THE CATHOLIC UNIVERSITY OF EASTERN AFRICA P.O. Box 62157 A. M. E. C. E. A 00200 Nairobi - KENYA Telephone: 891601-6 Fax: 254-20-891084 MAIN EXAMINATION E-mail:[email protected] SEPTEMBER-DECEMBER 2020 TRIMESTER SCHOOL OF NURSING REGULAR PROGRAMME NUR/UNUR 306: MIDWIFERY II-LABOUR Date: DECEMBER2020 Duration: 3 Hours INSTRUCTIONS: i. All questions are compulsory ii. Indicate the answers in the answer booklet provided PART -I: MULTIPLE CHOICE QUESTIONS (MCQs) (20 MARKS): Q1.The following are two emergencies that can occur in third stage of labour: a) Cord prolapsed, foetal distress. b) Ruptured uterus ,foetal distress. c) Uterine inversion, cord pulled off. d) Cord round the neck, foetal distress. Q2 A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: a). Stimulate fetal surfactant production. b). Reduce maternal and fetal tachycardia associated with ritodrine administration. c). Suppress uterine contractions. d). Maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy. Q3. Episiotomy should only be considered in case of : a) Breech, vacuum delivery, scarring from genital cutting, fetal distress. b) Primigravida, disturbed woman, genital cutting, obstructed labor. c) Obstructed labor, hypertonic contractions, multigravida, forceps delivery. Cuea/ACD/EXM/APRIL 2020/SCHOOL OF NURSING Page 1 ISO 9001:2015 Certified by the Kenya Bureau of Standards d) Primigravida, hypotonic contractions, fetal distress, genital cutting. Q4.A multiporous woman in labour tells the midwife “I feel like opening the bowels”.How should the midwife respond? a) Allow the woman to use the bedpan. b) Perform a pelvic examination c) Get the woman to go to the washroom. d) Check fetal heart rate. Q5.Causes of uterine inversion includes: a) Short cord, excessive fundal pressure, vaginal birth after caesarean section. b) Forces delivery, cord round the neck, frequent uterine operations. c) Vacuum extraction, long cord, precipitate labour. d) Uterine massage, forceps delivery, precipitate labour. Q6.The most common indicator of retained placental lobe is: a) A knot on the insertion site of the umbilical cord. b) Centrally inserted umbilical cord. c) Umbilical vessels running through the membranes. d) A hole into the placental membranes. Q7.Foetal distress occurs when the foetus: a) Inhale meconium in uterus. b) Does not get enough oxygen within 1 minute of birth. c) Does not breath spontaneously at birth. d) Suffer oxygen deprivation and becomes hypoxic. Q8.The correct sequence of Active Management of the Third stage of Labour (AMTSL) includes: a) Prophylactic use of oxytocin, controlled cord traction, uterine massage. b) Uterine massage, prophylactic use of oxytocin, controlled cord traction. c) Controlled cord traction, uterine massage, prophylactic use of oxytocin. d) Prophylactic use of oxytocin, uterine massage, controlled cord traction. Q9.Some of the reasons for a midwifeto performs a full physical examination of a woman in labour would include to: a) Confirm the gestational age, lie and descent. b) Assess the blood pressure, temperature and pulse. c) Past surgery scars skin colour, contractions d) Descent, vital signs, scars. Cuea/ACD/EXM/APRIL 2020/SCHOOL OF NURSING Page 2 ISO 9001:2015 Certified by the Kenya Bureau of Standards Q10.During second stage of labor the diameter that distends the vaginal orifice in brow presentation is; a) Occipital frontal. b) Submento-bregmatic. c) Submento vertical. d) Mento-vertical. Q11. Fetal Attitude refers to the:- a) Fetal part that is lying at the pelvic brim b) Lower pole of the uterus c) Relationship of the fetal head and limbs to its trunk d) Relationship between the denominator of the presenting part and land marks of the pelvic brim Q12.In breech classification Frank breech would mean: a) The fetal or knees are the lower most presenting part. b) Fetal hips and knees are flexed. c) The fetal hips are flexed and the limps are extended. d) Fetal limbs are flexed Q13.Predisposing factors for uterine rupture include: a) Bandl’s ring, free fluid in the abdomen, high parity. b) Dislodged presenting part, easily palpable fetal parts, abdominal distension. c) Primigravida, abdominal distension, tender abdomen. d) High parity, application of fundal pressure, previous operations. Q14.The most common cause of primary post-partum hemorrhage is; a) Atonic uterus. b) Tears of the genital tract. c) Disseminated intravascular coagulation. d) Anemia. Cuea/ACD/EXM/APRIL 2020/SCHOOL OF NURSING Page 3 ISO 9001:2015 Certified by the Kenya Bureau of Standards Q15 When Umbilical cord is inserted at the edge of the placenta is termed: a) . Central insertion b) . Battledore insertion c) . Velamentous insertion d) . Lateral insertion Q16.During third stage of labour if uterine inversion occurs ,first thing is to: a) Call the doctor. b) Arrange for hysterectomy. c) Reposition the uterus. d) Send the woman to theatre Q17 Vacuum Extraction would be contraindicated in the following instances: a) Suspected cephalopelvic disproportion, polyhydramnious, gestation more than 37 weeks. b) Gestation less than 37 weeks, no contractions, cephalopelvic disproportion. c) Trial of labour of four hours, brow presentation, oligohydramnious. d) Brow presentation, with ruptured membrane, oligohydramnious. Q18The most common indicator of retained placental lobe is: a) A knot on the insertion site of the umbilical cord. b) Centrally inserted umbilical cord. c) Umbilical vessels running through the membranes. d) A hole into the placental membranes Q19.The three cardinal signs of true labor are: a) Lightening, quickening, rupture of membranes. b) Show, dilatation of the cervix, painful rhythmical contractions. c) Frequency of micturition, lower abdominal pain, backache. d) Braxton hick’s contractions, show, rupture of membranes Q20. .Maternal complications of obstructed labour include: a) Intrauterine death, neonatal sepsis, foetal injury, puerperal sepsis. b) Foetal distress, puerperal sepsis, malnutrition, birth asphyxia. c) Birth asphyxia, history of previous still birth, intrauterine death, puerperal sepsis. d) Chorioamnionitis, obstetric fistula, puerperal sepsis, foot drop. Cuea/ACD/EXM/APRIL 2020/SCHOOL OF NURSING Page 4 ISO 9001:2015 Certified by the Kenya Bureau of Standards PART-II: SHORT ANSWER QUESTIONS (SAQs) (40 MARKS): Q1.State four (4) danger signs a midwife should exclude and take prompt action during labour (4mks) Q2. State three(3) physiological changes that take place in the following organs after normaldelivery(6 marks) i)Uterus ii)Breast Q3 Define the three(3) stages of labour. (3marks) Q4.Explain the seven(7) physiological changes that take place in the uterus during the first stage of labour (7marks) Q5. Explain six (6) specific interventions for a woman with retained placenta (6marks) Q6 Explain the specific management t of a woman with cord prolapsed during the first stage of labour. (6marks) Q7 State four (4) Conditions that would put a woman to be for trial of scar(4marks) Q8.State four (4) roles of a midwife in management ofprimary post-partumhemorrhage(4marks) PART III: LONG ANSWER QUESTIONS (LAQs) (40 MARKS) Q1A woman is admitted at 38weeks in labour. i) Define normal labour (2marks) ii) State the seven mechanisms of labor (7marks ) iii) Describe the management of first stage of labour (11marks). Cuea/ACD/EXM/APRIL 2020/SCHOOL OF NURSING Page 5 ISO 9001:2015 Certified by the Kenya Bureau of Standards Q2.Mrs B who had a normal delivery reports that she is bleeding heavily, on examination you find the uterus is above the umbilicus, i) Define postpartum hemorrhage (2marks) ii) State four(4) predisposing factors to primary postpartum hemorrhage (4marks). iii) Describe the management of Mrs B for the next 72hours. (11marks) iv) State three(3) compications that may occur to Mrs B (3marks) *END* Cuea/ACD/EXM/APRIL 2020/SCHOOL OF NURSING Page 6 ISO 9001:2015 Certified by the Kenya Bureau of Standards .