Certified Midwife Exam Prep Certified Midwife 4 — Questions and Answers
Question 1: A client at 32 weeks presents with painless, bright-red vaginal bleeding. Placenta previa is confirmed by ultrasound and the client is hemodynamically stable. Initial management should include:
- Hospital admission, IV access, and continuous fetal monitoring (Correct answer)
- Immediate cesarean delivery regardless of gestational age
- Outpatient management with pelvic rest instructions
- Digital cervical exam to assess dilation
Correct answer: Hospital admission, IV access, and continuous fetal monitoring
Stable preterm placenta previa warrants expectant inpatient management with IV access and fetal monitoring until delivery is indicated.
Question 2: Which cervical finding is consistent with Chadwick's sign?
- Bluish-violet discoloration of the cervix and vagina due to increased vascularity (Correct answer)
- Softening of the cervical isthmus at 6 weeks gestation
- Uterine enlargement asymmetric to the site of implantation
- Pulsation felt in the vaginal fornices
Correct answer: Bluish-violet discoloration of the cervix and vagina due to increased vascularity
Chadwick's sign is the bluish discoloration of the cervix, vagina, and vulva from hyperemia of early pregnancy.
Question 3: A client declines GBS testing at 36 weeks. During labor at 39 weeks, her membranes rupture prematurely and she has an intrapartum temperature of 38.1°C. The appropriate antibiotic management is:
- Treat as GBS-positive and administer intrapartum penicillin prophylaxis (Correct answer)
- Withhold antibiotics since GBS status is unknown
- Administer broad-spectrum antibiotics only if fever persists beyond 1 hour
- Perform rapid GBS test before initiating any antibiotics
Correct answer: Treat as GBS-positive and administer intrapartum penicillin prophylaxis
Unknown GBS status with risk factors (PROM, intrapartum fever) warrants treatment as GBS-positive per CDC guidelines.
Question 4: During shoulder dystocia management, the McRoberts maneuver involves:
- Hyperflexion of maternal thighs against the abdomen to flatten lumbar lordosis (Correct answer)
- Rotation of the posterior shoulder into the oblique diameter
- Suprapubic pressure applied laterally to dislodge the anterior shoulder
- Delivery of the posterior arm by sweeping it across the fetal chest
Correct answer: Hyperflexion of maternal thighs against the abdomen to flatten lumbar lordosis
McRoberts maneuver hyperflexes maternal thighs to rotate the symphysis pubis superiorly and increase the relative AP diameter of the pelvis.
Question 5: Which lab finding is most consistent with HELLP syndrome?
- Elevated AST, thrombocytopenia, and elevated LDH (Correct answer)
- Proteinuria >300 mg in 24 hours with normal liver enzymes
- Elevated serum creatinine with normal platelet count
- Low hemoglobin with elevated MCV and normal LFTs
Correct answer: Elevated AST, thrombocytopenia, and elevated LDH
HELLP is defined by Hemolysis (elevated LDH), Elevated Liver enzymes (AST/ALT), and Low Platelets (<100,000/μL).
Question 6: A client at 28 weeks with a singleton pregnancy is found to have a cervical length of 18 mm on transvaginal ultrasound. Evidence-based management includes:
- Vaginal progesterone supplementation to reduce preterm birth risk (Correct answer)
- Immediate cervical cerclage without further evaluation
- Bed rest and oral tocolytic therapy
- No intervention as cervical length <25 mm is normal in the third trimester
Correct answer: Vaginal progesterone supplementation to reduce preterm birth risk
Vaginal progesterone is recommended for singleton pregnancies with a short cervix (≤25 mm) between 16–24 weeks; benefit extends to 28 weeks in some protocols.
Question 7: Which medication is contraindicated for postpartum hemorrhage management in a client with active asthma?
- Carboprost tromethamine (Hemabate) (Correct answer)
- Oxytocin (Pitocin)
- Methylergonovine (Methergine)
- Misoprostol (Cytotec)
Correct answer: Carboprost tromethamine (Hemabate)
Carboprost is a prostaglandin F2α that causes bronchospasm and is absolutely contraindicated in asthma.
Certified Midwife Exam Prep Certified Midwife 4
A client at 32 weeks presents with painless, bright-red vaginal bleeding.
Placenta previa is confirmed by ultrasound and the client is hemodynamically stable.
Initial management should include: