GARDEN CITY UNIVERSITY COLLEGE

FACULTY OF HEALTH SCIENCES

DEPARTMENT OF MIDWIFERY

END OF SEMESTER EXAMINATIONS

(SECOND SEMESTER 2020/2021)

DURATION: 2 HOURS

MIDW 356: ABNORMAL LABOUR

LEVEL 300 (REGULAR/WEEKEND)

INDEX NUMBER: ……………………………………………

Instructions:

1.) Do not open the booklet until you are instructed to do so.

2.) Read the questions carefully and answer appropriately.

3.) Answer all questions.

4.) Write your index number on all the pages.

GOOD LUCK!
 1. Obstructed labour is defined as lack of progress in the delivery of the………………….
a. “after coming head” of the breech
b. Extended arms of the breech
c. Baby with weak uterine
d. Baby with good uterine contractions

Ans: …….

2. Rigid perineum during labour is well managed by………..

a. Fundal pressure
b. Generous episiotomy
c. Guarding the perineum
d. IV Oxytocin

Ans: …….

3. The following are abnormalities of the uterus that can obstruct labour…..
I. Constriction ring of the uterus
II. Cervical stenosis
III. Bicornuate uterus
IV. Septate uterus
a. I and II
b. I, II, and IV
c. I, III, and IV
d. I, II, III and Iv

Ans: …….

4. Faults with the passengers that can lead to abstraction include all EXCEPT………….
a. Brow
b. Deep Transverse arrest
c. Persistant occipito – posterior
d. Vertex

Ans: …….
 5. Which of the following is NOT an early sign of obstructed labour?
a. Anxiety and tiredness
b. Presenting part doen not enter the brim
c. Membranes are intact
d. Client loses the ability to co – operate

Ans: …….

6. In the obstructed labour there is …………………….

I. Hot and dry vagina
II. Warm and moist vagina
III. Cervix that is thick and oedematous
IV. Big caput on the head
a. I and II
b. II and IV
c. II, III, and IV
d. I, III and IV

Ans: …….

7. The name Bandle’s Ring is used when………………….

a. A Bandle is tightened to the body
b. Retraction ring fails to develop
c. Retraction ring over stretches
d. When invisible retraction ring becomes visible.

Ans: …….

8. In later signs of obstruction the woman experiences the following EXCEPT……….

a. Ill looking with high blood pressure
b. Cervical dilatation is fast.
c. Signs of maternal distress
d. Titanic and whacking uterine contractions.

Ans: …….
 From question 9 – 16 indicate whether the clinical manifestation fall under obstructed labour or
Antepartum Haemorrhage as differential diagnosis for Madame Sabetey who has be in Labour
for 18 hours.

a. Established
b. Signs of obstruction obvious
c. Foetal parts cannot be felt or identified
d. Foetal heart not heard
e. Maternal and foetal distress
f. Uterus is hard and tender
g. On V/E no signs of impaction
h. The woman is not necessary in labour

Obstructed Labour Concealed A.P.H

9.
10.
11.
12.
13.
14.
15.
16.

17. The under listed are danger signs of obstruction EXCEPT…………..

a. Infection
b. Haemorrhage
c. Amenorrhage
d. Recto – vagina fistula

Ans: …….
 18. Which of the following is not a complication of obstructed labour of the feotus……….
a. Severe asphyxia
b. Mentally alert
c. Intracranial injury
d. Still birth

Ans: …….

19. The actual causes of raptured uterus include ………………….

I. Hydatidiform Mole
II. Instrumental deliveries
III. Misuse of oxytocin
IV. Cervical dystocia
a. I and II
b. II, III, and IV
c. II and IV
d. I, II, III and IV

Ans: …….

20. Which of the under listed is NOT a characteristic of raptured uterus…………

a. Abdominal pain and weakness
b. Excessive vomiting
c. Bleeding into the pelvic cavity
d. Rapid Pulse

Ans: …….

21. During fertilization the ovum implants at the

a. Body of the uterus
b. Fundus
c. Isthmus
d. Lower uterine segment

Ans: …….
 22. CPD means
a. Cephalo pelvic disproportion
b. Cephalo pelvic deproportion
c. Cephalic pelvic disportion
d. Cephalo pelvic distortion

Ans: …….

23. Hydrops fetalis means;

a. Head of foetus is filled with water
b. Whole foetus is filled with blood
c. Foetus is swollen
d. Foetus is filled with plasma

Ans: …….

24. Which of the following drug is used to counteract rhesus incompatibility

a. Anti B
b. Anti C
c. Anti D
d. Anti A

Ans: …….

25. Indications for therapeutic abortions include the following EXCEPT

a. Abnormal baby
b. Suspected hydrocephalous
c. Pre eclampsia
d. Maternal desire

Ans: …….

26. During vagina examination the midwife observes the following at the vulva EXCEPT
a. Cervical dilation
b. Clitoredectory
c. Vulva oedema
d. Vulva warts

Ans: …….
 27. Amniotic fluid protects the foetus against

a. Infection
b. Shock
c. Growth
d. Hydrocephaly
Ans: …….

28. As a midwife which of the following observations would you make as a matter of
routine?
a. Blood for haemoglobin
b. Blood for malaria parasites
c. Weight
d. Urine for albumin and sugar

Ans: …….

29. The following are contraindication of trial of labour EXCEPT

a. malpresetation
b. Elderly primigravida
c. When the woman has had multiple caeseran section
d. Previous vaginal birth after caesaren section

Ans: …….

30. Which of the following causes of prolonged labour would NOT require for caesarean
section?
a. Hypotonic uterine contraction
b. Deep transverse arrest
c. Occipito-posterior position
d. Malpresentation

Ans: …….
 31. A midwife should be able to anticipate maternal distress by assessing the following;
I. The presence of ketosis
II. The amount of pain she has experienced
III. How long the woman has been in labour
IV. How much sleep she has had
a. I,II
b. I,II,III,IV
c. I,IV
d. II,III

Ans: …….

32. Which of the following is NOT a late sign of maternal distress?

a. Thirst
b. Vaginal feels hot
c. Anxious face
d. Poor skin turgor

Ans: …….

33. After delivery, puerperium is a period of

a. 4 weeks
b. 5 weeks
c. 6 weeks
d. 7 weeks
Ans: …….

34. In giving episiotomu the midwife should ensure that the head had

a. Crowned
b. Flexed very well
c. Restituted
d. Rotated entirely
Ans: …….
 35. Apgar score 4/10 is termed as

a. Asphyxia lavida
b. Asphyxia Pallida
c. Asphyxia Neonatorium
d. Mild Aphyxia
Ans…….

36. Which of the following are causes of prolonged labour?

I. hypertonic uterine dysfunction
II. Inefficient uterine action
III. Injudicious use of analgesia in labour
IV. Malpresentation

a. I and II
b. II, III and IV
c. I and IV
d. I, II, III and IV
Ans: …….

37. The midwife supported the fundus of the uterus to deliver the placenta. Which of the
following conditions did she intend to prevent.

a. Atrophy of the uterus

b. Inversion of the uterus
c. Prolapse of the uterus
d. Trauma to the uterus
Ans: …….

38. Breech presentation is referred to as

a. Anterior buttocks
b. Obliquity
c. Podalic
d. Version
Ans: …….
 39. Complication of breech include the following

i. Vesico vagina fistula

ii. Recto – vaginal fistula

iii. Amniotic fluid embolism

iv. Maternal distress

a. I and II
b. I, II and IV
c. II, III and IV
d. I, II, III and IV

Ans…….

40. The membrane that commonly tears at a point of its attachment in the falx cerebri in
excessive moulding is called
a. Conference de sanum
b. Foramen magnum
c. Great vein of galen
d. Tentorium

Ans: …..

41. Convelaire uterus in abruption is a bruised oedematous uterus, it is also referred to as

a. Apoplexy uterus
b. Bi cornuted uterus
c. Seplated uterus
d. Uterine inversion

Ans: …….
 42. Wringles forceps is used for delivery of
a. High head
b. Intermittent
c. Low head
d. Unsuited head

Ans: ……..

43. All these are warning signs of secondary Post-Partum Haemorrhage EXCEPT
a. Involution of the uterus
b. Pale lochia too soon after rubra
c. Red lochia persist after third day
d. Sub involution of the uterus

Ans: ……….

44. A condition in which there is delay in the uterus to return to normal or non-pregnant state
is referred to as
a. Evolution
b. Involution
c. Sub-involution
d. Sub-evolution

Ans: ……

45. All the following can predispose a woman to hypofibrinogeamia EXCEPT

a. Abruption placenta
b. Amniotic fluid embolism
c. Prolonged retention of dead fetus
d. Retained placenta

Ans: ……
 46. Madam Aba had delivered at KATH labour ward and had PPH.
Which of the following signs of postpartum haemorrhage may be obvious?
I. Falling blood pressure
II. Maternal collapse
III. Rising pulse rate
IV. Visible bleeding

a. I & III
b. I&I
c. II & IV
d. I, II, III and IV

Ans: ………

47. Madam Serwaa reported to the labour ward with 8cm dilated, on vaginal examination
membranes were ruptured with cord prolapse. Which of the following will indicate cord
prolapse?
a. Abnormal Foetal heart rate
b. High blood pressure
c. Passing of meconium in cephalic presentation
d. Low blood pressure

Ans: ……..

48. The following may cause maternal distress EXCEPT

a. Cardiac condition
b. Hypertension
c. Precipitate labour
d. Prolong labour

Ans: ……..

49. Labour is said to be prolonged when it exceeds

a. 8 hours
b. 12 hours
c. 15 hours
d. 24 hours

Ans: ……..
 50. The process whereby the cord is seen at the vulva or felt in the vagina when membranes
are ruptured is
a. Cord presentation
b. Cord prolapsed
c. Long cord
d. Occult cord

Ans: …..

51. The appropriate time for the removal of sutures after Caesarean Section is
a. 5th day
b. 6th day
c. 7th day
d. 10th day

Ans: ……

52. Which of the following is an obstetric emergency?

a. Anemia (10gms)
b. Maternal exhaustion
c. Precipitate labour
d. Uterine inversion

Ans: ……

53. Which of the following is NOT a sign of obstructed labour

a. High temperature
b. Low temperature
c. Dehydration
d. Vomiting

Ans: …….
 54. What should be the first action a midwife should take in PPH?
a. Give pithidine
b. Look for donor
c. Set I.V. line
d. Stimulate the uterus to contract

ANS: …….

55. The structures affected in episiotomy are the following EXCEPT

a. Fourchette
b. Levator ani muscle
c. Posterior vaginal wall
d. Superficial muscle

Ans: …….

56. Which of the following maneuver is used to deliver the extended arms of the fetus in
breech presentation
A. Lovset
B. Mathew,s Duncan
C. Mauriceau-smith –veit
D. Schultze

Ans: …….

Use the case history below to answer question 57 – 59

Madam Ayiba Esi, who visited the antenatal clinic, gave history of 2 abortions, 3 living births
and 6 months amenorrhea. She gave her LMP as 12/9/20. She gave a complaint of having painful
hemorrhoids.

57. Her obstetric profile can be summarized as

a. G6 P2 + 2
b. G6 P3 + 2
c. G6 P2
d. G5 P3 Ans: …….
 58. When advising Ayiba on diet, she will be asked to take a diet that is
a. High protein, high fiver and high in vitamins
b. High carbohydrates, high fiber and high protein
c. Moderate carbohydrates, high protein and low fat
d. Moderate proteins, high iron and high vitamins

Ans: …….

59. What will be Ayiba’s expected date of delivery (EDD)?

a. 19th April, 2021
b. 20th June 2021
c. 20th April 2021
d. 19th June 2021

Ans: …….

60. Which ONE of the following obstetric emergencies carries a greater risk to the mother?
a. Amniotic fluid embolism
b. Ruptured uterus
c. Placenta abruption
d. Vasa praevia

Ans: …….

61. Which of the under listed indicates that a client is having a postnatal depression?
a. Copes well with the needs of her baby
b. Feels worst in the morning
c. Improves as the day goes on
d. Sleeps well but feels tired

Ans: …….
 62. In monitoring a woman in labour, it becomes imperative that starvation should be avoided
in order to;
a. Check albuminuria
b. Prevent haemorrhage in the 4th stage
c. Prevent vomiting in the 2nd stage
d. Protect the woman against ketosis

Ans: …….

63. Which of the following types of abortion may precipitate disseminated intravascular
coagulation?
a. Habitual
b. Inevitable
c. Incomplete
d. Missed

Ans: …….

64. A full bladder may have the following effects on labour

I. Delayed delivery of placenta a. I, II and III
II. Early rupture of membranes b. II, III and IV
III. Poor uterine contractions c. I, II, and IV
IV. Slow descent of head d. I, III and IV

Ans: …….

65. Which of the following is NOT a sign of Keto acidosis during labour?
a. Ketone bodies in urine
b. Increase pulse rate
c. Temperature more than 38 degrees Celsius
d. Persistent vomiting

Ans:…….
 66. Madam Amina Para 1. Complained of after pains which occurred while breastfeeding her
baby, what will be the best response from the midwife?
a. It is bound to occur so she must bear the pains
b. It will help the uterus to go back to its normal state
c. It is normal and the pain will disappear after few days
d. You will be given analgesics to reduce the pains

Ans: …….

67. On abdominal examination, the midwife observes a saucer – shape depression below the
umbilicus. What presentation does this denote?
a. Breech
b. Compound
c. Occipito anterior
d. Occipito posterior

Ans: …….

68. The following are complications of version

I. Possibility of true knot in the cord
II. Premature separation of placenta
III. Premature onset of labour
IV. Prolapse of cord

a. I, II and III
b. II, III and IV
c. I, II, and IV
d. I, II, III and IV

Ans: …….

69. The factors that influence Binovular twins include all EXCEPT
a. Gonadothrophins to treat infertility
b. Increasing age
c. Multiparity
d. Primigravidae

Ans: …….
 70. The under listed are complications of multiple pregnancy EXCEPT
a. Abortions
b. Anaemia
c. Mobility of singleton foetus
d. Pre-eclampsia / Eclampsia

Ans: …….

71. In deep transverse arrest the head of foetus is stuck between which of the following
stuctures?
a. Ischial tuberocitie
b. Ischial spines
c. Promontory and ileo pertineal lines
d. Promontory and ileo pertineal eminence

Ans: …….

72. When the cord lies in front of the presenting part, it is known as
a. Compound presentation
b. Cord presentation
c. Cord prolapsed
d. Occult cord

Ans: ……

73. The following are all signs of cord presentation EXCEPT

a. Bleeding alongside with the cord
b. Cord is seen or felt at the vagina
c. Fetal heart may not be heard
d. Ulteration in fetal heart

Ans: ……..
 74. When the fetus lies across the long axis of the mother’s uterus is called
a. Oblique lie
b. Sacro-cotyloid lie
c. Transverse lie
d. Unstable – lie

Ans: ………

75. Which of the following presentation does the hand lie alongside the head during second
stage
a. Breech presentation
b. Compound presentation
c. Face presentation
d. Neglected shoulder presentation

Ans: ………

76. Breech presentation is confirmed at the;

a. 28th week
b. 32nd week
c. 36th week
d. 38th week

Ans: ………

77. Which of the following methods is used in the management of extended arms in breech
delivery
a. Burns Marshall method
b. Loveset maneuver
c. Mac Robert method
d. Marceau – smellieveit

Ans: ……..
 78. A woman started bleeding profusely immediately after delivery of the placenta. The
following are the primary responsibilities of the midwife EXCEPT
a. Administration of oxytocic drugs
b. Inspection of the genital areas for tears
c. Organization for possible nutritious food
d. Rubbing up uterine contractions

Ans: ………

79. Which of the following is a cause of secondary P.P.H?

a. A caesarean section done with the wound not healed by the first intension
b. Annular detachment
c. Cervical dystocia
d. Uterine inversion

Ans: …….

80. Which of the following is NOT a cause of puerperal sepsis?

a. Breast abscess
b. Foot drop
c. Genital tract infection
d. Uterine sepsis

Ans: ………..

81. Inability of the cervix to dilate despite normal uterine contraction is known as
a. Annular detachments
b. Cervical dystocia
c. Rigid
d. Oedema of the cervix

Ans: ……….
 81. The widest and most important transverse diameter of the fetal skull is
a. Bi-temporal
b. Bi-parietal
c. Mentovertical
d. Occipito frontal

Ans: ……….

82. Which of the following is NOT true about brow presentation?

a. The head is partially flexed
b. The presenting diameter is mento vertical (13.5 cm).
c. This presentation is rare with an incidence of about 1:1000 deliveries
d. The frontal bone, bounded by the anterior fontanelle and the orbital
e. ridges lies at the pelvic brim

Ans: …….

83. Which of the following is/are causes of uterine rupture?

I. Uterine interference during labour
II. Weak uterine scare
III. Hydatidiform mole
IV. Instrumental criminal abortion
A. I and II
B. I, II and IV
C. I and III
D. I, II, III and IV

Ans: …………..

84. The invisible ring which is formed between the upper and lower uterine segment is called?
a. Bandle’s ring
b. Circular ring
c. Constriction ring
d. Retraction ring

Ans: ………
 85. Hypofibrinogenaemia can also be termed as
a. Bleeding clots
b. Dissemination intravascular coagulation
c. Epistasis
d. Haemophilia

Ans: …………….

86. Which of the following ring indicates uterine rupture?

a. Bandle’s ring
b. Constriction ring
c. Hour glass
d. Retraction ring

Ans: ……….

87. When the placenta is attached to the myometrium, it is termed as placenta

a. Acreta
b. Adherent
c. Myometrium
d. Pacreta

Ans: ………..

88. During the obstructed labour, the vagina is

a. Firm and rigid
b. Tensed and warm
c. Warma and moist
d. Dry and hot

Ans: ……….
 89. Which period after delivery of the placenta will you expect the fundal height at the level of
the umbilicus
a. After 6 hours
b. Within 2 weeks
c. After first 2 hours
d. Within 6 weeks

Ans: …….

90. Which of the following is NOT an indication for caesarian section

a. Ante partum hemorrhage
b. Cancer of the cervix
c. Contracted pelvis
d. Multiple pregnancy

Ans……….

91. The following conditions predisposes a woman to coagulation disorders in pregnancy and
labour
I. Abruption placenta
II. Retention of dead fetus
III. Septic abortion
IV. Hypo fibrinogenaemia
a. I, II and IV
b. III and IV
c. I, II and III
d. I, II, III and IV

Ans: ……..

92. One of the following is adopted in breech delivery when the head is extended
a. Burn’s-marshal method
b. Love set maneuver
c. Mauriceau Smellie viet method
d. Robert maneuver

Ans: ………..
 93. Which of these injuries can occur as a result of difficulty in labour
I. Erb’s palsy
II. Torticollis
III. Fracture of femur
IV. Injuries of the liver and spleen
a. I and II
b. II, III and IV
c. III and IV
d. I, II, III and IV

Ans: ……….

94. Postpartum hemorrhage that comes in gushes and clot comes from
a. Cervical tear
b. Lacerated vagina
c. Placenta site
d. Perineal tear

Ans: ……..

95. Which of the following practices is done when giving syntocynon/Pitocin/ergometrin in

active management of third stage of labour at the delivery of the …………..
a. anterior shoulder
b. Head
c. Placenta
d. Whole body

Ans: …………

96. These are types of incomplete breech EXCEPT

a. Cord presentation
b. Frank presentation
c. Footing presentation
d. Knee presentation

Ans; ………..
 97. Causes of Occipito – Posterior Position includes the following EXCEPT
a. Contracted pelvis
b. Gynaecoid pelvis
c. Placenta praevia
d. Polyhydramious

Ans: ……..

98. Burn’s Marshal’s method is used if head is

a. Crowned
b. Extended
c. Flexed
d. Military

Ans: ……

99. Which of these conditions may NOT need a caesarian section

a. Cord prolapsed with pulsation
b. Eclampsia
c. Placenta praevia type 1
d. Placenta praevia type 3 and 4

Ans: ………..

100. Which one of the following is NOT a cause of obstructed labour

a. Cervical dystocia
b. Congenital malformation
c. Brow presentation
d. Vertex presentation

Ans: ………..
 GARDEN CITY UNIVERSITY COLLEGE

DEPARTMENT OF MIDWIFERY

LEVEL 300 (AUGUST ADMISSION)

ABNORMAL LABOUR

END OF 2ND SEMESTER EXAMINATIONS

OBJECTIVES (MARKING SCHEME)

1. D

2. B

3. D

4. D

5. C

6. D

7. D

8. B

9. A

10. B

11. C

12. D

13. E

14. F

15. G
16. H

17. C

18. B

19. D

20. C

21. B

22. A

23. D

24. C

25. D

26. A

27. B

28. A

29. D

30. A

31. B

32. B

33. C

34. A

35. B

36. B

37. B

38. C
39. D

40. D

41. A

42. C

43. A

44. C

45. D

46. D

47. A

48. C

49. D

50. B

51. C

52. D

53. B

54. D

55. C

56. A

57. B

58. D

59. D

60. A

61. B
62. D

63. D

64. D

65. C

66. B

67. D

68. D

69. D

70. C

71. B

72. B

73. A

74. C

75. B

76. B

77. B

78. C

79. B

80. B

81. B

82. A

83. D

84. A
85. B

86. A

87. A

88. D

89. C

90. D

91. D

92. C

93. D

94. C

95. D

96. A

97. B

98. C

99. C

100. D