NMC Midwifery OSCE cheat sheet

The midwifery care cycle runs assess → plan → implement → evaluate; each stage is documented and the plan is revised when findings or the woman's wishes change.

NICE antenatal schedule: booking appointment by 10 weeks, then 10 appointments for nulliparous and 7 for parous women with an uncomplicated pregnancy.

Dating ultrasound is offered at 11+2 to 14+1 weeks; the anomaly scan is offered at 18+0 to 20+6 weeks.

Combined screening (nuchal translucency plus free β-hCG and PAPP-A) is offered with the dating scan when crown–rump length is 45–84 mm.

A 75 g oral glucose tolerance test is offered at 24–28 weeks where risk factors exist: BMI ≥30, previous gestational diabetes, previous baby ≥4.5 kg, family history of diabetes, polycystic ovary syndrome, South Asian or Black African-Caribbean family origin.

Partogram: the alert line represents 1 cm dilatation per hour from 4 cm; the action line lies 4 hours to its right and crossing it triggers obstetric review and consideration of transfer.

Slow progress in established labour is cervical dilatation of less than 1 cm in 4 hours, or delay in descent or rotation, and requires obstetric review.

Systematic CTG review uses DR C BRAVADO: Define Risk, Contractions, Baseline Rate, Variability, Accelerations, Decelerations, Overall impression.

Apgar is scored at 1 and 5 minutes on Appearance, Pulse, Grimace, Activity and Respiration (0–2 each, maximum 10); scoring continues every 5 minutes to 20 minutes if the score remains below 7.

The NMC Code (2018) has four themes: prioritise people, practise effectively, preserve safety, and promote professionalism and trust.

Revalidation every 3 years requires 450 practice hours, 35 hours of CPD (at least 20 participatory), 5 reflective accounts, 5 pieces of practice-related feedback, health and character declaration, indemnity cover and confirmer sign-off.

The duty of candour requires apology, explanation and reporting when care causes or may cause harm; it is also a statutory organisational duty under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Mental Capacity Act 2005: capacity is presumed, is decision-specific and assessed at the time; if absent, act in best interests using the least restrictive option.

Gillick competence allows a person under 16 to consent if they have sufficient understanding and intelligence to comprehend the proposed intervention fully.

Midwives must hold current NMC registration and professional indemnity cover, practise within their competence, and escalate when a situation exceeds that competence.

Confidentiality: information is shared on a need-to-know basis; disclosure without consent occurs only where required by law or court order, or where necessary to prevent serious harm in the public interest.

Safeguarding: the child's welfare is paramount (Children Act 1989); statutory guidance is Working Together to Safeguard Children; known cases of female genital mutilation in under-18s must be reported to the police.

Staff raising concerns about unsafe care are protected by the Public Interest Disclosure Act 1998 and supported by an organisation's Freedom to Speak Up guardian.

Active management of the third stage: prophylactic 10 IU oxytocin IM after birth of the baby, controlled cord traction with signs of separation, assessment of uterine tone and measured blood loss.

Syntometrine (5 IU oxytocin with 500 micrograms ergometrine) is contraindicated in hypertension and pre-eclampsia because of the ergometrine component; oxytocin 10 IU IM is used instead.

Delayed cord clamping: clamp no sooner than 1 minute after birth, and between 1 and 5 minutes for babies not needing immediate resuscitation.

Vitamin K: single intramuscular dose of 1 mg for term babies weighing 2.5 kg or more; 0.5 mg for babies under 2.5 kg; parental refusal is documented and an oral regimen may be offered.

Primary postpartum haemorrhage is blood loss of 500 ml or more within 24 hours of vaginal birth, or 1000 ml or more after caesarean section, with or without signs of shock.

Intermittent auscultation: listen for at least 1 minute after a contraction and record the baseline every 15 minutes in the first stage and every 5 minutes in the second stage.

Newborn life support: reassess at 30 seconds, give 5 inflation breaths of 2–3 seconds each, then compressions at a 3:1 compression-to-ventilation ratio (about 90 compressions per minute).

Perineal tear classification: first degree = vaginal epithelium only; second degree = perineal muscles; third degree = anal sphincter (3a <50% external sphincter, 3b >50%, 3c internal sphincter); fourth degree = anal epithelium. Third and fourth degree tears are repaired in theatre.

Infection prevention: WHO 5 moments for hand hygiene, and aseptic non-touch technique protecting key parts during invasive procedures such as venepuncture and catheterisation.

Hierarchy of evidence from highest to lowest: systematic review or meta-analysis of randomised trials, individual randomised trial, cohort study, case-control study, cross-sectional study, case series, expert opinion.

PICO frames a searchable question: Population, Intervention, Comparison, Outcome.

CASP checklists structure critical appraisal around three questions: is the study valid, what are the results, and are the results applicable locally.

SBAR structures escalation and handover: Situation, Background, Assessment, Recommendation.

Montgomery v Lanarkshire (2015) established that consent requires disclosure of material risks a reasonable person in that patient's position would want to know.

Records must be contemporaneous, accurate, signed, dated, timed and attributable; errors are struck through and initialled so the original entry remains legible.

Use a trained interpreter rather than a family member where language is a barrier, and document the language need and interpreter use in the records.

Teach-back: the woman repeats the information in her own words so the midwife can confirm understanding and correct misunderstandings.

Shared decision-making: present the options, discuss benefits and harms, elicit the woman's values, agree a plan and record the decision and rationale.