Multiple choice questions

Chapter 3 Maternal resuscitation

1. How many women died between 2011 and 2013 due to direct/indirect causes?

   1. 147
   2. 200
   3. 214
   4. 260

2. Which of the following can complicate the resuscitation of a pregnant woman?

   1. Aortocaval compression/occlusion
   2. Relaxation of the cardiac sphincter
   3. Nasal and pharyngeal oedema
   4. All of the above

3. During the initial assessment what is the rescuer looking, listening and feeling for?

   1. Fetal movements
   2. Evidence of breathing
   3. Oedema of the glottis
   4. Oedema and movement of the lower extremities

4. Approximately how much of the woman's total blood volume can be sequestered in the lower limbs during aortocaval compression?

   1. 30%
   2. 20%
   3. 15%
   4. 10%

5. How quickly should chest compressions be delivered?

   1. 60-80 compressions per minute
   2. 80-100 compressions per minute
   3. 100-120 compressions per minute
   4. 120-140 compressions per minute

6. To what depth should chest compressions be administered?

   1. 4-5 cm
   2. 5-6 cm
   3. 6-7 cm
   4. No specified depth

7. What is the ratio of chest compressions to rescue breaths?

   1. 30 compressions to 2 breaths
   2. 15 compressions to 2 breaths
   3. 3 compressions to 1 breath
   4. 30 compressions to 1 breaths

8. A perimortem Caesarean section should be performed within how many minutes of the decision to resuscitate?

   1. 5 minutes
   2. 3 minutes
   3. 4 minutes
   4. 6 minutes

9. Which of the following statements is true re: the use of an automated external defibrillator (AED)?

   1. An AED can be used on a pregnant woman
   2. An AED can be used with caution when it is wet or raining
   3. An accidental shock cannot be administered
   4. All of the above

10. When should efforts to resuscitate the woman cease?

    1. When spontaneous respirations occur
    2. When spontaneous movement is seen
    3. When instructed by a senior member of staff
    4. Any of the above

Chapter 4 Neonatal resuscitation

1. Which of the following might predispose a newborn infant to require support at birth?

   1. Recent maternal sedation
   2. Precipitate delivery
   3. Obstetric emergency
   4. All of the above

2. Which four elements are assessed regularly throughout the resuscitation?

   1. Heart rate, respiratory effort, weight, blood glucose level
   2. Heart rate, respiratory effort, pupil reaction, Moro reflex
   3. Heart rate, respiratory effort, colour, tone
   4. Heart rate, respiratory effort, colour, reflexes

3. Why is it important to dry the neonate?

   1. To stimulate the baby to take a breath
   2. To dry the baby and prevent radiant heat loss
   3. To maintain the baby's temperature between 36.5°C and 37.5°C
   4. All of the above

4. What position should the neonate's head be in to aid resuscitation?

   1. Neutral position
   2. Extended position
   3. Flexed position
   4. Lateral position

5. What is the purpose of the inflation breaths?

   1. To remove the amniotic fluid in the alveoli in the lungs of the neonate and back-fill with air
   2. To maintain ventilation of the lungs
   3. To make the baby take a breath
   4. To open the airway

6. Approximately how much fluid may be present in the alveoli after birth in a term baby?

   1. 10-20 mL
   2. 30-50 mL
   3. 60-90 mL
   4. 100-150 mL

7. How frequently would you assess the baby's condition?

   1. Every 20 seconds
   2. Every 30 seconds
   3. Every 45 seconds
   4. Every 60 seconds

8. When is it appropriate to commence chest compressions?

   1. If the heart rate is below 60 beats per minute and you have seen the chest rise
   2. If the heart rate is below 60 beats per minute and you have not seen the chest rise
   3. If the heart rate is below 60 beats per minute, if you have seen the chest rise and if 30 seconds of ventilation breaths have been given
   4. If the chest has risen and if the heart rate is above 90 beats per minute

9. What is the acceptable preductal SpO2; in a term baby at 3 minutes of age?

   1. 60%
   2. 70%
   3. 80%
   4. 90%

10. What drugs are likely to be used should the neonate require pharmacological support?

    1. Sodium bicarbonate 4.2% (1-2 mmol per kg); adrenaline 1 in 10 000 solution (10 mcg per kg); dextrose 10% (2.5 mL per kg)
    2. Sodium bicarbonate 4.2% (5 mmol per kg); adrenaline 1 in 10 000 solution (10 mcg per kg); dextrose 10% (2.5 mL per kg)
    3. Sodium bicarbonate 4.2% (1-2 mmol per kg); adrenaline 1 in 10 000 solution (5 mcg per kg); dextrose 10% (2.5 mL per kg)
    4. Sodium bicarbonate 4.2% (1-2 mmol per kg; adrenaline 1 in 10 000 solution (10 mcg per kg); dextrose 5% (2.5 mL per kg)

Chapter 5 Antepartum haemorrhage

1. Antepartum haemorrhage is defined as:

   1. Bleeding from the gastrointestinal tract after 24 weeks' gestation and before the birth of the baby
   2. Bleeding from the genital tract during the first trimester of pregnancy
   3. Bleeding from the genital tract after 24 weeks' gestation and before the birth of the baby
   4. A blood loss from the genital tract of an amount greater than 500 ml

2. Which is a predisposing factor for antepartum haemorrhage caused by placental abruption?

   1. Maternal cardiac conditions
   2. Raised body mass index (BMI)
   3. Pre-eclampsia
   4. Gestational diabetes mellitus

3. Which is a predisposing factor for antepartum haemorrhage caused by placenta praevia?

   1. Teenage pregnancy
   2. Primigravid woman
   3. Intrauterine growth retardation
   4. Multiple pregnancy

4. From the possible complications arising from an antepartum haemorrhage, which one is incorrect?

   1. Postpartum haemorrhage
   2. Disseminated intravascular coagulation
   3. Diabetes mellitus
   4. Renal failure

5. Which presenting factor is not an indicator of uterine rupture?

   1. Fetal heart rate abnormalities
   2. Constant lower abdominal pain
   3. Vaginal bleeding
   4. Cord prolapse

6. What other differential diagnoses might present with similar symptoms?

   1. Acute polyhydramnios
   2. Chorioamnionitis
   3. Trauma to the maternal abdomen
   4. All of the above

7. Which of the following is not part of the role of the midwife?

   1. Reassure the woman and her partner
   2. Undertake an examination per vaginam to ascertain the cause of the bleeding
   3. Make a rapid referral as the woman's condition can deteriorate quickly
   4. Ascertain as much detail as possible regarding the history of the blood loss

8. Placenta praevia may be considered when:

   1. There is a lack of vaginal bleeding
   2. The abdomen feels 'board-like' on palpation
   3. The presenting part of the fetus is palpated above the pelvis and/or the lie is unstable
   4. The placenta is located in the upper segment of the uterus on ultrasound scanning

9. How would a woman present when experiencing a placental abruption?

   1. Anxious and in pain
   2. Relaxed
   3. Flushed
   4. Bradycardic

10. A concealed antepartum haemorrhage may lead to:

    1. The uterus feeling hard on palpation
    2. Difficulty in palpation of the fetus
    3. Auscultation of the fetal heart becoming difficult or impossible
    4. All of the above

Chapters 6 and 7 Postpartum haemorrhage

1. From the list below of the causes and predisposing factors for primary postpartum haemorrhage which one is incorrect?

   1. Genital tract sepsis
   2. Uterine atony
   3. Genital tract trauma
   4. Preterm labour

2. From the list below of the causes and predisposing factors for primary postpartum haemorrhage which one is ­correct?

   1. White ethnicity
   2. Mismanagement of the third stage of labour
   3. Active management of the third stage of labour
   4. Maternal haemoglobinopathy

3. The most common cause of postpartum haemorrhage is:

   1. Uterine atony
   2. Trauma to the genital tract
   3. Retained fragments of the placenta, membranes or retroplacental clot
   4. Maternal clotting disorder

4. Which pharmacological treatment is not used to manage uterine atony?

   1. Syntocinon 5-10 IU given IM
   2. Syntocinon 40 IU in 500 mL 0.9% sodium chloride IV infusion
   3. Syntometrine 1 mL given...