Afghanistan Midwifery Exit Exam (Institutes of Health Sciences) Feed

Question

A 22-year-old primigravida presents to the antenatal clinic for her first routine visit. She states that the first day of her last normal menstrual period (LMP) was June 10, 2025. Her menstrual cycles have always been regular, lasting 28 days. Using Naegele's rule, what is her estimated date of delivery (EDD)?

Antenatal Care

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A 19-year-old multigravida at 14 weeks of gestation visits the basic health center (BHC) for routine antenatal care. According to WHO and national maternal health guidelines, what is the standard daily preventive dose of iron and folic acid (IFA) supplementation recommended throughout pregnancy?

Antenatal Care

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A 20-year-old woman in her first pregnancy attends her first antenatal care visit at 16 weeks of gestation with no prior vaccination records. The midwife administers her first dose of Tetanus-Diphtheria toxoid (Td1/TT1). When should the midwife schedule the second dose (Td2/TT2) to ensure protective immunity for both mother and newborn?

Antenatal Care

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Question

During an antenatal checkup of a woman at 28 weeks of gestation, the midwife performs an abdominal examination to measure the symphysis-fundal height (SFH). Which landmark correctly corresponds to the expected fundal height at approximately 20 to 22 weeks of gestation in a singleton pregnancy?

Antenatal Care

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A 26-year-old primigravida at 34 weeks of gestation presents to the clinic complaining of a persistent severe frontal headache and blurred vision. Her blood pressure is 165/115 mmHg on two readings taken 15 minutes apart, and urine dipstick reveals 3+ proteinuria. What is the most accurate clinical diagnosis?

Antenatal Care

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A 24-year-old woman at 35 weeks of gestation is diagnosed with severe pre-eclampsia at a rural Comprehensive Health Center (CHC). Before urgent referral to a provincial hospital, what is the recommended standard loading dose of Magnesium Sulfate (MgSO4) to prevent eclamptic convulsions according to WHO/Pritchard protocol?

Antenatal Care

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A midwife is monitoring a pre-eclamptic patient receiving maintenance doses of intravenous Magnesium Sulfate. Prior to administering the next maintenance dose, which clinical assessment finding indicates Magnesium Sulfate toxicity and requires immediately withholding the drug?

Antenatal Care

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A 30-year-old pregnant woman at 32 weeks of gestation presents with severe fatigue, pallor of the conjunctiva and palmar creases, and breathlessness on light exertion. Laboratory testing confirms a hemoglobin level of 5.8 g/dL. How is this condition classified according to WHO criteria, and what is the appropriate management?

Antenatal Care

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A 29-year-old multigravida at 33 weeks of gestation arrives at the labor room reporting sudden onset of bright red vaginal bleeding that started while resting. She denies abdominal pain or uterine contractions. On examination, the abdomen is soft and non-tender, and fetal heart rate is 144 bpm. What critical action is strictly contraindicated?

Antenatal Care

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A 32-year-old gravida 4 para 3 at 36 weeks of gestation presents with sudden, severe continuous lower abdominal pain, dark vaginal bleeding, and a tense, tender, board-like uterus that does not relax. Fetal heart sounds are muffled and irregular at 100 bpm. What is the most likely diagnosis?

Antenatal Care

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A 23-year-old woman presents to the emergency unit with a 6-week history of amenorrhea, severe sharp right iliac fossa pain, dizziness, and shoulder tip pain. On examination, she is pale, BP is 85/50 mmHg, pulse is 120 bpm, and there is marked cervical motion tenderness on bimanual exam. What is the priority clinical diagnosis and initial step?

Antenatal Care

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A 21-year-old woman at 14 weeks from her LMP presents with excessive intractable vomiting and intermittent dark brownish ('prune juice') vaginal discharge. Abdominal examination reveals a fundal height measuring 22 cm (consistent with 22 weeks), and fetal heart sounds cannot be detected with Doppler. Ultrasound reveals a 'snowstorm' or vesicular appearance without a fetus. What is the diagnosis?

Antenatal Care

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A 28-year-old woman with a BMI of 31 kg/m² and a family history of type 2 diabetes presents for antenatal care at 24 weeks of gestation. According to international WHO guidelines, what is the standard diagnostic test for Gestational Diabetes Mellitus (GDM) at 24–28 weeks?

Antenatal Care

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A routine midstream urine culture of a 24-year-old pregnant woman at 18 weeks of gestation reveals > 100,000 CFU/mL of Escherichia coli. She has no fever, dysuria, or flank pain. Why must this asymptomatic bacteriuria be treated with an appropriate antimicrobial (e.g., Amoxicillin or Cephalexin)?

Antenatal Care

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A pregnant woman tests reactive on a routine Rapid Plasma Reagin (RPR) syphilis screening test during her first antenatal visit. Treponemal confirmatory testing is positive for early latent syphilis. What is the standard drug of choice for treating maternal syphilis and preventing congenital syphilis?

Antenatal Care

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A 25-year-old woman is newly diagnosed with HIV during her initial antenatal care visit. According to WHO guidelines for the Prevention of Mother-to-Child Transmission (PMTCT), what is the correct approach to antiretroviral therapy (ART)?

Antenatal Care

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An Rh-negative primigravida at 28 weeks of gestation has a negative indirect Coombs test (unsensitized). Her husband is known to be Rh-positive. To prevent Rh isoimmunization, when should anti-D (RhoGAM) immunoglobulin be administered?

Antenatal Care

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A midwife performs Leopold's maneuvers on a woman at 36 weeks of gestation. On the first maneuver, a round, hard, smooth, and ballotable mass is palpated in the uterine fundus. On the third maneuver (Pawlik's grip), a softer, irregular, non-ballotable mass is felt above the pelvic inlet. What is the fetal presentation?

Antenatal Care

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A 27-year-old woman is confirmed to have a twin pregnancy at 20 weeks of gestation. When providing antenatal counseling, which complication is significantly increased in multifetal gestations compared to singleton pregnancies?

Antenatal Care

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During an individual antenatal counseling session, a midwife works with a pregnant woman and her family on Birth Preparedness and Complication Readiness (BP/CR). Which core element must be established in the birth plan to avoid critical delays during obstetric emergencies?

Antenatal Care

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A 20-year-old primigravida at 9 weeks of gestation presents with severe nausea and persistent vomiting. She is unable to retain fluids or food, has lost 3 kg over the past week, has dry mucous membranes with skin tenting, and urine dipstick reveals 3+ ketones. What is the diagnosis and initial management?

Antenatal Care

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An ultrasound examination of a woman at 32 weeks of gestation reveals an Amniotic Fluid Index (AFI) of 3 cm (or single deepest vertical pocket < 2 cm), confirming severe oligohydramnios. Which maternal or fetal condition is most strongly associated with oligohydramnios?

Antenatal Care

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A midwife measures the symphysis-fundal height (SFH) of a healthy multipara at 34 weeks of gestation with accurate menstrual dating. The SFH measures 29 cm (a 5 cm lag below gestational age) on two consecutive visits spaced two weeks apart. What is the most appropriate next step in clinical management?

Antenatal Care

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A 28-year-old pregnant woman with known rheumatic mitral stenosis attends the clinic at 28 weeks of gestation. Which symptom should immediately alert the midwife to impending cardiac decompensation and pulmonary edema?

Antenatal Care

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When educating pregnant women and their families about obstetric danger signs during ANC visits, which of the following is considered an absolute emergency requiring immediate transfer to a health facility?

Antenatal Care

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A primiparous woman is admitted to the maternity ward with regular, painful uterine contractions occurring every 3 minutes. Vaginal examination reveals 5 cm cervical dilation and 80% effacement. In which phase and stage of labor is this patient?

Intrapartum Care

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A midwife is plotting labor progress on a WHO modified partograph for a woman admitted at 5 cm dilation. Four hours later, a repeat vaginal examination shows the cervix is still at 5 cm with moderate contractions. The plotting has crossed the Alert Line and is approaching the Action Line. What does this indicate and what action is required?

Intrapartum Care

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During the active first stage of a normal low-risk labor, how frequently should the midwife auscultate and record the Fetal Heart Rate (FHR) using a Pinard stethoscope or Doppler, and what is the normal baseline range?

Intrapartum Care

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Continuous fetal heart rate monitoring during an augmented labor demonstrates repeated, symmetrical decelerations that begin after the peak of the uterine contraction and return to baseline well after the contraction ends. What is the physiological mechanism and clinical interpretation of these late decelerations?

Intrapartum Care

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Before performing a vaginal examination, the midwife palpates the maternal abdomen to assess fetal head descent in fifths palpable above the pelvic brim. If only 1/5th of the fetal head is palpable above the symphysis pubis, what does this indicate?

Intrapartum Care

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During an intrapartum vaginal examination, the midwife identifies the leading bony point of the fetal skull at the level of the maternal ischial spines. What is the correct fetal station?

Intrapartum Care

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A multigravida in active labor at 7 cm dilation experiences spontaneous rupture of the amniotic membranes (SROM). What is the immediate, most crucial action the midwife must perform?

Intrapartum Care

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Upon artificial rupture of membranes at 8 cm dilation, the midwife observes thick, dark green, 'pea-soup' meconium-stained amniotic fluid. The fetal heart rate is 112 bpm with occasional variable decelerations. What is the most appropriate management plan?

Intrapartum Care

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While performing a vaginal examination following spontaneous membrane rupture in a woman at 6 cm dilation with an unengaged head, the midwife feels a pulsating loop of umbilical cord in the vagina. What is the immediate priority emergency management?

Intrapartum Care

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A 22-year-old primigravida has been in active labor for 12 hours. Vaginal examination shows the cervix remains at 6 cm for the past 4 hours despite strong contractions (4 contractions in 10 minutes, each lasting 50 seconds). Physical exam reveals severe parietal skull bone overlap that cannot be separated (Grade 3 molding) and a large caput succedaneum. What is the diagnosis?

Intrapartum Care

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A woman is brought from a remote village after 24 hours of obstructed labor. On abdominal palpation, the midwife observes an oblique groove/ridge running diagonally across the lower abdomen between the upper thick active segment and the thinned-out lower uterine segment. The maternal pulse is 120 bpm, and the uterus is continuously tender. What is this clinical sign?

Intrapartum Care

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According to WHO recommendations for intrapartum care for a positive childbirth experience, which supportive care measure should be actively encouraged for a woman in uncomplicated labor?

Intrapartum Care

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A primigravida has reached the second stage of labor. Cervical dilation is 10 cm and the fetal head is at station +2. How should the midwife guide the mother regarding pushing efforts during this stage?

Intrapartum Care

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In the cardinal mechanisms of normal labor for a fetus in the Left Occipito-Anterior (LOA) position, which sequence accurately represents the positional changes of the fetal head during passage through the birth canal?

Intrapartum Care

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As the fetal head crowns and stretches the perineum during a normal vaginal delivery, which hands-on technique should the midwife use to control delivery of the head and protect the perineum from tearing?

Intrapartum Care

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A midwife determines that an episiotomy is clinically indicated due to acute fetal distress requiring urgent delivery and a rigid, non-distensible perineum. Which episiotomy incision type is standard in midwifery practice to minimize the risk of anal sphincter injury?

Intrapartum Care

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Following the delivery of the fetal head, the midwife checks the fetal neck and discovers a single loop of umbilical cord loosely encircling the neck (nuchal cord). What is the appropriate management?

Intrapartum Care

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Active Management of the Third Stage of Labor (AMTSL) is a proven, evidence-based intervention that reduces the incidence of postpartum hemorrhage by up to 60%. What are the three core components of AMTSL?

Intrapartum Care

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During the third stage of labor, what is the drug of choice, recommended dose, and route for routine prophylactic uterotonic administration as part of AMTSL?

Intrapartum Care

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According to WHO guidelines for essential newborn care and management of the third stage of labor, when should the umbilical cord be clamped in a healthy, crying term or preterm infant?

Intrapartum Care

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While managing the third stage of labor, the midwife observes signs of placental separation before applying controlled cord traction. Which combination of signs confirms that the placenta has detached from the uterine wall?

Intrapartum Care

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Immediately after the placenta and membranes are delivered, the midwife conducts a systematic examination of the placenta. Which finding requires immediate exploration and intervention?

Intrapartum Care

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