General Midwifery/New Starters Quiz (September 2010)

1)Cassie is booking with her midwife for the first time. She is a primigravida and approximately 8 weeks pregnant at booking. What do the terms primigravida and multiparous mean?

A) Primigravida; a woman pregnant for the first time. Sometimes shortened to 'primip' although this is technically incorrect as it is short for primiparous which is a woman who has had one baby - gravid = pregnant, parous = given birth. Multiparous or multip - a woman who has had more than one baby. Again, often incorrectly shortened in practice to mean 'a pregnant woman who has given birth before' BONUS- Grand-Multip: Multiparous woman whom is pregnant with her 5th or subsequent pregnancies.

2) During this booking appointment she is asked to provide a urine specimen. She is told that this first specimen is sent to the laboratory to be tested. Why might the midwife be interested in a woman’s urine?

A) At this point of pregnancy, the woman’s urine would be sent for an M, C & S to check for any evidence of growth which may indicate an infection. Urinary infections increase the risk of miscarriage and premature labour. Therefore it is important that the midwife is aware of any infections or underlying conditions. Later in the pregnancy the midwife will test for protein in the urine as proteinuria is a symptom of pre-eclampsia.

3) Cassie is weighed and measured during this appointment. Her body mass index (BMI) is calculated and she has a BMI of 21. How do you calculate body mass index and what is the healthy range?

A) To calculate a BMI the body weight in kilos is divided by height in metres - squared. A healthy BMI is classified as between 18.5-24.9kg/m2
4) At 11 weeks pregnant, Cassie receives a letter from her hospital inviting her to attend an ultrasound appointment to date her pregnancy officially. She is asked to come to the maternity day assessment unit with a full bladder. What is the purpose of filling the bladder before the ultrasound?

A) Until the 12th week of pregnancy the uterus is situated within the pelvis and would be difficult for the sonographer to access abdominally. Filling the bladder will lift the uterus up and out of the pelvis. This means that the sonographer is able to access the uterus more easily and it will provide a better quality picture on the screen to make the process more reliable.

5) Cassie is attending her 28 week appointment with her community midwife. She states that she is feeling very tired, lethargic and weak. The midwife feels that Cassie looks quite pale. She is due blood tests today, what result may the midwife be particularly interested in following up after this conversation and what action may be taken?

A) The midwife would be interested in following up Cassie’s Hb result to determine whether it is anaemia that is causing Cassie to feel so drained. If Cassie’s Hb is deemed to be low, she will be offered iron supplements and advised to continue taking them until her Hb is tested again. She should be advised about the possible side effects of taking iron supplements, such as, constipation, diarrhoea, cramps and nausea.

6) Cassie rings the 24-hour advice line at 35/40 complaining about swollen hands, feet and ankles. What is the correct term for this swelling?

A) Oedema is an excessive amount of interstitial fluid. Excessive oedema can be a symptom of pregnancy induced hypertension or pre-eclampsia.

7) At 40 weeks gestation, Cassie attends an appointment with her Community Midwife. As she is a “primip” she is offered a stretch and sweep at this appointment. How is this performed and what is the purpose?

A) A stretch and sweep is a vaginal examination where the midwife puts her fingers inside the vagina and locates the cervix. The favourability of the cervix is assessed using the “Bishops Score”. If the midwife is able to put her finger/s inside the OS of the cervix she will “sweep” around the membranes and gently stretch the cervix. The purpose of this examination is to stimulate the production of prostaglandins which encourage the ripening of the cervix and start labour.

8) At 21.30 that night, Cassie starts to feel lower abdominal cramps. She calls the labour ward advice line and advises the midwife who has answered her call that she has “period like pains” following a S&S that morning, her membranes are still intact, she has had a “snotty, mucoid” loss and her baby is still moving. She advises the midwife she was put on iron at 28/40 as her Hb was 9.3. What advice might the midwife give her?

A) She would be advised that a bloody mucoid show and period cramps could either be her body’s reaction to having a S&S or could be her body preparing to go into labour. She would be advised to eat as normal, perhaps take a low strength analgesic such as 1g of paracetamol and to take a bath and get some sleep. She would be advised to call back when either her waters go, has any fresh blood loss PV, starts to get strong, regular contractions or is worried about her baby’s movements.

9) Cassie gave birth to a live female infant weighing 3.45kg at 13.45 the following day. The neonate’s APGAR scores were 9 at 1 minute and 10 at 5 minutes. What is the purpose of assessing a neonate’s APGAR score?

A) A neonate’s colour, tone, breathing, and heart rate is assessed at 1 minute and 5 minutes post-delivery. The purpose is to assess the condition of the neonate and to assess the need for resuscitation.

10) Upon arrival to the postnatal ward the midwife taking over her care put her hand on Cassie’s abdomen and looked at her sanitary pad. What was the purpose of examining her abdomen?

A) The midwife would assess the condition of her uterus and how well contracted the uterus was. The sanitary pad would be checked to assess the lochia loss PV, to ensure the woman wasn’t bleeding too much.

BONUS – Prior to discharge back to the community the midwife on the postnatal ward would like to take a full blood count from Cassie. What would be the purpose of taking this blood? Why might this be relevant to Cassie’s previous maternity care and any treatment she may have had?

A) The midwife providing care on the postnatal ward will be wanting to ensure that the process of giving birth hasn’t adversely affected Cassie’s Hb as she was previously given iron supplements after being anaemic. Cassie would probably be advised to continue to take any iron she may have left until the results of the FBC are forwarded to the Community Midwife.