MCQ 16/06

Preterm Labour (PTL)

Defined as labor that begins after 20 weeks but before 37 completed weeks of pregnancy.

Mortality and Morbidity in Preterm Births

Most mortality and morbidity occur in babies born before 34 weeks gestation.

Placenta Praevia

A condition where the placenta is located low in the uterus and may cover the cervical opening, leading to painless vaginal bleeding.

Placental Abruption

Premature separation of the normally positioned placenta from the uterus, often causing painful vaginal bleeding.

Eclampsia

A severe form of pre-eclampsia characterized by seizures.

HELLP Syndrome

A severe form of pre-eclampsia that includes Hemolysis, Elevated Liver enzymes, and Low Platelets.

Tocolytics

Medications administered to alleviate contractions and facilitate fetal lung maturity.

Fetal Fibronectin (fFN) Testing

A test used to assess the risk of preterm labor, where a negative result indicates a low likelihood of labor within seven days.

Chronic Hypertension

Diagnosis of hypertension before pregnancy or before 20 weeks gestation.

Gestational Hypertension

New onset hypertension after 20 weeks in a previously normotensive woman.

Pre-eclampsia Diagnosis

Characterized by new hypertension and either proteinuria or severe organ dysfunction.

Macrolide Antibiotics in PPROM

Erythromycin is preferred for preventing sepsis after rupture of membranes due to its low risk for the baby.

McRoberts Maneuver

A maneuver where the mother flexes her legs toward her chest to widen the pelvis.

Suprapubic Pressure

Application of pressure just above the pubic bone to shift the baby's shoulder during delivery.

Impacts of High Blood Sugar Levels

High blood glucose in pregnant women can increase risks of congenital abnormalities in the baby.

Monitoring Fetal Heart Rate

Continuous monitoring during labor is essential to assess fetal well-being and detect potential distress.

Fundal Height Measurement

A method to monitor fetal growth by measuring the distance from the pubic bone to the top of the uterus.

Nutrition Guidelines for GDM

Discussing dietary advice, calorie monitoring, and physical activity to manage gestational diabetes.

Bishop Score

A scoring system used to evaluate the favorability of the cervix for induction of labor.

Corticosteroids Administration

Medications given to pregnant women under 34 weeks to help mature the baby's lungs.

Assessment of Maternal Emotional State

Important to assess mental state as anxiety can impact perceived symptoms and overall well-being.

Education on GDM for Patients

Providing information about diet, lifestyle changes, and ongoing management for gestational diabetes.

Rule of 15 for Managing GDM

If blood glucose levels are greater than 15 mmol/L, take steps to correct high levels every 15 minutes.

Farah (G7 P3) is being induced for Small for Gestational Age (SGA) at 38 weeks. Farah's baby is currently on the 3rd centile on a GROW chart. Farah inquires of the safest way to birth baby. Which method of cervical ripening may provide the least risk to Farah given her parity and history?

Artificial rupture of membranes.

Regarding hypertensive conditions in pregnancy which of the following statement is correct?

When blood pressure is =/>140/90 mmHg after 20 weeks, pregnancy-induced hypertension is the most common diagnosis.

Emergency manoeuvres used by midwives during a shoulder dystocia are designed to:

Increase the functional size of the pelvis, decrease the bisacromial diameter and change the relationship of the bisacromial diameter within the bony pelvis.

Calista, 36 weeks pregnant has a diastolic blood pressure (BP) of 90mmHg. Previously her BP has been normal. There is no proteinuria. Your plan is:

To inform Calista that you need to consult with the Obstetrician as her diastolic BP is 90mmHg.

Which of the following is true about a woman's haemodynamic status in cases of placental abruption?

Blood pressure can be normotensive for normally-hypertensive women.

Which of the following is the correct management for Kara who has severe pre-eclampsia?

Kara should be stabilised prior to being transferred to a tertiary level care.

A low temperature could indicate:

Sepsis.

During pregnancy the fetal condition is best determined by:

Normal fetal development.

, Not Selected

Strength & frequency of fetal movement.

, Not Selected

Circadian pattern/rhythm.

Mia, 36/40 weeks pregnant has presented with a history of reduced fetal movements. The CTG has been on for 10 minutes.  The baseline is 140bpm, the variability is normal, there are no accelerations or decelerations. Mia is not contracting. Your immediate actions include:

Reassure Mia, change her position and continue to monitor the CTG trace.If there is no improvement, further assessment may be necessary.

Physiological changes that occur in a multiple pregnancy include:

Additional increase in blood volume and relative decrease in red blood cells.

Liala, 39 weeks pregnant has a platelet count of 80 x 10⁹/L (normal 140 - 450 x 10⁹/L). Liala asks if she will be able to have an epidural. You respond:

The platelet count requires a consultation.

When calculating a Bishops score, which cervical findings are considered?

Dilatation, length, consistency, position, and station/level.

Tai, 34 weeks pregnant presents with painless vaginal bleeding. The uterus is soft and the fetal heart rate is normal. What is the possible cause

Placenta praevia.

The most accurate reason women are asked to curl forward for epidural insertion in labour is:

To open the spaces between the vertebrae which allows greater access.

Which of the following is most likley to increase the chance of cord prolapse?

Polyhydramnios

Epigastric pain being related to pre-eclampsia is best distinguished by:

Offering Liver Function Tests - AST (aspartate aminotransferase) and ALT (alanine aminotransferase) to note increase in levels.

Which of the following is least likely to be a risk associated with breech presentation?

Antepartum haemorrhage.

Preterm labour is defined as occurring:

After 20 weeks but before 37 completed weeks of pregnancy.

Hadley has ruptured her membranes at 35 weeks gestation and is not in labour. According to Te Whatu Ora (2023) Referral Guidelines this is

Transfer

What is unlikely to be used in an Epidural?

Local anaesthetic and sedatives.

Which of the following fetal positions in late pregnancy most indicates the need for further investigation of placental position?

High presenting part, unstable lie, and transverse or oblique lie.

Considering legal scope of practice, who has the responsibility to provide primary care for Induction of Labour?

Obstetric team.

Zoe has a history of a stillborn baby at term in her first pregnancy; the baby was on the 5th customised centile. Zoe is very anxious and asks about her risks of another stillbirth. Your best response would be:

Acknowledge her anxiety and explain there is an increased risk of small for gestational age (SGA) baby in this pregnancy. Arrange for an early specialist review to discuss plan for care.

An antepartum haemorrhage of unknown cause should be suspected:

When the history and abdominal examination are not suggestive of an abruptio placentae.

When local causes of bleeding have been excluded by a speculum examination.

When a placenta praevia is excluded.

Correct answer:

When all of the above causes of an antepartum haemorrhage have been excluded.

At the birth of twins, the uterotonic is recommended to be administered:

After the birth of twin two.

Which of the following is the best clinical method of determining uterine growth between 18 and 36 weeks of pregnancy?

The distance in centimetres between the upper edge of the symphysis pubis and the fundus of the uterus.

Preterm labour: A Fetal Fibronectin test is considered when:

There are intact membranes and a cervix less than (<) 3 cm dilated

The purpose of the Cooks Cervical Ripening Catheter in Induction of Labour (IOL) is:

To apply mechanical pressure to the cervix to dilate enough for artificial rupture of membranes.

At the booking visit, Christina asks what is the best way to prevent GDM in pregnancy. Your best suggestion includes:

Maintaining weight and lifestyle advice during pregnancy.

The potential risks for women during pregnancy when Gestational Diabetes Mellitus (GDM) is untreated or not well controlled are:

Developing Type 2 Diabetes within 10 years.

Beatrix aged 42 is 23 weeks pregnant. The assessment indicates normal blood pressure (BP) and protein (1+) in her urine sample for the first time. Your plan is to:

Offer Beatrix a midstream urine sample (MSU) test and plan to see her within a week.

Which of the following multiple births is least likely to occur naturally?

Having quadruplets.

The use of castor oil to induce labour has been shown to increase risk of:

Meconium-stained amniotic fluid.

An increased concern for babies in breech presentations is due to its association with 🇦

Birth asphyxia or trauma.

The diagnosis of twin to twin transfusion syndrome (TTTS) is usually made in:

Second trimester fo pregnancy.

The absolute contradiction (inadvisable) for induction of labour (IOL) is:

Previous classical caesarean section.

Salini's cervix is 6 cm dilated after an induction of labour. She is experiencing 6 contraction in 10 minutes. The cardiotocograph shows decelerations to 80 bpm with most contractions. The syntocinon infusion is in progress. What is your first priority?

Stop the syntocinon infusion.

You are caring for Amelie who is progressing well in the second stage of labour.  The CTG baseline is 140bpm, the variability is normal, there are accelerations with contractions and no decelerations. Amelie is contracting every 2-3 minutes. Your immediate action is:

Assess maternal pulse.

Principles of physiological breech birth include which of the following?

Hands-off principle unless emergency manoeuvres required.

Juno has preterm prelabour rupture of membranes (PPROM) at 34 weeks gestation. As there are no contraindications Juno can continue with the pregnancy until

37 weeks of pregnancy.

Which is the antibiotic that should not be prescribed to Juno who has preterm prelabour rupture of membranes (PPROM) at 34 weeks of pregnancy?

Ampicillin - Clavulanic acid.

Letitia 29 weeks pregnant has had the oral glucose challenge test (OGCT) with result of 7.5mmol/L. Your plan is to:

Continue providing care to Letitia as the OGCT result is normal.

Cleo with gestational diabetes mellitus (GDM) birthed her baby at 38 weeks gestation. Cleo's baby is at risk of:

Hypoglycaemia

An antepartum haemorrhage with no fetal heart rate heard is usually caused by:

Antepartum haemorrhage of unknown cause.

Which strategies help to ensure optimum glucose levels in pregnancy?

Self-monitoring & laboratory measurements of blood glucose levels.

Which statement is correct regarding epidural management by the midwife?

All midwives must ensure women have full information about epidural.

Which of the following factors will place a pregnant person at the highest risk of abruptio placentae?

A history of abruptio placentae in a previous pregnancy.

, Not Selected

Any of the hypertensive disorders of pregnancy.

, Not Selected

Maternal age over 35 years.

, Not Selected

Correct answer:

All factors mentioned will place a pregnant person at highest risk.

Which side effect is least likely to occur with epidural analgesia?

Infection

What is the purpose of Maternity Early Warning System (MEWS)? 

A national system to detect early deterioration of people in the perinatal period.

Pia is pregnant with twins. What will be the least likely management if Pia's labour commences at 25 weeks gestation?

Considering use of bed rest.

HELPERR pneumonic stands for:

Call for help, evaluate for episiotomy, McRobert’s manoeuvre, apply suprapubic pressure, enter vagina for rotational manoeuvres, remove the posterior arm and roll the person onto hands and knees.

Which of the following statements about multiple pregnancy is not correct?

Conjoined twins are dizygotic eggs that fuse during development.

What is the recommended time for the Cooks Cervical Ripening Catheter to be in place?

12-24 hours.

Who has the responsibility for care when Gestational Diabetes Mellitus (GDM) is managed by diet alone?

Diabetes in pregnancy team & the LMC Midwife.

Alora presents with preterm labour. The first step in management is to:

Do an abdominal examination to evaluate the frequency and duration of uterine contractions.