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NMC Midwifery OSCE study materials
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NMC Midwifery OSCE practice questions

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Question 1Assessment, planning, implementation and evaluation of midwifery care

What is the normal baseline fetal heart rate range for a fetus at term?

  1. 100 to 135 bpm
  2. 110 to 160 bpm Correct answer.
  3. 120 to 180 bpm
  4. 90 to 140 bpm

Explanation

A baseline of 110–160 beats per minute sustained over at least 10 minutes is considered normal at term. Values outside this range are classed as baseline bradycardia or tachycardia and require assessment of maternal and fetal wellbeing.

Question 2Assessment, planning, implementation and evaluation of midwifery care

Which five parameters are assessed when calculating an Apgar score?

  1. Heart rate, breathing, tone, reflex response and colour Correct answer.
  2. Heart rate, blood pressure, temperature, tone and colour
  3. Heart rate, oxygen saturation, blood pressure and tone
  4. Breathing, temperature, blood glucose, tone and colour

Explanation

The Apgar score rates heart rate, respiratory effort, muscle tone, reflex irritability and skin colour, each from 0 to 2. It is recorded at 1 and 5 minutes after birth to summarise the newborn's condition and response to resuscitation.

Question 3Assessment, planning, implementation and evaluation of midwifery care

A midwife records that a woman in the first stage of labour is fully dilated. Which cervical dilatation does this represent?

  1. 10 cm Correct answer.
  2. 12 cm
  3. 7 cm
  4. 8 cm

Explanation

Full dilatation is reached when the cervix has opened to 10 cm, allowing the presenting part to descend into the birth canal. The first stage of labour ends at this point and the second stage begins.

Question 4Assessment, planning, implementation and evaluation of midwifery care

Which daily folic acid dose should be advised before conception for a woman who previously had a baby with a neural tube defect?

  1. 1 mg daily
  2. 400 micrograms daily
  3. 2 mg daily
  4. 5 mg daily Correct answer.

Explanation

A woman with a previous neural tube defect-affected pregnancy is advised to take 5 mg of folic acid daily, starting at least one month before conception and continuing until 12 weeks. The higher dose reduces the risk of recurrence.

Question 5Assessment, planning, implementation and evaluation of midwifery care

Which blood pressure reading meets the threshold used to define hypertension in pregnancy?

  1. 140/90 mmHg or higher Correct answer.
  2. 120/70 mmHg or higher
  3. 130/80 mmHg or higher
  4. 150/100 mmHg or higher

Explanation

Hypertension in pregnancy is defined as a systolic pressure of 140 mmHg or more and/or a diastolic pressure of 90 mmHg or more, measured on two occasions. This threshold triggers further assessment for pre-eclampsia.

Question 6Assessment, planning, implementation and evaluation of midwifery care

Which action forms part of active management of the third stage of labour?

  1. Pushing before there are signs of placental separation
  2. Giving a prophylactic uterotonic at birth of the baby Correct answer.
  3. Clamping the cord early and leaving the placenta in situ
  4. Applying cord traction before the placenta has separated

Explanation

Active management combines a prophylactic uterotonic given at the birth of the baby, controlled cord traction once the uterus contracts and the placenta separates, and assessment of uterine tone. These measures shorten the third stage and reduce postpartum haemorrhage.

Question 7Assessment, planning, implementation and evaluation of midwifery care

How many antenatal appointments are recommended for a healthy nulliparous woman with an uncomplicated pregnancy?

  1. Twelve appointments
  2. Six appointments
  3. Ten appointments Correct answer.
  4. Eight appointments

Explanation

Current guidance recommends ten appointments for a nulliparous woman and seven for a parous woman with an uncomplicated pregnancy. The schedule increases in frequency towards term to monitor maternal and fetal wellbeing.

Question 8Assessment, planning, implementation and evaluation of midwifery care

A woman at 38 weeks has just had spontaneous rupture of membranes and a loop of pulsating cord is visible at the introitus. What should the midwife do first?

  1. Rupture the membranes to relieve the pressure
  2. Replace the cord into the uterus and await review
  3. Give tocolysis before calling for assistance
  4. Call for help and elevate the presenting part Correct answer.

Explanation

Cord prolapse is an obstetric emergency; the priority is to summon help and relieve cord compression by elevating the presenting part, for example with a knee-chest or exaggerated Sims position or a hand in the vagina. Immediate preparation for expedited birth follows.

Question 9Assessment, planning, implementation and evaluation of midwifery care

A woman presents with heavy vaginal bleeding 10 days after a spontaneous vaginal birth. How should this be classified?

  1. Antepartum haemorrhage
  2. Primary postpartum haemorrhage
  3. Normal lochia rubra
  4. Secondary postpartum haemorrhage Correct answer.

Explanation

Secondary postpartum haemorrhage is abnormal or excessive bleeding from 24 hours to 12 weeks after birth. Primary postpartum haemorrhage occurs within the first 24 hours, so the timing here places it in the secondary category.

Question 10Assessment, planning, implementation and evaluation of midwifery care

A CTG shows recurrent late decelerations during an oxytocin infusion. Which action should the midwife take?

  1. Increase the oxytocin infusion to improve contractions
  2. Perform a fetal scalp blood sample without other change
  3. Continue monitoring and reassess in 30 minutes
  4. Stop oxytocin, reposition left lateral and escalate Correct answer.

Explanation

Recurrent late decelerations suggest uteroplacental insufficiency and require intrauterine resuscitation: stopping any oxytocin, maternal left lateral positioning, intravenous fluid and urgent obstetric review. Delivery may be needed if the pattern does not improve.

Question 11Assessment, planning, implementation and evaluation of midwifery care

A woman at 34 weeks has painless bright red vaginal bleeding and a fundal height greater than dates. Which action is most appropriate while awaiting ultrasound?

  1. Perform a speculum examination to visualise the cervix
  2. Avoid vaginal examination until placental site is known Correct answer.
  3. Perform a gentle vaginal examination to assess dilatation
  4. Offer a membrane sweep to reduce the risk of bleeding

Explanation

Painless bright red bleeding with a large-for-dates uterus raises suspicion of placenta praevia, so digital or speculum examination is deferred until the placental site is confirmed by ultrasound. Examination could provoke catastrophic haemorrhage.

Question 12Assessment, planning, implementation and evaluation of midwifery care

Which manoeuvre should be performed first when shoulder dystocia is diagnosed?

  1. McRoberts' position with suprapubic pressure Correct answer.
  2. McRoberts' position alone, awaiting spontaneous birth
  3. Fundal pressure followed by delivery of the posterior arm
  4. Symphysiotomy followed by internal rotational manoeuvres

Explanation

First-line management is calling for help and applying McRoberts' manoeuvre with suprapubic pressure to rotate and free the anterior shoulder. More invasive manoeuvres are reserved for failure of these initial steps.

Question 13Assessment, planning, implementation and evaluation of midwifery care

Which magnesium sulphate regimen is used for a woman with severe pre-eclampsia to prevent eclampsia?

  1. 6 g IV over 15 minutes, then 3 g per hour
  2. 2 g IV over 15 minutes, then 2 g per hour
  3. 10 g IV over 15 minutes, then 2 g per hour
  4. 4 g IV over 15 minutes, then 1 g per hour Correct answer.

Explanation

The standard regimen is a 4 g intravenous loading dose given over 5–20 minutes followed by a maintenance infusion of 1 g per hour, usually continued for 24 hours. Clinical monitoring for toxicity accompanies the infusion.

Question 14Assessment, planning, implementation and evaluation of midwifery care

For a non-sensitised RhD-negative woman, when is routine anti-D prophylaxis given?

  1. Within two weeks of birth if the baby is RhD positive
  2. At 20 weeks' gestation and again at 34 weeks
  3. At 28 weeks' gestation and within 72 hours of birth Correct answer.
  4. Only after birth if cord blood is RhD positive

Explanation

Routine antenatal prophylaxis is offered at around 28 weeks, with a further dose within 72 hours of birth if the baby is confirmed RhD positive. Additional doses are given after potentially sensitising events.

Question 15Assessment, planning, implementation and evaluation of midwifery care

Which breathing support should be given first to a newborn who is not breathing at birth?

  1. Twenty chest compressions followed by two breaths
  2. Five rescue breaths, each lasting one second
  3. Continuous positive airway pressure for 30 seconds
  4. Two to three inflation breaths of 2–3 seconds each Correct answer.

Explanation

Initial resuscitation begins with two to three inflation breaths, each delivered over 2–3 seconds, to aerate the lungs. Chest compressions are added only if the heart rate remains low after effective ventilation.

Question 16Assessment, planning, implementation and evaluation of midwifery care

Which variables make up the modified Bishop score used before induction of labour?

  1. Dilatation, consistency, fetal fibronectin and parity
  2. Dilatation, effacement, consistency, position, station Correct answer.
  3. Position, dilatation, membrane status and fetal lie
  4. Length, effacement, parity and estimated fetal weight

Explanation

The modified Bishop score assesses cervical dilatation, length (effacement), consistency and position, together with the station of the fetal head. The total score predicts the likelihood of successful induction.

Question 17Assessment, planning, implementation and evaluation of midwifery care

How is a third-degree perineal tear defined?

  1. Injury to the rectal mucosa
  2. Injury to the vaginal epithelium only
  3. Injury to the perineal skin only
  4. Injury to the anal sphincter complex Correct answer.

Explanation

A third-degree tear extends through the perineal muscles to involve the anal sphincter complex, subdivided into 3a, 3b and 3c. A fourth-degree tear additionally involves the anal or rectal mucosa.

Question 18Assessment, planning, implementation and evaluation of midwifery care

A woman at 38 weeks reports reduced fetal movements for the past 24 hours. What is the most appropriate action?

  1. Reassure and ask her to monitor movements for 24 hours
  2. Auscultate the fetal heart and discharge if the rate is normal
  3. Arrange cardiotocography and a growth scan promptly Correct answer.
  4. Arrange ultrasound only if movements stay reduced 48 hours

Explanation

Reduced fetal movements after 24 weeks warrant prompt assessment with cardiotocography and ultrasound, including growth and liquor volume assessment. Delay risks missing fetal compromise, and auscultation alone is insufficient.

Question 19Assessment, planning, implementation and evaluation of midwifery care

A term breastfed baby at 6 hours of age has a blood glucose of 2.2 mmol/L and is asymptomatic. What is the most appropriate first action?

  1. Admit to the neonatal unit for intravenous dextrose
  2. Give oral sucrose and continue routine observations
  3. Help the mother feed, then recheck glucose in one hour Correct answer.
  4. Reassure the parents and recheck the glucose in 24 hours

Explanation

An asymptomatic baby with a glucose between 2.0 and 2.6 mmol/L is managed initially by supporting feeding and rechecking the glucose within about an hour. Intravenous dextrose is reserved for lower or symptomatic readings that do not respond to feeding.

Question 20Assessment, planning, implementation and evaluation of midwifery care

A woman on day 3 after caesarean birth has a temperature of 38.5°C, a heart rate of 112 bpm and feels 'not herself'. Which action should the midwife take first?

  1. Encourage oral fluids and plan to review her tomorrow
  2. Change the wound dressing and document the appearance
  3. Escalate for urgent medical review and sepsis screening Correct answer.
  4. Give paracetamol and reassess the temperature in four hours

Explanation

Pyrexia with tachycardia and a subjective sense of feeling unwell suggests possible sepsis and requires immediate escalation and screening. Early recognition and timely antibiotics substantially reduce the risk of severe maternal morbidity.

Question 21Assessment, planning, implementation and evaluation of midwifery care

A CTG shows a smooth undulating waveform with 3–5 cycles per minute and no accelerations or normal variability. What does this pattern most likely indicate?

  1. Early decelerations caused by head compression
  2. Sinusoidal pattern from severe fetal anaemia Correct answer.
  3. Normal sleep phase requiring no further action
  4. Reduced variability caused by a fetal sleep cycle

Explanation

A true sinusoidal pattern has a smooth, undulating baseline with a frequency of 3–5 cycles per minute and absent accelerations, and is associated with severe fetal anaemia, for example from fetomaternal haemorrhage or alloimmunisation. It requires urgent senior review and investigation.

Question 22Assessment, planning, implementation and evaluation of midwifery care

A woman receiving a magnesium sulphate infusion has a respiratory rate of 11 per minute and absent knee reflexes. What is the priority action?

  1. Continue and repeat the observations in one hour
  2. Give a further 4 g loading dose of magnesium
  3. Increase the infusion to reach therapeutic levels
  4. Stop the infusion and give calcium gluconate Correct answer.

Explanation

Loss of deep tendon reflexes, respiratory depression and reduced urine output are signs of magnesium toxicity. The infusion must be stopped and calcium gluconate given as the antidote, with senior medical review and continued monitoring.

Question 23Assessment, planning, implementation and evaluation of midwifery care

A nulliparous woman at 7 cm dilatation has a partogram cervical dilatation plot that has crossed the action line. What is the appropriate next step?

  1. Give an opioid and encourage mobilisation
  2. Request obstetric review for amniotomy or oxytocin Correct answer.
  3. Continue the current plan and reassess in four hours
  4. Proceed straight to caesarean section without review

Explanation

Crossing the action line indicates slow progress and prompts obstetric review to confirm the diagnosis and consider amniotomy, oxytocin augmentation or caesarean birth. Further delay without review increases the risk of prolonged obstructed labour.

Question 24Assessment, planning, implementation and evaluation of midwifery care

A woman at 33 weeks has BP 158/98 mmHg, 3+ proteinuria, platelets 88 x 10⁹/L and ALT 130 U/L. Which plan of care is most appropriate?

  1. Discharge with weekly home blood pressure monitoring
  2. Admit for inpatient assessment with a view to delivery Correct answer.
  3. Prescribe antihypertensives and reassess in 48 hours
  4. Arrange an outpatient growth scan for the following week

Explanation

Thrombocytopenia and raised transaminases with severe hypertension and proteinuria indicate severe pre-eclampsia with HELLP features, requiring admission, antihypertensives, magnesium sulphate and planning for birth. Outpatient management would be unsafe.

Question 25Assessment, planning, implementation and evaluation of midwifery care

A CTG shows a baseline of 168 bpm, variability of 3 bpm, no accelerations and a deceleration to 70 bpm lasting 5 minutes. How should this be classified and managed?

  1. Inconclusive - take a fetal scalp sample after 60 minutes
  2. Pathological - escalate and prepare for expedited birth Correct answer.
  3. Suspicious - repeat the CTG in one hour
  4. Normal - document and continue routine monitoring

Explanation

A prolonged deceleration lasting more than 3 minutes with an abnormal baseline and reduced variability is a pathological trace requiring immediate intrauterine resuscitation and escalation for expedited birth. The fetus may be acutely compromised.

Question 26Assessment, planning, implementation and evaluation of midwifery care

In established first stage of labour, how often should the fetal heart be auscultated in a woman at low risk of fetal compromise?

  1. Every 5 minutes
  2. Every hour
  3. Every 30 minutes
  4. Every 15 minutes Correct answer.

Explanation

Intermittent auscultation should be performed for at least one minute after a contraction every 15 minutes during the established first stage. The frequency increases to every 5 minutes once the woman is in the second stage.

Question 27Assessment, planning, implementation and evaluation of midwifery care

Which daily folic acid dose should a woman take before and in early pregnancy if she has had a previous baby with a neural tube defect?

  1. 400 micrograms
  2. 1 mg
  3. 10 mg
  4. 5 mg Correct answer.

Explanation

A woman with a previous affected pregnancy is advised to take 5 mg of folic acid daily, starting at least three months before conception and continuing until 12 weeks of gestation. This higher dose reduces the risk of recurrence of a neural tube defect.

Question 28Assessment, planning, implementation and evaluation of midwifery care

What dose of intramuscular vitamin K should be given to a healthy term newborn?

  1. 1 mg Correct answer.
  2. 0.1 mg
  3. 0.5 mg
  4. 2 mg

Explanation

A healthy term baby should receive 1 mg of vitamin K intramuscularly at birth to prevent vitamin K deficiency bleeding. Preterm or low birth weight babies receive a weight-based dose instead.

Question 29Assessment, planning, implementation and evaluation of midwifery care

For a healthy term baby born in good condition, when should the umbilical cord be clamped?

  1. After the placenta is delivered
  2. Within 30 seconds of birth
  3. Immediately, before the baby is dried
  4. At least 1 minute after birth Correct answer.

Explanation

Delaying clamping for at least a minute allows placental transfusion, improving the baby's iron stores and early haemoglobin. The baby should be dried and kept warm while waiting.

Question 30Assessment, planning, implementation and evaluation of midwifery care

By when should the midwife make the first postnatal contact with a woman after birth?

  1. On day 3 after birth
  2. Within 48 hours of birth
  3. Within 24 hours of birth Correct answer.
  4. Within 72 hours of birth

Explanation

The first postnatal contact should take place within 24 hours of birth, when physical and mental health, feeding and safety are assessed. Later contacts are then scheduled over the following two weeks.

Question 31Assessment, planning, implementation and evaluation of midwifery care

Which aspirin regimen should be offered to a woman with two moderate risk factors for pre-eclampsia?

  1. Aspirin 150 mg daily from 36 weeks
  2. Aspirin 75 mg daily from 28 weeks
  3. Aspirin 75–150 mg daily from 12 weeks Correct answer.
  4. Aspirin 300 mg daily from 20 weeks of pregnancy

Explanation

Prophylactic aspirin at a dose of 75–150 mg once daily should be started from 12 weeks of gestation in women at increased risk of pre-eclampsia. Treatment is continued until birth.

Question 32Assessment, planning, implementation and evaluation of midwifery care

By what time after birth should the newborn and infant physical examination (NIPE) be completed?

  1. By 7 days after birth
  2. By 24 hours after birth
  3. By 72 hours after birth Correct answer.
  4. By 48 hours after birth

Explanation

The NIPE examination should be completed within 72 hours of birth, ideally before the baby leaves hospital. It is repeated at 6 to 8 weeks as part of the GP check.

Question 33Assessment, planning, implementation and evaluation of midwifery care

Which observation indicates effective attachment at the breast?

  1. Wide-open mouth with chin to breast and flanged lips Correct answer.
  2. The baby sucks rapidly and shallowly throughout the feed
  3. Only the nipple is drawn into the baby's mouth
  4. The baby's chin rests well away from the breast

Explanation

Effective attachment is shown by a wide-open mouth, the chin touching the breast, flanged lips and a pause in sucking as milk is transferred. Shallow, rapid sucking with a gaping chin suggests poor attachment and should prompt repositioning.

Question 34Assessment, planning, implementation and evaluation of midwifery care

A woman books at 10 weeks with a body mass index of 32 and a parent with type 2 diabetes. When should she be offered an oral glucose tolerance test?

  1. At 32 weeks of gestation
  2. At the booking appointment only
  3. At 16 weeks of gestation
  4. At 24 to 28 weeks of gestation Correct answer.

Explanation

Women with risk factors for gestational diabetes are offered a 75 g oral glucose tolerance test at 24 to 28 weeks. Earlier testing is reserved for women with previous gestational diabetes.

Question 35Assessment, planning, implementation and evaluation of midwifery care

A woman at 34 weeks reports intense itching of the palms and soles without a rash, and her serum bile acids are 25 micromol/L. How should this be interpreted?

  1. HELLP syndrome requiring immediate delivery
  2. Obstetric cholestasis needing treatment and review Correct answer.
  3. Pemphigoid gestationis needing topical steroids
  4. A normal pregnancy change needing no action

Explanation

Pruritus of the palms and soles with raised bile acids is diagnostic of obstetric cholestasis, which increases the risk of stillbirth and preterm labour. Ursodeoxycholic acid is used for symptom control and birth is planned according to bile acid levels.

Question 36Assessment, planning, implementation and evaluation of midwifery care

A woman whose previous baby developed group B streptococcal sepsis is now 36 weeks pregnant. What should the midwife plan for?

  1. Elective caesarean section at 39 weeks
  2. Weekly vaginal swabs until the onset of labour
  3. Intravenous benzylpenicillin in labour Correct answer.
  4. A single dose of benzylpenicillin at 36 weeks

Explanation

A previous baby with group B streptococcal disease is an indication for intrapartum intravenous antibiotic prophylaxis. Antibiotics given in labour reduce vertical transmission and neonatal infection.

Question 37Assessment, planning, implementation and evaluation of midwifery care

A woman at 28 weeks is in threatened preterm labour. Which antenatal corticosteroid regimen is recommended?

  1. Dexamethasone 6 mg orally twice daily for 2 days
  2. Betamethasone 12 mg intramuscularly once only
  3. Hydrocortisone 100 mg intravenously 6-hourly for 48 hours
  4. Betamethasone 12 mg intramuscularly twice, 24 hours apart Correct answer.

Explanation

The standard regimen is betamethasone 12 mg given intramuscularly on two occasions 24 hours apart. Antenatal corticosteroids given between 24 and 34 weeks reduce respiratory distress, intraventricular haemorrhage and neonatal death.

Question 38Assessment, planning, implementation and evaluation of midwifery care

Two days after a normal vaginal birth, a woman who had a previous unprovoked pulmonary embolism asks about thromboprophylaxis. What should be recommended?

  1. No pharmacological prophylaxis is required
  2. LMWH for 6 weeks postnatally Correct answer.
  3. LMWH for 24 hours only
  4. Aspirin 75 mg daily for 6 weeks after birth

Explanation

A previous unprovoked or oestrogen-related venous thromboembolism is a high-risk factor, so low molecular weight heparin should continue for six weeks after birth. Treatment is started or continued as soon as possible postnatally.

Question 39Assessment, planning, implementation and evaluation of midwifery care

A woman at 36 weeks and 2 days has a confirmed singleton breech presentation. Which option should be discussed with her first?

  1. Induction of labour with oxytocin at 39 weeks
  2. Immediate caesarean section at 37 weeks
  3. Moxibustion with a trained practitioner
  4. External cephalic version Correct answer.

Explanation

External cephalic version should be offered from 36 weeks to women with a singleton breech, as it reduces the chance of caesarean birth. It is performed with ultrasound guidance and fetal monitoring.

Question 40Assessment, planning, implementation and evaluation of midwifery care

At her 40-week appointment, a healthy nulliparous woman with an uncomplicated pregnancy asks about membrane sweeping. How should the midwife respond?

  1. It should not be discussed until 41 weeks
  2. It needs admission to hospital for monitoring
  3. It can be offered now, at 40 weeks Correct answer.
  4. It is only useful once the cervix is 3 cm dilated

Explanation

Membrane sweeping can be offered from 40 weeks to nulliparous women and from 41 weeks to parous women with uncomplicated pregnancies. It reduces the need for formal induction of labour and can be performed in the clinic or community setting.

Question 41Assessment, planning, implementation and evaluation of midwifery care

A term breastfed baby has lost 11% of birth weight by day 4. What is the most appropriate action?

  1. Admit the baby for intravenous fluids
  2. Advise her to switch to formula feeding
  3. Assess feeding urgently and plan supplementation Correct answer.
  4. Reassure her that this weight loss is normal

Explanation

Weight loss of 10% or more requires prompt assessment of feeding, including observation of a feed, and a plan such as expressing and supplementing with expressed milk. The baby should also be reviewed within 24 hours with weight and bilirubin checked.

Question 42Assessment, planning, implementation and evaluation of midwifery care

A woman has an estimated blood loss of 800 mL after vaginal birth and the uterus feels soft. Which drug is recommended for all women with postpartum haemorrhage of this size, alongside uterotonics?

  1. Misoprostol 800 micrograms sublingually
  2. Ergometrine 500 micrograms intramuscularly
  3. Tranexamic acid 1 g intravenously Correct answer.
  4. Carboprost 250 micrograms intramuscularly

Explanation

Tranexamic acid 1 g intravenously should be given to every woman with postpartum haemorrhage of 500 mL or more, as soon as possible and within three hours of birth. It reduces death from bleeding and is given alongside uterotonics.

Question 43Assessment, planning, implementation and evaluation of midwifery care

A woman at 29 weeks is in established preterm labour and birth is expected within 24 hours. Which intervention reduces the risk of cerebral palsy in the baby?

  1. Continuous fetal monitoring in labour
  2. Intravenous antibiotics for 5 days
  3. Intravenous magnesium sulphate Correct answer.
  4. Tocolysis with nifedipine until 37 weeks

Explanation

Magnesium sulphate given to the mother when preterm birth is imminent before 32 weeks reduces the risk of cerebral palsy. It is given as a loading dose followed by an infusion until birth or for up to 24 hours.

Question 44Assessment, planning, implementation and evaluation of midwifery care

A woman is found to be rubella non-immune at booking. When should MMR vaccination be offered?

  1. At 28 weeks of pregnancy
  2. Only after the baby is 6 months old
  3. Postnatally, before discharge Correct answer.
  4. During the first stage of labour

Explanation

MMR contains live attenuated virus and cannot be given in pregnancy, so vaccination is offered in the postnatal period, ideally before discharge. The woman should be advised to avoid pregnancy for one month afterwards.

Question 45Assessment, planning, implementation and evaluation of midwifery care

A woman at 39 weeks in labour at 5 cm has a temperature of 38.4°C, a fetal heart rate of 175 bpm and offensive meconium-stained liquor. After cultures are taken and intravenous access obtained, what is the most appropriate action?

  1. Give paracetamol and reassess in 2 hours
  2. Perform a fetal blood sample for lactate
  3. Start IV antibiotics and expedite birth Correct answer.
  4. Continue intermittent auscultation and review in 4 hours

Explanation

Maternal fever with fetal tachycardia and offensive liquor suggests chorioamnionitis, which is an obstetric emergency. Broad-spectrum intravenous antibiotics should be started within one hour and birth expedited.

Question 46Assessment, planning, implementation and evaluation of midwifery care

A woman at 36 weeks collapses on the antenatal ward and is unresponsive with no central pulse. How should she be positioned while cardiopulmonary resuscitation is started?

  1. Sitting upright at 45 degrees while rescue breaths are given
  2. Supine with the uterus displaced left, compressions started Correct answer.
  3. Prone with abdominal thrusts delivered
  4. Left lateral position with chest compressions started immediately

Explanation

After 20 weeks the gravid uterus compresses the vena cava, so the woman should be placed supine on a firm surface with manual left uterine displacement while compressions are performed. A left tilt of no more than 15 degrees can be used if needed.

Question 47Assessment, planning, implementation and evaluation of midwifery care

A woman with a twin pregnancy attends for her routine scan at 12 weeks. Which finding confirms dichorionic diamniotic twins?

  1. A single sac containing two fetuses and one yolk sac
  2. Two separate sacs with no membrane visible between them
  3. A lambda sign with a thick inter-twin membrane Correct answer.
  4. A T-shaped thin membrane inserting at right angles

Explanation

Before 14 weeks, a thick membrane inserting into the placental mass with a lambda (twin peak) sign indicates dichorionic twins. A thin membrane with a T sign indicates monochorionic diamniotic twins.

Question 48Assessment, planning, implementation and evaluation of midwifery care

A woman at 30 weeks reports a gush of clear fluid; speculum examination shows pooling in the vagina. She is afebrile, the uterus is soft and the cardiotocograph is normal. Which plan is most appropriate?

  1. Induce labour with oxytocin and continuous monitoring
  2. Admit for erythromycin, steroids and magnesium sulphate Correct answer.
  3. Arrange immediate caesarean section under general anaesthetic
  4. Discharge home with a repeat swab in one week

Explanation

Preterm prelabour rupture of membranes before 34 weeks is managed expectantly with oral erythromycin for 10 days, antenatal corticosteroids and magnesium sulphate for neuroprotection before 32 weeks. The woman is monitored for signs of chorioamnionitis and cord prolapse.

Question 49Assessment, planning, implementation and evaluation of midwifery care

A baby born at 34 weeks has a respiratory rate of 75, nasal flaring, grunting and oxygen saturation of 88% in air at 30 minutes of age. What is the most appropriate initial management?

  1. Give 100% oxygen by face mask and reassess in an hour
  2. Return the baby to the mother for uninterrupted skin-to-skin contact
  3. Arrange immediate intubation with chest compressions
  4. Start nasal CPAP, keep the baby warm and monitor temperature Correct answer.

Explanation

A preterm baby with grunting, flaring and low saturations has respiratory distress, and nasal CPAP is the appropriate first-line support. Saturations should be kept within the preterm target range of 90–95% and temperature carefully maintained.

Question 50Assessment, planning, implementation and evaluation of midwifery care

Which finding in a woman labouring after one previous lower-segment caesarean most suggests uterine rupture?

  1. Constant pain, contractions stopping and fetal bradycardia Correct answer.
  2. An urge to push at full dilatation with a visible head
  3. Blood-stained show with the cervix dilating to 4 cm
  4. Gradual increase in the frequency and strength of contractions

Explanation

Uterine rupture typically presents with sudden constant abdominal pain, loss of contractions, fetal heart rate abnormality and sometimes scar tenderness or vaginal bleeding. It is an obstetric emergency requiring immediate laparotomy.