OBSTETRICS Enhancement

1. What condition related to the manner of labor and delivery predisposes to uterine atony except?

A. Multiple pregnancy C. Arrest in fetal descent

B. Polyhydramnios D. Fetal macrosomia

2. What was the problem in a primigravida at term who underwent caesarean section due to an
arrest in the descent of the fetal head secondary to prominent ischial spines?

A. Passenger C. Passage
B. Power D. Physician

Choose the vaccine that can be given to a 25 y/o primigravid with history of multiple
sexual partners.

C. Measles, Mumps & Rubella vaccine

D. Varicella vaccine
C.HPV vaccine
D. Tetanus toxoid

3. At what period of pregnancy are teratogenic drugs or substances producing structural Defects
in the baby ingested by the mother?

A. first trimester C. third trimester

B. second trimester D. Just before pregnancy

4. What finding on the newborn is NOT a sign of live birth?

A. active muscle C. spontaneous respiration

B. Pulse rate D. blue/ pale skin

5. What is the next BEST step after inserting IV line and giving sedation to a patient who
Develop uterine inversion after delivering at home assisted by a traditional birth attendant?

A. Do manual reposition of the inverted uterus

B. Administer tocolytic agents
C. Start blood transfusion
D. Give oxytocin injection
 6. The expected date of confinement of a pregnant patient who had her last menstrual Period
on september 25-29,2021 but had vaginal spotting on october 26,2021, is

A. January 1, 2022 B.July 2, 2022

C.June 2,2022 D.July 2, 2021

7. On what phase of the menstrual cycle is a woman who had her menstrual period three Weeks
earlier?

A.Ovulatory C.Proliferative
B.secretory D.Menstrual

9 How many weeks after delivery is it safe to start combined oral contraceptive pills for those
not breastfeeding and with no venous thromboembolism risk?

A.12 C.24
B.6 D.3

10. After how many weeks postpartum do changes in the female reproductive organs return
to their non-pregnant state?

A.4 C.6
B.2 D.8

11.A pregnant women whose prepregnant body mass index is 23.87 kg/m2,and who gained
12kg (26.4lbs) during her present pregnancy is

A.Overweight C.normal
B.Obesed D.underweight

12. From what structure does the development of placenta start? -chorionic villi+decidua basalis

A. Developing morula
B. Outer cell mass of the blastocyst
C. Inner cell mass of the blastocyst – Langhan’s layer
D.Implanting blastocyst
13. What will a BEMONC - trained midwife do in a G2P1 patient in labor at 8 cm
cervical dilatation , whose BOW ruptured spontaneously?

A.Give oxytocin injection

B.Do internal examination every 30 minutes
C.Continue monitoring the progress of labor
D.Refer for cesarean section

14. What is the type of abortion in a 10 weeks pregnant patient who consulted for vaginal
bleeding with passage of meaty material and on internal examination showing an open cervix
with blood clots plugging the os?
A. Threatened C.Inevitable
B.Incomplete D.Missed

15. A breastfeeding mother remained amenorrheic since her delivery but claims to have
felt fetal movement for the first time the day before she consulted . How many weeks
is the age of gestation if she is pregnant?

A.16-20 C.12-14
B.6-8 D.8-12

Bromocriptine (parlodel) – lactation suppressant

16. What is the sound heard on auscultation at the right lower quadrant of a pregnant woman
amounting to 80 per minute?
A. Intestinal movement
B. Fetal heart tone
C. Uterine souffle
D. Uterine contraction

17. Determine the degree of perineal laceration involving the vaginal mucosa and
Muscles.
A. Fourth - S + VM+fascia+ muscle + anal sphincter + rectal mucosa
B. Third – S + VM+fascia+ muscle + anal sphincter but not rectal mucosa C.
Second – S+VM+muscle of perineal body
D. First -perineal skin+ vaginal mucosa but not fascia and muscle

18. Which is an example of a natural family planning method?

A. Subdermal contraceptive implant

B. Lactational amenorrhea
C. Oral contraceptive pills
D. Intrauterine device
 19. What is the course of action of a midwife attending to a G3P2 with a fully dilated
cervix lasting for 20 minutes?
A. Apply fundal pressure.
B. Ask the patient to bear down.
C. Give oxytocin injection.
D. Refer for forceps delivery

20. Choose the hormone which functions to produce milk, necessary in the let-down reflex
during breastfeeding

A. Progesterone
B. Estrogen
C. Oxytocin
D. Prolactin

21. What Should the midwife do in a G2P1, term , who delivered spontaneously in a Lying-in clinic,
with postpartum bleeding from vaginal mucosal lacerations?

A. Refer the patient to a higher level facility

B. Apply vaginal pack
C. Refer to the doctor for repair
D. Repair the vaginal lacerations

22. Choose a component of the symptothermal method of natural family planning. A.

Cervical mucus secretion
B. Cyanosis of the vagina
C. Breast tenderness
D. Softening of the cervix
23. What is the reason for NOT allowing vaginal birth after cesarean section in a 30 y/o
G2P1, term, breech, in beginning labor, previous low transverse cesarean section 3 years
ago for non-reassuring fetal heart rate patterns? VBAC – HIGH RISK
A. Type of previous cesarean section
B. Time interval from previous cesarean section
C. Indication of previous cesarean section D.
Malpresentation
24. What is important laboratory examination test to be initially requested in G3P3 (2101) who
complains of foul-smelling vaginal discharge and with history of intrauterine fetal
death?
A. VDRL – SYPHILLIS
B. RT-PCR test – GONORRHEA/ CHLAMYDIA
C. CA 125 – OVARIAN CANCER
D. Pap smear
25. Identify the irregular brownish patches of varying sizes appearing on the face and neck during
pregnancy
A. Chloasma
B. Striae gravidarum
C. Linea nigra
D. Vascular spider / TELENGECTASIA

26. What is the membrane that contains a thin transparent fluid in which the embryo is
suspended, providing a cushion against mechanical injury?
A. Amnion
B. Allantois
C. Placenta
D. Chorion

27. Which drug is given to pregnant women for the prevention of hypertensive disorders in
pregnancy

A. Ferrous sulfate
B. Ascorbic acid
C. Folic acid
D. Aspirin -
28. What is the abnormality in the menstrual cycle of an 18 y/o girl who consulted because of vaginal
bleeding occurring 40 days after her last normal menstrual period , lasting for 5
days , with moderate flow and no pain ?
A. Interval
B. Duration
C. Associated symptom
D. Amount

29. In what condition is the incidence of hypertension high ?

A. Hyperemesis gravidarum
B. Ectopic pregnancy
C. Multiple pregnancy
D. Breech presentation

30. At what part of labor is partograph PRIMARILY used in monitoring labor?

A. Second stage B.
Active first stage
C. Latent phase
D. Third stage
31. Which is the PRIMARY erogenous organ in the female reproductive system?
A. Labia majora
B. Vagina
C. Hymen
D. Clitoris

32. Describe a woman who has become pregnant but never completed a pregnancy beyond 20 weeks
gestation.
A. Primipara
B. Nullipara
C. Primigravida
D. Nulligravida

33. Determine the MOST likely presentation of the fetus in G3P2 patient at 38 weeks gestation
in which there is no fetal part at the fundus on Leopold’s maneuver and no definite fetal part
palpated on internal examination
A. Cephalic
B. Shoulder
C. Face
D. Breech

34. Determine which fetal part are the fetal heart tones auscultated on abdominal
Examination
A. Buttocks
B. Small parts
C. Presenting parts
D. Back

35. Which is the earliest cardinal movement of labor ?

A. Descent
B. Flexion
C. Extension
D. Internal rotation

36. What is the recommended position of a low-risk woman during the first stage of labor? A.
Upright
B. Supine
C. Lateral decubitus
D. Semi recumbent
37. What type of cancer is MOST likely seen in a 58 y/o , married nulligravid obese woman witch
postmenopausal bleeding and showing a thickned endometrium on ultrasound.
A. Fallopian tube
B. Cervical
C. Endometrial
D. Ovarian

38. What is the MOST likely condition of a hypertensive pregnant patient with unremarkable past
medical history, who developed convulsions after a normal spontaneous delivery ?
A. Brain tumor
B. Eclampsia – HELLP
C. Seizure disorder
D. Sepsis

39. What is the MOST accurate way to establish the age of gestation of a G3P2 , previous CS 2x with a
history of irregular menstruation and myoma uteri, in order to determine the schedule of repeat cesarean
section?
A. Result of the latest ultrasound
B. Size of the uterus palpation
C. Result of first trimester ultrasound
D. Date of the last menstrual period

40. Which nutrients has a greater quantity in the colostrum than in mature milk?
A. Protein
B. Sugar
C. Carbohydrate
D. Fat

41. What are the openings on the posterolateral aspects of the urethra?
A. Fourchette
B. Skene’s gland ducts
C. Labia minora
D. Bartholin’s gland ducts

42. What is the MOST likely diagnosis in a 26 y/o female employee who suddenly lost
consciousness, noted vaginal spotting after her last menstruation 2 months ago, and who on physical
examination was grossly pale with direct tenderness on the left hypogastric area ?

A. Ectopic pregnancy
B. H mole
C. Acute appendicitis
D. Abruptio placenta
43. What is a maternal condition that causes intrauterine fetal death?
A. Congenital syphilis
B. Hydrops fetalis
C. Hydrocephalus
D. Chronic hypertension

44. What should a midwife do with a G2P1 , 38 weeks AOG, who developed moderate vaginal
bleeding from a third degree perineal laceration after a normal spontaneous delivery in BEMONC
facility

A. Give hemostatic – Hemostan (Tranexamic Acid)

B. Give IV sedation
C. Repair the laceration
D. Insert IVF

45. With cephalic-transverse presentation on ultrasound, what is the mode of delivery of the second
of twins in which the first was already delivered spontaneously?
A. Caesarean section
B. Partial breech extraction
C. Normal spontaneous delivery
D. Total breech extraction

46. How many weeks age gestation is a woman who could not remember the date of her last
Menstruation but claims to have felt movement for the first time 8 weeks ago with
the uterine fundus palpated just above the umbilicus?
A. 16
B. 28
C. 24
D. 12

47. What clinic measurement is evaluated in trying to rule out contraction at the midpelvis?
A. Pubic angle
B. Diagonal conjugate
C. Bi Ischial tuberous diameter
D. Bi Ischial spinous diameter – interspinous diameter is less than 10 cm

48. Describe a fetus expelled from the mother before 20 weeks gestation or weighing less than
500 grams?

A. Immature fetus
B. Abortus
C. Stillbirth
D. Premature
49. What is the MOST likely body weight in kilograms of a pregnant woman whose Non-
pregnant body weight was 55 and her weight gain for the whole duration of Is
pregnancy normal? 55+12.5 =
A. 75.5
B. 67.5
C. 60.5
D. 80.5
50. What is the MOST practical advice to a woman on her trimester of pregnancy, who is
Complaining of breast tenderness with no fever,mass, nor discharge?

A. Wear well-fitted brassier

B. Give normal therapy
C. Apply warm compress
D. Give antibiotic

51. What is the diagnosis in a 16 y/o girl positive pregnancy test who developed profuse
Vaginal bleeding after being amenorrheic for 12 weeks?

A. Preterm labor
B. Placenta previa
C. Ectopic pregnancy
D. Abortion

52. Which structure is NOT part of the external genitalia?

A. Hymen
B. Clitoris
C. Labia minora
D. Cervix

53. What is the involvement of the midwife in the practice of obstetrics in the sustainable
Development goals (SDG-2030 agenda)?
A. Building resilient infrastructure
B. Promoting quality education
C. Eradicating poverty
D. Reducing maternal mortality

54. What is the sign characterized as bluish discoloration of the vagina occurring in early
Pregnancy as a result of increased blood flow?
A. Ladin’s Sign
B. Chadwick’s Sign
C. McDonald’s Sign
D. Hegar’s Sign
55. Identify the lie that demonstrates the relationship between the fetal and maternal parts Such that
fetal axis crosses the maternal axis making them perpendicular to one another.
A. Transverse / horizontal- perpendicular
B. Unstable
C. Longitudinal / vertical – parallel
D. Oblique – 45 degrees- asynclitism – Naegeles Obliquity-Anterior asynclitism and
Litzmann Obliquity- posterior asynclitism

56. Which finding is NOT part of diagnosis of preeclampsia? A.

16 weeks gestation
B. Bp: 160/110
C. Proteinuria ++
D. Headache

57. What is the management of a postpartum patient showing changes in behaviour with
episodes of fear, restlessness and insomnia?
A. Give antibiotics
B. Ensure that the needs of both mother & baby are met
C. Give sedatives
D. Refer to a neurologist

58. What is the factor considered in referring to a third level facility, a 24 y/o, G2P1, 24 weeks AOG,
with BP maintained at normal levels with antihypertensive medications, and with a Fundal height of 24
cm?
A. Gravidity
B. Big baby
C. Age
D. Medical complication

59. Select a parameter that is used to assess a characteristic of a uterine contraction.

A. Consistency
B. Position
C. Intensity
D. Effacement

60. What condition is referred to in a known hypertensive woman at 37 weeks gestation , who
sought admission at the hospital because of vaginal bleeding associated with Hypertonic
uterine contractions, with no fetal heart tones appreciated?
A. Abortion
B. Premature labour
C. Placenta previa –
D. Abruptio placenta - couvelaire uterus
61. Which is NOT a preventive maternal care measure ?
A. Immunization
B. Family planning
C. Blood transfusion
D. Risk assessment

62. The number of stillbirths plus neonatal deaths per 1000 total births is rate
A. Stillbirth
B. Perinatal mortality
C. Infant mortality
D. Neonatal mortality

63. Which is an indicator of preeclampsia that is NOT severe?

A. Visual disturbances
B. Bp -150/100 – mild
C. Oliguria
D. Fetal growth restriction

64. What is the MOST likely diagnosis in a women 16 weeks pregnant by early ultrasound , Whose
present uterine size is smaller than the age of gestation and with no fetal heart Tones ?
A. Early pregnancy
B. Pseudocyesis
C. Missed abortion – lithopedion formation
D. H-mole

65. What is the MOST important criterion in considering a diagnosis of postpartum

endometritis?
A. Dysuria
B. Fever
C. Foul- smelling discharge
D. Abdominal pain

66. Choose the maneuver in delivering the fetal head with support during crowning.
A. Pinard’s Maneuver
B. Zavanelli Maneuver -
C. Modified Ritgen’s Maneuver
D. MC Robert’s Maneuver – shoulder dystocia
67. The age of gestation of a pregnant woman who came for prenatal check-up on November
6,2021, and had her last normal menstrual period last june 26-30,2021 is
weeks.
A. 16
B. 18
C. 17
D. 19

68. What is the cause of vaginal bleeding in a non-breastfeeding mother occurring 8 weeks after an
uncomplicated normal spontaneous delivery ?
A. Retained placental fragments
B. Threatened abortion C.
Uterine subinvolution
D. Normal menstruation

69. What is a significant effect of decreased estrogen levels after menopause?

A. Ovarian cancer
B. Alzheimer’s disease
C. Osteoporosis – Hormonal replacement therapy, Evista, Fosamax
D. Breast cancer

70. What organ is MOST likely the source of cancer in a 55 y/o single nulligravid, with sudden
abdominal enlargement and a strong family history of cancer?
A. Cervix
B. Ovary
C. Uterus
D. Fallopian tube

71. What is the position of the presenting part, with the anterior fontanelle palpated anteriorly At the
right side of the midwife examining the patient in lithotomy position?
A. Left occiput anterior
B. Left occiput posterior
C. Right occiput anterior
D. Right occiput posterior

72. What will the midwife do in a term primigravida, with a fully dilated cervix for 2 hours and an
estimated fetal weight of 3,700 grams?
A. Ask the patient to bear down
B. Apply fundal pressure
C. Refer for outlet forceps extraction
D. Refer for cesarean section
73. At what age of gestation in weeks does the placenta take over the production of
progesterone from the corpus luteum?
A. 20
B. 12
C. 6
D. 16

74. What complication developed in a patient who delivered vaginally to a big baby with a fourth
degree perineal laceration and noted fecaloid material in her vagina two weeks later?
A. Infected Episiotomy
B. Endometritis
C. Rectovaginal fistula
D. Vesicovaginal fistula

75. Identify the hormone produced in the ovary resulting from the formation of corpus
Luteum after ovulation.
A. Estrogen
B. Progesterone
C. Follicle stimulating hormone
D. Luteinizing hormone

76. Identify the product of conception in a woman who had her last normal menstrual period 12
weeks earlier.
A. Zygote
B. Fetus
C. Baby
D. Embryo

77. How many months after delivery is it safe for a full breastfeeding mother to start taking
combined oral contraceptive pills?
A. 1
B. 2
C. 4
D. 6

78. What will a midwife do in a G2P1 who is undergoing a normal course of labor but
suddenly the fetal heart tones decreased to 100 beats per minute at 7 cm cervical
dilatation ?
A. Refer for cesarean section
B. Ask the patient to bear down
C. Advise left lateral decubitus position
D. Perform amniotomy
79. What is the MOST likely consideration in a 39 y/o obese , nulligravid, married for 9 years ,
amenorrheic for 16 weeks , claiming to be pregnant but with pelvic ultrasound result showing no
gestational sac?
A. Early pregnancy
B. Pseudocyesis
C. Ovarian new growth
D. Myoma uteri
80. What is the MOST likely consideration in a patient who developed vaginal bleeding with no
other sign and symptoms , one week after a home delivery assisted by a traditional birth
attendant?
A. Uterine atony
B. Endometritis
C. Ovarian growth
D. Myoma uteri

81. What is an example of direct maternal mortality ? A.

Complication of unsafe abortion
B. Postpartum pneumonia from covid 19 infection
C. Bleeding from a vehicular accident
D. Heart failure from congenital heart disease during delivery

82. Which is a barrier method of family planning which is also know to protect against
sexually transmitted diseases?
A. Intrauterine device
B. Condom
C. Bilateral tubal ligation
D. Subdermal implant

83. Which condition is NOT a predisposing factor to preterm delivery ? A.

Maternal age
B. Multiple pregnancy
C. Placenta previa
D. Hypertension

84. Which is an effect of bilateral tubal ligation? A.

Prevention of fertilization
B. Irregular menstruation
C. Osteoporosis
D. Hot flushes
85. Where is the normal site of fertilization?
A. Uterus
B. Fallopian tube
C. Vagina
D. Ovary

86. Which of the following organs is derived from ectoderm?

A. Bone
B. Intestine
C. Brain
D. Liver

87. What is the appropriate method of contraception in a postpartum woman who claim that natural
method of family planning not effective for her?
A. Symptothermal
B. Hormonal
C. Billing’s
D. Calendar

88. What is a common complication of sudden rupture of the amniotic membrane in a patient With
polyhydramnios?
A. Uterine inversion
B. Uterine rupture
C. Haemorrhage
D. Cord prolapse

89. What is the BEST advice for primary prevention of cervical cancer in a 16 y/o girl who has
just undergone curettage for abortion and whose mother died of cervical cancer? A. Have
human papilloma virus vaccination
B. Have annual ultrasound examination
C. Avoid getting pregnant
D. Undergo hysterectomy after completion of family size.

90. Where are the hormones FSH and LH, which function to regulate the female
reproductive system at the onset of puberty , mainly produced ?

A. Posterior pituitary gland

B. Hypothalamus
C. Ovaries
D. Anterior pituitary
91. What is the NEXT BEST thing to do in a 20 y/o primigravida , who developed postpartum
bleeding despite intramuscular oxytocin injection after delivery of the baby , with no cervical
and vaginal lacerations?
A. Curettage
B. Hysterectomy
C. Warm compress over the hypogastrium D.
Bimanual uterine compression

92. What is the NEXT course of action in a primigravida, whose fetal heart tones were noted to be
decreased at the height of a uterine contraction during the second stage of labor?

A. Put to left lateral decubitus position

B. Refer for cesarean section
C. Continue monitoring the fetal heart tones
D. Refer for outlet forceps extraction

93. What is the type of shock occurring in uterine inversion when blood vessels stop
working properly and do not push enough blood producing severe pain?
A. Hypovolemic
B. Neurogenic
C. Cardiogenic
D. Septic

94. Identify the homologue of the labia majora in males.

A. Epididymis
B. Prostate gland
C. Testis
D. Scrotum

95. Which layer of the uterus becomes the decidua during pregnancy ?

A. Serosa
B. Endometrium
C. Myometrium
D. Perimetrium

96. What is the general assessment of a pregnant patient on her third trimester of pregnancy , who is
grossly pale but asymptomatic, with BMI of 22 kg/m2, bp-130/80, CR-96/min, haemoglobin- 7.8 g/l.

A. Hypotension
B. Iron deficiency anaemia
C. Hypoglycaemia
 D. Malnutrition

97. What is the management of fever in a postpartum mother with breast engorgement?

A. Antibiotic
B. Incision and drainage
C. Antipyretic
D. Antihistamine

98. Determine the degree of perineal laceration to be repaired as a result of median

Episiotomy done with extension into the rectal mucosa.
A. Second
B. Third
C. First
D. Fourth
99. How many weeks pregnant is a teen-age girl who was accompanied by her mother to the
clinic because of a hypogastric mass extending to the fetal level of the umbilicus and with
heart tones heard on auscultation?

A. 20
B. 8
C. 12
D. 16

100. What is the finding on Leopold’s manoeuvre if the fetal heart tones are auscultated on the left
lower quadrant of the maternal abdomen?
A. Fetal back is on the right
B. Fetal small parts are on the right
C. Fetal small parts are on the right
D. Breech is the presenting part.