Midwives Council Midwifery Registration Exam (Hong Kong)

In Hong Kong, universal screening for Group B Streptococcus (GBS) is routinely offered to pregnant women at how many weeks of gestation?

• A28 to 30 weeks
• B32 to 34 weeks
• C35 to 37 weeks
• D38 to 40 weeks

A pregnant woman at 26 weeks of gestation undergoes a 75g Oral Glucose Tolerance Test (OGTT). According to the WHO diagnostic criteria adopted in Hong Kong, which of the following plasma glucose values is diagnostic of Gestational Diabetes Mellitus (GDM)?

• AFasting plasma glucose of 4.8 mmol/L
• B1-hour plasma glucose of 9.0 mmol/L
• C2-hour plasma glucose of 8.5 mmol/L
• DFasting plasma glucose of 5.0 mmol/L

Which of the following is considered a HIGH-RISK factor for pre-eclampsia that warrants the initiation of low-dose aspirin (100-150 mg daily) from 12 weeks of gestation?

• AFirst pregnancy (nulliparity)
• BMaternal age of 35 years or older
• CChronic kidney disease
• DBody mass index (BMI) of 28 kg/m²

A pregnant woman is Rh-negative (D-negative) and has no detectable anti-D antibodies. In accordance with standard antenatal care in Hong Kong, when should routine antenatal anti-D prophylaxis be administered?

• AAt 12 and 20 weeks of gestation
• BAt 28 and 34 weeks of gestation
• COnly within 72 hours after delivery
• DImmediately after any routine ultrasound scan

What is the recommended daily dose of folic acid for a low-risk pregnant woman starting at least one month before conception and continuing through the first 12 weeks of pregnancy to prevent neural tube defects (NTDs)?

• A0.4 mg (400 micrograms)
• B1.0 mg
• C4.0 mg
• D5.0 mg

When measuring symphysis-fundal height (SFH) to assess fetal growth between 24 and 36 weeks of gestation, what is the generally accepted normal variance in centimeters compared to the gestational age in weeks?

• AWithin +/- 1 cm
• BWithin +/- 2 cm
• CWithin +/- 3 cm
• DWithin +/- 4 cm

During abdominal palpation of a pregnant woman (Leopold's maneuvers), what is the primary purpose of the third maneuver (Pawlik's grip)?

• ATo identify the fetal parts occupying the uterine fundus
• BTo determine the location of the fetal back and small parts
• CTo identify the presenting part and check if it is engaged
• DTo determine the degree of flexion of the fetal head

Ideally, a pregnant woman's antenatal booking visit (first booking) in Hong Kong should take place within which gestational timeframe?

• ABefore 10 to 12 weeks of gestation
• BAt 14 to 16 weeks of gestation
• CAt 18 to 20 weeks of gestation
• DWhenever quickening is first felt

A routine antenatal blood test reveals that a pregnant woman at 10 weeks of gestation is not immune to Rubella. Which of the following is the correct management strategy?

• AAdminister the MMR vaccine immediately
• BAdminister the MMR vaccine at 28 weeks of gestation
• CAdvise her to avoid contact with infected individuals and vaccinate her in the immediate…
• DRe-test her rubella antibodies in the third trimester to see if immunity has developed

When educating a pregnant woman about monitoring fetal movements using a 'kick chart' in the third trimester, what advice should the midwife give regarding when to contact the hospital?

• AIf she counts fewer than 10 movements in a 12-hour period
• BIf she counts fewer than 10 movements in 2 hours during a period of focused attention
• CIf she does not feel any movement for a single hour
• DOnly if she feels no movement for a full 24 hours

What is the primary physiological mechanism responsible for the 'physiological anemia of pregnancy'?

• ADeficiency in dietary iron absorption due to maternal hormone changes
• BA rapid increase in maternal plasma volume that exceeds the increase in red blood cell ma…
• CSuppression of erythropoietin production by high progesterone levels
• DIncreased maternal blood loss through the placental circulation

A newborn is diagnosed with congenital toxoplasmosis presenting with chorioretinitis and intracranial calcifications. What antenatal education topic should the midwife emphasize to prevent this infection in pregnant women?

• AAvoiding public swimming pools and saunas
• BEnsuring all dairy products consumed are pasteurized
• CAvoiding handling cat litter boxes and consuming raw or undercooked meat
• DAvoiding contact with young children in day care centers

First-trimester combined screening for Down syndrome (trisomy 21) in Hong Kong involves which combination of markers?

• AMaternal age, maternal serum alpha-fetoprotein (AFP), and unconjugated estriol
• BMaternal age, fetal nuchal translucency (NT) on ultrasound, and maternal serum free beta-…
• CFetal femur length, amniotic fluid index (AFI), and maternal serum beta-hCG
• DMaternal age, maternal serum inhibin-A, and maternal serum AFP

When assessing amniotic fluid volume on ultrasound, which of the following findings is diagnostic of oligohydramnios?

• AAn Amniotic Fluid Index (AFI) of 8 cm
• BA Single Deepest Pocket (SDP) of 3 cm
• CAn Amniotic Fluid Index (AFI) of less than 5 cm
• DA Single Deepest Pocket (SDP) of 9 cm

Which of the following ranges represents the normal baseline fetal heart rate (FHR) at term?

• A90 to 120 beats per minute
• B100 to 140 beats per minute
• C110 to 160 beats per minute
• D120 to 180 beats per minute

A midwife is providing dietary counseling to a pregnant woman who follows a strict vegan diet. Which nutrient supplement is essential to discuss due to its lack in plant-based diets?

• AVitamin C
• BVitamin B12
• CVitamin A
• DFolic acid

A pregnant woman is confirmed to be a Hepatitis B surface antigen (HBsAg) carrier. What is the standard management plan in Hong Kong to prevent vertical transmission to the newborn?

• APlan for a cesarean section for all HBsAg-positive mothers
• BAdminister Hepatitis B immunoglobulin (HBIG) and the Hepatitis B vaccine to the newborn w…
• CStart the mother on daily antiviral therapy from the first trimester
• DAdvise the mother to avoid breastfeeding to prevent transmission through breast milk

Which pelvic shape is characterized by a rounded inlet, parallel side walls, a wide subpubic arch, and is considered the most favorable for a normal vaginal delivery?

• AAndroid pelvis
• BGynecoid pelvis
• CPlatypelloid pelvis
• DAnthropoid pelvis

Which of the following medications is a first-line, safe antihypertensive agent used for managing chronic or gestational hypertension in pregnant women in Hong Kong?

• AEnalapril (ACE inhibitor)
• BLabetalol
• CLosartan (Angiotensin receptor blocker)
• DAtenolol

To reduce the risk of acquiring Cytomegalovirus (CMV) infection during pregnancy, which primary preventative measure should the midwife discuss with a pregnant woman, particularly if she has young children?

• AAvoiding public transport during peak hours
• BAvoiding fresh green salad and raw vegetables
• CPracticing strict hand hygiene and avoiding contact with the saliva and urine of young ch…
• DGetting the CMV vaccine at the booking visit

According to the WHO Labour Care Guide (2020) and modern practice in Hong Kong, the active phase of the first stage of labor is defined as starting at how many centimeters of cervical dilatation?

• A3 cm
• B4 cm
• C5 cm
• D6 cm

During cardiotocography (CTG) monitoring of a laboring woman, late decelerations are observed. What is the primary underlying cause of late decelerations?

• AFetal head compression
• BUmbilical cord compression
• CUteroplacental insufficiency
• DMaternal hypotension

For a primigravida in the active phase of labor, what is the minimum rate of cervical dilatation that is generally accepted as normal progress before considering labor delay?

• A0.5 cm per hour
• B1.0 cm per hour
• C1.5 cm per hour
• D2.0 cm per hour

According to FIGO standards, what is the definition of a fetal heart rate (FHR) acceleration at >= 32 weeks of gestation?

• AAn increase of at least 10 bpm above baseline lasting for at least 10 seconds
• BAn increase of at least 15 bpm above baseline lasting for at least 15 seconds
• CAn increase of at least 20 bpm above baseline lasting for at least 20 seconds
• DAn increase of at least 25 bpm above baseline lasting for at least 30 seconds

When performing intermittent auscultation of the fetal heart rate using a Pinard stethoscope during the active phase of labor, what is the correct technique?

• AAuscultate for 15 seconds during a contraction and multiply by 4
• BAuscultate for 30 seconds between contractions and multiply by 2
• CAuscultate immediately after a contraction for at least 1 minute
• DAuscultate continuously during the peak of three contractions

Which of the following describes the correct components and sequence of Active Management of the Third Stage of Labor (AMTSL)?

• AUterine massage, followed by maternal pushing, and immediate cord clamping
• BAdministration of a uterotonic agent, controlled cord traction (CCT) with counter-tractio…
• CControlled cord traction, clamping the cord at 5 minutes, and manual removal of the place…
• DImmediate clamping of the cord, administration of ergometrine, and sustained cord pulling

During the mechanism of labor, what is the primary benefit of fetal head flexion as it descends into the pelvis?

• AIt presents the suboccipito-bregmatic diameter, which is the smallest anteroposterior dia…
• BIt allows the head to rotate directly to an occiput posterior position
• CIt decreases the strength of uterine contractions
• DIt prevents the rupture of the amniotic sac

In Hong Kong midwifery practice, why is a mediolateral episiotomy preferred over a midline (median) episiotomy when an episiotomy is clinically indicated?

• AIt is easier and faster to repair
• BIt is associated with significantly less blood loss
• CIt reduces the risk of extension into the anal sphincter (third- and fourth-degree tears)
• DIt causes less postpartum pain and discomfort

A woman wishes to use inhaled nitrous oxide and oxygen (Entonox) for pain relief during labor. What instruction should the midwife give her to ensure maximum efficacy?

• AInhale deeply only during the peak of the contraction
• BStart inhaling deeply as soon as the contraction begins, or slightly before (about 15-20…
• CHyperventilate through the mouthpiece continuously between contractions
• DHold her breath for 30 seconds after inhaling the gas

A laboring woman experiences spontaneous rupture of membranes (SROM). What is the priority assessment that the midwife must perform immediately?

• ACheck the maternal blood pressure
• BPerform a vaginal examination to check cervical dilatation
• CAuscultate the fetal heart rate to check for cord compression or prolapse
• DCheck the pH of the amniotic fluid with Nitrazine paper

The second stage of labor is defined as the period of time spanning which two clinical events?

• AFrom the onset of regular contractions to full cervical dilatation
• BFrom full cervical dilatation (10 cm) to the birth of the baby
• CFrom the birth of the baby to the delivery of the placenta
• DFrom the urge to push to the crowning of the fetal head

A woman's fetus is confirmed to be in an occiput posterior (OP) position during labor. Which clinical signs is the midwife most likely to observe?

• ARapid progress of labor and early urge to push
• BSevere backache, a prolonged latent phase, and a persistent urge to push before full dila…
• CAn easy labor with minimal pain
• DA high, floating presenting part that does not enter the pelvis

Which of the following describes the physiological management of the third stage of labor?

• AAdministering IM syntometrine, clamping the cord immediately, and applying controlled cor…
• BDelivering the placenta by maternal effort and gravity alone, without uterotonics or cord…
• CMassaging the uterus continuously until the placenta spontaneously expels
• DManual removal of the placenta under epidural anesthesia immediately after birth

When assessing uterine contractions in a laboring woman, how should the midwife measure contraction frequency?

• AThe duration of relaxation between contractions
• BThe number of contractions occurring within a 10-minute period
• CThe duration of one contraction from start to finish
• DThe intensity of the contraction felt during abdominal palpation

The Bishop score is a pre-labor scoring system used to predict the likelihood of successful labor induction. Which five clinical parameters are assessed?

• ADilation, effacement, station, consistency, and position of the cervix
• BContraction frequency, duration, intensity, maternal pulse, and FHR
• CFetal presentation, position, lie, attitude, and station
• DGestational age, maternal age, parity, amniotic fluid volume, and fetal weight

In midwifery, when is the fetal head defined as being 'engaged' in the pelvis?

• AWhen the presenting part is felt at the level of the ischial spines (station 0)
• BWhen the biparietal diameter of the fetal head has passed through the pelvic inlet
• CWhen the head is no longer ballotable on abdominal palpation
• DWhen the occiput is visible at the vaginal introitus

A midwife is evaluating a perineal tear after delivery. The tear involves the perineal muscles and fascia, but does not extend into the anal sphincter. How should this tear be classified?

• AFirst-degree tear
• BSecond-degree tear
• CThird-degree tear
• DFourth-degree tear

To prevent aortocaval compression (supine hypotensive syndrome) during labor when a woman is resting in bed, what position should the midwife recommend?

• AStrict supine position with the head of the bed flat
• BLeft lateral position or semi-recumbent with a wedge/tilt under the right hip
• CProne position with a pillow under the abdomen
• DTrendelenburg position (feet elevated above the head)

When assisting a woman with a water birth, what is the recommended pool water temperature during the second stage of labor to prevent fetal hyperthermia?

• A32.0°C to 34.0°C
• B35.0°C to 37.5°C
• C38.0°C to 39.5°C
• D40.0°C to 41.5°C

Which clinical behaviors are commonly associated with the 'transitional phase' of labor (at 8-10 cm dilatation)?

• ARelaxation, talkativeness, and minimal pain
• BIrritability, shaking, nausea, feeling of losing control, and vocalizing a desire to go h…
• CQuiet focus, slow deep breathing, and falling asleep between contractions
• DActive bearing down and crowning of the head

What is the normal sequence of lochia progression in the postpartum period?

• ALochia rubra, Lochia alba, Lochia serosa
• BLochia serosa, Lochia rubra, Lochia alba
• CLochia rubra, Lochia serosa, Lochia alba
• DLochia alba, Lochia serosa, Lochia rubra

What is the primary definition of Postpartum Hemorrhage (PPH) following a vaginal delivery, and after a Caesarean section, respectively?

• ABlood loss >= 200 mL (vaginal) and >= 500 mL (Caesarean)
• BBlood loss >= 500 mL (vaginal) and >= 1000 mL (Caesarean)
• CBlood loss >= 1000 mL (vaginal) and >= 1500 mL (Caesarean)
• DAny blood loss that causes maternal tachycardia

A newborn is evaluated at 1 minute of life. The infant has a heart rate of 110 bpm, exhibits a weak cry with stimulation, shows some flexion of the extremities, has a pink body with blue hands and feet, and displays slow, irregular respirations. What is this infant's Apgar score?

• A5
• B6
• C7
• D8

Why is Vitamin K (phytomenadione) routinely administered intramuscularly (IM) to all newborns in Hong Kong within the first hour of birth?

• ATo stimulate the maturation of neonatal liver function
• BTo prevent Vitamin K Deficiency Bleeding (VKDB), also known as hemorrhagic disease of the…
• CTo reduce the risk of neonatal hyperbilirubinemia
• DTo promote early passage of meconium

In a healthy term neonate, what plasma glucose concentration threshold is generally used to diagnose neonatal hypoglycemia within the first 24 hours of life?

• ALess than 1.8 mmol/L
• BLess than 2.6 mmol/L
• CLess than 3.3 mmol/L
• DLess than 4.0 mmol/L

To promote successful breastfeeding and maternal-infant bonding, within what timeframe after birth should the midwife encourage the initiation of breastfeeding?

• AWithin 1 hour of birth, during skin-to-skin contact
• BAfter the infant has slept for 4 to 6 hours
• COnly after the maternal milk supply (colostrum) has transitioned to mature milk
• DImmediately after the first bath is completed

A breastfeeding mother presents 3 weeks postpartum with a localized painful, red, and swollen area on her right breast, accompanied by a fever of 38.5°C and flu-like symptoms. What is the correct management advice?

• AStop breastfeeding immediately from the affected breast to avoid infecting the baby
• BContinue breastfeeding frequently from both breasts, apply warm compresses before feeds,…
• CPump and discard the milk from the right breast and feed only from the left breast
• DApply ice packs continuously and restrict fluid intake to decrease milk production