I85PREP
⌘ K
Mongolia Midwife Licensing Exam study materials
Mongolia Midwife Licensing Exam study resources

Mongolia Midwife Licensing Exam practice questions

One question at a time. Build your Mongolia Midwife Licensing Exam understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Antenatal Care and Normal Pregnancy

A woman with a confirmed intrauterine pregnancy at 10 weeks' gestation asks how her due date is calculated. Using Naegele's rule, the estimated date of delivery is determined by which method?

  1. Add 9 months and 7 days to the first day of the last menstrual period Correct answer.
  2. Add 7 days to the last day of the last menstrual period and subtract 3 months
  3. Add 280 days to the date of the first positive pregnancy test
  4. Subtract 3 months from the first day of the last menstrual period and add 14 days

Explanation

Naegele's rule takes the first day of the last menstrual period, subtracts 3 months, and adds 7 days and 1 year, which is equivalent to adding about 280 days (40 weeks). The calculation depends on a reliable LMP and a regular 28-day cycle; if either is uncertain, early ultrasound is preferred for dating.

Question 2Antenatal Care and Normal Pregnancy

At a first antenatal visit, a woman reports that her last menstrual period began on 3 March. Applying Naegele's rule, her estimated date of delivery falls in which month?

  1. December Correct answer.
  2. October
  3. November
  4. January

Explanation

Subtracting 3 months from March gives December, and adding 7 days to the 3rd gives the 10th, so the EDD is 10 December of the same year. This assumes a 28-day regular cycle with ovulation around day 14.

Question 3Antenatal Care and Normal Pregnancy

Which parameter measured at the 11–14 week ultrasound is most accurate for confirming gestational age when the LMP is uncertain?

  1. Femur length
  2. Crown-rump length Correct answer.
  3. Biparietal diameter
  4. Abdominal circumference

Explanation

Between about 7 and 14 weeks, crown-rump length predicts gestational age within roughly 3 to 5 days and is the preferred dating parameter when the LMP is unreliable. Biparietal diameter, femur length, and abdominal circumference become useful later in pregnancy but are less precise in the first trimester.

Question 4Antenatal Care and Normal Pregnancy

A woman at 32 weeks' gestation has a fundal height measuring 27 cm. Which interpretation is most appropriate?

  1. The measurement is normal because fundal height is unrelated to gestational age after 28 weeks
  2. The measurement indicates polyhydramnios and should prompt immediate amnioreduction
  3. The measurement is smaller than expected and warrants further assessment for growth restriction or oligohydramnios Correct answer.
  4. The measurement confirms a multiple pregnancy and requires no further evaluation

Explanation

Between roughly 20 and 36 weeks, fundal height in centimeters approximates gestational age in weeks, so 27 cm at 32 weeks is about 5 cm below expectation. A discrepancy of 3 cm or more generally prompts ultrasound assessment of fetal growth, amniotic fluid, and placental position.

Question 5Antenatal Care and Normal Pregnancy

Which laboratory test is routinely offered at the first antenatal visit to identify women who may benefit from anti-D immunoglobulin prophylaxis?

  1. Cervical cytology
  2. Urine culture for bacteriuria
  3. Random blood glucose
  4. ABO and RhD blood group with antibody screen Correct answer.

Explanation

Determining ABO and RhD status together with an antibody screen identifies RhD-negative women who are candidates for anti-D prophylaxis and detects red cell alloimmunization. This is a standard component of the first antenatal blood panel in most national programs, including Mongolia.

Question 6Antenatal Care and Normal Pregnancy

A woman at 12 weeks' gestation has a hemoglobin of 105 g/L with normal red cell indices and no other abnormalities. What is the most appropriate action?

  1. Refer immediately for blood transfusion
  2. Diagnose iron-deficiency anemia and start parenteral iron
  3. Repeat the test only after delivery
  4. Reassure her that this is consistent with physiological hemodilution and continue routine antenatal care Correct answer.

Explanation

Plasma volume expands more than red cell mass in pregnancy, producing physiological hemodilution and lower hemoglobin values. Many programs use a threshold around 110 g/L in the first trimester and 105 g/L later, so a value of 105 g/L at 12 weeks with normal indices generally warrants monitoring and dietary advice rather than urgent intervention.

Question 7Antenatal Care and Normal Pregnancy

Which supplement is recommended for all pregnant women in Mongolia from the periconceptional period through the first trimester to reduce the risk of neural tube defects?

  1. Iron 200 mg daily
  2. Vitamin A 10,000 IU daily
  3. Calcium 2 grams daily
  4. Folic acid 400 micrograms daily Correct answer.

Explanation

Periconceptional folic acid at 400 micrograms daily reduces the incidence of neural tube defects, which form in the first 4 weeks of gestation. Women with a previous affected pregnancy typically receive a higher dose under medical guidance.

Question 8Antenatal Care and Normal Pregnancy

A pregnant woman asks how much weight she should gain. Her pre-pregnancy BMI is 31 kg/m². Which advice is most consistent with current guidance?

  1. Gain approximately 16 to 20 kg over the pregnancy
  2. Avoid any weight gain during pregnancy
  3. Gain approximately 5 to 9 kg over the pregnancy Correct answer.
  4. Gain approximately 12 to 16 kg over the pregnancy

Explanation

The Institute of Medicine guidelines recommend 5 to 9 kg total gain for women with a pre-pregnancy BMI of 30 or above, reflecting the higher risk of hypertensive and metabolic complications with excessive gain. Normal-weight women are advised to gain roughly 11 to 16 kg.

Question 9Antenatal Care and Normal Pregnancy

Which routine screening is recommended at 24 to 28 weeks' gestation to detect gestational diabetes mellitus?

  1. Random urine glucose dipstick
  2. HbA1c measurement
  3. 75 g oral glucose tolerance test Correct answer.
  4. Fasting lipid profile

Explanation

The 75 g oral glucose tolerance test at 24 to 28 weeks is the standard approach for diagnosing gestational diabetes, a period when insulin resistance rises substantially. Universal screening is recommended in many settings, including for Mongolian women with risk factors.

Question 10Antenatal Care and Normal Pregnancy

A 28-year-old woman at 36 weeks' gestation reports a sudden gush of clear fluid from the vagina. On speculum examination, pooling of fluid is seen in the posterior fornix. Which diagnosis is most likely?

  1. Preterm prelabor rupture of membranes Correct answer.
  2. Placental abruption
  3. Urinary incontinence
  4. Physiological vaginal discharge of pregnancy

Explanation

A sudden gush of clear fluid with visible pooling in the posterior fornix is characteristic of rupture of membranes. At 36 weeks this is termed preterm prelabor rupture of membranes because it occurs before 37 weeks; confirmation can be supported by pH testing or ferning.

Question 11Antenatal Care and Normal Pregnancy

Which sign is most characteristic of pre-eclampsia in a woman at 34 weeks' gestation?

  1. Glycosuria on a routine urine dipstick
  2. New hypertension after 20 weeks with proteinuria Correct answer.
  3. Isolated ankle edema in the third trimester
  4. Blood pressure of 110/70 mmHg with headache

Explanation

Pre-eclampsia is defined by new-onset hypertension after 20 weeks' gestation accompanied by proteinuria or other maternal organ dysfunction. Edema alone is common in normal pregnancy and is not diagnostic.

Question 12Antenatal Care and Normal Pregnancy

A woman at 30 weeks' gestation has a blood pressure of 158/108 mmHg on two occasions four hours apart, with 2+ proteinuria. Which initial management step is most appropriate?

  1. Admit for monitoring and start antihypertensive treatment with fetal assessment Correct answer.
  2. Advise bed rest at home and review in one week
  3. Prescribe a diuretic to lower blood pressure
  4. Perform an immediate cesarean delivery

Explanation

Severe hypertension at or above 160/110 mmHg, or persistent hypertension with proteinuria, requires hospital assessment, antihypertensive therapy, and fetal surveillance. Delivery is considered based on gestational age, maternal status, and fetal wellbeing rather than being automatic at 30 weeks.

Question 13Antenatal Care and Normal Pregnancy

Which preventive measure reduces the risk of pre-eclampsia in women at high risk, such as those with previous pre-eclampsia or chronic hypertension?

  1. Routine antibiotic prophylaxis in the third trimester
  2. Strict sodium restriction throughout pregnancy
  3. High-dose vitamin C supplementation
  4. Low-dose aspirin started before 16 weeks Correct answer.

Explanation

Low-dose aspirin, typically 75 to 150 mg daily, started before 16 weeks reduces the incidence of preterm pre-eclampsia in high-risk women. It is thought to act through inhibition of thromboxane production and improved placentation.

Question 14Antenatal Care and Normal Pregnancy

A woman at 38 weeks' gestation reports decreased fetal movements since the previous evening. What is the most appropriate next step?

  1. Ask her to count movements for 48 hours before seeking care
  2. Schedule a routine visit in two weeks
  3. Reassure her that fetal movements normally decrease near term
  4. Perform cardiotocography and ultrasound assessment of fetal wellbeing the same day Correct answer.

Explanation

Reduced fetal movements can precede fetal compromise and warrant same-day assessment with cardiotocography and ultrasound, including amniotic fluid volume and biophysical profile as indicated. Delay increases the risk of missing hypoxia or growth restriction.

Question 15Antenatal Care and Normal Pregnancy

At what gestational age is a pregnant woman typically first offered a routine ultrasound scan in many national antenatal programs?

  1. Around 11 to 14 weeks Correct answer.
  2. Around 24 to 26 weeks
  3. Around 36 to 38 weeks
  4. Around 4 to 6 weeks

Explanation

The first-trimester scan at 11 to 14 weeks confirms viability, dates the pregnancy by crown-rump length, and can assess nuchal translucency. An anomaly scan is typically offered at 18 to 22 weeks, and later scans are performed for specific indications.

Question 16Antenatal Care and Normal Pregnancy

A woman at 16 weeks' gestation has a rubella IgG that is negative. What is the most appropriate advice?

  1. Receive the rubella vaccine immediately during this pregnancy
  2. No action is needed because rubella is no longer a concern
  3. Avoid contact with people who have a rubella-like rash and arrange vaccination after delivery Correct answer.
  4. Repeat the test only after 36 weeks

Explanation

Rubella vaccine contains a live attenuated virus and is contraindicated in pregnancy, so susceptible women should avoid exposure and be vaccinated postpartum. Pre-pregnancy immunity screening allows vaccination before conception.

Question 17Antenatal Care and Normal Pregnancy

Which statement about the use of anti-D immunoglobulin in pregnancy is correct?

  1. It is given to all RhD-positive women at 28 weeks
  2. It can be given only after delivery, never antenatally
  3. It is given to RhD-negative women after potentially sensitizing events and in the third trimester Correct answer.
  4. It is contraindicated in women with a history of miscarriage

Explanation

Anti-D immunoglobulin prevents alloimmunization in RhD-negative women after events such as bleeding, amniocentesis, or external cephalic version, and routine antenatal prophylaxis is often given around 28 weeks. A history of miscarriage is not a contraindication.

Question 18Antenatal Care and Normal Pregnancy

A woman at 20 weeks' gestation has a blood pressure of 88/56 mmHg and no symptoms. What is the most appropriate interpretation?

  1. This confirms a diagnosis of chronic hypotension requiring medication
  2. This suggests an ectopic pregnancy
  3. This indicates impending shock and requires immediate fluid resuscitation
  4. This is a common normal finding in mid-pregnancy and requires no treatment Correct answer.

Explanation

Blood pressure normally falls in the second trimester because of peripheral vasodilation and reduced systemic vascular resistance, reaching a nadir around 20 to 24 weeks. Asymptomatic low blood pressure within this range is physiological and does not require treatment.

Question 19Antenatal Care and Normal Pregnancy

Which change in maternal physiology increases susceptibility to urinary tract infection during pregnancy?

  1. Increased glomerular filtration rate
  2. Increased gastric emptying time
  3. Ureteral dilation and reduced bladder tone from progesterone Correct answer.
  4. Reduced plasma volume

Explanation

Progesterone relaxes smooth muscle, causing ureteral dilation and reduced bladder tone, which promotes urinary stasis and ascending infection. Asymptomatic bacteriuria should therefore be screened for and treated in pregnancy.

Question 20Antenatal Care and Normal Pregnancy

A woman at 39 weeks' gestation is RhD-negative and reports that her previous baby was RhD-positive. Which complication is she at risk of, and how is it prevented?

  1. ABO incompatibility, prevented by maternal blood transfusion
  2. Gestational diabetes, prevented by dietary restriction
  3. RhD alloimmunization, prevented by anti-D immunoglobulin Correct answer.
  4. Pre-eclampsia, prevented by calcium supplementation

Explanation

Exposure to RhD-positive fetal blood can sensitize an RhD-negative mother, and subsequent pregnancies with RhD-positive fetuses may develop hemolytic disease of the newborn. Anti-D immunoglobulin given at appropriate times prevents sensitization.

Question 21Antenatal Care and Normal Pregnancy

Which of the following is a recognized warning sign that should prompt a pregnant woman to seek immediate care at any gestational age?

  1. Vaginal bleeding Correct answer.
  2. Braxton Hicks contractions relieved by rest
  3. Mild ankle swelling in the evening
  4. Occasional heartburn after meals

Explanation

Vaginal bleeding in pregnancy may indicate miscarriage, placenta previa, abruption, or labor and requires urgent assessment. Mild edema, heartburn, and irregular painless contractions are common discomforts of normal pregnancy.

Question 22Antenatal Care and Normal Pregnancy

A woman at 34 weeks' gestation has a hemoglobin of 78 g/L with microcytic indices and low ferritin. Which treatment is most appropriate?

  1. Immediate blood transfusion
  2. No treatment because anemia is normal in the third trimester
  3. Folic acid alone
  4. Oral iron therapy with reassessment, escalating to parenteral iron if not responding Correct answer.

Explanation

Microcytic anemia with low ferritin indicates iron deficiency, which should be treated with oral iron and dietary counseling, with reassessment after a few weeks. Parenteral iron or transfusion is reserved for severe, symptomatic, or refractory cases.

Question 23Antenatal Care and Normal Pregnancy

Which factor places a pregnant woman in a higher-risk category requiring more frequent antenatal visits?

  1. First pregnancy at age 24
  2. Mild nausea in early pregnancy
  3. Living in an urban area
  4. A history of previous stillbirth Correct answer.

Explanation

A previous stillbirth is a major risk factor for recurrence and warrants closer surveillance, including fetal movement monitoring and growth assessment. Age 24 in a first pregnancy, mild nausea, and urban residence are not high-risk indicators.

Question 24Antenatal Care and Normal Pregnancy

A woman at 24 weeks' gestation reports regular painful contractions and low back pain. What is the most appropriate action?

  1. Reassurance that contractions are normal at this gestation
  2. Urgent assessment for preterm labor including cervical examination and fetal monitoring Correct answer.
  3. Advice to increase physical activity
  4. Scheduling a routine visit in four weeks

Explanation

Regular painful contractions before 37 weeks may indicate preterm labor and require urgent evaluation of cervical change, membrane status, and fetal wellbeing. Early detection allows interventions such as corticosteroids and tocolysis where appropriate.

Question 25Antenatal Care and Normal Pregnancy

A woman at 28 weeks' gestation has a symphysio-fundal height of 34 cm. Which condition is most likely to explain this discrepancy?

  1. Polyhydramnios or macrosomia Correct answer.
  2. Fetal demise
  3. Oligohydramnios
  4. Intrauterine growth restriction

Explanation

Fundal height larger than expected by 3 cm or more may reflect polyhydramnios, fetal macrosomia, multiple pregnancy, or inaccurate dating. Oligohydramnios, growth restriction, and fetal demise would tend to produce a smaller-than-expected measurement.

Question 26Antenatal Care and Normal Pregnancy

A woman at 10 weeks' gestation asks when her first antenatal visit should ideally occur. According to standard antenatal care guidance, by which gestational age should the first visit take place?

  1. By 20 weeks' gestation
  2. By 12 weeks' gestation Correct answer.
  3. By 28 weeks' gestation
  4. By 36 weeks' gestation

Explanation

The first antenatal visit should ideally occur before 12 weeks' gestation to confirm pregnancy, establish gestational age, screen for risk factors, and provide early supplementation and health education. Later booking misses opportunities for early detection and intervention.

Question 27Antenatal Care and Normal Pregnancy

A woman at 16 weeks' gestation has a blood pressure of 92/58 mmHg and no symptoms. What is the most appropriate interpretation?

  1. This suggests a hypertensive disorder and requires antihypertensive therapy
  2. This is abnormal and warrants investigation for cardiac disease
  3. This is a normal finding in pregnancy due to peripheral vasodilation Correct answer.
  4. This indicates impending shock and requires immediate fluid resuscitation

Explanation

During pregnancy, systemic vascular resistance falls and blood pressure often decreases, especially in the second trimester, with diastolic values commonly 5–15 mmHg lower than prepregnancy. A blood pressure of 92/58 mmHg in an asymptomatic woman is therefore a normal physiological finding.

Question 28Antenatal Care and Normal Pregnancy

Which vaccine is routinely recommended during pregnancy to protect the newborn against pertussis?

  1. Measles-mumps-rubella (MMR)
  2. Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) Correct answer.
  3. Varicella
  4. Human papillomavirus (HPV)

Explanation

Tdap vaccination during pregnancy, preferably between 27 and 36 weeks' gestation, boosts maternal antibodies that are transferred to the fetus and protect the infant before routine immunisation begins. MMR, varicella, and HPV vaccines are not recommended during pregnancy.

Question 29Antenatal Care and Normal Pregnancy

A woman at 32 weeks' gestation has a haemoglobin of 88 g/L with microcytic indices and a low ferritin. She has no other symptoms. What is the most appropriate management?

  1. Intravenous iron as first-line therapy
  2. No treatment, as haemodilution explains the low haemoglobin
  3. Immediate blood transfusion
  4. Oral iron supplementation with recheck in 2–4 weeks Correct answer.

Explanation

Microcytic anaemia with low ferritin indicates iron deficiency, and oral iron is the first-line treatment unless the woman is near term, has severe anaemia, or cannot tolerate oral iron. Rechecking haemoglobin after 2–4 weeks assesses response and adherence.

Question 30Antenatal Care and Normal Pregnancy

A woman at 26 weeks' gestation reports regular painful contractions and low back pain. What is the most appropriate initial action?

  1. Prescribe a tocolytic agent without assessment
  2. Arrange immediate assessment for possible preterm labour Correct answer.
  3. Advise bed rest at home and review in one week
  4. Reassure her that Braxton Hicks contractions are normal

Explanation

Regular painful contractions with back pain at 26 weeks may indicate preterm labour, which requires urgent evaluation including cervical assessment and fetal monitoring. Braxton Hicks contractions are typically irregular and painless, so reassurance without assessment is unsafe.

Question 31Antenatal Care and Normal Pregnancy

A woman at 18 weeks' gestation has a rubella IgG that is negative. What is the most appropriate advice?

  1. Avoid contact with anyone who has a rash and arrange vaccination after delivery Correct answer.
  2. No action is needed because rubella is not harmful in pregnancy
  3. Repeat the test in 4 weeks to check for seroconversion
  4. Receive the rubella vaccine now to protect the fetus

Explanation

Rubella vaccination is contraindicated during pregnancy because it contains a live attenuated virus. A susceptible pregnant woman should be advised to avoid contact with people who have a rash and be offered vaccination in the postpartum period.

Question 32Antenatal Care and Normal Pregnancy

A woman at 24 weeks' gestation has a blood pressure of 148/96 mmHg on two occasions 6 hours apart, with no proteinuria and no symptoms. What is the most appropriate diagnosis?

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

Explanation

Gestational hypertension is defined as new hypertension after 20 weeks' gestation without proteinuria or other features of pre-eclampsia. Chronic hypertension would have been present before 20 weeks, and pre-eclampsia requires proteinuria or maternal organ dysfunction.

Question 33Antenatal Care and Normal Pregnancy

Which finding on history is most suggestive of a multiple pregnancy before any ultrasound is performed?

  1. Uterine size larger than expected for gestational age
  2. Severe nausea and vomiting in early pregnancy Correct answer.
  3. Braxton Hicks contractions in the third trimester
  4. Linea nigra appearing after 20 weeks

Explanation

Severe nausea and vomiting in early pregnancy can be elicited from the history and are associated with multiple pregnancy. They also occur in singleton pregnancies and are not diagnostic. Uterine size larger than dates is an examination finding; ultrasound is used to confirm multiple pregnancy.

Question 34Antenatal Care and Normal Pregnancy

A woman at 28 weeks' gestation with a history of previous pre-eclampsia is considering aspirin prophylaxis. At what gestational age should aspirin be started to be most effective?

  1. Before 16 weeks' gestation Correct answer.
  2. After 32 weeks' gestation
  3. At 28 weeks' gestation
  4. At 20 weeks' gestation

Explanation

Low-dose aspirin for pre-eclampsia prevention is most effective when started before 16 weeks' gestation, ideally before 12 weeks, because it interferes with early placental vascular remodelling. Starting later reduces the preventive benefit.

Question 35Antenatal Care and Normal Pregnancy

A woman at 36 weeks' gestation with a singleton pregnancy and no complications asks about the recommended timing of birth. What is the most appropriate advice?

  1. Elective caesarean section at 38 weeks
  2. Plan for birth between 39 and 41 weeks' gestation Correct answer.
  3. Await spontaneous labour until 42 weeks without any monitoring
  4. Induction of labour at 37 weeks to reduce stillbirth risk

Explanation

For an uncomplicated singleton pregnancy, birth is recommended between 39 and 41 weeks' gestation, which balances fetal maturity against the rising risk of stillbirth after 41 weeks. Induction before 39 weeks without a medical indication may increase neonatal respiratory problems.

Question 36Antenatal Care and Normal Pregnancy

A woman at 22 weeks' gestation has a history of two previous second-trimester losses and a current cervical length of 18 mm. Which intervention is most likely to reduce the risk of preterm birth?

  1. Prophylactic antibiotics
  2. Bed rest
  3. Cervical cerclage Correct answer.
  4. Routine tocolysis

Explanation

A history of second-trimester loss with a short cervix on ultrasound is an indication for cervical cerclage, which can reduce the risk of preterm birth in selected women. Bed rest, prophylactic antibiotics, and routine tocolysis have not been shown to prevent preterm birth in this context.

Question 37Intrapartum Care and Normal Birth

A nulliparous woman at 38 weeks is admitted in active labour. On vaginal examination the cervix is 5 cm dilated, fully effaced, and the fetal head is at station 0 with the sagittal suture in the left occiput anterior position. Which finding best confirms that she is in active first stage of labour rather than the latent phase?

  1. Rupture of membranes without any change in cervical dilatation
  2. Cervical dilatation of 5 cm with full effacement and regular painful contractions Correct answer.
  3. A cervix that is 2 cm dilated and 50% effaced with irregular contractions
  4. Descent of the presenting part to station 0 before any cervical change

Explanation

Active first stage is defined by regular contractions combined with progressive cervical dilatation from about 5 cm onward, together with increasing effacement and descent. A cervix at 5 cm with full effacement in a woman having regular painful contractions therefore places her in active labour. Latent phase findings, isolated membrane rupture, and station alone do not establish active first stage.

Question 38Intrapartum Care and Normal Birth

During a vaginal birth, which mechanism of labour immediately follows complete extension of the fetal head?

  1. Restitution Correct answer.
  2. Internal rotation
  3. Descent
  4. Flexion

Explanation

After the head is born by extension, the neck untwists and the head turns back to align with the shoulders, a movement called restitution. Internal rotation and flexion occur earlier in the mechanism, and descent continues throughout. Recognising restitution helps the midwife anticipate external rotation of the shoulders.

Question 39Intrapartum Care and Normal Birth

A woman in the second stage has been pushing for 45 minutes. The fetal heart rate is 140 beats per minute with normal variability. The head is visible at the vulva and the perineum is stretching. What is the most appropriate immediate action by the midwife?

  1. Apply fundal pressure to shorten the second stage
  2. Support a controlled birth of the head and encourage the woman to stop pushing as the head crowns Correct answer.
  3. Instruct the woman to hold her breath and push as hard as possible continuously
  4. Perform an episiotomy routinely to prevent perineal tears

Explanation

When the head crowns, controlled birth with the woman easing off pushing and the midwife supporting the perineum reduces the risk of rapid perineal injury. Fundal pressure is unsafe and can cause uterine rupture or fetal injury. Routine episiotomy and prolonged breath-holding are not recommended in normal birth.

Question 40Intrapartum Care and Normal Birth

Which finding on vaginal examination best indicates that the fetal head is engaged?

  1. The sagittal suture is palpable at the level of the ischial spines
  2. The presenting part is felt at station −3 and moves freely on palpation
  3. The biparietal diameter has passed through the pelvic inlet, with the head at station 0 or lower Correct answer.
  4. The cervix is 3 cm dilated with a ballotable head

Explanation

Engagement means the widest transverse diameter of the head, the biparietal diameter, has passed the pelvic inlet, corresponding to station 0 or below. A ballotable head at a high station indicates the head is not yet engaged. Palpating the suture alone does not establish engagement.

Question 41Intrapartum Care and Normal Birth

A woman at 40 weeks reports spontaneous rupture of membranes one hour ago. She has no contractions, the fetal heart rate is 138 beats per minute, and the fluid is clear. What is the most appropriate initial management?

  1. Immediate caesarean section for all prelabour rupture of membranes
  2. Administration of oxytocin without any assessment
  3. Expectant management with assessment of maternal and fetal wellbeing and discussion of timing of induction Correct answer.
  4. Discharge home without any follow-up

Explanation

For term prelabour rupture of membranes with a reassuring fetal heart rate and clear fluid, initial assessment of maternal and fetal wellbeing is appropriate, followed by discussion about induction timing. Immediate caesarean section is not indicated for uncomplicated term rupture. Oxytocin should not be started before assessment, and discharge without follow-up risks infection.

Question 42Intrapartum Care and Normal Birth

Which parameter is the most reliable indicator of adequate uterine perfusion and fetal oxygenation during labour?

  1. The colour of the amniotic fluid at rupture
  2. The frequency of uterine contractions alone
  3. Fetal heart rate pattern with baseline, variability, accelerations and decelerations Correct answer.
  4. Maternal blood pressure measured every four hours

Explanation

The fetal heart rate pattern integrates baseline rate, variability, accelerations and decelerations and is the primary tool for assessing fetal oxygenation during labour. Contraction frequency alone does not show how the fetus is tolerating labour. Maternal blood pressure and fluid colour provide useful but indirect information.

Question 43Intrapartum Care and Normal Birth

A fetal heart rate tracing shows a baseline of 145 beats per minute, moderate variability, and repetitive decelerations that begin after the peak of each contraction and return to baseline after the contraction ends. What is the most likely interpretation?

  1. Early decelerations caused by head compression
  2. Late decelerations suggesting uteroplacental insufficiency Correct answer.
  3. Prolonged deceleration requiring immediate delivery
  4. Variable decelerations caused by cord compression

Explanation

Decelerations that start after the contraction peak and recover after the contraction ends are late decelerations, which suggest impaired uteroplacental oxygen transfer. Early decelerations mirror the contraction and are benign. Variable decelerations have an abrupt onset and are linked to cord compression, while a prolonged deceleration lasts more than two minutes.

Question 44Intrapartum Care and Normal Birth

Which action is the first response when a Category III fetal heart rate pattern with a persistent bradycardia is identified during labour?

  1. Wait 30 minutes and reassess the tracing
  2. Reposition the woman, stop oxytocin if running, and perform a vaginal examination to assess for cord prolapse Correct answer.
  3. Give the woman oral fluids and continue monitoring
  4. Increase the oxytocin infusion to speed delivery

Explanation

Intrauterine resuscitation begins with maternal repositioning, stopping any oxytocin, and a vaginal examination to exclude cord prolapse, together with attention to blood pressure and hydration. Waiting risks fetal hypoxia. Increasing oxytocin worsens the situation, and oral fluids alone do not address acute compromise.

Question 45Intrapartum Care and Normal Birth

During the third stage of labour, which combination of signs best suggests that the placenta has separated?

  1. The umbilical cord shortening and the uterus becoming broad and soft
  2. A gush of blood, lengthening of the umbilical cord, and the uterus becoming globular and firm Correct answer.
  3. Continued vaginal bleeding with a soft, non-contracted uterus
  4. Maternal bradycardia and a fall in blood pressure

Explanation

Placental separation is suggested by a gush of blood, lengthening of the cord, and the uterus becoming globular and firm as it contracts. A soft, non-contracted uterus with continuing bleeding suggests atony rather than separation. Cord shortening and maternal bradycardia are not signs of separation.

Question 46Intrapartum Care and Normal Birth

A woman who has just given birth has a boggy uterus and heavy vaginal bleeding 15 minutes after delivery of the placenta. Which action should the midwife take first?

  1. Give antibiotics before any other measure
  2. Perform uterine massage and give a uterotonic agent while calling for help Correct answer.
  3. Place the woman in a head-up position and restrict fluids
  4. Wait for the bleeding to stop spontaneously

Explanation

Uterine atony is the most common cause of postpartum haemorrhage, and immediate uterine massage plus a uterotonic agent is the first-line response while summoning assistance. Delaying treatment allows blood loss to continue. Antibiotics are not the initial treatment for atony, and restricting fluids is not appropriate in acute haemorrhage.

Question 47Intrapartum Care and Normal Birth

What is the recommended first-line uterotonic for routine active management of the third stage of labour?

  1. Oxytocin 10 IU given intramuscularly Correct answer.
  2. Misoprostol 800 micrograms sublingually for all women
  3. Carboprost given routinely before delivery of the placenta
  4. Methylergometrine given to every woman regardless of blood pressure

Explanation

Oxytocin 10 IU intramuscularly is the recommended first-line uterotonic for active management of the third stage because it is effective and has few contraindications. Misoprostol is generally used when oxytocin is unavailable or as a second-line option. Methylergometrine is avoided in hypertension, and carboprost is reserved for refractory haemorrhage.

Question 48Intrapartum Care and Normal Birth

A woman in labour has a cervical dilatation of 4 cm at 08:00 and 6 cm at 12:00, with regular contractions and a reassuring fetal heart rate. How should this progress be described?

  1. Prolonged latent phase requiring immediate caesarean section
  2. Second stage of labour
  3. Arrest of labour requiring oxytocin augmentation
  4. Normal progress in active first stage Correct answer.

Explanation

A change from 4 cm to 6 cm over four hours reflects progressive active first-stage labour, and with regular contractions and a reassuring fetal heart rate this is normal. Arrest of labour refers to no cervical change over an adequate period with strong contractions. The second stage begins only at full dilatation.

Question 49Intrapartum Care and Normal Birth

Which position is most appropriate for a woman with an uncomplicated pregnancy in the first stage of labour who has no epidural and no restrictions?

  1. The position she finds most comfortable, encouraging mobility and upright positions Correct answer.
  2. Strict supine bed rest throughout labour
  3. Lithotomy position from admission until full dilatation
  4. Prone position with the abdomen compressed

Explanation

For uncomplicated labour, women should be encouraged to move freely and adopt whatever upright or side-lying position is most comfortable, since mobility supports normal labour progress. Strict supine bed rest and lithotomy positioning restrict movement and are not routine. The prone position is not used in labour.

Question 50Intrapartum Care and Normal Birth

During a vaginal examination in labour, the midwife palpates a pulsating cord in the vagina after spontaneous rupture of membranes. What is the correct immediate action?

  1. Replace the cord into the uterus and continue labour
  2. Give oxytocin to accelerate delivery
  3. Push the presenting part up to relieve cord compression and arrange emergency delivery Correct answer.
  4. Wait for further dilatation before acting

Explanation

Cord prolapse is an obstetric emergency; the midwife should elevate the presenting part to relieve compression and arrange immediate delivery, often by caesarean section. Attempting to replace the cord is not recommended and delays definitive care. Waiting or giving oxytocin worsens fetal compromise.