphysis pubis to the top of the uterine fundus. It is measured with a tape from 24 weeks onward to screen for growth deviation.

Question 4Antenatal Care and Midwifery Assessment

A pregnant woman has a haemoglobin of 10.5 g/dL at 28 weeks. Which interpretation is most appropriate?

  1. Normal physiological haemodilution of pregnancy Correct answer.
  2. Severe anaemia requiring immediate transfusion
  3. Indicates haemoconcentration and dehydration
  4. Moderate anaemia requiring iron therapy review

Explanation

Plasma volume expands more than red cell mass, lowering haemoglobin concentration physiologically. Values around 10.5 g/dL at 28 weeks are within the expected pregnancy range. More marked drops warrant iron assessment.

Question 5Antenatal Care and Midwifery Assessment

Which vaccine is routinely recommended during pregnancy to prevent neonatal tetanus?

  1. Tetanus toxoid-containing vaccine Correct answer.
  2. Oral polio vaccine
  3. Yellow fever vaccine
  4. Live attenuated measles vaccine

Explanation

Tetanus toxoid vaccination in pregnancy protects both mother and newborn against tetanus. Live vaccines such as measles and yellow fever are generally avoided in pregnancy.

Question 6Antenatal Care and Midwifery Assessment

A woman at 38 weeks presents with painless bright red vaginal bleeding. Which condition should be suspected first?

  1. Placenta praevia Correct answer.
  2. Cervical ectropion
  3. Placental abruption
  4. Uterine rupture

Explanation

Painless bright red bleeding in late pregnancy classically suggests placenta praevia. Digital vaginal examination must be avoided until placental location is confirmed by ultrasound. Abruption usually presents with pain and a tender uterus.

Question 7Antenatal Care and Midwifery Assessment

Which finding on antenatal assessment most strongly suggests pre-eclampsia?

  1. Blood pressure 110/70 mmHg with ankle oedema
  2. Isolated glycosuria at 16 weeks
  3. Blood pressure 150/100 mmHg with proteinuria after 20 weeks Correct answer.
  4. Blood pressure 140/90 mmHg before 20 weeks with no proteinuria

Explanation

Pre-eclampsia is defined by new hypertension after 20 weeks together with proteinuria or other organ dysfunction. The combination of elevated blood pressure and proteinuria is diagnostic.

Question 8Antenatal Care and Midwifery Assessment

A woman at 26 weeks reports a burning sensation on urination and urinary frequency. Which action is most appropriate?

  1. Obtain a midstream urine sample for culture and treat accordingly Correct answer.
  2. Reassure that frequency is normal in pregnancy and review later
  3. Refer for immediate caesarean section
  4. Advise increased fluid intake only and no testing

Explanation

Urinary tract infection in pregnancy can progress to pyelonephritis and is associated with preterm labour. Urine culture guides appropriate antibiotic treatment. Symptoms should not be dismissed as normal pregnancy frequency.

Question 9Antenatal Care and Midwifery Assessment

Which test is used to screen for gestational diabetes mellitus at 24 to 28 weeks in most antenatal programmes?

  1. Random blood glucose only
  2. Haemoglobin A1c
  3. Oral glucose tolerance test Correct answer.
  4. Urine ketone testing

Explanation

The oral glucose tolerance test is the standard screening and diagnostic test for gestational diabetes at 24 to 28 weeks. It assesses the glycaemic response to a measured glucose load.

Question 10Antenatal Care and Midwifery Assessment

Which fetal heart rate finding on auscultation warrants further assessment?

  1. A rate of 140 beats per minute
  2. A rate of 120 beats per minute
  3. A persistent rate of 180 beats per minute Correct answer.
  4. A rate of 150 beats per minute

Explanation

The normal fetal heart rate is approximately 110 to 160 beats per minute. A persistent rate above 160 suggests tachycardia requiring investigation. Rates within the normal range are reassuring.

Question 11Antenatal Care and Midwifery Assessment

A woman at 36 weeks has a fundal height of 30 cm. Which interpretation is most appropriate?

  1. Indicates multiple pregnancy
  2. Suggests possible fetal growth restriction Correct answer.
  3. Indicates polyhydramnios
  4. Normal for gestational age

Explanation

Fundal height typically approximates gestational age in centimetres between 24 and 36 weeks. A measurement several centimetres below expectation raises concern for growth restriction and warrants ultrasound assessment.

Question 12Antenatal Care and Midwifery Assessment

Which routine laboratory test at the first antenatal visit identifies a woman at risk of RhD alloimmunisation?

  1. Urine culture
  2. Complete blood count
  3. Blood group and Rh factor Correct answer.
  4. Thyroid function test

Explanation

Determining ABO and Rh status identifies Rh-negative women who may need anti-D prophylaxis. This prevents sensitisation to fetal Rh-positive cells. Other tests assess anaemia, infection, or thyroid disease.

Question 13Antenatal Care and Midwifery Assessment

A woman at 10 weeks has not yet had any antenatal contact. Which action best reflects the principle of early antenatal booking?

  1. Defer all tests until the anatomy scan at 20 weeks
  2. Advise her to return only if she develops symptoms
  3. Begin assessment now including history, examination, and screening Correct answer.
  4. Schedule the first visit at 28 weeks to reduce workload

Explanation

Early booking allows timely screening, risk identification, and health promotion. Delaying assessment misses opportunities to detect and manage conditions early. The first visit should occur as soon as pregnancy is confirmed.

Question 14Antenatal Care and Midwifery Assessment

Which instruction should be given to a woman regarding folic acid supplementation before conception and in early pregnancy?

  1. Take 400 micrograms daily from before conception through the first trimester Correct answer.
  2. Take 5 milligrams only after 20 weeks
  3. Start at 28 weeks to prevent anaemia
  4. Take it only if anaemia is diagnosed

Explanation

Periconceptional folic acid reduces the risk of neural tube defects, which develop in early gestation. Supplementation should begin before conception and continue through the first trimester. Higher doses are used for women with specific risk factors.

Question 15Antenatal Care and Midwifery Assessment

A woman at 32 weeks has a blood pressure of 160/110 mmHg and reports severe headache. Which action is most appropriate?

  1. Recommend reducing salt intake only
  2. Arrange urgent assessment and treatment for severe hypertension Correct answer.
  3. Reassure and review in one week
  4. Advise bed rest at home without follow-up

Explanation

Severe hypertension with neurological symptoms suggests severe pre-eclampsia and requires urgent management. Delay risks eclampsia, stroke, and placental abruption. Treatment includes antihypertensives and often magnesium sulphate.

Question 16Antenatal Care and Midwifery Assessment

Which pelvic measurement is assessed clinically to estimate the adequacy of the pelvic inlet?

  1. Diagonal conjugate Correct answer.
  2. Sacrococcygeal distance
  3. Obstetric conjugate measured externally
  4. Intertrochanteric diameter

Explanation

The diagonal conjugate estimates the anteroposterior diameter of the pelvic inlet and helps assess pelvic adequacy. It is measured from the lower border of the symphysis to the sacral promontory. The obstetric conjugate cannot be measured directly.

Question 17Antenatal Care and Midwifery Assessment

A woman at 18 weeks has a uterus that is larger than expected for dates. Which condition is most likely?

  1. Fetal growth restriction
  2. Oligohydramnios
  3. Missed miscarriage
  4. Molar pregnancy Correct answer.

Explanation

A uterus larger than dates in early pregnancy can indicate multiple pregnancy, molar pregnancy, or incorrect dating. Molar pregnancy often causes exaggerated uterine size. Growth restriction and oligohydramnios usually reduce size.

Question 18Antenatal Care and Midwifery Assessment

Which finding on antenatal examination suggests a multiple pregnancy?

  1. Fundal height equal to dates with a single heart rate
  2. Fundal height greater than dates with multiple fetal heart rates Correct answer.
  3. Uterine tenderness with fever
  4. Fundal height less than dates with reduced movements

Explanation

A uterus larger than expected together with more than one fetal heart rate suggests multiple pregnancy. Ultrasound confirms the diagnosis. A single heart rate and appropriate size are reassuring.

Question 19Antenatal Care and Midwifery Assessment

What is the recommended position for a pregnant woman during a prolonged antenatal assessment to avoid supine hypotension?

  1. Flat supine
  2. Prone
  3. Left lateral tilt Correct answer.
  4. Trendelenburg

Explanation

The gravid uterus can compress the inferior vena cava when the woman lies supine, reducing venous return and causing hypotension. A left lateral tilt displaces the uterus off the vena cava. This improves maternal and fetal perfusion.

Question 20Antenatal Care and Midwifery Assessment

A woman at 24 weeks reports a history of a previous preterm birth at 30 weeks. Which antenatal measure is most appropriate?

  1. Routine care with no additional monitoring
  2. Plan elective delivery at 34 weeks
  3. Advise complete bed rest until term
  4. Assess cervical length and consider preventive interventions Correct answer.

Explanation

A prior preterm birth is a strong risk factor for recurrence. Cervical length assessment and interventions such as progesterone or cerclage may be considered. Bed rest and early elective delivery are not recommended.

Question 21Antenatal Care and Midwifery Assessment

Which screening test is offered at 11 to 14 weeks to assess risk of chromosomal anomaly?

  1. Oral glucose tolerance test
  2. Non-stress test
  3. Nuchal translucency measurement with maternal serum markers Correct answer.
  4. Group B streptococcus swab

Explanation

First-trimester combined screening uses nuchal translucency and maternal serum markers to estimate chromosomal anomaly risk. It is performed between 11 and 14 weeks. The other tests assess different conditions at different times.

Question 22Antenatal Care and Midwifery Assessment

A woman at 30 weeks has a random blood glucose of 11 mmol/L and reports excessive thirst. Which interpretation is most appropriate?

  1. Possible undiagnosed hyperglycaemia requiring evaluation Correct answer.
  2. Indicates dehydration only
  3. Suggests hyperemesis gravidarum
  4. Normal pregnancy-related thirst

Explanation

Marked hyperglycaemia with polydipsia suggests diabetes requiring formal evaluation and management. Untreated hyperglycaemia increases risks of macrosomia and neonatal hypoglycaemia. Symptoms should not be attributed to normal pregnancy alone.

Question 23Antenatal Care and Midwifery Assessment

Which component is essential in the initial antenatal history to identify risk of inherited disorders?

  1. Usual dietary salt intake
  2. Preferred sleeping position
  3. Family history of genetic or congenital conditions Correct answer.
  4. Number of previous dental visits

Explanation

Family history helps identify inherited disorders and guides counselling and possible testing. It is a standard component of the antenatal history. The other items do not inform genetic risk.

Question 24Antenatal Care and Midwifery Assessment

A woman at 28 weeks has a symphysio-fundal height measured with the bladder full. How does this affect the measurement?

  1. It may falsely increase the fundal height Correct answer.
  2. It falsely reduces the fundal height
  3. It changes the fetal heart rate
  4. It has no effect on the measurement

Explanation

A full bladder can elevate the uterus and artificially increase fundal height. The woman should empty her bladder before measurement. Accurate technique improves the reliability of growth screening.

Question 25Antenatal Care and Midwifery Assessment

Which advice about alcohol should be given to a pregnant woman at her first antenatal visit?

  1. One unit per week is acceptable
  2. Small amounts in the third trimester are safe
  3. Alcohol is safe after 20 weeks
  4. Avoid alcohol completely throughout pregnancy Correct answer.

Explanation

There is no established safe level of alcohol in pregnancy, so complete avoidance is advised. Alcohol exposure risks fetal alcohol spectrum disorders. Counselling should occur early and be reinforced at visits.

Question 26Antenatal Care and Midwifery Assessment

At the first antenatal visit, which component of the history is most important for identifying a woman at risk of pre-eclampsia?

  1. Age at menarche
  2. Number of previous sexual partners
  3. Duration of oral contraceptive use
  4. Previous history of pre-eclampsia Correct answer.

Explanation

A history of pre-eclampsia in a previous pregnancy is a strong risk factor for recurrence and should prompt increased surveillance. Other listed factors are not established risk factors for pre-eclampsia.

Question 27Antenatal Care and Midwifery Assessment

A woman at 34 weeks has a haemoglobin of 8.5 g/dL. Which action is most appropriate?

  1. Reassure and recheck at 36 weeks
  2. Start iron supplementation and repeat haemoglobin in 4 weeks Correct answer.
  3. Arrange immediate blood transfusion
  4. Advise increased dietary iron only

Explanation

Haemoglobin below 11 g/dL in pregnancy indicates anaemia; iron deficiency is common, so oral iron and follow-up testing are recommended. Transfusion is reserved for severe or symptomatic anaemia, and dietary advice alone is insufficient for moderate anaemia.

Question 28Antenatal Care and Midwifery Assessment

Which method is most accurate for confirming the presence of a fetal heartbeat at 12 weeks of gestation?

  1. Ultrasound examination Correct answer.
  2. Handheld Doppler auscultation
  3. Pinard stethoscope
  4. Maternal perception of fetal movement

Explanation

Ultrasound directly visualizes fetal cardiac activity and is the most reliable method at 12 weeks. Doppler and Pinard devices may not detect the heartbeat reliably at this early gestation, and fetal movements are not felt by the mother until later.

Question 29Antenatal Care and Midwifery Assessment

A woman at 28 weeks has a symphysio-fundal height of 26 cm. Which interpretation is most appropriate?

  1. Consistent with polyhydramnios
  2. Indicative of multiple pregnancy
  3. Suggestive of intrauterine growth restriction Correct answer.
  4. Normal for gestational age

Explanation

Symphysio-fundal height in centimetres usually approximates gestational age in weeks between 20 and 36 weeks; a measurement 3 cm less than expected raises concern for fetal growth restriction. Multiple pregnancy and polyhydramnios typically cause a larger-than-expected fundal height.

Question 30Antenatal Care and Midwifery Assessment

A woman at 32 weeks has a blood pressure of 150/95 mmHg on two occasions 4 hours apart and 2+ proteinuria. She has no symptoms. Which diagnosis is most likely?

  1. White-coat hypertension
  2. Gestational hypertension
  3. Pre-eclampsia Correct answer.
  4. Chronic hypertension

Explanation

New-onset hypertension after 20 weeks with proteinuria defines pre-eclampsia. Gestational hypertension lacks proteinuria, chronic hypertension predates pregnancy or appears before 20 weeks, and white-coat hypertension is not associated with proteinuria.

Question 31Intrapartum Care and Labor Management

According to the WHO simplified partograph, a woman in active first stage of labour should be referred for further assessment when the cervix remains to the right of which line?

  1. The action line Correct answer.
  2. The latent phase line
  3. The descent line
  4. The alert line

Explanation

The partograph plots cervical dilatation against time with an alert line and a parallel action line four hours to its right. When the dilatation curve crosses the action line, prolonged labour is diagnosed and referral or intervention is indicated. The alert line alone only signals the need for close observation.

Question 32Intrapartum Care and Labor Management

A primigravida at term is in the second stage of labour. Which finding best indicates that she should be encouraged to push with contractions?

  1. Cervix fully dilated with a strong urge to bear down Correct answer.
  2. Cervix 6 cm dilated with spontaneous rupture of membranes
  3. Cervix fully dilated with no descent of the head
  4. Cervix 8 cm dilated with intact membranes

Explanation

Active pushing is appropriate once the cervix is fully dilated and the woman has a spontaneous urge to bear down, provided the presenting part has descended. Pushing before full dilatation risks cervical oedema and tearing. Full dilatation without descent warrants reassessment rather than coached pushing.

Question 33Intrapartum Care and Labor Management

Which parameter is plotted on the partograph to assess fetal condition during labour?

  1. Fetal heart rate Correct answer.
  2. Blood pressure
  3. Cervical dilatation
  4. Maternal pulse

Explanation

The fetal heart rate is recorded every 30 minutes in the first stage and every 5 minutes in the second stage to detect fetal distress. Maternal pulse and blood pressure assess maternal condition, and cervical dilatation tracks labour progress.

Question 34Intrapartum Care and Labor Management

During a vaginal examination in labour, which finding defines the station of the fetal head as 0?

  1. The occiput is at the level of the ischial spines
  2. The presenting part is at the pelvic inlet
  3. The sagittal suture is in the transverse diameter
  4. The biparietal diameter is at the level of the ischial spines Correct answer.

Explanation

Station describes the level of the fetal biparietal diameter relative to the maternal ischial spines, with station 0 meaning the BPD is at the spines. This is the landmark used to judge engagement and descent. The suture orientation describes position, not station.

Question 35Intrapartum Care and Labor Management

A woman at 38 weeks in active labour has a fetal heart rate of 100 beats per minute persisting for 5 minutes. What is the most appropriate initial action?

  1. Rupture the membranes artificially
  2. Give an oxytocin infusion to speed delivery
  3. Reposition her to the left lateral side and reassess Correct answer.
  4. Ask her to push with the next contraction

Explanation

Persistent fetal bradycardia requires immediate intrauterine resuscitation, starting with maternal repositioning to the left lateral position to relieve aortocaval compression and improve placental perfusion, then reassessment. Oxytocin, if running, should be stopped, not started.

Question 36Intrapartum Care and Labor Management

Which fetal heart rate pattern most strongly suggests umbilical cord compression?

  1. Baseline tachycardia
  2. Early decelerations
  3. Late decelerations
  4. Variable decelerations Correct answer.

Explanation

Variable decelerations are abrupt, sharp drops in fetal heart rate of variable shape and timing, classically caused by cord compression. Early decelerations reflect head compression and late decelerations reflect uteroplacental insufficiency.

Question 37Intrapartum Care and Labor Management

A woman in active labour has a cervical dilatation of 5 cm. After 4 hours it remains 5 cm with regular contractions. Which term best describes this?

  1. Normal active phase progress
  2. Precipitate labour
  3. Latent phase labour
  4. Prolonged active phase Correct answer.

Explanation

The active phase is expected to progress at roughly 1 cm per hour; arrest of dilatation for 2 or more hours despite adequate contractions defines prolonged or arrested active phase labour. Remaining unchanged over 4 hours is therefore abnormal.

Question 38Intrapartum Care and Labor Management

Which of the following is a recognised sign of the second stage of labour?

  1. Spontaneous rupture of membranes at 3 cm
  2. Cervical dilatation of 6 cm
  3. Bulging of the perineum with each contraction Correct answer.
  4. Blood-stained show with irregular contractions

Explanation

Perineal bulging with contractions, along with an urge to push and visible presenting part, indicates that the second stage has begun. Cervical dilatation of 6 cm and irregular contractions with show belong to the first stage.

Question 39Intrapartum Care and Labor Management

What is the recommended frequency for assessing the fetal heart rate during the second stage of labour?

  1. Every 60 minutes
  2. Every 15 minutes
  3. Every 30 minutes
  4. Every 5 minutes Correct answer.

Explanation

Because contractions are stronger and closer together in the second stage, the fetal heart rate should be auscultated every 5 minutes, and after every contraction. In the first stage, every 30 minutes is sufficient.

Question 40Intrapartum Care and Labor Management

A woman at term in active labour has a cord prolapse diagnosed immediately after spontaneous rupture of membranes. What is the priority action?

  1. Clamp the cord and wait for full dilatation
  2. Elevate the presenting part and arrange immediate delivery Correct answer.
  3. Give oxytocin to hasten delivery
  4. Perform a vaginal examination every 30 minutes

Explanation

Cord prolapse is an obstetric emergency; the priority is to relieve cord compression by elevating the presenting part (or filling the bladder) while arranging the fastest possible delivery. Time-critical action prevents fetal hypoxia.

Question 41Intrapartum Care and Labor Management

Which of the following best describes the mechanism of normal labour known as 'extension'?

  1. The head flexes as it meets the pelvic floor
  2. The head rotates to the occipito-anterior position
  3. The shoulders rotate to the oblique diameter
  4. The head is born as the occiput escapes under the symphysis Correct answer.

Explanation

Extension is the movement whereby the well-flexed head pivots under the symphysis pubis and the vertex, forehead, and face are born in sequence. Flexion, internal rotation, and restitution are separate mechanisms.

Question 42Intrapartum Care and Labor Management

A woman in active labour is found to have a cervical dilatation of 4 cm that has not changed after 2 hours with adequate contractions. What is the most likely diagnosis?

  1. Normal latent phase
  2. Second stage of labour
  3. Prolonged active phase Correct answer.
  4. Precipitate labour

Explanation

Once active phase is established (usually around 4-5 cm), lack of dilatation for 2 or more hours with adequate contractions defines prolonged active phase labour. This warrants reassessment of fetal position and pelvis and consideration of intervention.

Question 43Intrapartum Care and Labor Management

Which intervention is most appropriate first-line for a woman in labour with poor progress and a well-located fetal head with adequate contractions?

  1. Encourage bed rest only
  2. Amniotomy and reassessment of progress Correct answer.
  3. Immediate forceps delivery
  4. Immediate caesarean section

Explanation

When progress is slow with a well-positioned head, artificial rupture of membranes (amniotomy) can augment contractions and allow reassessment. Caesarean or operative delivery is reserved for confirmed obstruction or fetal compromise.

Question 44Intrapartum Care and Labor Management

Which of the following is a contraindication to the use of misoprostol for induction of labour?

  1. Intrauterine fetal death at term
  2. Post-term pregnancy
  3. Hypertensive disorder of pregnancy
  4. Previous caesarean section with uterine scar Correct answer.

Explanation

Misoprostol is a potent uterotonic and is contraindicated in women with a uterine scar because of the risk of uterine rupture. It may be used in other indications such as post-term pregnancy or fetal death, with appropriate dosing.

Question 45Intrapartum Care and Labor Management

A woman at 41 weeks is being induced with oxytocin. Which finding requires stopping the infusion immediately?

  1. Contractions every 3 minutes lasting 40 seconds
  2. Mild back pain with contractions
  3. Contractions every 2 minutes lasting 90 seconds Correct answer.
  4. Cervical dilatation of 4 cm

Explanation

Contractions every 2 minutes lasting 90 seconds indicate hyperstimulation, which risks fetal hypoxia and uterine rupture, so the oxytocin must be stopped. Normal labour contractions are typically every 3-4 minutes lasting under 60 seconds.

Question 46Intrapartum Care and Labor Management

Which pelvic shape is associated with the most favourable progress in labour?

  1. Gynecoid pelvis Correct answer.
  2. Android pelvis
  3. Anthropoid pelvis
  4. Platypelloid pelvis

Explanation

The gynecoid pelvis has a rounded inlet and wide subpubic arch that accommodate rotation and descent of the fetal head, favouring normal labour. Android, anthropoid, and platypelloid shapes are associated with more difficult progress.

Question 47Intrapartum Care and Labor Management

What is the normal duration of the third stage of labour?

  1. Up to 30 minutes Correct answer.
  2. Up to 60 minutes
  3. Up to 2 hours
  4. Up to 5 minutes

Explanation

The third stage is considered prolonged if it exceeds 30 minutes with active management, at which point intervention may be needed to prevent postpartum haemorrhage. Delivery of the placenta usually occurs within 5-15 minutes with active management.

Question 48Intrapartum Care and Labor Management

Which action is part of active management of the third stage of labour?

  1. Waiting for spontaneous placental separation
  2. Clamping the cord after pulsation stops
  3. Massaging the uterus before delivery of the placenta
  4. Administering a uterotonic within one minute of birth Correct answer.

Explanation

Active management includes giving a prophylactic uterotonic (commonly oxytocin) within one minute of birth, controlled cord traction, and uterine massage after placental delivery. Expectant management relies on spontaneous separation.

Question 49Intrapartum Care and Labor Management

A woman in the second stage is bearing down but the fetal head is visible and the perineum is stretched thin. What is the most appropriate action to prevent perineal tearing?

  1. Apply fundal pressure to speed delivery
  2. Ask her to stop pushing and breathe through the contraction Correct answer.
  3. Perform an episiotomy routinely
  4. Pull the fetal head downward

Explanation

When the perineum is stretched thin, controlled delivery of the head by asking the woman to stop pushing and breathe allows gradual stretching and reduces tearing. Fundal pressure and pulling the head increase trauma.

Question 50Intrapartum Care and Labor Management

Which finding on vaginal examination suggests full cervical dilatation?

  1. Membranes bulging through a 6 cm opening
  2. Cervix felt as a thick firm ring
  3. Presenting part above the ischial spines
  4. Cervix felt as a thin rim around the presenting part Correct answer.

Explanation

At full dilatation the cervix is effaced and felt only as a thin rim or not at all around the presenting part. A thick ring or a 6 cm opening indicates incomplete dilatation.