Certified Midwife Exam Prep Intrapartum Management & Labor Support 1 — Questions and Answers
Question 1: A patient in active labor has a Category II fetal heart rate tracing. What is the midwife's priority action?
- Immediately prepare for cesarean delivery
- Apply intrauterine resuscitation measures and continue monitoring (Correct answer)
- Document and reassess in 30 minutes without intervention
- Administer oxytocin augmentation
Correct answer: Apply intrauterine resuscitation measures and continue monitoring
Category II tracings are indeterminate and require intrauterine resuscitation (repositioning, IV fluids, oxygen) and close ongoing evaluation.
Question 2: Which Bishop score indicates a favorable cervix for labor induction?
- Score ≤3
- Score 4–5
- Score ≥8 (Correct answer)
- Score 6–7
Correct answer: Score ≥8
A Bishop score of ≥8 indicates a favorable cervix and predicts successful labor induction similar to spontaneous labor outcomes.
Question 3: Which fetal heart rate pattern is most reassuring during active labor?
- Late decelerations with moderate variability
- Early decelerations with moderate variability (Correct answer)
- Variable decelerations without return to baseline
- Prolonged deceleration lasting 4 minutes
Correct answer: Early decelerations with moderate variability
Early decelerations are benign, caused by fetal head compression during contractions, and are reassuring when accompanied by moderate variability.
Question 4: A laboring patient at 7 cm dilation suddenly reports a severe, tearing abdominal pain with cessation of contractions and fetal bradycardia. What is the most likely diagnosis?
- Placental abruption
- Uterine rupture (Correct answer)
- Cord prolapse
- Amniotic fluid embolism
Correct answer: Uterine rupture
Uterine rupture presents with sudden severe abdominal pain, cessation of contractions, fetal bradycardia, and often a loss of fetal station.
Question 5: What is the recommended maximum dose of oxytocin for labor augmentation according to standard low-dose protocols?
- 10 mU/min
- 20 mU/min (Correct answer)
- 40 mU/min
- 60 mU/min
Correct answer: 20 mU/min
Standard low-dose oxytocin protocols typically cap at 20 mU/min to minimize the risk of uterine tachysystole and fetal distress.
Question 6: Cord prolapse is identified in a patient at 9 cm dilation. What is the immediate management priority?
- Prepare for emergency cesarean and elevate the presenting part off the cord (Correct answer)
- Apply firm fundal pressure to expedite vaginal delivery
- Administer tocolytics and reassess in 10 minutes
- Place the patient in Trendelenburg and push the cord back
Correct answer: Prepare for emergency cesarean and elevate the presenting part off the cord
Cord prolapse requires immediate relief of cord compression by manually elevating the presenting part while preparing for emergency delivery.
Certified Midwife Exam Prep Intrapartum Management & Labor Support 1
A patient in active labor has a Category II fetal heart rate tracing.
What is the midwife's priority action?