1.

A 27-year-old woman is in labor at 39 weeks gestation when passage of

meconium is noted. A cardiotocography (CTG) is arranged that shows a fetal
heart rate (FHR) of 149 bpm, a beat-to-beat variability of 15, no acceleration,
and no deceleration. Which one of the following should be the next best step in
management?

A. Fetal scalp blood sampling as there is a 10% chance of hypoxia.

B. Fetal scalp blood sampling as there is a 50% chance of hypoxia.
C. Fetal scalp blood sampling as there is 75% chance of hypoxia.
D. Emergency cesarean section
E. Close monitoring until delivery as there is no abnormality

2. A 37-year-old woman presented to your clinic for an antenatal check-up. She

has past obstetric history of breech presentation, premature rupture of
amniotic membrane and twin pregnancy. She also had post- natal depression
during her last 2 pregnancies, anaemia and gestational diabetes in her last
Pregnancy. Which ONE of the following would not increase the risk for cord
prolapse during delivery?
A. Multiple gestation
B. Anemia
C. Breech presentation
D. Gestational diabetes
E. Premature rupture of membrane

3. A 35-year-old woman presented with breech presentation confirmed on

ultrasound at 37 weeks of gestation. External cephalic version has failed. What
is the most appropriate next step in her management?

A. Steroids
B. Elective cesarian delivery at 38 weeks of gestation
C. Consider vitamin K
D. Emergency cesarean delivery
E. Induce labour now

4. A 34-year-old woman from country-side of Victoria presents to the hospital at

37 weeks gestation after she noticed a sudden gush of clear fluid per vagina.
Uterine contractions are absent. Speculum examination shows pooling of
liquor in the posterior fornix. After 12 hours, she develops fever, tachycardia
and chills. Apart from giving antibiotics, which one of the following would be
the next best step in management?
 A. Discharge from hospital after 14 days of antibiotics
B. Induce labour now
C. Perform vaginal examination
D. Continue the pregnancy until natural delivery
E. Give corticosteroids
5. A 28-year-old pregnant woman is involved in a car accident at 26 weeks
gestation,while wearing seatbelt. On examination, there are visible bruises on
the abdomen. She is otherwise normal. Fetal heart sounds are audible and
within normal parameters and CTG is reassuring. Which one of the following
the next best step in management?

A. Observe for six hours and discharge home

B. Admit her and observe for 24 hour
C. Perform a continuous 30-minute CTG and discharge home if reassuring
D. Perform 24-hour cardiotocography (CTG) monitoring
E. Reassure and discharge home

6. Mary, 27 years old, is admitted to the Matemity Ward after her labor pain
started. After amniotomy, she is placed in the left lateral position and on
supplemental oxygen by nasal canula, and intravenous fluids and
Syntocinon® (oxytocin) infusion is started. A while later and during fetal
heart auscultation, fetal heart rate (FHR) of 70 bpm is noted. CTG is applied
which reveals a baseline fetal heart rate of 140 bpm dropping to 70 bpm
periodically with each episode of bradycardia lasting approximately three
minutes. Which one of the following is the most appropriate next step in
management?

A. Fetal scalp blood sampling.

B. Stop Syntocinon.
C. Immediate cesarean delivery.
D. Continuous CTG monitoring
E. Reposition to supine.

7.. A 27-year-old nulliparous woman is admitted to hospital at 37 weeks of gestation

having lost about 200mL of blood per vaginum after having had sexual intercourse.
The bleeding has now ceased. On clinical examination the pulse rate is 64/min, BP
120/80mmHg and temperature 36.8°C. The uterus is enlarged to a level 37cm above
the pubic symphysis, is lax and non-tender, the presentation is cephalic with the
head still freely mobile above the pelvic brim. The fetal heart rate assessed by
auscultation is 155/min. Which one of the following is the most likely cause for the
bleeding?
 A. Vasa praevia
B. Placental abruption.
C. Placenta praevia.
D. A cervical polyp.
E. A heavy show.

8.A 35-year-old 'grand multiparous' woman, with seven children previously born by
vaginal delivery, had a normal delivery of a live baby weighing 4750gm one hour ago
after a three-hour labour. She is now suddenly found to be profoundly shocked
(pulse 140/min, BP 80/50mmHg) after an apparently normal and spontaneous third
stage of labour. Total blood loss at the time of delivery of the placenta was 500ml,
and the vaginal blood loss since then has not been excessive. Which one of the
following is the most likely diagnosis?

A. Acute inversion of the uterus.

B. Overwhelming infection.
C. Uterine atony.
D. Amniotic fluid embolism.
E. Uterine rupture.

9. A 19-year-old primigravida at 41 weeks of gestation has had irregular

painful contractions for the last nine hours. Pelvic examination shows the
cervix is fully effaced but only 2-3cm dilated. The fetal head is at the level of
the ischial spines in a left occipito-posterior (LOP) position. The membranes
ruptured one hour ago. Which one of the following would be the most
appropriate next step in management?

A. Oxytocic (Syntocinon®) infusion.

B. Hydration drip of 5% dextrose.
C. Cross-match blood.
D. Caesarean section.
E. Lumbar epidural block

10. In the event of chord prolapse during labor, which one of the following findings is
more likely on CTG monitoring?

A. Sinusoidal pattern.
B. Early decelerations.
C. Variable decelerations.
D. Late decelerations.
E. Fetal tachycardia