Midwifery & Reproductive Health: NCK Exam Questions & Revision

The indicative signs of the second stage of labor consist of:

• A. Uterine action, soft tissue displacement.
• B. Rupture of the forewaters, expulsive uterine contractions.
• C. Backache, progressive cervical dilation.
• D. Show, erratic uterine contractions.

Why: The second stage of labor is characterized by the expulsion of the fetus. This stage begins with full cervical dilation and ends with the delivery of the baby. The indicative signs include expulsive uterine contractions and often the rupture of the forewaters (amniotic sac), which facilitate the descent and delivery of the baby. Options a, c, and d describe signs and symptoms more typical of the first stage of labor, which involves cervical dilation and effacement.

The most common cause of primary postpartum haemorrhage is:

• A. Retained placenta
• B. Uterine atony
• C. Genital tract trauma
• D. A clotting disorder

Why: Uterine atony (a poorly contracted uterus) causes most cases of primary PPH. First actions are uterine massage and uterotonic drugs.

The drug of choice to prevent and treat seizures in eclampsia is:

• A. Diazepam
• B. Phenytoin
• C. Magnesium sulphate
• D. Carbamazepine

Why: Magnesium sulphate is the first-line drug for preventing and controlling seizures in pre-eclampsia and eclampsia.

A woman at 32 weeks has BP 160/110, proteinuria and a headache. This is most consistent with:

• A. Gestational diabetes
• B. Severe pre-eclampsia
• C. Normal pregnancy changes
• D. Iron-deficiency anaemia

Why: New hypertension with proteinuria after 20 weeks, plus symptoms such as headache, indicates severe pre-eclampsia and a risk of progression to eclampsia.

During a vaginal exam in labor, you find that the sagittal suture is aligned with the left oblique diameter of the pelvis, and the occiput is directed towards the right iliopectineal eminence. What is the vertex presentation position?

• A. Right occipito anterior.
• B. Right occipito posterior.
• C. Left occipito posterior.
• D. Left occipito anterior.

Why: In this scenario, the sagittal suture is aligned with the left oblique diameter, and the occiput is directed towards the right iliopectineal eminence, indicating that the baby's occiput is facing the mother's right anterior side. This corresponds to the right occipito anterior (ROA) position. The other options do not match the described orientation of the occiput and the pelvis.

What are the clear indications for performing an elective cesarean section?

• A. Intrauterine growth retardation, antepartum haemorrhage, cephalopelvic disproportion
• B. Placenta praevia type II posterior, cord presentation, diabetes mellitus.
• C. Fulminating pregnancy induced hypertension, diabetes mellitus, breech presentation in a primigravida.
• D. Placenta praevia Type III, cephalopelvic disproportion, multiple pregnancy with three or more fetuses.

Why: Elective cesarean sections are typically indicated in situations where vaginal delivery poses significant risks to the mother or fetus. Placenta praevia Type III presents a high risk of hemorrhage during vaginal delivery, cephalopelvic disproportion indicates that the baby's head is too large to pass through the mother's pelvis, and multiple pregnancies with three or more fetuses often require cesarean delivery due to complications associated with vaginal birth. Options a, b, and c include conditions that may not always necessitate a cesarean section or can be managed differently depending on the clinical scenario.