FOR MIDWIFERY PRACTITIONERS AND MEDICAL STUDENTS

1. MIDWIFERY MCQS REVISION QUESTION
MOHAMED SHUKRI ELMI
LECTURER KMTC IV

2. Monitoring the condition of the fetus during
the first stage of labour
1. Compression of the fetal head during
labour:
A. Usually does not harm the fetus
B. Usually damages the fetal brain
C. Usually causes blindness in the newborn
infant
D. Usually kills the fetus

3. 2. What is the commonest cause of a reduced
supply of oxygen to the fetus during labour?
A. Uterine contractions
B. Partial placental separation
C. Placental insufficiency
D. Infection of the membranes

4. 3. How does the fetus usually respond to a
lack of oxygen during labour?
A. There is an increase in fetal movements.
B. There is a decrease in the fetal heart rate.
C. There is an increase in the fetal heart rate.
D. There is a decrease in fetal movements.

5. 4. How should the fetal heart rate be monitored
in labour?
A. A cardiotocograph (CTG machine) should
preferably be used in all labours .
B. A doptone is the preferred method in primary-
care clinics and hospitals.
C. A fetal stethoscope is the best method for most
labours.
D. The fetal heart rate does not need to be
monitored in all low-risk pregnancies.

6. 5. The fetal heart rate pattern should be monitored:
A. During a contraction
B. Before a contraction
C. After a contraction
D. Before, during, and after a contraction

7. 6. How often should the fetal heart rate be
monitored during the first stage of labour in
low-risk pregnancies where there is no
meconium staining of the liquor?
A. Every 3 hours during the latent phase
B. Every 2 hours during the latent phase
C. Every 2 hours during the active phase
D. Every 15 minutes during the active phase

8. 7. What is the normal baseline fetal heart rate
in labour?
A. 100–120 beats per minute
B. 120–140 beats per minute
C. 140–160 beats per minute
D. 110–160 beats per minute

9. 8. Early decelerations:
A. Start at the beginning of a contraction and
return to the baseline at the end of a
contraction
B. Start at the beginning of a contraction and end
30 seconds or more after the contraction
C. Do not have any relation to contractions
D. Occur during the period of uterine relaxation

10. 9. Early decelerations are usually caused by:
A. Intracranial haemorrhage
B. Compression of the fetal head
C. A short umbilical cord
D. A decreased supply of oxygen to the fetus

11. 10. What are late decelerations?
A. Decelerations that occur after 38 weeks gestation
B. Decelerations that are only present at the end of
the first stage of labour
C. Decelerations that start 30 seconds or more after
the beginning of the contraction
D. Decelerations that return to the baseline 30
seconds or more after the end of the contraction

12. 11. Late decelerations:
A. Always indicate fetal distress
B. Only suggest that fetal distress may be
present
C. May be normal
D. Cannot be diagnosed with a fetal stethoscope

13. 12.A baseline tachycardia:
A. Indicates that the fetus is in good condition
B. Is common when the mother is given
pethidine
C. May be caused by infection of the placenta
and membranes
D. Indicates that the fetus is dying from lack of
oxygen

14. 13. A baseline bradycardia:
A. Is a safe pattern
B. Is a pattern which indicates an increased risk
of fetal distress
C. Indicates severe fetal distress
D. Is usually caused by infection of the placenta
and membranes

15. 14. Which fetal heart rate pattern warns that
there is an increased risk of fetal distress?
A. Early decelerations
B. Late decelerations
C. Baseline bradycardia
D. Late decelerations plus a baseline bradycardia

16. 15. When can you be confident that the fetal
condition is good?
A. When the baseline fetal heart rate is normal
and there are no decelerations
B. When the baseline fetal heart rate is normal
and there are only early decelerations
C. When fetal tachycardia is present and there
are no decelerations
D. All of the above

17. 16. Meconium staining of the liquor:
A. Is uncommon
B. Occurs in 10–20% of patients
C. Occurs in 30–40% of patients
D. Occurs in most patients

18. 17. Meconium staining of the liquor is
commonest in:
A. Patients in post-term labour
B. Patients in term labour
C. Patients in preterm labour
D. Patients whose fetuses move a lot during
pregnancy

19. 18. Which form of meconium in the liquor is most
likely to indicate the presence of fetal distress?
A. Fresh meconium indicates definite fetal distress and is
an indication for an emergency Caesarean section.
B. Old meconium indicates that there was a problem but
that there is no need to be concerned
C. Yellow meconium is of no clinical importance
D. The management is the same as it does not matter
what the consistency or colour of the meconium is

20. 19. Why does a fetus pass meconium during
labour?
A. Because there is fetal hypoxia
B. Because it makes the second stage of labour
shorter
C. Because the mother has been given liquid
paraffin
D. Because it is mature and ready for delivery

21. 20. What is the correct management when the
liquor is meconium stained?
A. Monitor the fetal heart rate carefully.
B. Deliver the fetus immediately by Caesarean
section.
C. Give the patient an oxytocin infusion to
shorten labour.
D. Transfer the patient urgently to a level 3
hospital.

22. Monitoring the fetus during the first stage of
labour
1) a
2) a
3) b
4) b
5) d
6) b
7) d
8) a
9) b
10) d

23. 11.a
12. c
13. c
14. a
15. a
16. b
17. a
18. d
19. a
20 a

24. Monitoring and management of the first stage of
labour
1. The latent phase of the first stage of labour is:
A. The period of time the cervix takes to dilate from
3 cm to full dilatation
B. The period of time from the onset of labour to
full cervical dilatation
C. The period of time from the onset of labour to 3
cm cervical dilatation
D. The period of time during which the cervix
becomes effaced

25. 2. What is the name given to the first oblique
line on the partogram?
A. The action line
B. The alert line
C. The normal cervical dilatation line
D. The danger line

26. 3. If a patient’s cervix is 2 cm dilated, when
should you perform the next vaginal
examination?
A. When there are signs that the patient is in
established labour with more regular and
painful contractions
B. After 2 hours
C. After 8 hours
D. When the patient wants to bear down

27. 4. A patient presents in the latent phase of labour.
After 12 hours she has not progressed to the active
phase of labour despite regular contractions. Which of
the following is the correct management?
A. She should be discharged home.
B. If there have been no cervical changes, the membranes
should be ruptured.
C. If there has been slow dilatation and effacement of the
cervix, it may be necessary to rupture the membranes.
D. An oxytocin infusion should be started.

28. 5. A patient is admitted in established labour with regular
contractions and ruptured membranes. On vaginal
examination the cervix is 5 cm dilated. Where should her
cervical dilatation be noted on the partogram?
A. On the alert line opposite 6 cm cervical dilatation
B. At the beginning of the latent phase of labour opposite 6 cm
cervical dilatation
C. At the end of the latent phase of labour opposite 6 cm cervical
dilatation
D. On the vertical line at the beginning of the active phase of
labour opposite 6 cm cervical dilatation

29. 6. You should be satisfied with the progress of labour
during the active phase when:
A. Cervical dilatation falls on or to the left of the alert
line together with less fetal head palpable above the
pelvis.
B. The cervix dilates at a rate of 2 cm per hour
C. Cervical dilatation falls on or to the left of the alert
line together with improvement in the station of the
presenting part as assessed on vaginal examination
D. There is progressive dilatation and effacement of the
cervix

30. 7. What should be your first step in the management
of a patient who fails to progress in the active phase
of the first stage of labour?
A. Make sure that the patient is in the active phase of
the first stage of labour and that her membranes are
ruptured.
B. Perform a pelvic assessment to determine whether
she has a small pelvis.
C. Evaluate the patient by following the rule of the ‘4
Ps’.
D. Make sure that the patient has adequate analgesia.

31. 8. What should be your second step in the
management of a patient who fails to progress in
the active phase of the first stage of labour?
A. Determine whether the uterine contractions are
adequate.
B. Start an oxytocin infusion.
C. Evaluate the patient by following the rule of the
‘4 Ps’.
D. Make sure that the patient is adequately
hydrated.

32. 9. When does a patient have adequate and
effective uterine contractions?
A. If she has 2 or more contractions every 10
minutes with each contraction lasting 30 seconds
or longer
B. If she has 3 or more contractions every 10
minutes with each contraction lasting 60 seconds
or longer
C. If she progresses normally during labour
D. If she has pain with every contraction

33. 10. If a primigravida has poor progress in
labour in spite of good, painful uterine
contractions, without any moulding, your
diagnosis should be:
A. Ineffective uterine contractions
B. Cephalopelvic disproportion
C. A small pelvis
D. Braxton Hicks contractions

34. 11. A patient presents in labour at term with 2
contractions of 35 seconds each every 10 minutes. The
cervix is 3 cm dilated and the membranes are bulging.
The cervical dilatation is plotted on the alert line of the
partogram. After 4 hours the cervix is 4 cm dilated while
the other observations are unchanged. What is the
correct management?
A. An oxytocin infusion should be started.
B. A Caesarean section should be done.
C. The patient’s membranes should be ruptured.
D. The doctor should be called to examine the patient.

35. 12. What should you do if the cervical dilatation falls
on the action line?
A. A Caesarean section should be done immediately.
B. The patient should be given the correct dose of
oxytocin in an infusion.
C. The patient must be personally assessed by a doctor,
and further management must be under the direction
and responsibility of the doctor.
D. After making sure that the patient is in the active
phase of the first stage of labour and her membranes
are ruptured, she should be managed according to the
rule of the ‘4 Ps’.

36. 13. Cephalopelvic disproportion due to a small
pelvic inlet should be diagnosed when:
A. There is no further dilatation of the cervix
B. There is 3/5 or more of the fetal head palpable
above the pelvic brim and 3+ or more moulding
is present
C. There is 2/5 or less of the fetal head palpable
above the pelvic brim and 1+ moulding is
present
D. The measurements of the pelvic inlet are
assessed as small during a pelvic examination

37. 14. A patient at term presents after having been
in labour at home for some time. On admission,
Cephalopelvic disproportion is diagnosed. What
is the correct further management of this
patient?
A. An oxytocin infusion should be started.
B. A Caesarean section should be done.
C. The patient should be given pethidine and
promethazine (Phenergan).
D. The patient should be reassured that she will
labour and deliver normally.

38. 15. A primigravida presents in labour at term. She is
having 2 contractions of 35 seconds each every 10
minutes. The cervix is 5 cm dilated and the
membranes have ruptured. Her cervical dilatation is
plotted on the alert line. 4 hours later the cervix is 6
cm dilated and her other observations are unchanged.
There are no signs of Cephalopelvic disproportion.
What is the correct management?
A. An oxytocin infusion should be started.
B. A Caesarean section should be done.
C. She should be given pethidine and hydroxyzine
(Aterax).
D. The doctor should be called to examine the patient.

39. 16. A patient at term progresses slowly during the active
phase of labour. During a thorough physical
examination, an occipito-posterior position with mild
caput and 1+ moulding is diagnosed. What should be the
further management?
A. An oxytocin infusion should be started.
B. A Caesarean section should be done.
C. The patient should be given pethidine and hydroxyzine
(Aterax).
D. Oxytocin is contraindicated. Rather, an intravenous
infusion should be started and the patient should be
given adequate analgesia.

40. 17. Which of the following patients should receive
oxytocin if they developed poor progress due to
inadequate uterine contractions during the active
phase of labour?
A. A patient with 2+ moulding
B. A primigravida patient with a vertex presentation
and no moulding
C. A multipara with a vertex presentation and no
moulding
D. A primigravida patient with a breech presentation

41. 18. A patient is being referred from a peripheral clinic
to a hospital with the diagnosis of cephalopelvic
disproportion. Which of the following is the best
management for the patient and her fetus, before the
patient is transported?
A. Adequate analgesia, e.g. pethidine and hydroxyzine
(Aterax)
B. An infusion with oxytocin to improve uterine
contractions
C. 3 nifedipine (Adalat) 10 mg capsules (total 30 mg)
should be given orally to suppress labour
D. Oxygen administration with a mask

42. 19. Which one of the following patients is at
high risk of cord prolapse?
A. A patient with a breech presentation
B. A patient with a cephalic presentation
C. A patient with a post-term pregnancy
D. A patient who ruptures her membranes when
the fetal head is still palpable 3/5 above the
pelvic brim

43. 20. What should be done first if a patient, whose cervix
is 6 cm dilated, presents with a prolapsed cord?
A. Immediately replace the umbilical cord into the vagina
and take steps to lift the presenting part off the cord.
B. An oxytocin infusion should be started in order to
deliver the infant as soon as possible.
C. Give the patient oxygen by face mask in order to
ensure that the fetus receives enough oxygen.
D. The patient must be rushed to theatre for an
emergency Caesarean section.

44. Monitoring and management of the first stage of
labour
1) c
2) b
3) a
4) c
5) a
6) a
7) a
8) c
9) c
10) a

45. 11. c
12. c
13. b
14. b
15. a
16. d
17. b
18. c
19. a
20. a