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Ahpra Midwifery OBA study materials
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Ahpra Midwifery OBA practice questions

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Question 1Midwifery practice (domain weights not published in the retrieved source)

A woman at 10 weeks' gestation reports mild nausea and asks whether it is normal. Which response by the midwife is most appropriate?

  1. Nausea and vomiting in early pregnancy are common and usually settle by around 16 to 20 weeks. Correct answer.
  2. Nausea should be treated with antiemetics before any other advice is given.
  3. Nausea in the first trimester is uncommon and warrants immediate hospital referral.
  4. Nausea at 10 weeks indicates an underlying liver disorder until proven otherwise.

Explanation

Mild nausea and vomiting affect a large proportion of pregnant women in the first trimester and generally improve by around 16 to 20 weeks. Midwifery assessment focuses on hydration, ketones, weight and ability to function to distinguish normal symptoms from hyperemesis. Reassurance with safety-netting is appropriate when symptoms are mild.

Question 2Midwifery practice (domain weights not published in the retrieved source)

Which finding on a routine antenatal visit most strongly suggests a need to screen for pre-eclampsia?

  1. Fundal height measuring 1 cm below gestation at 24 weeks
  2. Mild ankle oedema at the end of the day
  3. New proteinuria together with a rise in blood pressure after 20 weeks Correct answer.
  4. Blood pressure of 118/70 mmHg at 28 weeks

Explanation

Pre-eclampsia is defined by new hypertension after 20 weeks together with proteinuria or other maternal organ dysfunction. The combination of rising blood pressure and new protein is the classic trigger for further investigation. Isolated oedema is common and non-specific.

Question 3Midwifery practice (domain weights not published in the retrieved source)

A woman at 39 weeks reports reduced fetal movements since the previous evening. What is the most appropriate initial action?

  1. Reassure her that movements naturally reduce near term and arrange routine review.
  2. Advise her to drink a cold sweet drink and reassess in the morning.
  3. Arrange immediate assessment with auscultation or cardiotocography and full maternal observations. Correct answer.
  4. Advise her to count movements for 24 hours and call back if still reduced.

Explanation

Reduced fetal movements can be the first sign of fetal compromise and require prompt assessment rather than watchful waiting. Current guidance advises immediate contact and same-day evaluation including auscultation or CTG and maternal observations. Delay risks missing deteriorating placental function.

Question 4Midwifery practice (domain weights not published in the retrieved source)

During the active first stage of labour, how often should the fetal heart rate be auscultated intermittently in an otherwise low-risk labour?

  1. Every 15 minutes for one minute after a contraction Correct answer.
  2. Every 5 minutes during and after a contraction
  3. Every 30 minutes for one minute after a contraction
  4. Hourly for one minute between contractions

Explanation

Intermittent auscultation in established low-risk first-stage labour is performed at least every 15 minutes for a full minute after a contraction. This interval allows early detection of fetal heart rate changes while avoiding continuous monitoring. The second stage requires more frequent listening, typically every 5 minutes.

Question 5Midwifery practice (domain weights not published in the retrieved source)

A woman in the second stage has been pushing for two hours and is making no progress; the fetal head is at the level of the ischial spines and the position is occipito-posterior. Which interpretation is most accurate?

  1. This indicates an immediate need for emergency caesarean section without further assessment.
  2. This represents a delay in the second stage requiring obstetric review for possible intervention. Correct answer.
  3. This suggests the woman should stop pushing and rest for one hour before reassessment.
  4. This is normal progress because occipito-posterior positions always take longer.

Explanation

Nulliparous second stage beyond about two hours with no descent or rotation meets criteria for delayed second stage and warrants obstetric review. Occipito-posterior position is a recognised contributor but does not make lack of progress normal. The response should follow structured assessment rather than an immediate predetermined mode of birth.

Question 6Midwifery practice (domain weights not published in the retrieved source)

Which parameter is the most reliable early indicator of hypovolaemia in a woman with primary postpartum haemorrhage?

  1. Heart rate and clinical signs such as pallor and restlessness Correct answer.
  2. Blood pressure
  3. Haemoglobin concentration
  4. Respiratory rate alone

Explanation

In acute obstetric haemorrhage, haemoglobin falls only after haemodilution and blood pressure is maintained by compensatory vasoconstriction until late. Rising pulse rate with pallor, restlessness or delayed capillary refill signals deteriorating perfusion earlier. Clinical assessment of shock indices and urine output guides resuscitation.

Question 7Midwifery practice (domain weights not published in the retrieved source)

A woman is diagnosed with asymptomatic bacteriuria at 16 weeks. Why is treatment recommended?

  1. To eliminate the need for further urine testing
  2. To reduce the risk of fetal chromosomal abnormality
  3. To reduce the risk of preterm birth and pyelonephritis Correct answer.
  4. To prevent gestational diabetes

Explanation

Untreated asymptomatic bacteriuria in pregnancy is associated with ascending infection, pyelonephritis and preterm birth. Antibiotic treatment based on culture and sensitivities reduces these risks. Screening is therefore offered as part of routine antenatal care.

Question 8Midwifery practice (domain weights not published in the retrieved source)

Which statement about rhesus prophylaxis is correct for a non-sensitised RhD-negative woman?

  1. Anti-D should be given only if the woman has had a previous pregnancy.
  2. Anti-D is given only after delivery of an RhD-positive baby.
  3. Anti-D is offered in the antenatal period and after potentially sensitising events, plus after birth if the baby is RhD-positive. Correct answer.
  4. Anti-D is unnecessary if the father is also RhD-negative.

Explanation

Routine antenatal anti-D prophylaxis is offered to non-sensitised RhD-negative women, along with additional doses after sensitising events and after delivery of an RhD-positive infant. This combined approach substantially reduces alloimmunisation. Paternity status is not a reliable basis for withholding prophylaxis.

Question 9Midwifery practice (domain weights not published in the retrieved source)

A woman at 34 weeks presents with a painless, bright red vaginal bleed. What is the most appropriate initial management?

  1. Advise bed rest at home and review in 48 hours
  2. Arrange immediate transfer for assessment without digital vaginal examination Correct answer.
  3. Perform a digital vaginal examination to determine cervical dilatation
  4. Perform a speculum examination to visualise the cervix

Explanation

Painless bright red bleeding in later pregnancy raises suspicion of placenta praevia, and digital vaginal examination risks provoking catastrophic haemorrhage. Assessment should occur in a setting with theatre and blood available, using ultrasound to localise the placenta. Speculum examination is also avoided until praevia is excluded.

Question 10Midwifery practice (domain weights not published in the retrieved source)

Which feature best distinguishes pre-labour rupture of membranes from normal late-pregnancy vaginal discharge?

  1. Mild lower abdominal discomfort with backache
  2. A single gush of fluid followed by dryness for several days
  3. Clear fluid that continues to leak and pools in the posterior fornix on speculum examination Correct answer.
  4. Thick white discharge that is more noticeable after exercise

Explanation

Pre-labour rupture of membranes is confirmed by visualisation of amniotic fluid pooling in the vagina on sterile speculum examination, supported by history of continuing fluid loss. Discharge changes and discomfort are non-specific. Digital examination is avoided because of infection risk.

Question 11Midwifery practice (domain weights not published in the retrieved source)

A woman at 32 weeks has a blood pressure of 150/100 mmHg on two occasions four hours apart, with no proteinuria or symptoms. What is the most appropriate midwifery action?

  1. Document and review at the next routine visit
  2. Advise her to reduce salt intake and return in one week
  3. Reassure her that blood pressure rises normally in the third trimester
  4. Arrange urgent assessment for hypertension in pregnancy, including blood tests and fetal monitoring Correct answer.

Explanation

Persistent hypertension at this level after 20 weeks requires prompt assessment for pre-eclampsia and maternal organ involvement, even without proteinuria. Blood tests, blood pressure management and fetal wellbeing assessment are indicated. Deferring review risks missing progression to severe disease.

Question 12Midwifery practice (domain weights not published in the retrieved source)

Which vaccine is routinely recommended in pregnancy to protect the newborn from pertussis?

  1. Live attenuated measles vaccine
  2. Live attenuated varicella vaccine
  3. Inactivated pertussis-containing vaccine (dTpa) in each pregnancy Correct answer.
  4. Oral polio vaccine

Explanation

Inactivated dTpa vaccine is recommended in every pregnancy, usually in the second or third trimester, to provide passive antibody protection against pertussis in early infancy. Live vaccines are generally avoided in pregnancy. Timing optimises transplacental antibody transfer.

Question 13Midwifery practice (domain weights not published in the retrieved source)

A woman at 28 weeks has a random plasma glucose of 9.0 mmol/L. What is the most appropriate next step?

  1. Arrange diagnostic testing for gestational diabetes with an oral glucose tolerance test Correct answer.
  2. Recommend immediate insulin therapy
  3. Reassure her that random glucose is not a valid screening test
  4. Advise a repeat random glucose in four weeks

Explanation

A random plasma glucose of 9.0 mmol/L or above warrants formal diagnostic testing with an oral glucose tolerance test. Diagnosis guides dietary and pharmacological management to reduce macrosomia and other complications. Treatment decisions follow confirmed diagnosis rather than a single screening value.

Question 14Midwifery practice (domain weights not published in the retrieved source)

Which aspect of care most directly reduces the risk of group B streptococcal early-onset disease in a newborn?

  1. Universal maternal vaccination in the third trimester
  2. Intrapartum antibiotic prophylaxis for women with identified risk factors or colonisation Correct answer.
  3. Bathing the newborn immediately after birth
  4. Routine caesarean section for all carriers

Explanation

Intrapartum antibiotic prophylaxis given to colonised women or those with risk factors substantially reduces vertical transmission of group B streptococcus. Prophylaxis is timed in labour so that antibiotics are present at delivery. Routine caesarean and immediate bathing do not prevent transmission.

Question 15Midwifery practice (domain weights not published in the retrieved source)

What is the recommended first-line pharmacological treatment for severe hypertension (160/110 mmHg or above) in pregnancy?

  1. Intravenous or oral labetalol, or oral nifedipine, according to protocol Correct answer.
  2. Intramuscular diazepam
  3. Oral ramipril
  4. Sublingual nifedipine given repeatedly without monitoring

Explanation

Severe hypertension in pregnancy is treated urgently with agents such as labetalol or nifedipine, chosen according to local protocol and maternal condition. The aim is controlled reduction of blood pressure to reduce stroke risk while maintaining placental perfusion. ACE inhibitors and diazepam are not appropriate.

Question 16Midwifery practice (domain weights not published in the retrieved source)

A woman in labour with a known low-lying placenta begins to bleed heavily. Which action should the midwife take first?

  1. Call for emergency help, initiate maternal resuscitation measures and prepare for operative delivery Correct answer.
  2. Send a urine sample for culture
  3. Administer an oxytocin infusion to accelerate labour
  4. Perform a vaginal examination to assess dilatation

Explanation

Heavy bleeding with a low-lying placenta is an obstetric emergency. The priority is to summon senior help, secure maternal observations, gain intravenous access and prepare for expedited delivery. Vaginal examination and oxytocin could worsen bleeding and are inappropriate.

Question 17Midwifery practice (domain weights not published in the retrieved source)

Which statement about the physiology of the third stage of labour is correct?

  1. Clotting at the placental site is unnecessary because vessels are already sealed.
  2. Uterine contraction and retraction compress vessels at the placental site to limit bleeding. Correct answer.
  3. The placenta separates mainly because of maternal abdominal pushing.
  4. Uterine tone decreases after delivery to allow the placenta to detach.

Explanation

After delivery, strong uterine contraction and retraction act as a living ligature, compressing spiral arteries at the placental site. Placental separation results from this contraction and retraction along with clot formation. Loss of tone is the mechanism behind atonic haemorrhage.

Question 18Midwifery practice (domain weights not published in the retrieved source)

Which action best supports the establishment of breastfeeding in the first hour after an uncomplicated birth?

  1. Delaying feeding until the second postnatal day
  2. Separating mother and baby for routine observations before feeding
  3. Skin-to-skin contact with early unrestricted breastfeeding Correct answer.
  4. Offering a formula feed to settle the baby

Explanation

Early skin-to-skin contact and unrestricted feeding in the first hour support thermoregulation, bonding and lactogenesis. Newborn observations can be performed with the baby on the mother's chest. Separation and formula supplementation interfere with establishment of breastfeeding.

Question 19Midwifery practice (domain weights not published in the retrieved source)

A woman at 36 weeks reports a persistent headache with visual disturbance and epigastric pain. Which condition should be the primary concern?

  1. Pre-eclampsia with severe features Correct answer.
  2. Tension headache related to posture
  3. Gastro-oesophageal reflux disease
  4. Migraine without aura

Explanation

Headache with visual disturbance and epigastric or right upper quadrant pain in the third trimester suggests pre-eclampsia with severe features and possible hepatic involvement. Immediate assessment of blood pressure, urine and blood tests is required. These symptoms should not be attributed to benign causes without investigation.

Question 20Midwifery practice (domain weights not published in the retrieved source)

Which method of contraception is considered suitable for immediate initiation after an uncomplicated vaginal birth for a woman who is not breastfeeding?

  1. Combined oral contraceptive pill immediately on the first postnatal day
  2. Lactational amenorrhoea method regardless of feeding pattern
  3. Copper intrauterine device within 48 hours only
  4. Progestogen-only methods or combined hormonal contraception after risk assessment, with combined methods generally delayed until venous thromboembolism risk falls Correct answer.

Explanation

Postnatal contraception requires assessment of venous thromboembolism risk, breastfeeding status and preferences. Progestogen-only methods can often be started promptly, while combined hormonal methods are generally deferred until thrombotic risk declines. Intrauterine devices can be inserted at various times with appropriate timing.

Question 21Midwifery practice (domain weights not published in the retrieved source)

A woman with a body mass index of 35 is planning pregnancy. Which antenatal recommendation is most appropriate?

  1. No additional monitoring is needed because obesity has little effect on pregnancy
  2. Routine weight loss medication during pregnancy
  3. Referral for specialist antenatal care with screening for gestational diabetes and hypertension Correct answer.
  4. Advice to limit all weight gain to under 2 kg

Explanation

Maternal obesity increases the risk of gestational diabetes, hypertensive disorders, thromboembolism and fetal macrosomia. Specialist antenatal care with early screening and thromboprophylaxis assessment improves outcomes. Weight-loss medication is not used in pregnancy, and restrictive targets are not advised.

Question 22Midwifery practice (domain weights not published in the retrieved source)

Which finding on a newborn examination in the first 24 hours requires urgent paediatric review?

  1. A single episode of mild regurgitation after feeding
  2. Capillary refill of 2 seconds with pink centrally
  3. A heart murmur with absent femoral pulses Correct answer.
  4. Mild moulding of the head after vaginal birth

Explanation

A murmur with weak or absent femoral pulses may indicate coarctation of the aorta or other critical congenital heart disease and requires urgent assessment. Moulding and mild regurgitation are common and benign. Delayed capillary refill would also warrant review but is not present here.

Question 23Midwifery practice (domain weights not published in the retrieved source)

Which statement about physiological jaundice in a term breastfed newborn is correct?

  1. It requires immediate exchange transfusion in all affected babies.
  2. It indicates an underlying haemolytic disease in every case.
  3. It always appears within the first 12 hours of life.
  4. It typically appears after 24 hours, peaks around days 3 to 5 and resolves without treatment in most cases. Correct answer.

Explanation

Physiological jaundice appears after the first 24 hours, peaks around days 3 to 5 in term infants and usually resolves spontaneously. Feeding support and monitoring of bilirubin are important. Jaundice within 24 hours is always pathological and requires urgent investigation.

Question 24Midwifery practice (domain weights not published in the retrieved source)

A woman is diagnosed with a complete miscarriage. Which statement best describes this finding?

  1. The pregnancy is viable but bleeding has occurred.
  2. The cervix is closed and the uterus is empty on ultrasound. Correct answer.
  3. The pregnancy is ectopic and requires surgery.
  4. The cervix is open and pregnancy tissue remains in the uterus.

Explanation

A complete miscarriage means all pregnancy tissue has been passed, so the uterus appears empty on ultrasound and the cervix is typically closed. Incomplete miscarriage involves retained tissue with an open cervix. Distinguishing these guides management and follow-up.

Question 25Midwifery practice (domain weights not published in the retrieved source)

A woman in the second stage of labour has a prolonged deceleration lasting four minutes on cardiotocography. What is the priority action?

  1. Perform a vaginal examination to confirm full dilatation before any other action
  2. Continue routine monitoring and document the event
  3. Administer a further dose of epidural analgesia
  4. Call for urgent obstetric review, change maternal position and initiate intrauterine resuscitation measures Correct answer.

Explanation

A prolonged deceleration lasting several minutes indicates possible fetal hypoxia and requires urgent escalation. Intrauterine resuscitation includes left lateral positioning, intravenous fluids, stopping oxytocin if running and preparing for expedited birth. Documentation and examination follow the immediate response.

Question 26Midwifery practice (domain weights not published in the retrieved source)

Which maternal position is recommended for a woman in the second stage of labour who has an epidural in situ and no other complications?

  1. Lithotomy with the head of the bed flat
  2. Any position she finds comfortable, including upright or side-lying Correct answer.
  3. Supine with legs in stirrups for all pushing efforts
  4. Left lateral with the upper leg strapped to a pole

Explanation

A woman with a working epidural should be encouraged to change position and to use upright or side-lying positions where possible, because these improve comfort and pelvic diameters. Supine and lithotomy positions are associated with longer second stage and greater perineal trauma. The midwife supports mobility with assistance rather than imposing a single posture.

Question 27Midwifery practice (domain weights not published in the retrieved source)

A woman at 10 weeks of gestation reports nausea and vomiting that prevents her from keeping down fluids for 24 hours. Which finding most strongly indicates she needs hospital assessment for hyperemesis gravidarum?

  1. Ketones in the urine with weight loss Correct answer.
  2. Aversion to the smell of cooking
  3. Occasional vomiting after breakfast
  4. Mild nausea relieved by dry toast

Explanation

Hyperemesis gravidarum is suggested by persistent vomiting with dehydration, ketonuria and weight loss, and these features warrant assessment and intravenous fluid therapy. Simple nausea that settles with dietary measures does not meet the threshold. The presence of ketones with weight loss reflects significant catabolism and volume depletion.

Question 28Midwifery practice (domain weights not published in the retrieved source)

Which parameter is used to define the active phase of the first stage of labour in current intrapartum guidance?

  1. Cervical dilatation of at least 5 cm with regular painful contractions Correct answer.
  2. Rupture of membranes with any cervical dilatation
  3. Full effacement of the cervix regardless of dilatation
  4. Cervical dilatation of at least 2 cm with any contractions

Explanation

The active first stage is now defined as regular painful contractions with progressive cervical change from about 5 cm dilatation. Earlier definitions using 3 or 4 cm led to over-diagnosis of slow progress. Recognising the change in definition matters because it alters decisions about augmentation.

Question 29Midwifery practice (domain weights not published in the retrieved source)

A woman who is 38 weeks pregnant reports a sudden gush of clear fluid and feels the baby is less active. Which action should the midwife advise first?

  1. Attend the maternity unit promptly for assessment of mother and baby Correct answer.
  2. Wait at home until contractions begin spontaneously
  3. Take a warm bath and reassess activity in 24 hours
  4. Perform vaginal douching to reduce infection risk

Explanation

Suspected rupture of membranes at term requires prompt assessment for cord prolapse, fetal wellbeing and signs of infection. Reduced fetal movements add urgency because they may signal fetal compromise. Expectant waiting at home is inappropriate when membranes may have ruptured and movements have decreased.

Question 30Midwifery practice (domain weights not published in the retrieved source)

Which statement describes the correct technique for assessing the newborn's heart rate immediately after birth?

  1. Observe colour alone and record the rate as normal if pink
  2. Count pulsation at the anterior fontanelle for 30 seconds
  3. Palpate the umbilical cord pulsation for one full minute
  4. Auscultate the precordium for six seconds and multiply by ten Correct answer.

Explanation

The newborn heart rate is best assessed by auscultation over the precordium, counting for six seconds and multiplying by ten. Cord palpation is unreliable and colour is a poor proxy for rate. An accurate rate guides decisions about stimulation and resuscitation.

Question 31Midwifery practice (domain weights not published in the retrieved source)

Which screening test is offered to all pregnant women in Australia to assess risk of gestational diabetes?

  1. A fasting insulin level at 20 weeks
  2. Urine glucose testing at every antenatal visit
  3. A random blood glucose at booking only
  4. A 75 g oral glucose tolerance test at 24 to 28 weeks Correct answer.

Explanation

Universal screening uses a 75 g oral glucose tolerance test, usually between 24 and 28 weeks, with earlier testing for women at high risk. Random glucose and urine testing are not sufficiently sensitive or specific. The test requires fasting and has defined diagnostic thresholds.

Question 32Midwifery practice (domain weights not published in the retrieved source)

What is the recommended duration of skin-to-skin contact immediately after an uncomplicated birth to support thermoregulation and feeding?

  1. At least one hour uninterrupted where possible Correct answer.
  2. Two hours, but only after the first bath
  3. Until the cord stops pulsating only
  4. Five minutes before weighing the baby

Explanation

Uninterrupted skin-to-skin contact for at least the first hour supports thermoregulation, breastfeeding initiation and bonding. Routine tasks such as weighing can be delayed until after this period. Early bathing is discouraged because it interferes with thermal stability and contact.

Question 33Midwifery practice (domain weights not published in the retrieved source)

Which observation suggests a newborn is in the transitional period of thermoregulation and needs attention?

  1. Passing meconium in the first hour
  2. Axillary temperature of 37.0 degrees Celsius with pink skin
  3. Crying vigorously while being dried
  4. Axillary temperature of 36.2 degrees Celsius with cool extremities Correct answer.

Explanation

A temperature below 36.5 degrees Celsius with cool extremities indicates cold stress, which increases oxygen consumption and can worsen respiratory distress. Normal newborn temperature is maintained around 36.5 to 37.5 degrees Celsius. Prompt rewarming with skin-to-skin contact and a hat is required.

Question 34Midwifery practice (domain weights not published in the retrieved source)

A woman at 18 weeks is found to have a haemoglobin of 95 g/L with low ferritin. Which management is most appropriate?

  1. Advise a blood transfusion in the antenatal clinic
  2. Reassure her that dilutional anaemia is expected at this gestation
  3. Defer all treatment until the third trimester
  4. Commence oral iron therapy and arrange repeat testing Correct answer.

Explanation

Iron deficiency anaemia in pregnancy is treated with oral iron, with retesting to confirm response, and attention to adherence and side effects. Low ferritin confirms iron deficiency rather than haemodilution alone. Untreated anaemia is associated with preterm birth and postpartum haemorrhage.

Question 35Midwifery practice (domain weights not published in the retrieved source)

A woman in the second stage of labour is pushing but the fetal head has not descended after two hours; she is a first-time mother with an epidural. Which initial action is most appropriate?

  1. Assess position and station and consider the need for obstetric review Correct answer.
  2. Leave her alone to allow spontaneous descent
  3. Instruct her to push harder with each contraction
  4. Apply fundal pressure to assist descent

Explanation

Prolonged second stage requires a structured assessment of fetal position, station, contractions and maternal effort before deciding on intervention. Fundal pressure is unsafe and can cause uterine rupture and fetal injury. The decision to augment or proceed to operative birth rests with the obstetric team after review.

Question 36Midwifery practice (domain weights not published in the retrieved source)

A woman in the first stage of labour has a temperature of 38.2 degrees Celsius and fetal tachycardia of 170 beats per minute. Which action should the midwife take?

  1. Give paracetamol and reassess in two hours
  2. Document the findings and continue routine observations
  3. Encourage a cool shower and continue labour as normal
  4. Escalate for urgent obstetric and paediatric review and consider sepsis Correct answer.

Explanation

Maternal fever with fetal tachycardia suggests possible chorioamnionitis or maternal sepsis and requires prompt senior review, investigations and antibiotics. Fetal tachycardia is a compensatory response to maternal pyrexia and infection. Delay in treatment increases the risk of neonatal sepsis and maternal deterioration.

Question 37Midwifery practice (domain weights not published in the retrieved source)

Which statement about the use of a partogram is correct?

  1. It replaces the need for vaginal examination once labour is established
  2. It plots cervical dilatation, descent and observations against time to detect slow progress Correct answer.
  3. It is only used in women who have had an epidural
  4. It records only fetal heart rate and maternal blood pressure

Explanation

A partogram is a graphic record of labour progress, including dilatation, descent, contractions and maternal and fetal observations over time. It supports early recognition of slow progress and prompts review. It does not replace clinical assessment or vaginal examination.

Question 38Midwifery practice (domain weights not published in the retrieved source)

A woman who is 30 weeks pregnant reports a sudden onset of generalised itching without a rash, worst on the palms and soles. Which condition should the midwife suspect?

  1. Candidal skin infection
  2. Atopic eczema of pregnancy
  3. Intrahepatic cholestasis of pregnancy Correct answer.
  4. Pruritic urticarial papules and plaques of pregnancy

Explanation

Itching without a rash, particularly on the palms and soles, suggests intrahepatic cholestasis of pregnancy, which requires bile acid and liver function testing. It carries a risk of stillbirth and preterm labour and needs obstetric management. A rash would point towards other dermatoses.

Question 39Midwifery practice (domain weights not published in the retrieved source)

A woman at 26 weeks has a fundal height that measures 3 cm less than expected. Which action is most appropriate?

  1. Recommend bed rest until the next visit
  2. Reassure her that fundal height is unreliable and take no action
  3. Arrange an ultrasound scan to assess fetal growth and liquor volume Correct answer.
  4. Repeat the measurement in six weeks

Explanation

A fundal height measurement that differs by 3 cm or more from gestation should prompt ultrasound assessment of fetal biometry and amniotic fluid. Serial measurement alone is insufficient when growth restriction is possible. Early detection guides surveillance and timing of birth.

Question 40Midwifery practice (domain weights not published in the retrieved source)

A woman with a history of a previous caesarean section is planning a vaginal birth. Which factor most increases the likelihood of a successful vaginal birth after caesarean?

  1. A previous vaginal birth before or after the caesarean Correct answer.
  2. A short interpregnancy interval of six months
  3. Induction of labour with a closed cervix
  4. Maternal obesity with a body mass index above 35

Explanation

A prior vaginal birth, whether before or after the caesarean, is the strongest predictor of successful vaginal birth after caesarean. Other favourable factors include spontaneous labour and a non-recurrent indication for the original caesarean. Induction with an unfavourable cervix and obesity reduce the chance of success.

Question 41Midwifery practice (domain weights not published in the retrieved source)

A woman at 41 weeks with an uncomplicated pregnancy is discussing options for birth. Which statement about induction of labour at this gestation is correct?

  1. Induction around 41 to 42 weeks reduces perinatal mortality compared with expectant management Correct answer.
  2. Membrane sweeping is contraindicated at this gestation
  3. Expectant management beyond 42 weeks carries no additional risk
  4. Induction should be avoided until 43 weeks in all women

Explanation

Offering induction between 41 and 42 weeks reduces stillbirth and perinatal mortality compared with expectant management, and this is reflected in national guidance. Risks of prolonged pregnancy include placental insufficiency and meconium. Membrane sweeping can be offered earlier to reduce the need for formal induction.

Question 42Midwifery practice (domain weights not published in the retrieved source)

A woman in established labour with a known breech presentation at 8 cm dilatation has membranes that rupture and the cord is felt in the vagina. Which action should the midwife take first?

  1. Leave her to continue labour and document the finding
  2. Give her oral fluids and reassess in 30 minutes
  3. Attempt to replace the cord into the uterus
  4. Call for urgent help and position her to relieve cord compression Correct answer.

Explanation

Cord prolapse is an obstetric emergency requiring immediate senior help and measures to relieve compression, such as kneeling or a steep head-down position, while preparing for expedited birth. Manual replacement of the cord is not recommended. Delay increases the risk of fetal hypoxia and death.

Question 43Midwifery practice (domain weights not published in the retrieved source)

Which finding in a woman at 36 weeks suggests a diagnosis of pre-eclampsia rather than gestational hypertension?

  1. Blood pressure of 135/85 mmHg at booking
  2. Proteinuria with new-onset symptoms such as headache and visual disturbance Correct answer.
  3. Isolated ankle oedema in the evening
  4. A single blood pressure reading of 150/95 mmHg

Explanation

Pre-eclampsia is defined by new hypertension after 20 weeks together with proteinuria or maternal organ dysfunction, including symptoms such as headache and visual disturbance. Gestational hypertension lacks these features. Oedema alone is common and non-specific.

Question 44Midwifery practice (domain weights not published in the retrieved source)

A woman who is 12 weeks pregnant asks about exercise. Which advice is most appropriate?

  1. She should avoid all exercise until after the birth
  2. Exercise should be limited to stretching in bed
  3. Moderate aerobic exercise such as walking or swimming is encouraged most days Correct answer.
  4. Only high-intensity interval training is beneficial

Explanation

Moderate-intensity aerobic exercise for around 150 minutes per week is recommended in uncomplicated pregnancy and is associated with reduced gestational diabetes and improved wellbeing. Contact sports and activities with a high fall risk should be avoided. Bed rest and inactivity are not advised.

Question 45Midwifery practice (domain weights not published in the retrieved source)

A woman in labour is using nitrous oxide and oxygen for pain relief. Which statement about this method is correct?

  1. It is contraindicated in all women with asthma
  2. It should be used continuously without breaks throughout labour
  3. It provides complete pain relief for most women
  4. It provides partial analgesia and is self-administered with a tight-fitting mask Correct answer.

Explanation

Nitrous oxide and oxygen offers partial analgesia with rapid onset and offset, and self-administration allows the woman to control intake. It does not abolish pain completely. Continuous use without breaks can cause maternal sedation and is discouraged.

Question 46Midwifery practice (domain weights not published in the retrieved source)

A woman who is 35 weeks pregnant with a twin pregnancy reports contractions and lower back pain. Which factor most strongly influences the decision to transfer her to a unit with neonatal intensive care?

  1. The number of previous antenatal visits
  2. Whether the twins are the same sex
  3. The woman's preference for a particular hospital
  4. Gestational age and estimated fetal weights Correct answer.

Explanation

The decision to transfer in a preterm twin pregnancy is guided by gestational age, estimated fetal weight and the availability of appropriate neonatal intensive care. These determine the level of nursery support likely to be needed. Non-clinical factors such as sex or visit frequency do not drive the decision.

Question 47Midwifery practice (domain weights not published in the retrieved source)

A woman at 22 weeks presents with a history of a second-trimester loss and a short cervix on ultrasound. Which intervention is most likely to be offered?

  1. Immediate induction of labour at 24 weeks
  2. Elective caesarean section at 34 weeks
  3. Vaginal progesterone or cervical cerclage, depending on history Correct answer.
  4. Routine antibiotics for the remainder of pregnancy

Explanation

A history of second-trimester loss with a short cervix may be managed with vaginal progesterone or a cervical cerclage, depending on whether the history is typical of cervical insufficiency. These interventions aim to prolong pregnancy. Antibiotics and early induction do not address the underlying problem.

Question 48Midwifery practice (domain weights not published in the retrieved source)

A woman with type 1 diabetes is planning pregnancy. Which preparation most reduces the risk of congenital malformation?

  1. Optimising glycaemic control with a target HbA1c below 6.5 percent before conception Correct answer.
  2. Switching to an insulin pump on the first day of pregnancy
  3. Starting a high-dose folic acid supplement alone without glucose review
  4. Delaying folic acid until a pregnancy test is positive

Explanation

Preconception care aiming for an HbA1c below about 6.5 percent substantially reduces the risk of congenital malformations, which are linked to periconceptional hyperglycaemia. High-dose folic acid is also advised, but glycaemic optimisation is the dominant factor. Care should begin well before conception.

Question 49Midwifery practice (domain weights not published in the retrieved source)

A woman in the third stage of labour has a retained placenta 40 minutes after birth with heavy bleeding. Which action is most appropriate?

  1. Continue controlled cord traction repeatedly for another hour
  2. Escalate for assessment and consider manual removal with analgesia and antibiotics Correct answer.
  3. Massage the abdomen and perform a vaginal examination without analgesia
  4. Give oral misoprostol and await spontaneous expulsion

Explanation

Retained placenta with haemorrhage requires escalation for possible manual removal under analgesia or anaesthesia with prophylactic antibiotics, alongside resuscitation and uterotonics. Repeated traction risks cord avulsion and uterine inversion. Expectant waiting is unsafe when bleeding is heavy.

Question 50Midwifery practice (domain weights not published in the retrieved source)

A woman who is 33 weeks pregnant has a blood pressure of 165/115 mmHg and has received two doses of a corticosteroid. Which statement about magnesium sulphate in this situation is correct?

  1. It reduces the risk of eclampsia and should be considered for severe pre-eclampsia Correct answer.
  2. It lowers blood pressure rapidly and replaces antihypertensives
  3. It is given only after a seizure has occurred
  4. It is contraindicated in any woman with renal impairment

Explanation

Magnesium sulphate is recommended for women with severe pre-eclampsia to reduce the risk of eclampsia, not only after a seizure. It is not a primary antihypertensive and does not replace agents such as hydralazine or labetalol. Renal impairment requires dose adjustment and monitoring rather than automatic exclusion.