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EHPLE Midwifery study materials
EHPLE Midwifery study resources

EHPLE Midwifery practice questions

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Question 1Antenatal Care and Midwifery Assessment

A midwife plots fundal height on a customized growth chart at each antenatal visit. Which measurement technique best ensures the plotted value is reliable across visits?

  1. Measure from the symphysis pubis to the uterine fundus with a non-elastic tape along the abdominal curve Correct answer.
  2. Estimate fundal height by counting finger-breadths above the symphysis pubis
  3. Measure from the xiphisternum to the fundus with the woman standing upright
  4. Measure from the umbilicus to the fundus with a flexible tape while the woman lies flat

Explanation

Serial fundal height is only meaningful when the same landmarks and technique are used each time. The standard is a non-elastic tape from the upper border of the symphysis pubis to the top of the fundus, following the abdominal contour, with the bladder empty and the woman semi-recumbent. Consistency of method, not the specific number alone, is what allows a trend to be interpreted.

Question 2Antenatal Care and Midwifery Assessment

At the first antenatal contact, which maternal history finding most strongly warrants referral for specialist obstetric review rather than routine midwifery-led care?

  1. A body mass index of 24 kg/m² recorded before pregnancy
  2. Two previous uncomplicated vaginal births at term
  3. A previous pregnancy complicated by pre-eclampsia requiring delivery before 34 weeks Correct answer.
  4. Mild seasonal allergic rhinitis controlled with an antihistamine

Explanation

Early-onset pre-eclampsia requiring preterm delivery is a marker of underlying vascular or placental pathology and carries a substantial recurrence risk. It places the woman in a higher-risk category that warrants consultant-led review and closer surveillance. The other findings are either normal or low-risk and do not by themselves mandate specialist care.

Question 3Antenatal Care and Midwifery Assessment

A woman at 10 weeks' gestation reports nausea and vomiting that has caused a 3 kg weight loss and ketonuria on dipstick. Which action is most appropriate?

  1. Reassure her that nausea is normal and review in four weeks
  2. Advise her to eat small dry meals and continue routine antenatal scheduling
  3. Prescribe a course of oral antibiotics for presumed urinary infection
  4. Arrange same-day assessment for intravenous fluids and antiemetic therapy Correct answer.

Explanation

Weight loss with ketonuria indicates hyperemesis gravidarum rather than ordinary morning sickness, because the woman is catabolic and dehydrated. Same-day assessment for intravenous rehydration and antiemetic treatment is required, with consideration of admission and thromboprophylaxis. Delay risks electrolyte disturbance and maternal deterioration.

Question 4Antenatal Care and Midwifery Assessment

When taking a blood pressure reading in later pregnancy, which technique best reduces falsely elevated readings?

  1. Measure with the woman lying flat and her arm resting on the couch
  2. Use a standard adult cuff regardless of arm circumference
  3. Use a cuff that fits the upper arm with the woman seated and her arm supported at heart level Correct answer.
  4. Take the reading immediately after the woman has walked to the clinic room

Explanation

Correct cuff size and positioning at heart level minimise hydrostatic and cuff-related error. The woman should be rested and seated, since recent activity and an unsupported arm both raise the reading. This matters because a false elevation can trigger unnecessary intervention.

Question 5Antenatal Care and Midwifery Assessment

Routine antenatal urinalysis at 28 weeks shows proteinuria of 1+ with a normal blood pressure and no symptoms. What is the most appropriate midwifery response?

  1. Repeat the urine test to exclude contamination and check blood pressure, and escalate if protein persists Correct answer.
  2. Exclude pre-eclampsia because the blood pressure is normal
  3. Advise the woman to increase her fluid intake and take cranberry juice
  4. Record the result and repeat the test at the next scheduled visit

Explanation

A single dipstick result can reflect contamination, vaginal discharge, or trace protein, so it should be repeated with a clean sample alongside a repeat blood pressure. Persistent proteinuria requires further investigation even when the blood pressure is normal, because pre-eclampsia can present without hypertension initially. Documenting and simply waiting four weeks could delay diagnosis.

Question 6Antenatal Care and Midwifery Assessment

A woman at 26 weeks has a symphysis–fundal height of 22 cm. Which is the most appropriate next step?

  1. Advise bed rest and reassess in two weeks
  2. Reassure her that fundal height is inaccurate after 24 weeks
  3. Arrange an ultrasound assessment for fetal growth and liquor volume Correct answer.
  4. Schedule the next measurement at 32 weeks as per routine

Explanation

A fundal height more than 3 cm below the gestation-specific expected value is a recognised trigger for ultrasound assessment of fetal biometry and amniotic fluid. The discrepancy could reflect growth restriction, oligohydramnios, or simply inaccurate measurement, and imaging distinguishes these. Reassurance alone without investigation is unsafe.

Question 7Antenatal Care and Midwifery Assessment

Which finding on booking blood tests requires the midwife to arrange partner screening and specialist referral?

  1. Hepatitis B surface antigen positive in the woman Correct answer.
  2. Haemoglobin of 118 g/L at 10 weeks
  3. Blood group O rhesus positive
  4. Rubella IgG immunity documented in the woman

Explanation

Hepatitis B surface antigen positivity requires referral for specialist hepatology and obstetric input, plus neonatal vaccination and immunoglobulin planning. Partner screening and counselling about transmission are part of the package. The other results are either reassuring or not indications for partner testing.

Question 8Antenatal Care and Midwifery Assessment

A rhesus-negative woman with no pre-formed anti-D antibodies has a first-trimester surgical evacuation for miscarriage. When should anti-D immunoglobulin be offered?

  1. At 28 weeks only, as part of routine prophylaxis
  2. Only if she develops vaginal bleeding after the procedure
  3. Within 72 hours of the procedure Correct answer.
  4. It is not indicated after surgical management of first-trimester loss

Explanation

Surgical evacuation of a pregnancy, including first-trimester loss, can cause fetomaternal haemorrhage, so anti-D is offered to non-sensitised rhesus-negative women. It should be given as soon as possible and within 72 hours of the sensitising event. Routine 28-week prophylaxis is a separate intervention and does not cover the earlier event.

Question 9Antenatal Care and Midwifery Assessment

At 24 weeks, a woman reports a sudden reduction in fetal movements. Which response reflects best practice?

  1. Advise her to attend for immediate assessment including auscultation of the fetal heart Correct answer.
  2. Reassure her that movements are not reliably felt until 28 weeks
  3. Book her for a routine growth scan at 32 weeks
  4. Ask her to lie on her left side and count movements for two hours, then call if fewer than ten

Explanation

Reduced fetal movements from 24 weeks onward warrant prompt assessment rather than a period of maternal counting at home. The midwife should arrange same-day review with auscultation and, where indicated, cardiotocography and ultrasound. This reflects the recognised association between reduced movements and adverse outcomes.

Question 10Antenatal Care and Midwifery Assessment

Which screening test is offered at the 18–20 week anomaly scan in addition to fetal structural assessment?

  1. Assessment of placental site and cervical appearance Correct answer.
  2. Measurement of cervical length to predict preterm birth
  3. Oral glucose tolerance testing
  4. Doppler assessment of the umbilical artery

Explanation

The mid-trimester scan includes assessment of placental position and the cervix as well as fetal anatomy, since a low-lying placenta identified then can be followed up later. Cervical length, umbilical artery Doppler, and glucose testing are not part of the routine anomaly scan. Placental localisation has direct implications for birth planning and bleeding risk.

Question 11Antenatal Care and Midwifery Assessment

A woman with a body mass index of 34 kg/m² books at 9 weeks. Which antenatal intervention is specifically recommended for her?

  1. Serial cervical length measurement from 16 weeks
  2. Routine growth scans every two weeks from 24 weeks
  3. Routine aspirin from 12 weeks regardless of other risk factors
  4. Early screening for gestational diabetes with a glucose tolerance test Correct answer.

Explanation

Obesity is a recognised risk factor for gestational diabetes, and early testing with a glucose tolerance test is recommended rather than waiting for the usual 24–28 week window. Aspirin is indicated for pre-eclampsia risk, which depends on additional factors. Serial cervical length and fortnightly growth scans are not standard for obesity alone.

Question 12Antenatal Care and Midwifery Assessment

Which statement about the oral glucose tolerance test at 24–28 weeks is correct?

  1. The test should be deferred until 34 weeks for accurate results
  2. The woman should fast overnight and have blood sampled before and after a glucose load Correct answer.
  3. A single random plasma glucose is sufficient to diagnose gestational diabetes
  4. The test can be performed at any time of day without fasting

Explanation

The oral glucose tolerance test requires an overnight fast, a fasting sample, then a measured glucose load with further samples at defined intervals. Standardisation of fasting and timing is what makes the thresholds interpretable. Random glucose and delayed testing do not fulfil these conditions.

Question 13Antenatal Care and Midwifery Assessment

A woman at 32 weeks has a haemoglobin of 95 g/L with a ferritin within the normal range. Which interpretation is most appropriate?

  1. She should be transfused to restore haemoglobin before birth
  2. Iron deficiency is excluded by the normal ferritin, so other causes and the need for treatment should be reviewed Correct answer.
  3. The result is invalid because haemoglobin cannot be measured after 28 weeks
  4. This is physiological haemodilution and requires no action

Explanation

Plasma volume expansion lowers haemoglobin, but a value of 95 g/L is below the threshold regarded as acceptable in the third trimester. A normal ferritin makes iron deficiency less likely, so other causes should be considered and treatment decisions reviewed. Transfusion is reserved for severe symptomatic anaemia and is not indicated here.

Question 14Antenatal Care and Midwifery Assessment

Which vaccine is routinely recommended in the third trimester to protect the newborn?

  1. Oral live typhoid vaccine
  2. Live attenuated varicella vaccine
  3. Measles–mumps–rubella vaccine
  4. Pertussis-containing (Tdap) vaccine Correct answer.

Explanation

Pertussis vaccination in pregnancy transfers protective antibody across the placenta and reduces severe pertussis in young infants before their own immunisation begins. Live vaccines are generally avoided in pregnancy because of theoretical fetal risk. The timing in the third trimester maximises antibody transfer.

Question 15Antenatal Care and Midwifery Assessment

A woman at 36 weeks has a singleton breech presentation confirmed on ultrasound. Which option should the midwife discuss first, assuming no contraindication?

  1. External cephalic version offered from around 37 weeks Correct answer.
  2. Immediate caesarean section at 37 weeks
  3. Awaiting spontaneous version until the onset of labour
  4. Vaginal breech birth as the default plan

Explanation

External cephalic version from around 37 weeks in an uncomplicated singleton breech increases the chance of cephalic presentation and vaginal birth. It should be discussed and offered before planning caesarean or vaginal breech birth. Spontaneous version becomes less likely as term approaches.

Question 16Antenatal Care and Midwifery Assessment

Which pre-eclampsia risk profile meets the threshold for aspirin prophylaxis starting before 16 weeks?

  1. Two moderate risk factors such as first pregnancy and a family history of pre-eclampsia Correct answer.
  2. A body mass index of 23 kg/m²
  3. A single previous uncomplicated term birth
  4. Mild intermittent asthma

Explanation

Prophylactic low-dose aspirin is recommended when there is one high risk factor or two or more moderate risk factors for pre-eclampsia. First pregnancy and a family history are both moderate factors, so together they meet the threshold. Aspirin should be started before 16 weeks and continued to birth.

Question 17Antenatal Care and Midwifery Assessment

A woman at 15 weeks reports a two-day history of vulval itching and a thick white discharge. Which action is most appropriate?

  1. Prescribe oral fluconazole as first-line treatment
  2. Advise topical clotrimazole and arrange review if symptoms persist Correct answer.
  3. Arrange immediate induction of labour
  4. Reassure her that discharge always increases in pregnancy and take no action

Explanation

Vulvovaginal candidiasis is common in pregnancy and topical imidazole treatment is effective and safe. Oral azoles are generally avoided in pregnancy because of fetal safety concerns. Reassurance alone leaves a treatable infection unaddressed.

Question 18Antenatal Care and Midwifery Assessment

Which sonographic finding at the anomaly scan most strongly suggests the need for serial growth surveillance?

  1. Mild unilateral pyelectasis that resolves
  2. A two-vessel cord with normal fetal biometry
  3. A choroid plexus cyst with otherwise normal anatomy
  4. A single umbilical artery Correct answer.

Explanation

A single umbilical artery is associated with renal and cardiac anomalies and with impaired fetal growth, so serial growth assessment is recommended even when the initial scan is otherwise normal. This reflects the increased risk of growth restriction. The other findings are either isolated soft markers or transient.

Question 19Antenatal Care and Midwifery Assessment

A woman at 20 weeks reports a burning sensation on urination and urinary frequency. Which is the most appropriate management?

  1. Send a midstream urine sample and treat empirically if symptomatic, with culture-guided adjustment Correct answer.
  2. Prescribe a tetracycline antibiotic
  3. Withhold treatment until the culture result returns in 48 hours
  4. Advise increased oral fluids and review in one week

Explanation

Symptomatic urinary tract infection in pregnancy should be treated promptly because of the risk of progression to pyelonephritis and preterm birth. A urine sample is sent for culture, but treatment should not be delayed for the result. Tetracyclines are contraindicated in pregnancy because of effects on fetal teeth and bone.

Question 20Antenatal Care and Midwifery Assessment

Which statement about screening for asymptomatic bacteriuria in pregnancy is correct?

  1. It only matters in women with a history of urinary infection
  2. It is unnecessary because asymptomatic bacteriuria resolves spontaneously
  3. It can be excluded by dipstick testing alone without culture
  4. It should be screened for at booking with a midstream urine culture and treated if positive Correct answer.

Explanation

Asymptomatic bacteriuria affects a significant minority of pregnant women and, if untreated, substantially increases the risk of pyelonephritis and preterm birth. Screening is by midstream urine culture at booking and treatment is guided by sensitivities. Dipstick testing is insufficiently sensitive to replace culture.

Question 21Antenatal Care and Midwifery Assessment

A woman with a previous caesarean section is planning a vaginal birth. Which antenatal discussion point is most important?

  1. She should be advised against vaginal birth in all circumstances
  2. The relative risks of planned vaginal birth and elective repeat caesarean should be discussed and documented Correct answer.
  3. The risk of uterine rupture is negligible and need not be mentioned
  4. A repeat caesarean is automatically booked unless she refuses

Explanation

Women with a previous caesarean should receive balanced information about the chances of successful vaginal birth and the comparative risks of uterine rupture, hysterectomy, and neonatal outcomes for each mode. The decision is made jointly and documented. Neither option should be imposed.

Question 22Antenatal Care and Midwifery Assessment

A midwife is assessing a woman at 12 weeks who reports palpitations and heat intolerance. Which finding would most raise concern for hyperthyroidism rather than normal pregnancy adaptation?

  1. Mild fatigue relieved by rest
  2. A resting pulse of 88 beats per minute
  3. A blood pressure of 110/68 mmHg
  4. A small, diffuse, non-tender goitre with tremor and weight loss Correct answer.

Explanation

Pregnancy normally increases heart rate and can slightly enlarge the thyroid, but a diffuse goitre with tremor and weight loss suggests thyrotoxicosis. These features exceed normal physiological adaptation and require thyroid function testing. Isolated mild tachycardia or fatigue is common in normal pregnancy.

Question 23Antenatal Care and Midwifery Assessment

Which approach best supports a woman with tokophobia during antenatal care?

  1. Avoid discussing birth until the third trimester to reduce anxiety
  2. Reassure her that everyone is anxious and no further action is needed
  3. Recommend elective caesarean section as the first-line solution
  4. Explore the fear, offer continuity of carer, and involve perinatal mental health support where needed Correct answer.

Explanation

Tokophobia is a specific and disabling fear of childbirth that benefits from early exploration, continuity of carer, and psychological support. Perinatal mental health services should be involved when the fear is severe or affects function. Avoidance and blanket reassurance allow the anxiety to persist untreated.

Question 24Antenatal Care and Midwifery Assessment

A woman at 34 weeks has a blood pressure of 138/88 mmHg and a platelet count of 95 × 10⁹/L. Which interpretation is most appropriate?

  1. Thrombocytopenia with borderline hypertension warrants prompt assessment for pre-eclampsia and HELLP syndrome Correct answer.
  2. She should be reassured and reviewed at 36 weeks
  3. Both values are normal for gestation and require no action
  4. The platelet count indicates immune thrombocytopenia unrelated to pregnancy

Explanation

A platelet count below 100 × 10⁹/L in later pregnancy, particularly with borderline hypertension, raises concern for pre-eclampsia with haematological involvement or HELLP syndrome. Prompt assessment with liver enzymes, blood film, and blood pressure monitoring is needed. Waiting two weeks could allow serious deterioration.

Question 25Antenatal Care and Midwifery Assessment

Which factor most increases the likelihood that a midwife should offer a woman antenatal screening for sickle cell disease?

  1. The woman lives in an urban area
  2. The woman is of white European origin
  3. The woman has had two previous uncomplicated pregnancies
  4. The woman's partner is known to be a carrier of a haemoglobinopathy Correct answer.

Explanation

Screening for sickle cell and thalassaemia is offered universally, but a partner known to be a carrier raises the risk of an affected fetus and makes prompt testing and genetic counselling particularly important. Family origin and family history are the other main factors used to target testing. Geographic residence alone is not a criterion.

Question 26Antenatal Care and Midwifery Assessment

A woman books at 10 weeks and asks why her midwife is calculating a body mass index rather than simply recording her weight. Which statement best explains the purpose of recording BMI at booking?

  1. It identifies women who need a higher or lower gestational weight-gain trajectory and targeted nutrition or anaesthetic planning. Correct answer.
  2. It determines the woman's blood group and therefore her need for anti-D prophylaxis.
  3. It predicts the exact birth weight of the baby so that paediatric staffing can be arranged in advance.
  4. It replaces the need for any further weight measurement throughout the remainder of pregnancy.

Explanation

Booking BMI is used to stratify risk and tailor care, because both low and high BMI are linked to outcomes such as fetal growth restriction, gestational diabetes, pre-eclampsia, thromboembolism and anaesthetic difficulty. It informs weight-gain advice, referral thresholds and birth planning, but it does not predict individual birth weight or replace later assessment.

Question 27Antenatal Care and Midwifery Assessment

At a 16-week antenatal review, a woman mentions that her mother and sister both had pre-eclampsia. She has no other risk factors. Which action reflects correct application of pre-eclampsia risk assessment?

  1. Reassure her that family history alone does not alter recommended care.
  2. Arrange immediate admission for observation and steroid administration.
  3. Recommend aspirin 75–150 mg daily from before 16 weeks, continuing to 36 weeks. Correct answer.
  4. Repeat her blood pressure measurement only at the routine 25-week contact.

Explanation

A first-degree family history of pre-eclampsia is a recognised moderate risk factor, and national guidance recommends low-dose aspirin for women with one high or two moderate risk factors, started before 16 weeks and continued to 36 weeks. Aspirin reduces the risk of preterm pre-eclampsia and should be offered rather than deferred.

Question 28Antenatal Care and Midwifery Assessment

A woman at 28 weeks reports a single episode of light vaginal bleeding after intercourse, with no pain and normal fetal movements. Which initial midwifery action is most appropriate?

  1. Recommend a course of vaginal antifungal treatment without examination.
  2. Advise her that post-coital bleeding is always benign and needs no review.
  3. Arrange urgent assessment of maternal observations and fetal wellbeing, and refer for speculum and ultrasound assessment. Correct answer.
  4. Book her for a routine repeat appointment at 31 weeks.

Explanation

Any antepartum bleeding must be taken seriously until placenta praevia, placental abruption and cervical or vaginal pathology are excluded. The midwife should arrange same-day assessment of maternal observations and fetal wellbeing and ensure speculum and ultrasound evaluation, while avoiding digital vaginal examination until praevia is excluded.

Question 29Antenatal Care and Midwifery Assessment

During a 24-week consultation, a woman discloses that her partner has physically assaulted her twice since she became pregnant. She asks that nothing be shared. Which response best reflects midwifery responsibilities?

  1. Advise her to return only when she feels ready to discuss the issue further.
  2. Promise complete confidentiality and record nothing in the maternity notes.
  3. Explain that safeguarding information may be shared on a need-to-know basis, provide domestic abuse support, and follow local safeguarding referral pathways with her involvement. Correct answer.
  4. Tell her that the police will be informed immediately regardless of her wishes.

Explanation

Domestic abuse in pregnancy is a safeguarding concern, and the midwife should be transparent about the limits of confidentiality while supporting the woman's choices. Information is shared on a need-to-know basis, and referral to specialist domestic abuse services and safeguarding leads should be made with the woman's involvement wherever it is safe to do so.

Question 30Antenatal Care and Midwifery Assessment

A woman at 30 weeks has a symphyseal–fundal height plotted on her customised chart that lies on the 50th centile. At 33 weeks the measurement is unchanged. Which interpretation and action is most appropriate?

  1. Interpret it as a sign of polyhydramnios and refer for immediate amnioreduction.
  2. Repeat the measurement in four weeks to confirm the trend.
  3. This is normal because fundal height plateaus in the third trimester; no action needed.
  4. A static measurement across three weeks suggests inadequate growth; arrange ultrasound assessment of fetal growth and liquor volume. Correct answer.

Explanation

Fundal height should increase steadily after 24 weeks, and a static measurement across successive visits is a recognised trigger for ultrasound assessment of growth and amniotic fluid. Serial plotting against customised charts is used to detect growth restriction, and unexplained static growth warrants investigation rather than reassurance.

Question 31Antenatal Care and Midwifery Assessment

Which statement about the midwife's role in the 20-week fetal anomaly screening scan is correct?

  1. The scan replaces the need for any later growth assessment in pregnancy.
  2. The scan is mandatory and refusal should be recorded as a safeguarding concern.
  3. The midwife should give information before the scan and ensure the woman understands that screening is optional and that not all anomalies are detected. Correct answer.
  4. The midwife performs the scan and interprets the images independently of a sonographer.

Explanation

The midwife's role is to support informed choice by explaining the purpose and limitations of the anomaly scan before it happens, including that it is optional and cannot exclude every condition. Counselling after unexpected findings is also part of the role, alongside referral to fetal medicine where needed.

Question 32Antenatal Care and Midwifery Assessment

A woman with a body mass index of 38 kg/m² attends her booking appointment. Which antenatal action is specifically recommended because of her BMI?

  1. Offer referral to a dietitian and consultant-led care with assessment for thromboprophylaxis and anaesthetic review. Correct answer.
  2. Arrange delivery by caesarean section at 34 weeks as a planned approach.
  3. Advise her to avoid all weight monitoring for the whole pregnancy.
  4. Recommend routine early induction of labour at 37 weeks for all women with this BMI.

Explanation

A booking BMI of 35 kg/m² or above places a woman in a higher-risk category, prompting consultant-led care, dietetic input, individualised assessment of venous thromboembolism risk and early anaesthetic review. These measures address the increased risks of thromboembolism, gestational diabetes, pre-eclampsia and intrapartum difficulty.

Question 33Antenatal Care and Midwifery Assessment

A woman at 12 weeks has a booking haemoglobin of 108 g/L with a normal ferritin. Which interpretation is most appropriate?

  1. This is unrelated to pregnancy and should be ignored until after birth.
  2. This indicates thalassaemia major and requires urgent haematology admission.
  3. This is physiological haemodilution of pregnancy; no iron supplementation is needed on the basis of haemoglobin alone. Correct answer.
  4. This confirms iron-deficiency anaemia and requires immediate intravenous iron.

Explanation

Plasma volume expands more than red cell mass in pregnancy, lowering haemoglobin concentration, so a value around 108 g/L at 12 weeks with normal iron stores is consistent with physiological dilution. Iron studies, particularly ferritin, guide whether supplementation is needed, and a normal ferritin argues against iron deficiency.

Question 34Antenatal Care and Midwifery Assessment

A woman at 34 weeks reports a persistent headache and visual disturbance. Her blood pressure is 150/95 mmHg and urine dipstick shows 2+ protein. Which action should the midwife take?

  1. Recommend increasing fluid intake and resting at home for 24 hours.
  2. Advise paracetamol and a review at the next routine appointment.
  3. Defer assessment until a second blood pressure reading can be taken a week later.
  4. Arrange immediate assessment in an obstetric unit for suspected pre-eclampsia, including blood tests and fetal monitoring. Correct answer.

Explanation

Headache and visual disturbance with hypertension and proteinuria are red-flag features of pre-eclampsia, which can deteriorate rapidly and lead to eclampsia, HELLP syndrome or placental abruption. Same-day obstetric assessment with blood tests, blood pressure management and fetal monitoring is required.

Question 35Antenatal Care and Midwifery Assessment

A woman asks at 11 weeks about screening for Down syndrome. She is unsure whether she wants testing. Which approach best supports informed choice?

  1. Advise her that declining screening is irresponsible and should be reconsidered.
  2. Explain only the diagnostic test because it gives a definite answer.
  3. Explain the difference between screening and diagnostic testing, discuss options and timing, and support her decision without pressure. Correct answer.
  4. Book the combined test automatically because it is part of routine care.

Explanation

Informed choice requires the midwife to explain that screening estimates risk while diagnostic testing gives a definitive answer, along with the timing, benefits and limitations of each option. The woman's decision, including declining testing, must be respected and documented without pressure.

Question 36Antenatal Care and Midwifery Assessment

A woman at 36 weeks has a singleton pregnancy and a previous caesarean birth. She asks about planning for birth. Which antenatal discussion point is most important for the midwife to cover?

  1. The relative risks and benefits of planned vaginal birth versus elective repeat caesarean, including uterine rupture and success rates. Correct answer.
  2. That induction of labour is always the preferred option after a previous caesarean.
  3. That vaginal birth is contraindicated after any caesarean section.
  4. That no additional monitoring is required in labour after a previous caesarean.

Explanation

Women with a previous caesarean should receive balanced information about planned vaginal birth and elective repeat caesarean, covering success rates, uterine rupture risk and the need for continuous fetal monitoring in labour. The decision is shared and should be documented in the antenatal period.

Question 37Intrapartum Care and Fetal Monitoring

During a vaginal examination in active labour, the midwife notes the sagittal suture in the right oblique diameter with the anterior fontanelle directed toward the maternal right acetabulum. Which fetal position does this describe?

  1. Right occipito-posterior
  2. Right occipito-anterior Correct answer.
  3. Left occipito-anterior
  4. Direct occipito-posterior

Explanation

In a right occipito-anterior position the occiput (and therefore the anterior fontanelle) lies toward the maternal right acetabulum, and the sagittal suture runs in the right oblique diameter of the pelvis. A posterior position would place the anterior fontanelle toward the sacroiliac joint rather than the acetabulum.

Question 38Intrapartum Care and Fetal Monitoring

A CTG shows a baseline of 140 bpm with accelerations of 20 bpm lasting 20 seconds. According to standard classification, how is this trace categorised?

  1. Category III (abnormal)
  2. Preterminal
  3. Category II (indeterminate)
  4. Category I (normal) Correct answer.

Explanation

A Category I trace requires a baseline of 110–160 bpm, moderate variability, no late or variable decelerations, and accelerations that may be present or absent. The described accelerations and baseline fit this normal category, so no further intervention beyond routine observation is indicated.

Question 39Intrapartum Care and Fetal Monitoring

During the second stage, the midwife observes a gush of clear fluid followed by a sudden prolonged deceleration to 70 bpm. What is the most appropriate immediate action?

  1. Administer a tocolytic and await further tracing
  2. Document the finding and continue pushing as normal
  3. Perform a fetal scalp blood sample immediately
  4. Reposition the woman to her left side and call for senior obstetric review Correct answer.

Explanation

A sudden prolonged deceleration after rupture of membranes may indicate cord prolapse, and the priority is to relieve cord compression by changing maternal position while urgently summoning senior help. Immediate repositioning and escalation allow preparation for expedited delivery if the deceleration persists.

Question 40Intrapartum Care and Fetal Monitoring

A primigravida at 6 cm dilatation has a contraction frequency of two in ten minutes, each lasting 30 seconds. Which finding does this represent?

  1. Hypertonic uterine dysfunction
  2. Tachysystole
  3. Normal active-phase contractions
  4. Inadequate uterine activity Correct answer.

Explanation

Adequate active-phase contractions are typically three to five in ten minutes, each lasting 45–60 seconds. Two contractions of 30 seconds suggest inadequate uterine activity, which may slow progress and warrants assessment of membranes, position and the need for augmentation.

Question 41Intrapartum Care and Fetal Monitoring

Which finding on vaginal examination best supports a diagnosis of full dilatation in a woman with an epidural in situ?

  1. No cervix palpable around the presenting part Correct answer.
  2. Station at the ischial spines
  3. Presence of a caput succedaneum
  4. A thin rim of cervix anteriorly

Explanation

Full dilatation is confirmed when no cervix can be felt encircling the presenting part. A residual anterior rim indicates that dilatation is incomplete, even when the woman feels an urge to push.

Question 42Intrapartum Care and Fetal Monitoring

A woman at 39 weeks has spontaneous rupture of membranes with clear liquor and no contractions. Which management is most consistent with current midwifery guidance?

  1. Perform an immediate caesarean section
  2. Offer induction of labour or expectant management with monitoring after discussion Correct answer.
  3. Advise bed rest until contractions begin
  4. Give antibiotics prophylactically for 48 hours regardless of GBS status

Explanation

For term prelabour rupture of membranes, guidelines support offering induction of labour or expectant management with appropriate surveillance, following a shared decision with the woman. Immediate caesarean section or routine prolonged antibiotics without indication are not standard.

Question 43Intrapartum Care and Fetal Monitoring

During intermittent auscultation in the first stage, how often should the fetal heart rate be auscultated in a woman with no risk factors?

  1. Every 30 minutes for 30 seconds
  2. Every 15 minutes for one minute after a contraction Correct answer.
  3. Every 5 minutes for one minute
  4. Only on admission and in the second stage

Explanation

For low-risk labour, intermittent auscultation is performed at least every 15 minutes in the first stage, listening for a full minute after a contraction to capture the baseline and any deceleration. In the second stage the interval shortens to every 5 minutes.

Question 44Intrapartum Care and Fetal Monitoring

A CTG shows reduced baseline variability of 3 bpm with no accelerations and no decelerations. Which action is most appropriate?

  1. Reassure the woman and continue routine monitoring
  2. Immediately perform a caesarean section without further assessment
  3. Increase oxytocin to improve contraction strength
  4. Exclude reversible causes, reposition the woman and escalate for review Correct answer.

Explanation

Minimal variability without decelerations is an indeterminate feature that may reflect fetal sleep, drugs, or evolving hypoxia. The midwife should exclude reversible factors such as supine position or hypotension, stimulate the fetus and escalate for obstetric review.

Question 45Intrapartum Care and Fetal Monitoring

Which feature characterises a true labour contraction compared with Braxton Hicks contractions?

  1. Confined to the lower abdomen
  2. Associated with constant abdominal tone
  3. Irregular and relieved by rest
  4. Regular, progressively stronger with cervical change Correct answer.

Explanation

True labour contractions become regular, increase in frequency and intensity, and produce progressive cervical effacement and dilatation. Braxton Hicks contractions are irregular, often painless, and do not cause cervical change.

Question 46Intrapartum Care and Fetal Monitoring

A woman in the second stage has a Category II trace with recurrent variable decelerations. Which manoeuvre should the midwife try first?

  1. Ask the woman to push more forcefully with each contraction
  2. Change to a lateral or knee-chest position Correct answer.
  3. Administer an oxytocin bolus
  4. Perform fundal pressure

Explanation

Variable decelerations usually reflect umbilical cord compression, and maternal repositioning to lateral or knee-chest can relieve pressure on the cord. Pushing harder or applying fundal pressure would not address cord compression and may worsen fetal status.

Question 47Intrapartum Care and Fetal Monitoring

What is the definition of the station of the fetal head when it is at the level of the ischial spines?

  1. Station +4
  2. Station +2
  3. Station 0 Correct answer.
  4. Station −2

Explanation

Station is measured relative to the ischial spines, which are designated zero. When the leading point is at the spines, engagement is described as station 0; positive values indicate descent below the spines and negative values above.

Question 48Intrapartum Care and Fetal Monitoring

A woman with a previous caesarean section is in spontaneous labour with a reassuring CTG. Which monitoring approach is most appropriate?

  1. Intermittent auscultation every 15 minutes
  2. Continuous electronic fetal monitoring with readiness for urgent review Correct answer.
  3. No monitoring until the second stage
  4. Auscultation only after rupture of membranes

Explanation

A previous caesarean scar places the woman at increased risk of scar rupture, so continuous electronic fetal monitoring is recommended to detect sudden fetal heart rate changes. Intermittent auscultation would not reliably identify the abrupt deceleration associated with rupture.

Question 49Intrapartum Care and Fetal Monitoring

Which finding is most suggestive of obstructed labour in a woman who has been pushing for three hours?

  1. Bandl's ring and a rising fetal heart rate Correct answer.
  2. Clear amniotic fluid draining
  3. Progressive descent of the presenting part
  4. Regular contractions every three minutes

Explanation

A Bandl's ring, formed by retraction of the upper uterine segment, together with a rising fetal heart rate and lack of descent suggests obstructed labour and possible impending rupture. These signs require urgent obstetric review and preparation for operative delivery.

Question 50Intrapartum Care and Fetal Monitoring

What does a sinusoidal CTG pattern most strongly suggest?

  1. Normal fetal sleep
  2. Severe fetal anaemia Correct answer.
  3. Umbilical cord prolapse
  4. Maternal pyrexia

Explanation

A true sinusoidal pattern is a smooth undulating baseline with absent variability and no accelerations, and it is strongly associated with severe fetal anaemia, such as from fetomaternal haemorrhage. It is a Category III pattern requiring urgent escalation.