MNMC Competency Examination for Midwife Registration (မြန်မာနိုင်ငံသူနာပြုနှင့်သားဖွားကောင်စီ — MNMC)

A pregnant woman presents for her initial antenatal visit reporting that the first day of her last normal menstrual period (LMP) was April 10, 2025. Her menstrual cycle is regular every 28 days. Using Naegele's rule, what is her estimated date of delivery (EDD)?

• AJanuary 17, 2026
• BJanuary 10, 2026
• CJanuary 24, 2026
• DDecember 17, 2025

A client is currently pregnant. Her obstetric history reveals she gave birth to one full-term infant who is alive, one preterm infant at 32 weeks who is alive, and experienced one spontaneous miscarriage at 10 weeks gestation. How should the midwife record her obstetric history using the GTPAL system?

• AG4 T1 P1 A1 L2
• BG3 T1 P1 A1 L2
• CG4 T2 P0 A1 L2
• DG4 T1 P2 A0 L2

During a routine second-trimester antenatal checkup, a laboratory report shows maternal hemoglobin of 10.8 g/dL and hematocrit of 33%. The midwife explains that maternal blood volume increases during pregnancy. Which physiological mechanism primarily accounts for this 'physiological anemia of pregnancy'?

• APlasma volume expands by approximately 45-50% while red blood cell mass expands by only 2…
• BMaternal erythropoietin production ceases due to high circulating placental estrogen and…
• CExcessive fetal bone marrow sequestration of maternal iron stores prevents normal materna…
• DIncreased maternal renal excretion of iron and folic acid leads to diminished red cell su…

According to WHO antenatal-care guidance, what daily oral supplement is recommended during pregnancy to help prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth?

• A30–60 mg of elemental iron and 400 mcg (0.4 mg) of folic acid daily
• B120 mg of elemental iron and 5 mg of folic acid daily
• C10 mg of elemental iron and 100 mcg of folic acid daily
• D200 mg of elemental iron and 1 mg of folic acid daily

A midwife is using MNMC's published midwife competency appendix to plan an initial antenatal assessment. Which group of investigations is explicitly included in that competency document?

• AAnaemia testing, HIV testing, syphilis testing, and urine protein testing
• BCytomegalovirus, toxoplasmosis, and Epstein–Barr virus serology for every client
• CRoutine amniocentesis, fetal karyotyping, and maternal tumour markers
• DDengue serology, stool culture, and chest radiography for every client

A pregnant woman who has never received any tetanus toxoid vaccination in her life presents for antenatal care at 16 weeks gestation. To ensure protective immunity against maternal and neonatal tetanus, what is the appropriate schedule for the first two doses (Td1 and Td2)?

• AGive Td1 at the earliest contact, and give Td2 at least 4 weeks later, preferably at leas…
• BGive Td1 at 16 weeks, and give Td2 exactly 6 months later after delivery.
• CGive Td1 and Td2 simultaneously in opposite deltoid muscles at the first visit.
• DWithhold vaccination until after delivery because tetanus toxoid is contraindicated in pr…

When measuring symphysis-fundal height (SFH) with a non-elastic tape measure between 24 and 36 weeks of gestation in a singleton pregnancy, what is the expected relationship between SFH in centimeters and gestational age in weeks?

• ASFH in centimeters corresponds approximately to gestational age in weeks, within a varian…
• BSFH in centimeters is consistently 5 cm greater than gestational age in weeks.
• CSFH in centimeters is half the gestational age in weeks.
• DSFH measurement remains constant at 30 cm regardless of gestational week after 24 weeks.

A midwife performs Leopold maneuvers on a woman at 36 weeks gestation. The midwife stands facing the woman's head, places both hands on the lateral sides of the maternal abdomen, and feels a firm, smooth, continuous resistance on the maternal left side and irregular small nodular parts on the maternal right side. Which maneuver is being performed and what does it identify?

• ASecond maneuver (lateral palpation); identifies the fetal back and extremities.
• BFirst maneuver (fundal grip); identifies the presenting part in the lower pelvis.
• CThird maneuver (Pawlik's grip); assesses whether the fetal head is engaged.
• DFourth maneuver (pelvic grip); determines the degree of cephalic flexion.

What is the normal baseline range for the fetal heart rate (FHR) in a healthy fetus at term when auscultated during routine antenatal examination?

• A110 to 160 beats per minute
• B80 to 100 beats per minute
• C170 to 200 beats per minute
• D60 to 90 beats per minute

A 22-year-old primigravida at 9 weeks gestation presents with persistent severe nausea and vomiting, inability to tolerate oral fluids for 3 days, weight loss of 6% from pre-pregnancy weight, dry mucous membranes, and 3+ ketonuria on urinalysis. Which diagnosis is most consistent with these findings?

• AHyperemesis gravidarum
• BPhysiological morning sickness (nausea and vomiting of pregnancy)
• CAcute gestational pyelonephritis
• DPeptic ulcer perforation

A 26-year-old woman presents to the primary healthcare center with 6 weeks of amenorrhea, sharp unilateral lower abdominal pain, and scant dark brown vaginal spotting. On examination, she is pale with a blood pressure of 90/60 mmHg, heart rate of 110 bpm, and marked cervical motion tenderness. What life-threatening obstetric emergency should the midwife immediately suspect?

• ARuptured tubal ectopic pregnancy
• BThreatened intrauterine miscarriage
• CBenign corpus luteum cyst
• DAcute appendicitis in pregnancy

At what gestational age is routine screening for gestational diabetes mellitus (GDM) using an oral glucose tolerance test (OGTT) typically recommended for women without prior documented glycemic abnormalities?

• A24 to 28 weeks of gestation
• B6 to 10 weeks of gestation
• C14 to 16 weeks of gestation
• D36 to 38 weeks of gestation

An Rh-negative, non-sensitized primigravida with negative antibody screen attends her 28-week visit. When should anti-D immune globulin (RhIG) be administered to prevent Rh isoimmunization?

• AProphylactically at 28 weeks gestation, and again within 72 hours after delivery if the n…
• BOnly after delivery regardless of maternal antibody screening status.
• CAt 12 weeks gestation only, with no further doses required in the third trimester.
• DOnly if the maternal blood test demonstrates active Rh antibody formation.

What is the most accurate sonographic parameter for establishing gestational age and confirming the estimated date of delivery when performed in the first trimester between 11 and 13 weeks + 6 days of gestation?

• ACrown-rump length (CRL)
• BBiparietal diameter (BPD)
• CFemur length (FL)
• DAbdominal circumference (AC)

A healthy pregnant woman with a normal pre-pregnancy body mass index (BMI 18.5–24.9 kg/m²) asks the midwife about appropriate total weight gain during a singleton pregnancy. What is the recommended total gestational weight gain range?

• A11.5 to 16.0 kg (25 to 35 lbs)
• B5.0 to 9.0 kg (11 to 20 lbs)
• C18.0 to 25.0 kg (40 to 55 lbs)
• DLess than 4.0 kg (less than 9 lbs)

Which of the following signs observed during an obstetric examination is classified as a 'positive (diagnostic) sign of pregnancy', definitively confirming the presence of a fetus?

• AAuscultation of fetal heart tones by a trained clinician using a Doppler or fetoscope
• BAmenorrhea and morning nausea
• CSoftening of the uterine isthmus (Hegar's sign) on bimanual examination
• DA positive urine pregnancy test detecting human chorionic gonadotropin (hCG)

Why is routine screening and treatment of asymptomatic bacteriuria (ASB) in early pregnancy considered an essential antenatal intervention?

• AUntreated bacteriuria increases the risk of maternal pyelonephritis and is associated wit…
• BAsymptomatic bacteriuria causes congenital cardiovascular malformations in the developing…
• CAsymptomatic bacteriuria is the primary causative factor in maternal gestational diabetes…
• DAsymptomatic bacteriuria invariably leads to irreversible bilateral renal cortical necros…

A woman at 34 weeks of gestation presents with a persistent severe frontal headache unresponsive to paracetamol, accompanied by spots in her vision (scotoma) and sharp epigastric pain. Blood pressure is 154/98 mmHg. What is the midwife's primary clinical concern?

• AImpending eclampsia associated with severe pre-eclampsia
• BPhysiological tension headache from lack of sleep
• CAcute cholecystitis with gallstones
• DOphthalmic migraine

At approximately what gestational age does a primigravida typically first perceive maternal fetal movements ('quickening')?

• A18 to 20 weeks of gestation
• B10 to 12 weeks of gestation
• C28 to 30 weeks of gestation
• D34 to 36 weeks of gestation

Which of the following components is an essential element of a community 'Birth Preparedness and Complication Readiness' (BPCR) plan developed during antenatal visits?

• AIdentifying a skilled birth attendant, designating an emergency transport arrangement, an…
• BPurchasing infant formula and artificial feeding bottles in advance of delivery.
• CScheduling an elective cesarean delivery at 36 weeks to avoid spontaneous labor.
• DSelecting an unaccredited traditional birth attendant to perform delivery at home without…

According to World Health Organization labor management guidelines, what cervical dilation marks the transition from the latent first stage of labor to the active first stage of labor in spontaneous labor?

• A5 cm of cervical dilation
• B2 cm of cervical dilation
• C8 cm of cervical dilation
• D10 cm of cervical dilation

Before a vaginal examination in labour, the client asks that a relative leave the room and requests an explanation of the examination. What should the midwife do first?

• AProvide privacy, explain the purpose and process, obtain the client's consent, and procee…
• BProceed immediately because vaginal examinations in labour never require an explanation o…
• CAsk the relative to consent on the client's behalf even though the client can decide for…
• DCancel all further labour assessment because requesting privacy means the client refuses…

When using the WHO Labour Care Guide, at what cervical dilatation does the active first stage of labour begin?

• AAt 5 cm cervical dilatation, with ongoing assessment of the woman and fetus
• BAt the very first perception of irregular uterine tightening at home
• COnly after the spontaneous rupture of the amniotic membranes occurs
• DOnly after the fetal head has completely crowned at the vulva

A woman using the WHO Labour Care Guide progresses more slowly than an expected 1 cm per hour but has reassuring maternal and fetal findings. What is the best interpretation?

• ADo not diagnose labour arrest from the 1 cm-per-hour threshold alone; reassess the comple…
• BBegin oxytocin immediately because any rate below 1 cm per hour proves obstruction
• CPerform an immediate caesarean birth because the guide treats 1 cm per hour as an absolut…
• DStop maternal and fetal observations until the cervix reaches 10 cm

During a vaginal examination in labor, the midwife determines that the leading bony point of the fetal head has reached the level of the maternal ischial spines. What station is assigned to this fetal position?

• AStation 0
• BStation -3
• CStation +3
• DStation -5

Which fetal head presentation and position is considered the most favorable and optimal for spontaneous vaginal birth through the female pelvis?

• AVertex presentation in an Occipito-Anterior (OA) position
• BFace presentation in a Mento-Posterior position
• CBrow presentation in a Fronto-Anterior position
• DBreech presentation in a Sacro-Posterior position

A woman in active labor experiences spontaneous rupture of membranes. The amniotic fluid draining is observed to be thick, opaque, and dark green. What is the clinical significance of this finding?

• AThick meconium staining indicates passage of fetal stool, which can be a sign of in utero…
• BIt represents physiological vernix caseosa and confirms excellent fetal well-being.
• CIt confirms maternal rupture of a urinary tract diverticulum.
• DIt is an expected normal color caused by breakdown of cervical mucus.

How should uterine contractions be assessed and plotted on the modified WHO partograph during active labor?

• APalpate the number of contractions occurring in a 10-minute period and note their duratio…
• BMeasure maternal blood pressure every 5 minutes and record it as contraction pressure.
• CCount contractions over a 1-hour period and calculate the average per minute.
• DRely exclusively on maternal subjective pain scores on a 1-to-10 scale.

Which non-pharmacological comfort measure is strongly recommended by WHO for women during labor to enhance coping, reduce pain perception, and improve birth outcomes?

• AContinuous supportive companionship from a chosen birth partner or midwife throughout lab…
• BEnforced strict flat supine immobilization on the delivery bed
• CComplete prohibition of oral clear fluids throughout labor
• DRoutine administration of sedatives to all laboring mothers upon admission

What is the primary physiological benefit of encouraging a laboring woman to adopt upright and mobile positions (such as walking, standing, sitting, or kneeling) during the first stage of labor?

• AGravity assists fetal descent, optimizes pelvic diameters, and strengthens effective uter…
• BIt completely eliminates the possibility of postpartum hemorrhage.
• CIt guarantees delivery within exactly one hour of standing.
• DIt prevents fetal heart rate accelerations during uterine contractions.

In the mechanism of normal labor for a vertex presentation, what movement must occur to allow the biparietal diameter of the fetal head to pass through the pelvic inlet?

• AEngagement and descent
• BExtension of the fetal head
• CExternal rotation of the head
• DExpulsion of the shoulders

During the mechanism of normal labor in an occipito-anterior position, what is the purpose of 'internal rotation' of the fetal head?

• AIt rotates the occiput from the oblique or transverse diameter of the pelvic cavity to th…
• BIt brings the chin up toward the chest to increase the presenting diameter.
• CIt rotates the fetal face forward beneath the pubic symphysis.
• DIt twists the umbilical cord safely around the fetal neck to prevent rapid delivery.

At the pelvic outlet during a normal vertex delivery, by which cardinal movement is the fetal head born once the subocciput pivots beneath the subpubic arch?

• AExtension
• BExtreme flexion
• CInternal rotation
• DLateral flexion

Immediately following the delivery of the fetal head by extension, the head untwists 45 degrees to align with the shoulders inside the pelvis. Which cardinal movement does this represent?

• ARestitution
• BExternal rotation
• CEngagement
• DMolding

What is the current evidence-based policy regarding the use of episiotomy during normal spontaneous vaginal birth?

• ARestrictive (selective) use of episiotomy, performed only for specific clinical indicatio…
• BRoutine universal episiotomy for all primigravid women to prevent pelvic floor relaxation.
• CMandatory episiotomy whenever labor duration exceeds 2 hours in the active phase.
• DTotal prohibition of episiotomy under all clinical circumstances.

Which manual technique should the midwife use to protect the perineum during crowning of the fetal head?

• APlace fingers of one hand gently over the occiput to control delivery speed and maintain…
• BApply forceful manual pressure pushing the perineal body downward toward the rectum.
• CForcefully pull the fetal head outward immediately when the parietal bones appear.
• DPerform vigorous fundal pushing while having the mother hold her breath continuously.

Immediately following the delivery of the fetal head and before the restitution of the shoulders, what is the midwife's next immediate action?

• AGently feel around the fetal neck with a finger to check for a nuchal umbilical cord.
• BImmediately apply forceful traction to pull the anterior shoulder out.
• CAdminister an intramuscular bolus of ergometrine before checking the cord.
• DClamp and cut the cord before the baby's body is delivered.

In delivering the shoulders during an uncomplicated vaginal birth, how should the midwife assist the expulsion of the anterior and posterior shoulders?

• AApply gentle downward traction on the biparietal aspect of the head to deliver the anteri…
• BPull upward vigorously to deliver the anterior shoulder over the pubic bone.
• CTwist the baby's neck 180 degrees while pulling forcefully.
• DApply vigorous fundal pressure while pulling the arms.

What is the recommended first-line uterotonic drug and standard dosage for the Active Management of the Third Stage of Labor (AMTSL) to prevent postpartum hemorrhage?

• AOxytocin 10 International Units (IU) administered intramuscularly (IM)
• BErgometrine 0.5 mg administered intravenously (IV)
• CMisoprostol 800 mcg administered rectally
• DCarboprost tromethamine 250 mcg administered intramyometrially

How is Controlled Cord Traction (CCT / Brandt-Andrews technique) correctly executed during the active management of the third stage of labor?

• AStabilize the uterus by placing the palm of one hand above the pubic symphysis pushing up…
• BPull forcefully on the umbilical cord while the uterus is completely relaxed between cont…
• CGrasp the fundus and push it downward into the pelvis while pulling the cord horizontally.
• DTie a heavy weight to the umbilical cord and wait for gravity to deliver the placenta.

Following expulsion of the placenta, which immediate assessment best supports early recognition and management of postpartum haemorrhage?

• AAssess uterine tone and bleeding; if the uterus is boggy, begin uterine massage while ini…
• BPack the uterine cavity with sterile gauze rolls immediately.
• CAdminister intravenous broad-spectrum antibiotics to prevent puerperal sepsis.
• DCatheterize the bladder and irrigate the bladder with ice-cold saline.

Which trio of clinical signs indicates that physiological separation of the placenta has occurred and that it has descended into the lower uterine segment?

• ALengthening of the umbilical cord outside the vulva, a sudden small gush of blood, and th…
• BImmediate cessation of all uterine contractions, maternal hypotension, and cord retractio…
• CRapid elevation of maternal body temperature, profuse watery discharge, and softening of…
• DInversion of the vaginal vault, disappearance of the fundus, and absence of bleeding.

When examining the delivered placenta, the midwife notices a distinct defect where cotyledons appear to be missing, accompanied by continuing vaginal bleeding. What is the clinical implication?

• APossible retained placental tissue contributing to postpartum haemorrhage, requiring urge…
• BNormal anatomical variation with no clinical significance.
• CPlacenta succenturiata with complete expulsion of all tissue.
• DEvidence of congenital fetal renal agenesis.

On gross anatomical examination of the cut end of a normal newborn's umbilical cord, what is the expected normal vascular structure?

• ATwo umbilical arteries and one umbilical vein surrounded by Wharton's jelly
• BOne umbilical artery and two umbilical veins
• CTwo umbilical arteries and two umbilical veins
• DOne large umbilical artery and no umbilical veins

A postpartum woman sustains a perineal laceration during birth. Inspection reveals involvement of the vaginal mucosa, perineal skin, and the external anal sphincter muscle, but the anal mucosa remains intact. How is this perineal tear classified?

• AThird-degree perineal tear
• BFirst-degree perineal tear
• CSecond-degree perineal tear
• DFourth-degree perineal tear

Immediately at the moment of birth, what is the most critical initial action the midwife must take for a vigorous, crying newborn to prevent neonatal hypothermia?

• AThoroughly dry the baby with a warm, dry towel, discard the wet linen, and place the baby…
• BImmerse the newborn immediately in a warm water bath to remove all blood and vernix.
• CVigorously suction the stomach and trachea with a rigid catheter.
• DPlace the baby naked under a ceiling fan to stimulate crying.

In a vigorous newborn who does not require positive-pressure resuscitation, what is the recommended timing for clamping and cutting the umbilical cord, and what is its primary physiological benefit?

• ADelayed cord clamping between 1 and 3 minutes after birth; facilitates placental transfus…
• BImmediate cord clamping within 10 seconds of delivery; prevents polycythemia and neonatal…
• CClamping after 30 minutes; ensures complete transfer of maternal hormones.
• DClamping before delivery of the fetal trunk; prevents neonatal hyperbilirubinemia.