Certified Midwife Exam Prep Risk Assessment & Management 3 — Questions and Answers
Question 1: A client with a twin pregnancy at 34 weeks presents with preterm labor. Baby A is vertex, Baby B is breech. Which risk factor most influences delivery mode decision?
- Maternal preference for vaginal birth
- Estimated weight discordance greater than 20% (Correct answer)
- Chorionicity of the twin pregnancy
- Gestational age at delivery
Correct answer: Estimated weight discordance greater than 20%
Weight discordance greater than 20% significantly increases risk for the smaller twin during vaginal delivery and favors cesarean consideration.
Question 2: Which finding on a biophysical profile (BPP) is MOST associated with acute fetal compromise requiring urgent intervention?
- Absent fetal breathing movements only
- Score of 4/10 with oligohydramnios (Correct answer)
- Score of 6/10 with normal AFI
- One episode of fetal movement in 30 minutes
Correct answer: Score of 4/10 with oligohydramnios
A BPP score of 4/10 combined with oligohydramnios indicates significant fetal jeopardy requiring urgent delivery or further evaluation.
Question 3: A client with known Group B Streptococcus (GBS) colonization labors before receiving the full prophylactic antibiotic course. The infant is born after a 2-hour antibiotic exposure. What neonatal risk management applies?
- No additional monitoring needed if infant appears well
- Infant requires 48-hour observation per CDC guidelines (Correct answer)
- Immediate NICU transfer is mandatory
- Repeat GBS culture on the neonate at birth
Correct answer: Infant requires 48-hour observation per CDC guidelines
Infants born to GBS-positive mothers who received less than 4 hours of penicillin require at least 48 hours of clinical observation per CDC neonatal management guidelines.
Question 4: A primigravida at 39 weeks has a Bishop score of 3 and is being evaluated for elective induction. What does this score indicate about her induction risk?
- High likelihood of successful induction within 12 hours
- Favorable cervix requiring no cervical ripening
- Unfavorable cervix with higher risk of failed induction and cesarean (Correct answer)
- Cervix unsuitable for any induction method
Correct answer: Unfavorable cervix with higher risk of failed induction and cesarean
A Bishop score below 6 indicates an unfavorable cervix, associated with higher rates of failed induction and cesarean delivery.
Question 5: During the second stage of labor, a client with epidural analgesia develops maternal tachycardia (HR 130), fever (38.4°C), and uterine tenderness. What is the priority diagnosis to exclude?
- Epidural-related fever without infection
- Chorioamnionitis (Correct answer)
- Dehydration
- Normal physiologic response to labor
Correct answer: Chorioamnionitis
The combination of maternal fever, tachycardia, and uterine tenderness during labor meets diagnostic criteria for chorioamnionitis requiring antibiotic treatment and expedited delivery.
Question 6: A client with antiphospholipid syndrome (APS) is planning pregnancy. Which antepartum risk management regimen is evidence-based?
- Low-dose aspirin alone throughout pregnancy
- Low molecular weight heparin plus low-dose aspirin (Correct answer)
- Warfarin throughout all trimesters
- No pharmacologic intervention unless thrombosis occurs
Correct answer: Low molecular weight heparin plus low-dose aspirin
Combined low molecular weight heparin and low-dose aspirin is the evidence-based standard for reducing thrombotic and obstetric complications in APS-positive pregnant clients.
Question 7: Which client scenario warrants immediate referral to maternal-fetal medicine due to risk level exceeding typical midwifery scope?
- G2P1 at 20 weeks with mild iron-deficiency anemia
- Primigravida at 28 weeks with new-onset Class III cardiac disease (Correct answer)
- G3P2 at 36 weeks requesting VBAC after one prior cesarean
- Client with diet-controlled GDM at 32 weeks with normal growth ultrasound
Correct answer: Primigravida at 28 weeks with new-onset Class III cardiac disease
New-onset Class III cardiac disease in pregnancy represents high-risk cardio-obstetric pathology requiring multidisciplinary maternal-fetal medicine co-management.
Certified Midwife Exam Prep Risk Assessment & Management 3
A client with a twin pregnancy at 34 weeks presents with preterm labor.
Baby A is vertex, Baby B is breech.
Which risk factor most influences delivery mode decision?