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Kuwait MOH Midwife practice questions

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Question 1Antenatal Care and Normal Pregnancy

At a first antenatal visit at 9 weeks of gestation, which finding is the most reliable evidence that the pregnancy is intrauterine and viable?

  1. A history of amenorrhoea for 9 weeks
  2. A positive urine pregnancy test
  3. An ultrasound showing a fetal heartbeat Correct answer.
  4. A soft cervix on vaginal examination

Explanation

Visualisation of fetal cardiac activity on ultrasound confirms a living intrauterine pregnancy and is the definitive early evidence of viability. A positive pregnancy test only shows that hCG is present, and amenorrhoea and cervical softening are supportive but non-specific signs.

Question 2Antenatal Care and Normal Pregnancy

A woman at 12 weeks of gestation asks how much folic acid she should take. She has no previous affected pregnancy and no other risk factors. What is the recommended dose?

  1. 4 mg daily
  2. 1 mg daily
  3. 5 mg daily
  4. 0.4 mg daily Correct answer.

Explanation

Routine supplementation of 0.4 mg (400 micrograms) of folic acid daily is recommended for all women planning pregnancy and through the first trimester to reduce the risk of neural tube defects. Higher doses are reserved for women with specific risk factors such as a previous affected pregnancy, diabetes, or obesity.

Question 3Antenatal Care and Normal Pregnancy

At what gestational age is the routine dating ultrasound most accurate for estimating the expected date of delivery?

  1. Between 8 and 13 weeks Correct answer.
  2. Between 28 and 32 weeks
  3. Between 18 and 22 weeks
  4. Between 6 and 8 weeks

Explanation

Crown-rump length measurement between about 8 and 13 weeks gives the most accurate gestational dating, with an error of only a few days. Later scans are increasingly affected by biological variation in fetal growth and are therefore less reliable for establishing dates.

Question 4Antenatal Care and Normal Pregnancy

A pregnant woman at 26 weeks reports a sudden gush of clear fluid and continued leakage. Which initial assessment best distinguishes ruptured membranes from urinary incontinence?

  1. Measurement of maternal blood pressure
  2. Sterile speculum examination for pooling of fluid in the posterior fornix Correct answer.
  3. Abdominal palpation of fetal lie
  4. Urine dipstick for protein

Explanation

Direct visualisation of amniotic fluid pooling in the vaginal vault during sterile speculum examination is a standard clinical method for confirming membrane rupture. Palpation, urinalysis, and blood pressure measurement provide unrelated information and cannot demonstrate rupture of membranes.

Question 5Antenatal Care and Normal Pregnancy

A woman at 34 weeks has a haemoglobin of 9.0 g/dL with a mean corpuscular volume of 70 fL. Which is the most appropriate next step?

  1. Arrange an immediate blood transfusion
  2. Reassure her that haemodilution explains the result
  3. Start oral iron therapy and arrange follow-up testing Correct answer.
  4. Advise a repeat test only after delivery

Explanation

A low haemoglobin with a microcytic mean corpuscular volume suggests iron deficiency anaemia, which is common in pregnancy and treated with oral iron plus dietary advice and repeat testing. Transfusion is reserved for severe or symptomatic anaemia, and simple reassurance would leave a treatable deficiency unaddressed.

Question 6Antenatal Care and Normal Pregnancy

Which screening test performed between 24 and 28 weeks is used to detect gestational diabetes mellitus in a woman with risk factors?

  1. Oral glucose tolerance test Correct answer.
  2. Non-stress cardiotocography
  3. Cervical length measurement
  4. Group B streptococcus swab

Explanation

The oral glucose tolerance test, usually performed between 24 and 28 weeks, is the standard method for diagnosing gestational diabetes. Cardiotocography assesses fetal wellbeing, cervical length predicts preterm birth, and a streptococcus swab screens for colonisation near term.

Question 7Antenatal Care and Normal Pregnancy

A woman at 28 weeks reports regular fetal movements have reduced since yesterday. Which action should the midwife take?

  1. Arrange urgent assessment with cardiotocography and ultrasound Correct answer.
  2. Reassure her that movement patterns change in the third trimester
  3. Schedule a routine visit at the next antenatal appointment
  4. Advise her to lie on her left side and count movements for 24 hours

Explanation

Reduced fetal movements after 28 weeks require prompt assessment, including auscultation or cardiotocography and ultrasound if indicated, because they may signal fetal compromise. Delaying assessment or simple reassurance risks missing a deteriorating fetus.

Question 8Antenatal Care and Normal Pregnancy

Which supplement is routinely recommended for all pregnant women from the second trimester to support fetal skeletal development?

  1. Vitamin K
  2. Vitamin D Correct answer.
  3. Vitamin A
  4. Vitamin B12

Explanation

Vitamin D supplementation, commonly 10 micrograms daily, is recommended in pregnancy to support calcium absorption and fetal bone development and to reduce neonatal hypocalcaemia. High-dose vitamin A is avoided in pregnancy because of teratogenic risk, and vitamins K and B12 are not given routinely to all women.

Question 9Antenatal Care and Normal Pregnancy

A woman at 38 weeks has a blood pressure of 150/100 mmHg on two occasions four hours apart, with 2+ proteinuria. Which condition should the midwife suspect?

  1. Gestational hypertension without proteinuria
  2. Pre-eclampsia Correct answer.
  3. Chronic hypertension
  4. Normal pregnancy variation

Explanation

New hypertension after 20 weeks together with significant proteinuria is the classic presentation of pre-eclampsia. Gestational hypertension lacks proteinuria, chronic hypertension predates pregnancy or appears before 20 weeks, and normal pregnancy does not cause this degree of hypertension with proteinuria.

Question 10Antenatal Care and Normal Pregnancy

At 16 weeks, a woman reports mild lower abdominal cramping and a small amount of vaginal bleeding. Which is the most appropriate initial action?

  1. Advise bed rest at home for one week
  2. Schedule a routine anomaly scan at 20 weeks
  3. Reassure her that spotting is normal at this stage
  4. Arrange urgent assessment to exclude threatened miscarriage Correct answer.

Explanation

Bleeding with cramping in the second trimester warrants prompt assessment to confirm fetal viability and exclude complications such as threatened miscarriage or cervical causes. Bed rest is not an effective treatment, and reassurance without assessment is unsafe.

Question 11Antenatal Care and Normal Pregnancy

Which is the recommended position for a pregnant woman during a non-stress test to avoid supine hypotension?

  1. Prone with a pillow
  2. Standing upright
  3. Left lateral tilt Correct answer.
  4. Supine with legs elevated

Explanation

A left lateral tilt displaces the uterus off the inferior vena cava and prevents supine hypotension caused by impaired venous return. The supine position can cause dizziness and reduced placental perfusion, while prone or standing positions are unsuitable for monitoring.

Question 12Antenatal Care and Normal Pregnancy

A woman at 30 weeks has a random plasma glucose of 12 mmol/L and symptoms of polyuria and thirst. What is the most appropriate interpretation?

  1. This suggests gestational diabetes requiring further evaluation Correct answer.
  2. This suggests hyperemesis gravidarum
  3. This is a normal finding in late pregnancy
  4. This indicates gestational hypertension

Explanation

Markedly elevated random glucose with classic symptoms strongly suggests gestational diabetes and requires formal diagnostic testing and management. Normal pregnancy lowers fasting glucose, so a value of 12 mmol/L is clearly abnormal and unrelated to hypertension or hyperemesis.

Question 13Antenatal Care and Normal Pregnancy

Which routine screening is offered to pregnant women at around 28 weeks to detect anaemia?

  1. Cervical smear
  2. Full blood count Correct answer.
  3. Thyroid ultrasound
  4. Mammography

Explanation

A full blood count at around 28 weeks screens for anaemia, which becomes more common as plasma volume expands. Cervical smear, mammography, and thyroid ultrasound are not routine antenatal screening tests at this gestation.

Question 14Antenatal Care and Normal Pregnancy

A woman at 24 weeks asks about the safety of dental treatment during pregnancy. Which advice is correct?

  1. Dental radiographs are absolutely contraindicated at any stage
  2. All dental treatment must be postponed until after delivery
  3. Routine dental care and necessary treatment should not be delayed Correct answer.
  4. Only extractions are permitted during pregnancy

Explanation

Routine dental care and necessary treatment, including fillings and treatment of infection, should continue during pregnancy because untreated dental disease can harm maternal and fetal health. Necessary radiographs can be performed with appropriate shielding when clinically justified.

Question 15Antenatal Care and Normal Pregnancy

Which finding at the 20-week anomaly scan would most strongly suggest a neural tube defect?

  1. Mild pyelectasis
  2. Placenta praevia
  3. Single umbilical artery
  4. Absent or small skull vault with a lemon-shaped head Correct answer.

Explanation

An absent or small skull vault, often with a lemon-shaped head, is characteristic of anencephaly and other open neural tube defects. Placenta praevia, a single umbilical artery, and mild pyelectasis are separate findings with different implications.

Question 16Antenatal Care and Normal Pregnancy

A woman at 36 weeks has a fetus in the breech presentation confirmed by ultrasound. Which management option is most appropriate to discuss?

  1. Immediate induction of labour
  2. External cephalic version Correct answer.
  3. No discussion needed until labour begins
  4. Routine caesarean section before 37 weeks

Explanation

External cephalic version, usually offered from 36 to 37 weeks, attempts to turn the fetus to a cephalic presentation and can reduce the need for caesarean birth. Immediate induction or elective caesarean before 37 weeks is not the first-line option for an uncomplicated breech at this gestation.

Question 17Antenatal Care and Normal Pregnancy

Which test is used to screen for haemoglobinopathies in early antenatal care?

  1. Haemoglobin electrophoresis Correct answer.
  2. Clotting profile
  3. Erythrocyte sedimentation rate
  4. Platelet count

Explanation

Haemoglobin electrophoresis identifies abnormal haemoglobin variants such as sickle cell disease and thalassaemia trait, allowing early counselling and management. Clotting profile, platelet count, and sedimentation rate assess other aspects of blood and do not detect haemoglobinopathies.

Question 18Antenatal Care and Normal Pregnancy

A woman at 10 weeks has severe vomiting, weight loss, and ketonuria. Which condition should the midwife suspect?

  1. Gestational diabetes
  2. Hyperemesis gravidarum Correct answer.
  3. Gastro-oesophageal reflux disease
  4. Urinary tract infection

Explanation

Persistent severe vomiting with weight loss and ketonuria in early pregnancy suggests hyperemesis gravidarum, which may require intravenous fluids and antiemetics. Simple reflux, urinary infection, and diabetes do not typically present with this combination of severe vomiting and ketosis.

Question 19Antenatal Care and Normal Pregnancy

Which is the recommended approach to pelvic examination for a woman at 38 weeks with no complications who requests a check?

  1. Perform without explanation to save time
  2. Perform only if clinically indicated and with consent Correct answer.
  3. Refuse all examinations in late pregnancy
  4. Perform routinely on every visit

Explanation

Digital vaginal examination should be performed only when clinically indicated and with the woman's informed consent, as routine examinations add little and may cause discomfort. Respecting consent and clinical need is central to midwifery practice.

Question 20Antenatal Care and Normal Pregnancy

At 32 weeks, a woman's symphysis-fundal height measures 26 cm. What does this most likely indicate?

  1. Possible fetal growth restriction requiring assessment Correct answer.
  2. Normal growth for this gestation
  3. Multiple pregnancy
  4. Polyhydramnios

Explanation

Symphysis-fundal height generally corresponds to gestational age in centimetres between 24 and 36 weeks, so 26 cm at 32 weeks is smaller than expected and raises concern about fetal growth restriction. Ultrasound assessment of growth and liquor volume is indicated.

Question 21Antenatal Care and Normal Pregnancy

Which vaccination is routinely recommended during pregnancy to protect the newborn from pertussis?

  1. Varicella vaccine
  2. Tetanus-diphtheria-pertussis vaccine Correct answer.
  3. Yellow fever vaccine
  4. Measles-mumps-rubella vaccine

Explanation

The tetanus-diphtheria-pertussis vaccine is recommended in pregnancy, usually in the second or third trimester, so that maternal antibodies transfer to the newborn. Live vaccines such as MMR and varicella are avoided in pregnancy, and yellow fever vaccine is given only when clearly indicated.

Question 22Antenatal Care and Normal Pregnancy

A woman at 28 weeks has a blood pressure of 138/88 mmHg with no proteinuria and no symptoms. What is the most appropriate action?

  1. Start antihypertensive medication immediately
  2. Reassure her that no follow-up is needed
  3. Admit for urgent caesarean section
  4. Repeat blood pressure measurement and monitor closely Correct answer.

Explanation

A mildly elevated blood pressure without proteinuria or symptoms warrants repeat measurement and closer monitoring to detect progression to pre-eclampsia. Immediate medication, urgent delivery, or no follow-up would be disproportionate to this finding.

Question 23Antenatal Care and Normal Pregnancy

Which is the most appropriate advice for a woman at 20 weeks who asks about sleeping position?

  1. Sleep only on the right side
  2. Sleep in any comfortable position, avoiding prolonged supine posture later in pregnancy Correct answer.
  3. Sleep sitting upright every night
  4. Sleep prone throughout pregnancy

Explanation

Women may sleep in any comfortable position, but from later pregnancy they should avoid going to sleep on their back because of the association with stillbirth and supine hypotension. Prone sleeping becomes uncomfortable, and no single side is mandatory.

Question 24Antenatal Care and Normal Pregnancy

A woman at 12 weeks has a body mass index of 35. Which additional antenatal consideration is most relevant?

  1. Increased risk of gestational diabetes and pre-eclampsia Correct answer.
  2. Reduced risk of thromboembolism
  3. Lower risk of caesarean birth
  4. No change in antenatal care needs

Explanation

Maternal obesity increases the risk of gestational diabetes, pre-eclampsia, thromboembolism, and caesarean birth, so additional screening and counselling are required. It does not reduce thromboembolic risk or caesarean rates, and care needs are increased rather than unchanged.

Question 25Antenatal Care and Normal Pregnancy

Which statement best describes the purpose of the dating scan performed in the first trimester?

  1. To diagnose fetal chromosomal abnormalities definitively
  2. To establish gestational age and estimated date of delivery Correct answer.
  3. To measure cervical dilatation
  4. To assess fetal position for delivery

Explanation

The first-trimester dating scan uses crown-rump length to establish gestational age and the estimated date of delivery accurately. Definitive diagnosis of chromosomal abnormalities requires diagnostic testing, and fetal position and cervical dilatation are assessed much later in pregnancy.

Question 26Antenatal Care and Normal Pregnancy

A woman at 10 weeks of gestation attends her first antenatal visit. Which routine laboratory test should the midwife ensure is offered at this visit to detect a common pre-existing condition that can affect pregnancy?

  1. Rubella antibody titre Correct answer.
  2. Haemoglobin A1c
  3. Urine culture
  4. Full blood count

Explanation

Rubella antibody screening is offered at the first antenatal visit to identify women who are not immune, so that vaccination can be arranged after delivery and advice on avoiding infection can be given. Full blood count and urine culture are also routine but are repeated later, whereas rubella screening is specifically a first-visit test. Haemoglobin A1c is not a routine antenatal screening test in Kuwait.

Question 27Antenatal Care and Normal Pregnancy

A woman at 18 weeks of gestation has a body mass index of 34 kg/m². Which antenatal complication is she at increased risk of developing compared with women of normal body mass index?

  1. Cervical insufficiency
  2. Polyhydramnios
  3. Gestational diabetes mellitus Correct answer.
  4. Placenta praevia

Explanation

Maternal obesity is a well-established risk factor for gestational diabetes mellitus, and women with a body mass index of 30 kg/m² or more should be offered early screening. Placenta praevia, polyhydramnios, and cervical insufficiency are not primarily associated with raised maternal body mass index. The midwife should therefore ensure timely glucose testing and provide dietary advice.

Question 28Antenatal Care and Normal Pregnancy

A woman at 14 weeks of gestation reports occasional mild lower abdominal discomfort and asks whether she can continue her usual aerobic exercise. What is the most appropriate advice from the midwife?

  1. She should exercise only in the supine position.
  2. She should restrict exercise to stretching only.
  3. She should stop all exercise until after delivery.
  4. She can continue moderate-intensity exercise if she feels well. Correct answer.

Explanation

Moderate-intensity aerobic exercise is safe and recommended in uncomplicated pregnancy and helps reduce the risk of gestational diabetes and excessive weight gain. Mild occasional discomfort without bleeding or regular contractions is not a reason to stop exercise. Supine exercise should be avoided after the first trimester because of pressure on the inferior vena cava.

Question 29Antenatal Care and Normal Pregnancy

A woman at 26 weeks of gestation has a symphysis-fundal height of 23 cm. Which action should the midwife take next?

  1. Advise her to increase her dietary intake.
  2. Repeat the measurement in four weeks.
  3. Reassure her that the measurement is normal for gestation.
  4. Arrange an ultrasound scan to assess fetal growth. Correct answer.

Explanation

Symphysis-fundal height should approximately equal gestational age in weeks between 24 and 36 weeks; a measurement 3 cm below gestation suggests fetal growth restriction and warrants ultrasound assessment. Reassurance or simple dietary advice would delay diagnosis, and waiting four weeks could allow further compromise. The midwife should refer for a growth scan and review placental function.

Question 30Antenatal Care and Normal Pregnancy

A woman at 22 weeks of gestation asks about the purpose of the mid-trimester ultrasound scan. Which is the most accurate explanation the midwife should give?

  1. It detects fetal structural anomalies and assesses placental position. Correct answer.
  2. It predicts the risk of pre-eclampsia.
  3. It determines the fetal sex with complete accuracy.
  4. It confirms the estimated date of delivery.

Explanation

The mid-trimester scan at around 20–22 weeks is performed to screen for fetal structural anomalies and to assess placental location, amniotic fluid, and fetal growth. Dating is established earlier in the first trimester, and fetal sex determination is not the primary purpose. Prediction of pre-eclampsia relies on clinical risk factors and biochemical markers, not on the anomaly scan.

Question 31Antenatal Care and Normal Pregnancy

A woman at 30 weeks of gestation reports a sudden gush of clear fluid from the vagina. On examination, the midwife observes fluid pooling in the posterior fornix. Which is the most appropriate initial action?

  1. Arrange immediate transfer to the delivery suite for assessment. Correct answer.
  2. Perform a digital vaginal examination to assess cervical dilatation.
  3. Perform a speculum examination to confirm membrane rupture.
  4. Advise the woman to return home and monitor for contractions.

Explanation

A history of sudden fluid loss with pooling in the posterior fornix suggests prelabour rupture of membranes at preterm gestation, which requires assessment in a unit with facilities for fetal monitoring and neonatal care. Digital vaginal examination should be avoided because it increases the risk of infection. Speculum examination may be performed by an experienced clinician but is not the initial action before transfer.

Question 32Antenatal Care and Normal Pregnancy

A woman at 34 weeks of gestation has a haemoglobin concentration of 9.8 g/dL. Which is the most appropriate management?

  1. Arrange immediate blood transfusion.
  2. Advise iron supplementation and dietary review. Correct answer.
  3. Repeat the test after delivery.
  4. Reassure her that this is normal in pregnancy.

Explanation

A haemoglobin of 9.8 g/dL at 34 weeks indicates anaemia, which is common in pregnancy and is usually managed with oral iron supplementation and dietary advice. Reassurance is inappropriate because anaemia is associated with maternal fatigue, preterm birth, and postpartum haemorrhage. Transfusion is reserved for severe or symptomatic anaemia, and delaying repeat testing until after delivery misses the opportunity for treatment.

Question 33Antenatal Care and Normal Pregnancy

A woman at 28 weeks of gestation has a blood pressure of 146/94 mmHg on two occasions six hours apart. She has no proteinuria and no symptoms. Which is the most appropriate next step?

  1. Schedule a routine visit in four weeks.
  2. Admit her for immediate antihypertensive treatment.
  3. Arrange close monitoring with repeat blood pressure and urine testing. Correct answer.
  4. Reassure her that this blood pressure is normal in pregnancy.

Explanation

A blood pressure of 146/94 mmHg at 28 weeks meets the criteria for gestational hypertension, which requires close monitoring for progression to pre-eclampsia. Admission and antihypertensive treatment are not indicated in the absence of severe hypertension or symptoms. Reassurance is incorrect because the blood pressure is above the normal pregnancy range, and a four-week interval is too long for safe monitoring.

Question 34Antenatal Care and Normal Pregnancy

A woman at 16 weeks of gestation is rhesus negative and has a negative antibody screen. She has no history of bleeding or invasive procedures. Which is the most appropriate management regarding anti-D immunoglobulin?

  1. Test the father's blood group before deciding.
  2. Withhold anti-D immunoglobulin unless bleeding occurs.
  3. Plan anti-D immunoglobulin at 28 weeks. Correct answer.
  4. Administer anti-D immunoglobulin now.

Explanation

Routine antenatal anti-D prophylaxis is offered to all rhesus-negative women without immune anti-D at around 28 weeks, with a second dose after delivery if the baby is rhesus positive. Administration at 16 weeks is not routine in the absence of sensitising events. Withholding prophylaxis unless bleeding occurs ignores the benefit of routine antenatal prophylaxis, and paternal testing does not replace it.

Question 35Antenatal Care and Normal Pregnancy

A woman at 32 weeks of gestation has a body mass index of 36 kg/m² and a history of a previous macrosomic infant. Which additional antenatal surveillance is most appropriate?

  1. Weekly cardiotocography from 28 weeks.
  2. Routine serial growth scans every two weeks. Correct answer.
  3. No additional scans unless fundal height is abnormal.
  4. A single growth scan at 36 weeks only.

Explanation

Women with obesity and a previous macrosomic infant are at increased risk of fetal macrosomia and should be offered serial growth scans in the third trimester to detect excessive fetal growth. A single scan at 36 weeks may miss earlier acceleration, and relying on fundal height alone is less reliable in obesity. Weekly cardiotocography is not routine in the absence of other indications.

Question 36Antenatal Care and Normal Pregnancy

A woman at 24 weeks of gestation has a history of two previous second-trimester losses. Which is the most appropriate antenatal intervention to reduce the risk of recurrence?

  1. Elective caesarean section at 36 weeks.
  2. Weekly vaginal progesterone.
  3. Prophylactic cervical cerclage. Correct answer.
  4. Routine cervical length surveillance.

Explanation

A history of two or more second-trimester losses suggests cervical insufficiency, and prophylactic cervical cerclage is offered to reduce the risk of recurrence. Cervical length surveillance alone is used for women with a shorter history, and vaginal progesterone is an alternative for those with a short cervix on ultrasound. Elective caesarean section does not prevent preterm birth related to cervical insufficiency.

Question 37Intrapartum Care and Normal Birth

During the active phase of the first stage of labour, which finding best defines true progress of cervical dilatation?

  1. A steady increase in effacement with irregular mild contractions
  2. A fixed dilatation of 3 cm for six hours with intact membranes
  3. Dilatation accompanied by constant severe back pain and no change in station
  4. Progressive dilatation from 4 cm to 10 cm with regular contractions Correct answer.

Explanation

The active first stage is defined by regular contractions producing progressive cervical dilatation from about 4 cm to full dilatation. Effacement alone, a static finding, or pain without cervical change does not demonstrate active-phase progress. Recognising this pattern helps the midwife time examinations and avoid unnecessary intervention.

Question 38Intrapartum Care and Normal Birth

A woman at 38 weeks is admitted in labour. Which observation should the midwife document as a normal finding in the latent phase?

  1. Cervix fully dilated with presenting part at the perineum
  2. Cervix 2 cm dilated, 70% effaced, contractions every 8 minutes Correct answer.
  3. Cervix 6 cm dilated with urge to push
  4. Cervix 9 cm dilated with bulging membranes

Explanation

The latent phase is characterised by slow cervical change, effacement, and irregular contractions that gradually become more organised. Dilatation of 2 cm with 70% effacement and contractions eight minutes apart fits this description. The other options describe advanced active phase or second stage.

Question 39Intrapartum Care and Normal Birth

What is the recommended frequency of fetal heart rate auscultation during the active first stage for a low-risk woman?

  1. Every 15 minutes Correct answer.
  2. Every hour
  3. Only on admission
  4. Every 30 minutes

Explanation

Intermittent auscultation for low-risk labour is recommended at least every 15 minutes in the active first stage and every 5 minutes in the second stage. More frequent assessment allows early detection of fetal compromise. Hourly or admission-only checks are inadequate for safe intrapartum monitoring.

Question 40Intrapartum Care and Normal Birth

A primigravida at term has a cervix 5 cm dilated, 100% effaced, and station 0. Which term correctly describes this finding?

  1. Engagement has not occurred
  2. The presenting part is engaged Correct answer.
  3. The station indicates a floating head
  4. The cervix is not yet effaced

Explanation

Engagement is present when the widest part of the presenting part has passed the pelvic inlet, commonly recorded as station 0 or the head being two-fifths palpable abdominally. A station of 0 therefore indicates engagement. Full effacement and mid-active dilatation are consistent with this.

Question 41Intrapartum Care and Normal Birth

Which maternal position is most appropriate to encourage during the second stage when no epidural is in place and the fetal heart rate is normal?

  1. Upright or lateral positions that the woman finds comfortable Correct answer.
  2. Lithotomy with sustained breath-holding for every contraction
  3. Supine with legs in stirrups throughout
  4. Flat on the back with the head of the bed lowered

Explanation

Upright and lateral positions are associated with shorter second stages, fewer instrumental births, and better fetal oxygenation than sustained supine positions. The midwife should support the woman's choice of comfortable upright or side-lying positions. Directed prolonged breath-holding is no longer recommended.

Question 42Intrapartum Care and Normal Birth

Which sign indicates that the placenta has separated and is ready to be delivered in the third stage?

  1. A gush of blood and lengthening of the cord Correct answer.
  2. Leakage of clear fluid from the vagina
  3. Continued strong contractions with no change in the fundus
  4. A sudden drop in maternal pulse

Explanation

Placental separation is suggested by a gush of blood, lengthening of the umbilical cord, and the uterus becoming smaller and firmer. These signs guide controlled cord traction in active management. Clear fluid leakage would be amniotic fluid, not a sign of separation.

Question 43Intrapartum Care and Normal Birth

What is the correct first action when a newborn is born and the midwife notes meconium-stained liquor but the baby is vigorous and crying?

  1. Intubate and suction the trachea immediately
  2. Dry, stimulate, and keep the baby warm while assessing breathing Correct answer.
  3. Begin chest compressions
  4. Delay drying until the placenta is delivered

Explanation

A vigorous newborn with meconium-stained liquor does not require routine tracheal suction; standard care is drying, warming, stimulation, and assessment of breathing. Tracheal suction is reserved for the non-vigorous infant in consultation with neonatal services. Chest compressions are only for absent or inadequate heart rate after effective ventilation.

Question 44Intrapartum Care and Normal Birth

Which finding should prompt the midwife to perform a vaginal examination during labour?

  1. Fetal heart rate of 140 beats per minute with variability
  2. Regular contractions every three minutes with no other change
  3. A sudden urge to push in a woman who was 5 cm dilated an hour earlier Correct answer.
  4. Mild backache relieved by position change

Explanation

A sudden urge to push before full dilatation may indicate rapid progress, a malposition, or a prolapsed cord and warrants prompt assessment. Regular contractions alone, positional backache, and a normal fetal heart pattern do not by themselves require examination. Vaginal examinations should be performed for a clinical question.

Question 45Intrapartum Care and Normal Birth

A woman in active labour has a cervical dilatation of 4 cm, and membranes rupture spontaneously with clear fluid. What is the priority midwifery action?

  1. Withhold all oral fluids until delivery
  2. Perform a vaginal examination to confirm full dilatation
  3. Auscultate the fetal heart rate immediately and note the colour and time of fluid Correct answer.
  4. Advise the woman to remain strictly supine until reviewed

Explanation

After spontaneous rupture of membranes, immediate fetal auscultation detects cord compression or prolapse, and documenting the time, colour, and volume of fluid guides ongoing care. Clear fluid is reassuring, but monitoring remains essential. Routine supine restriction, immediate examination, and fasting are not indicated for uncomplicated rupture.

Question 46Intrapartum Care and Normal Birth

A nulliparous woman at 6 cm dilatation has had no cervical change for four hours with adequate contractions and ruptured membranes. What does this finding most likely represent?

  1. Active-phase arrest of labour requiring senior review Correct answer.
  2. Second-stage delay
  3. False labour
  4. Normal latent-phase prolongation

Explanation

Active-phase arrest is diagnosed when there is no cervical dilatation for at least four hours with adequate contractions, or six hours with inadequate contractions, after the active phase has begun. This situation requires senior obstetric review and consideration of augmentation or caesarean birth. It is not a normal latent-phase pattern because the woman is already at 6 cm.

Question 47Intrapartum Care and Normal Birth

Which pattern on cardiotocography is classified as normal and requires no intervention?

  1. Baseline 140 beats per minute, moderate variability, accelerations present, no decelerations Correct answer.
  2. Baseline 170 beats per minute with minimal variability
  3. Baseline 140 beats per minute with recurrent variable decelerations
  4. Baseline 110 beats per minute with late decelerations

Explanation

A normal CTG has a baseline between 110 and 160 beats per minute, moderate variability, accelerations, and no decelerations. This pattern indicates an adequately oxygenated fetus. Tachycardia, minimal variability, late decelerations, and recurrent variable decelerations are all abnormal features requiring review.

Question 48Intrapartum Care and Normal Birth

During active management of the third stage, which action is correct immediately after birth of the baby?

  1. Massage the fundus vigorously before giving a uterotonic
  2. Apply strong traction before any uterine contraction
  3. Wait 30 minutes before giving any uterotonic
  4. Administer a uterotonic, clamp the cord, and apply controlled cord traction with counter-traction Correct answer.

Explanation

Active management comprises a prophylactic uterotonic given soon after birth, controlled cord traction with suprapubic counter-traction, and assessment of uterine tone and blood loss. This reduces the risk of postpartum haemorrhage. Delaying the uterotonic, pulling before contraction, and vigorous massage before the uterotonic are unsafe practices.

Question 49Intrapartum Care and Normal Birth

A woman at 39 weeks in established labour reports a sudden gush of fluid and feels something in the vagina. What is the midwife's immediate action?

  1. Place her in a deep squatting position
  2. Ask her to push to deliver the presenting part
  3. Reassure her and continue routine auscultation in 30 minutes
  4. Perform a vaginal examination to identify a pulsating cord and call for help Correct answer.

Explanation

A sudden gush with a sensation of something in the vagina raises suspicion of cord prolapse. The midwife should perform an immediate examination to confirm the diagnosis, call for emergency help, and relieve cord compression by positioning and elevating the presenting part. Pushing or waiting would worsen fetal hypoxia.

Question 50Intrapartum Care and Normal Birth

Which measure best prevents perineal trauma during a spontaneous vaginal birth?

  1. Immediate delivery of the shoulders with strong traction
  2. Fundal pressure during crowning
  3. Routine episiotomy for all nulliparous women
  4. Warm compresses and controlled, spontaneous birth of the head Correct answer.

Explanation

Warm compresses, perineal support, and allowing the head to crown slowly reduce the likelihood of significant perineal tears. Routine episiotomy is not recommended because it increases morbidity without benefit for uncomplicated births. Fundal pressure and forceful shoulder extraction increase trauma.