Mongolia Midwife Licensing Exam cheat sheet

WHO 2016 ANC model: 8 contacts (first before 12 weeks, then 20, 26, 30, 34, 36, 38, 40 weeks); replaces the older 4-visit Focused ANC model.

Estimated date of delivery: Naegele's rule - first day of last menstrual period + 280 days (or +7 days, −3 months, +1 year).

Gravida = number of pregnancies including current; para = births after 24 weeks (or 20 weeks in some definitions) regardless of outcome; GTPAL records term, preterm, abortions, living.

Symphysis-fundal height in cm approximates gestational age in weeks from about 20–36 weeks; a lag of ≥3 cm below expected warrants growth assessment.

Routine first-visit labs: haemoglobin, blood group and Rh, HIV, syphilis (VDRL), hepatitis B, urinalysis; glucose screening for gestational diabetes at 24–28 weeks.

Fetal heart rate is audible by Doppler from about 10–12 weeks and by Pinard stethoscope from 18–20 weeks; normal baseline 110–160 bpm.

Iron-folic acid supplementation: 60 mg elemental iron + 400 µg folic acid daily; folic acid 5 mg daily for women with prior neural tube defect.

Danger signs to teach at every contact: vaginal bleeding, severe headache/blurred vision, fever, reduced fetal movement, leaking fluid, convulsions.

First stage: latent phase to 5 cm with regular contractions; active phase 5–10 cm with cervical change of ≥1 cm/hour is a common reference threshold.

Partograph: plot cervical dilatation, descent, contractions, fetal heart rate, blood pressure, urine, and amniotic fluid; an action line crossing signals referral or intervention.

Second stage: full dilatation to birth; nulliparous up to 3 hours and multiparous up to 2 hours without epidural is a common non-intervention window.

Third stage: active management = prophylactic oxytocin (10 IU IM), controlled cord traction, uterine massage; reduces postpartum haemorrhage compared with expectant management.

Delayed cord clamping 1–3 minutes improves neonatal iron stores; keep the newborn warm and dry and initiate breastfeeding within the first hour.

Normal fetal heart rate 110–160 bpm; decelerations with contractions that recover quickly are typically head-compression (early) or cord-compression (variable) patterns.

Do not perform routine episiotomy; restrictive use and perineal warm compresses reduce severe perineal trauma.

Hand hygiene and sterile gloves at every vaginal examination; keep vaginal examinations to the minimum needed to assess progress.

Postpartum haemorrhage: blood loss ≥500 mL after vaginal birth or ≥1000 mL after caesarean, or any loss causing haemodynamic instability; uterine atony is the most common cause.

First-line PPH drugs: oxytocin 10 IU IM/IV, then misoprostol 800 µg sublingual or carboprost 250 µg IM; tranexamic acid 1 g IV within 3 hours of birth.

Check the 4 T's of PPH: Tone (atony), Trauma (laceration, haematoma), Tissue (retained placenta), Thrombin (coagulopathy).

Newborn: Apgar score at 1 and 5 minutes assesses heart rate, respiratory effort, muscle tone, reflex irritability, colour (0–2 each, max 10).

Newborn danger signs: not feeding, hypothermia (<36.5 °C axillary), fast breathing >60/min, severe chest indrawing, convulsions, jaundice in the first 24 hours or of the palms/soles.

Kangaroo mother care: skin-to-skin contact, exclusive breastfeeding, and early discharge reduce mortality in low-birth-weight infants.

Postpartum visits recommended at 24 hours, day 3, day 7–14, and week 6; screen for depression, anaemia, infection, and family-planning needs.

Vitamin K 1 mg IM to the newborn within 1 hour of birth prevents haemorrhagic disease of the newborn.

Pre-eclampsia: new hypertension ≥140/90 after 20 weeks plus proteinuria or end-organ signs; severe features include BP ≥160/110, platelets <100,000, elevated liver enzymes, pulmonary oedema, visual or cerebral symptoms.

Eclampsia management: magnesium sulfate loading 4 g IV + 10 g IM, then maintenance; monitor respiratory rate, urine output, and reflexes for magnesium toxicity; antidote is calcium gluconate.

Shoulder dystocia: call for help, McRoberts position, suprapubic pressure, then internal manoeuvres (Rubin II, Woods screw, delivery of posterior arm).

Obstructed labour signs: Bandl's ring, maternal exhaustion, fetal distress, and no descent; refer urgently for caesarean.

Cord prolapse: elevate the presenting part, knee-chest or Trendelenburg position, and immediate caesarean.

Gestational diabetes targets: fasting <5.3 mmol/L, 1-hour postprandial <7.8 mmol/L; insulin is preferred when diet fails.

Puerperal sepsis: fever ≥38 °C after the first 24 hours with uterine tenderness; start broad-spectrum antibiotics and refer.

Rh-negative mother with Rh-positive fetus: anti-D immunoglobulin at 28 weeks and within 72 hours of birth or sensitising event.

Emergency contraception: levonorgestrel 1.5 mg within 72 hours (best within 24 hours); copper IUD within 5 days is the most effective option.

STI screening and syndromic management: treat for the most common pathogens based on symptoms; partner notification is essential.

Cervical cancer screening: HPV testing or Pap smear from age 30 (or 21–25 in some programmes); HPV vaccination before sexual debut is most effective.

Menstrual cycle: ovulation about 14 days before the next menses; the fertile window is roughly 5 days before to 1 day after ovulation.

Infertility definition: no conception after 12 months of regular unprotected intercourse (6 months if the woman is over 35).

Post-abortion care: uterine evacuation plus contraception counselling; abortion is legal in Mongolia and should be safe and confidential.

Adolescent reproductive health: confidentiality, non-judgemental counselling, and access to contraception reduce unintended pregnancy.

Violence screening: ask about intimate partner violence privately; document and refer to support services.

LARC: implants (3–5 years) and copper IUD (10 years) have failure rates under 1%; typical-use failure is higher for pills and condoms.

Combined oral contraceptives are contraindicated with migraine with aura, smoking over 35, hypertension, and history of venous thromboembolism.

Progestogen-only methods (injectable DMPA, implants, progestin pills) are suitable during breastfeeding; DMPA may delay return of fertility.

Lactational amenorrhoea method is effective only if: exclusively breastfeeding, amenorrhoea present, and <6 months postpartum.

Emergency contraception is not an abortifacient; it prevents or delays ovulation.

Male condoms are the only method that also protects against STIs; use correctly with every act of intercourse.

Counselling: discuss effectiveness, side effects, return to fertility, and STI protection; offer a choice of methods.

Postpartum contraception can start immediately after birth; IUD insertion is safe within 48 hours or after 4 weeks.

Informed consent: the woman must understand the procedure, risks, benefits, and alternatives; consent is voluntary and can be withdrawn.

Confidentiality: health information is shared only with consent or when required by law; breaches may be disciplinary offences.

Scope of practice: midwives practise within their defined competencies; refer when care exceeds competence or resources.

Mandatory reporting: report suspected abuse, neglect, or unsafe practice to the appropriate authority.

Professional accountability: maintain competence, keep records accurate and contemporaneous, and never falsify documentation.

Respect for autonomy: support the woman's choices, including birth preferences, within safe limits.

Non-discrimination: provide care regardless of age, ethnicity, religion, disability, or HIV status.

Documentation is a legal record; errors are corrected with a single line, date, and signature, not erased.

WHO 5 moments for hand hygiene: before patient contact, before aseptic task, after body fluid exposure, after patient contact, after contact with surroundings.

Alcohol-based hand rub for visibly clean hands; soap and water when hands are visibly soiled or after contact with spore-forming organisms.

Sterile technique for invasive procedures; single-use items are never reused.

Sharps: never recap by hand; dispose immediately in puncture-resistant containers filled to no more than three-quarters.

Standard precautions apply to all patients: gloves, gown, mask, eye protection based on anticipated exposure.

Post-exposure prophylaxis: wash the site, report immediately, and start HIV PEP within 72 hours (ideally within 2 hours).

Clean, then disinfect, then sterilise - cleaning must precede disinfection and sterilisation.

Waste segregation: infectious waste in yellow bags, sharps in puncture-proof containers, and general waste separately.

Skilled birth attendance at every birth, with emergency obstetric and newborn care (EmONC) referral pathways available.

Signal functions of basic EmONC: parenteral antibiotics, oxytocics, anticonvulsants, manual placenta removal, retained products removal, assisted vaginal delivery, newborn resuscitation.

Three delays model: delay in deciding to seek care, delay in reaching care, delay in receiving care - target each.

Quality of care: safe, effective, timely, efficient, equitable, people-centred; measure with clinical audits and maternal near-miss reviews.

Respectful maternity care: dignity, privacy, informed choice, freedom from mistreatment, and a companion of choice.

Maternal death review: identify avoidable factors and act on findings; report within the required timeframe.

Continuity of care and birth preparedness plans reduce delays and improve outcomes.

Monitoring indicators: antenatal coverage, skilled birth attendance, caesarean rate, PPH case fatality, and neonatal mortality.

Evidence hierarchy: systematic reviews and randomised controlled trials rank above cohort, case-control, and expert opinion.

PICO framework: Population, Intervention, Comparison, Outcome - used to frame a clinical question.

Critical appraisal: check study design, sample size, bias, and applicability to the local population before changing practice.

Relative risk vs absolute risk: report both; number needed to treat = 1/absolute risk reduction.

Health promotion uses education, counselling, and community engagement; tailor messages to literacy and culture.

Audit cycle: define standards, measure practice, implement change, re-audit.

Informed decision-making: present benefits and harms in absolute terms and check understanding.

Research ethics: voluntary participation, informed consent, confidentiality, and ethics committee approval.

WHO 2016 ANC model: 8 contacts (first before 12 weeks, then 20, 26, 30, 34, 36, 38, 40 weeks); replaces the older 4-visit Focused ANC model.

Estimated date of delivery: Naegele's rule - first day of last menstrual period + 280 days (or +7 days, −3 months, +1 year).

Gravida = number of pregnancies including current; para = births after 24 weeks (or 20 weeks in some definitions) regardless of outcome; GTPAL records term, preterm, abortions, living.

Symphysis-fundal height in cm approximates gestational age in weeks from about 20–36 weeks; a lag of ≥3 cm below expected warrants growth assessment.

Routine first-visit labs: haemoglobin, blood group and Rh, HIV, syphilis (VDRL), hepatitis B, urinalysis; glucose screening for gestational diabetes at 24–28 weeks.

Fetal heart rate is audible by Doppler from about 10–12 weeks and by Pinard stethoscope from 18–20 weeks; normal baseline 110–160 bpm.

Iron-folic acid supplementation: 60 mg elemental iron + 400 µg folic acid daily; folic acid 5 mg daily for women with prior neural tube defect.

Danger signs to teach at every contact: vaginal bleeding, severe headache/blurred vision, fever, reduced fetal movement, leaking fluid, convulsions.

First stage: latent phase to 5 cm with regular contractions; active phase 5–10 cm with cervical change of ≥1 cm/hour is a common reference threshold.

Partograph: plot cervical dilatation, descent, contractions, fetal heart rate, blood pressure, urine, and amniotic fluid; an action line crossing signals referral or intervention.

Second stage: full dilatation to birth; nulliparous up to 3 hours and multiparous up to 2 hours without epidural is a common non-intervention window.

Third stage: active management = prophylactic oxytocin (10 IU IM), controlled cord traction, uterine massage; reduces postpartum haemorrhage compared with expectant management.

Delayed cord clamping 1–3 minutes improves neonatal iron stores; keep the newborn warm and dry and initiate breastfeeding within the first hour.

Normal fetal heart rate 110–160 bpm; decelerations with contractions that recover quickly are typically head-compression (early) or cord-compression (variable) patterns.

Do not perform routine episiotomy; restrictive use and perineal warm compresses reduce severe perineal trauma.

Hand hygiene and sterile gloves at every vaginal examination; keep vaginal examinations to the minimum needed to assess progress.

Postpartum haemorrhage: blood loss ≥500 mL after vaginal birth or ≥1000 mL after caesarean, or any loss causing haemodynamic instability; uterine atony is the most common cause.

First-line PPH drugs: oxytocin 10 IU IM/IV, then misoprostol 800 µg sublingual or carboprost 250 µg IM; tranexamic acid 1 g IV within 3 hours of birth.

Check the 4 T's of PPH: Tone (atony), Trauma (laceration, haematoma), Tissue (retained placenta), Thrombin (coagulopathy).

Newborn: Apgar score at 1 and 5 minutes assesses heart rate, respiratory effort, muscle tone, reflex irritability, colour (0–2 each, max 10).

Newborn danger signs: not feeding, hypothermia (<36.5 °C axillary), fast breathing >60/min, severe chest indrawing, convulsions, jaundice in the first 24 hours or of the palms/soles.

Kangaroo mother care: skin-to-skin contact, exclusive breastfeeding, and early discharge reduce mortality in low-birth-weight infants.

Postpartum visits recommended at 24 hours, day 3, day 7–14, and week 6; screen for depression, anaemia, infection, and family-planning needs.

Vitamin K 1 mg IM to the newborn within 1 hour of birth prevents haemorrhagic disease of the newborn.

Pre-eclampsia: new hypertension ≥140/90 after 20 weeks plus proteinuria or end-organ signs; severe features include BP ≥160/110, platelets <100,000, elevated liver enzymes, pulmonary oedema, visual or cerebral symptoms.

Eclampsia management: magnesium sulfate loading 4 g IV + 10 g IM, then maintenance; monitor respiratory rate, urine output, and reflexes for magnesium toxicity; antidote is calcium gluconate.

Shoulder dystocia: call for help, McRoberts position, suprapubic pressure, then internal manoeuvres (Rubin II, Woods screw, delivery of posterior arm).

Obstructed labour signs: Bandl's ring, maternal exhaustion, fetal distress, and no descent; refer urgently for caesarean.

Cord prolapse: elevate the presenting part, knee-chest or Trendelenburg position, and immediate caesarean.

Gestational diabetes targets: fasting <5.3 mmol/L, 1-hour postprandial <7.8 mmol/L; insulin is preferred when diet fails.

Puerperal sepsis: fever ≥38 °C after the first 24 hours with uterine tenderness; start broad-spectrum antibiotics and refer.

Rh-negative mother with Rh-positive fetus: anti-D immunoglobulin at 28 weeks and within 72 hours of birth or sensitising event.

Emergency contraception: levonorgestrel 1.5 mg within 72 hours (best within 24 hours); copper IUD within 5 days is the most effective option.

STI screening and syndromic management: treat for the most common pathogens based on symptoms; partner notification is essential.

Cervical cancer screening: HPV testing or Pap smear from age 30 (or 21–25 in some programmes); HPV vaccination before sexual debut is most effective.

Menstrual cycle: ovulation about 14 days before the next menses; the fertile window is roughly 5 days before to 1 day after ovulation.

Infertility definition: no conception after 12 months of regular unprotected intercourse (6 months if the woman is over 35).

Post-abortion care: uterine evacuation plus contraception counselling; abortion is legal in Mongolia and should be safe and confidential.

Adolescent reproductive health: confidentiality, non-judgemental counselling, and access to contraception reduce unintended pregnancy.

Violence screening: ask about intimate partner violence privately; document and refer to support services.

LARC: implants (3–5 years) and copper IUD (10 years) have failure rates under 1%; typical-use failure is higher for pills and condoms.

Combined oral contraceptives are contraindicated with migraine with aura, smoking over 35, hypertension, and history of venous thromboembolism.

Progestogen-only methods (injectable DMPA, implants, progestin pills) are suitable during breastfeeding; DMPA may delay return of fertility.

Lactational amenorrhoea method is effective only if: exclusively breastfeeding, amenorrhoea present, and <6 months postpartum.

Emergency contraception is not an abortifacient; it prevents or delays ovulation.

Male condoms are the only method that also protects against STIs; use correctly with every act of intercourse.

Counselling: discuss effectiveness, side effects, return to fertility, and STI protection; offer a choice of methods.

Postpartum contraception can start immediately after birth; IUD insertion is safe within 48 hours or after 4 weeks.

Informed consent: the woman must understand the procedure, risks, benefits, and alternatives; consent is voluntary and can be withdrawn.

Confidentiality: health information is shared only with consent or when required by law; breaches may be disciplinary offences.

Scope of practice: midwives practise within their defined competencies; refer when care exceeds competence or resources.

Mandatory reporting: report suspected abuse, neglect, or unsafe practice to the appropriate authority.

Professional accountability: maintain competence, keep records accurate and contemporaneous, and never falsify documentation.

Respect for autonomy: support the woman's choices, including birth preferences, within safe limits.

Non-discrimination: provide care regardless of age, ethnicity, religion, disability, or HIV status.

Documentation is a legal record; errors are corrected with a single line, date, and signature, not erased.

WHO 5 moments for hand hygiene: before patient contact, before aseptic task, after body fluid exposure, after patient contact, after contact with surroundings.

Alcohol-based hand rub for visibly clean hands; soap and water when hands are visibly soiled or after contact with spore-forming organisms.

Sterile technique for invasive procedures; single-use items are never reused.

Sharps: never recap by hand; dispose immediately in puncture-resistant containers filled to no more than three-quarters.

Standard precautions apply to all patients: gloves, gown, mask, eye protection based on anticipated exposure.

Post-exposure prophylaxis: wash the site, report immediately, and start HIV PEP within 72 hours (ideally within 2 hours).

Clean, then disinfect, then sterilise - cleaning must precede disinfection and sterilisation.

Waste segregation: infectious waste in yellow bags, sharps in puncture-proof containers, and general waste separately.

Skilled birth attendance at every birth, with emergency obstetric and newborn care (EmONC) referral pathways available.

Signal functions of basic EmONC: parenteral antibiotics, oxytocics, anticonvulsants, manual placenta removal, retained products removal, assisted vaginal delivery, newborn resuscitation.

Three delays model: delay in deciding to seek care, delay in reaching care, delay in receiving care - target each.

Quality of care: safe, effective, timely, efficient, equitable, people-centred; measure with clinical audits and maternal near-miss reviews.

Respectful maternity care: dignity, privacy, informed choice, freedom from mistreatment, and a companion of choice.

Maternal death review: identify avoidable factors and act on findings; report within the required timeframe.

Continuity of care and birth preparedness plans reduce delays and improve outcomes.

Monitoring indicators: antenatal coverage, skilled birth attendance, caesarean rate, PPH case fatality, and neonatal mortality.

Evidence hierarchy: systematic reviews and randomised controlled trials rank above cohort, case-control, and expert opinion.

PICO framework: Population, Intervention, Comparison, Outcome - used to frame a clinical question.

Critical appraisal: check study design, sample size, bias, and applicability to the local population before changing practice.

Relative risk vs absolute risk: report both; number needed to treat = 1/absolute risk reduction.

Health promotion uses education, counselling, and community engagement; tailor messages to literacy and culture.

Audit cycle: define standards, measure practice, implement change, re-audit.

Informed decision-making: present benefits and harms in absolute terms and check understanding.

Research ethics: voluntary participation, informed consent, confidentiality, and ethics committee approval.

WHO 2016 ANC model: 8 contacts (first before 12 weeks, then 20, 26, 30, 34, 36, 38, 40 weeks); replaces the older 4-visit Focused ANC model.

Estimated date of delivery: Naegele's rule - first day of last menstrual period + 280 days (or +7 days, −3 months, +1 year).

Gravida = number of pregnancies including current; para = births after 24 weeks (or 20 weeks in some definitions) regardless of outcome; GTPAL records term, preterm, abortions, living.

Symphysis-fundal height in cm approximates gestational age in weeks from about 20–36 weeks; a lag of ≥3 cm below expected warrants growth assessment.

Routine first-visit labs: haemoglobin, blood group and Rh, HIV, syphilis (VDRL), hepatitis B, urinalysis; glucose screening for gestational diabetes at 24–28 weeks.

Fetal heart rate is audible by Doppler from about 10–12 weeks and by Pinard stethoscope from 18–20 weeks; normal baseline 110–160 bpm.

Iron-folic acid supplementation: 60 mg elemental iron + 400 µg folic acid daily; folic acid 5 mg daily for women with prior neural tube defect.

Danger signs to teach at every contact: vaginal bleeding, severe headache/blurred vision, fever, reduced fetal movement, leaking fluid, convulsions.

First stage: latent phase to 5 cm with regular contractions; active phase 5–10 cm with cervical change of ≥1 cm/hour is a common reference threshold.

Partograph: plot cervical dilatation, descent, contractions, fetal heart rate, blood pressure, urine, and amniotic fluid; an action line crossing signals referral or intervention.

Second stage: full dilatation to birth; nulliparous up to 3 hours and multiparous up to 2 hours without epidural is a common non-intervention window.

Third stage: active management = prophylactic oxytocin (10 IU IM), controlled cord traction, uterine massage; reduces postpartum haemorrhage compared with expectant management.

Delayed cord clamping 1–3 minutes improves neonatal iron stores; keep the newborn warm and dry and initiate breastfeeding within the first hour.

Normal fetal heart rate 110–160 bpm; decelerations with contractions that recover quickly are typically head-compression (early) or cord-compression (variable) patterns.

Do not perform routine episiotomy; restrictive use and perineal warm compresses reduce severe perineal trauma.

Hand hygiene and sterile gloves at every vaginal examination; keep vaginal examinations to the minimum needed to assess progress.

Postpartum haemorrhage: blood loss ≥500 mL after vaginal birth or ≥1000 mL after caesarean, or any loss causing haemodynamic instability; uterine atony is the most common cause.

First-line PPH drugs: oxytocin 10 IU IM/IV, then misoprostol 800 µg sublingual or carboprost 250 µg IM; tranexamic acid 1 g IV within 3 hours of birth.

Check the 4 T's of PPH: Tone (atony), Trauma (laceration, haematoma), Tissue (retained placenta), Thrombin (coagulopathy).

Newborn: Apgar score at 1 and 5 minutes assesses heart rate, respiratory effort, muscle tone, reflex irritability, colour (0–2 each, max 10).

Newborn danger signs: not feeding, hypothermia (<36.5 °C axillary), fast breathing >60/min, severe chest indrawing, convulsions, jaundice in the first 24 hours or of the palms/soles.

Kangaroo mother care: skin-to-skin contact, exclusive breastfeeding, and early discharge reduce mortality in low-birth-weight infants.

Postpartum visits recommended at 24 hours, day 3, day 7–14, and week 6; screen for depression, anaemia, infection, and family-planning needs.

Vitamin K 1 mg IM to the newborn within 1 hour of birth prevents haemorrhagic disease of the newborn.

Pre-eclampsia: new hypertension ≥140/90 after 20 weeks plus proteinuria or end-organ signs; severe features include BP ≥160/110, platelets <100,000, elevated liver enzymes, pulmonary oedema, visual or cerebral symptoms.

Eclampsia management: magnesium sulfate loading 4 g IV + 10 g IM, then maintenance; monitor respiratory rate, urine output, and reflexes for magnesium toxicity; antidote is calcium gluconate.

Shoulder dystocia: call for help, McRoberts position, suprapubic pressure, then internal manoeuvres (Rubin II, Woods screw, delivery of posterior arm).

Obstructed labour signs: Bandl's ring, maternal exhaustion, fetal distress, and no descent; refer urgently for caesarean.

Cord prolapse: elevate the presenting part, knee-chest or Trendelenburg position, and immediate caesarean.

Gestational diabetes targets: fasting <5.3 mmol/L, 1-hour postprandial <7.8 mmol/L; insulin is preferred when diet fails.

Puerperal sepsis: fever ≥38 °C after the first 24 hours with uterine tenderness; start broad-spectrum antibiotics and refer.

Rh-negative mother with Rh-positive fetus: anti-D immunoglobulin at 28 weeks and within 72 hours of birth or sensitising event.

Emergency contraception: levonorgestrel 1.5 mg within 72 hours (best within 24 hours); copper IUD within 5 days is the most effective option.

STI screening and syndromic management: treat for the most common pathogens based on symptoms; partner notification is essential.

Cervical cancer screening: HPV testing or Pap smear from age 30 (or 21–25 in some programmes); HPV vaccination before sexual debut is most effective.

Menstrual cycle: ovulation about 14 days before the next menses; the fertile window is roughly 5 days before to 1 day after ovulation.

Infertility definition: no conception after 12 months of regular unprotected intercourse (6 months if the woman is over 35).

Post-abortion care: uterine evacuation plus contraception counselling; abortion is legal in Mongolia and should be safe and confidential.

Adolescent reproductive health: confidentiality, non-judgemental counselling, and access to contraception reduce unintended pregnancy.

Violence screening: ask about intimate partner violence privately; document and refer to support services.

LARC: implants (3–5 years) and copper IUD (10 years) have failure rates under 1%; typical-use failure is higher for pills and condoms.

Combined oral contraceptives are contraindicated with migraine with aura, smoking over 35, hypertension, and history of venous thromboembolism.

Progestogen-only methods (injectable DMPA, implants, progestin pills) are suitable during breastfeeding; DMPA may delay return of fertility.

Lactational amenorrhoea method is effective only if: exclusively breastfeeding, amenorrhoea present, and <6 months postpartum.

Emergency contraception is not an abortifacient; it prevents or delays ovulation.

Male condoms are the only method that also protects against STIs; use correctly with every act of intercourse.

Counselling: discuss effectiveness, side effects, return to fertility, and STI protection; offer a choice of methods.

Postpartum contraception can start immediately after birth; IUD insertion is safe within 48 hours or after 4 weeks.

Informed consent: the woman must understand the procedure, risks, benefits, and alternatives; consent is voluntary and can be withdrawn.

Confidentiality: health information is shared only with consent or when required by law; breaches may be disciplinary offences.

Scope of practice: midwives practise within their defined competencies; refer when care exceeds competence or resources.

Mandatory reporting: report suspected abuse, neglect, or unsafe practice to the appropriate authority.

Professional accountability: maintain competence, keep records accurate and contemporaneous, and never falsify documentation.

Respect for autonomy: support the woman's choices, including birth preferences, within safe limits.

Non-discrimination: provide care regardless of age, ethnicity, religion, disability, or HIV status.

Documentation is a legal record; errors are corrected with a single line, date, and signature, not erased.

WHO 5 moments for hand hygiene: before patient contact, before aseptic task, after body fluid exposure, after patient contact, after contact with surroundings.

Alcohol-based hand rub for visibly clean hands; soap and water when hands are visibly soiled or after contact with spore-forming organisms.

Sterile technique for invasive procedures; single-use items are never reused.

Sharps: never recap by hand; dispose immediately in puncture-resistant containers filled to no more than three-quarters.

Standard precautions apply to all patients: gloves, gown, mask, eye protection based on anticipated exposure.

Post-exposure prophylaxis: wash the site, report immediately, and start HIV PEP within 72 hours (ideally within 2 hours).

Clean, then disinfect, then sterilise - cleaning must precede disinfection and sterilisation.

Waste segregation: infectious waste in yellow bags, sharps in puncture-proof containers, and general waste separately.

Skilled birth attendance at every birth, with emergency obstetric and newborn care (EmONC) referral pathways available.

Signal functions of basic EmONC: parenteral antibiotics, oxytocics, anticonvulsants, manual placenta removal, retained products removal, assisted vaginal delivery, newborn resuscitation.

Three delays model: delay in deciding to seek care, delay in reaching care, delay in receiving care - target each.

Quality of care: safe, effective, timely, efficient, equitable, people-centred; measure with clinical audits and maternal near-miss reviews.

Respectful maternity care: dignity, privacy, informed choice, freedom from mistreatment, and a companion of choice.

Maternal death review: identify avoidable factors and act on findings; report within the required timeframe.

Continuity of care and birth preparedness plans reduce delays and improve outcomes.

Monitoring indicators: antenatal coverage, skilled birth attendance, caesarean rate, PPH case fatality, and neonatal mortality.

Evidence hierarchy: systematic reviews and randomised controlled trials rank above cohort, case-control, and expert opinion.

PICO framework: Population, Intervention, Comparison, Outcome - used to frame a clinical question.

Critical appraisal: check study design, sample size, bias, and applicability to the local population before changing practice.

Relative risk vs absolute risk: report both; number needed to treat = 1/absolute risk reduction.

Health promotion uses education, counselling, and community engagement; tailor messages to literacy and culture.

Audit cycle: define standards, measure practice, implement change, re-audit.

Informed decision-making: present benefits and harms in absolute terms and check understanding.

Research ethics: voluntary participation, informed consent, confidentiality, and ethics committee approval.

WHO 2016 ANC model: 8 contacts (first before 12 weeks, then 20, 26, 30, 34, 36, 38, 40 weeks); replaces the older 4-visit Focused ANC model.

Estimated date of delivery: Naegele's rule - first day of last menstrual period + 280 days (or +7 days, −3 months, +1 year).

Gravida = number of pregnancies including current; para = births after 24 weeks (or 20 weeks in some definitions) regardless of outcome; GTPAL records term, preterm, abortions, living.

Symphysis-fundal height in cm approximates gestational age in weeks from about 20–36 weeks; a lag of ≥3 cm below expected warrants growth assessment.

Routine first-visit labs: haemoglobin, blood group and Rh, HIV, syphilis (VDRL), hepatitis B, urinalysis; glucose screening for gestational diabetes at 24–28 weeks.

Fetal heart rate is audible by Doppler from about 10–12 weeks and by Pinard stethoscope from 18–20 weeks; normal baseline 110–160 bpm.

Iron-folic acid supplementation: 60 mg elemental iron + 400 µg folic acid daily; folic acid 5 mg daily for women with prior neural tube defect.

Danger signs to teach at every contact: vaginal bleeding, severe headache/blurred vision, fever, reduced fetal movement, leaking fluid, convulsions.

First stage: latent phase to 5 cm with regular contractions; active phase 5–10 cm with cervical change of ≥1 cm/hour is a common reference threshold.

Partograph: plot cervical dilatation, descent, contractions, fetal heart rate, blood pressure, urine, and amniotic fluid; an action line crossing signals referral or intervention.

Second stage: full dilatation to birth; nulliparous up to 3 hours and multiparous up to 2 hours without epidural is a common non-intervention window.

Third stage: active management = prophylactic oxytocin (10 IU IM), controlled cord traction, uterine massage; reduces postpartum haemorrhage compared with expectant management.

Delayed cord clamping 1–3 minutes improves neonatal iron stores; keep the newborn warm and dry and initiate breastfeeding within the first hour.

Normal fetal heart rate 110–160 bpm; decelerations with contractions that recover quickly are typically head-compression (early) or cord-compression (variable) patterns.

Do not perform routine episiotomy; restrictive use and perineal warm compresses reduce severe perineal trauma.

Hand hygiene and sterile gloves at every vaginal examination; keep vaginal examinations to the minimum needed to assess progress.

Postpartum haemorrhage: blood loss ≥500 mL after vaginal birth or ≥1000 mL after caesarean, or any loss causing haemodynamic instability; uterine atony is the most common cause.

First-line PPH drugs: oxytocin 10 IU IM/IV, then misoprostol 800 µg sublingual or carboprost 250 µg IM; tranexamic acid 1 g IV within 3 hours of birth.

Check the 4 T's of PPH: Tone (atony), Trauma (laceration, haematoma), Tissue (retained placenta), Thrombin (coagulopathy).

Newborn: Apgar score at 1 and 5 minutes assesses heart rate, respiratory effort, muscle tone, reflex irritability, colour (0–2 each, max 10).

Newborn danger signs: not feeding, hypothermia (<36.5 °C axillary), fast breathing >60/min, severe chest indrawing, convulsions, jaundice in the first 24 hours or of the palms/soles.

Kangaroo mother care: skin-to-skin contact, exclusive breastfeeding, and early discharge reduce mortality in low-birth-weight infants.

Postpartum visits recommended at 24 hours, day 3, day 7–14, and week 6; screen for depression, anaemia, infection, and family-planning needs.

Vitamin K 1 mg IM to the newborn within 1 hour of birth prevents haemorrhagic disease of the newborn.

Pre-eclampsia: new hypertension ≥140/90 after 20 weeks plus proteinuria or end-organ signs; severe features include BP ≥160/110, platelets <100,000, elevated liver enzymes, pulmonary oedema, visual or cerebral symptoms.

Eclampsia management: magnesium sulfate loading 4 g IV + 10 g IM, then maintenance; monitor respiratory rate, urine output, and reflexes for magnesium toxicity; antidote is calcium gluconate.

Shoulder dystocia: call for help, McRoberts position, suprapubic pressure, then internal manoeuvres (Rubin II, Woods screw, delivery of posterior arm).

Obstructed labour signs: Bandl's ring, maternal exhaustion, fetal distress, and no descent; refer urgently for caesarean.

Cord prolapse: elevate the presenting part, knee-chest or Trendelenburg position, and immediate caesarean.

Gestational diabetes targets: fasting <5.3 mmol/L, 1-hour postprandial <7.8 mmol/L; insulin is preferred when diet fails.

Puerperal sepsis: fever ≥38 °C after the first 24 hours with uterine tenderness; start broad-spectrum antibiotics and refer.

Rh-negative mother with Rh-positive fetus: anti-D immunoglobulin at 28 weeks and within 72 hours of birth or sensitising event.

Emergency contraception: levonorgestrel 1.5 mg within 72 hours (best within 24 hours); copper IUD within 5 days is the most effective option.

STI screening and syndromic management: treat for the most common pathogens based on symptoms; partner notification is essential.

Cervical cancer screening: HPV testing or Pap smear from age 30 (or 21–25 in some programmes); HPV vaccination before sexual debut is most effective.

Menstrual cycle: ovulation about 14 days before the next menses; the fertile window is roughly 5 days before to 1 day after ovulation.

Infertility definition: no conception after 12 months of regular unprotected intercourse (6 months if the woman is over 35).

Post-abortion care: uterine evacuation plus contraception counselling; abortion is legal in Mongolia and should be safe and confidential.

Adolescent reproductive health: confidentiality, non-judgemental counselling, and access to contraception reduce unintended pregnancy.

Violence screening: ask about intimate partner violence privately; document and refer to support services.

LARC: implants (3–5 years) and copper IUD (10 years) have failure rates under 1%; typical-use failure is higher for pills and condoms.

Combined oral contraceptives are contraindicated with migraine with aura, smoking over 35, hypertension, and history of venous thromboembolism.

Progestogen-only methods (injectable DMPA, implants, progestin pills) are suitable during breastfeeding; DMPA may delay return of fertility.

Lactational amenorrhoea method is effective only if: exclusively breastfeeding, amenorrhoea present, and <6 months postpartum.

Emergency contraception is not an abortifacient; it prevents or delays ovulation.

Male condoms are the only method that also protects against STIs; use correctly with every act of intercourse.

Counselling: discuss effectiveness, side effects, return to fertility, and STI protection; offer a choice of methods.

Postpartum contraception can start immediately after birth; IUD insertion is safe within 48 hours or after 4 weeks.

Informed consent: the woman must understand the procedure, risks, benefits, and alternatives; consent is voluntary and can be withdrawn.

Confidentiality: health information is shared only with consent or when required by law; breaches may be disciplinary offences.

Scope of practice: midwives practise within their defined competencies; refer when care exceeds competence or resources.

Mandatory reporting: report suspected abuse, neglect, or unsafe practice to the appropriate authority.

Professional accountability: maintain competence, keep records accurate and contemporaneous, and never falsify documentation.

Respect for autonomy: support the woman's choices, including birth preferences, within safe limits.

Non-discrimination: provide care regardless of age, ethnicity, religion, disability, or HIV status.

Documentation is a legal record; errors are corrected with a single line, date, and signature, not erased.

WHO 5 moments for hand hygiene: before patient contact, before aseptic task, after body fluid exposure, after patient contact, after contact with surroundings.

Alcohol-based hand rub for visibly clean hands; soap and water when hands are visibly soiled or after contact with spore-forming organisms.

Sterile technique for invasive procedures; single-use items are never reused.

Sharps: never recap by hand; dispose immediately in puncture-resistant containers filled to no more than three-quarters.

Standard precautions apply to all patients: gloves, gown, mask, eye protection based on anticipated exposure.

Post-exposure prophylaxis: wash the site, report immediately, and start HIV PEP within 72 hours (ideally within 2 hours).

Clean, then disinfect, then sterilise - cleaning must precede disinfection and sterilisation.

Waste segregation: infectious waste in yellow bags, sharps in puncture-proof containers, and general waste separately.

Skilled birth attendance at every birth, with emergency obstetric and newborn care (EmONC) referral pathways available.

Signal functions of basic EmONC: parenteral antibiotics, oxytocics, anticonvulsants, manual placenta removal, retained products removal, assisted vaginal delivery, newborn resuscitation.

Three delays model: delay in deciding to seek care, delay in reaching care, delay in receiving care - target each.

Quality of care: safe, effective, timely, efficient, equitable, people-centred; measure with clinical audits and maternal near-miss reviews.

Respectful maternity care: dignity, privacy, informed choice, freedom from mistreatment, and a companion of choice.

Maternal death review: identify avoidable factors and act on findings; report within the required timeframe.

Continuity of care and birth preparedness plans reduce delays and improve outcomes.

Monitoring indicators: antenatal coverage, skilled birth attendance, caesarean rate, PPH case fatality, and neonatal mortality.

Evidence hierarchy: systematic reviews and randomised controlled trials rank above cohort, case-control, and expert opinion.

PICO framework: Population, Intervention, Comparison, Outcome - used to frame a clinical question.

Critical appraisal: check study design, sample size, bias, and applicability to the local population before changing practice.

Relative risk vs absolute risk: report both; number needed to treat = 1/absolute risk reduction.

Health promotion uses education, counselling, and community engagement; tailor messages to literacy and culture.

Audit cycle: define standards, measure practice, implement change, re-audit.

Informed decision-making: present benefits and harms in absolute terms and check understanding.

Research ethics: voluntary participation, informed consent, confidentiality, and ethics committee approval.