Midwife Prometric exam questions with answers

1. Question 1Pre-pregnancy, Preconception & Family Planningmedium

   A 30-year-old woman with type 1 diabetes attends for preconception advice. According to NICE guidance, what HbA1c should she aim for before conceiving, if achievable without problematic hypoglycaemia?

   1. ABelow 58 mmol/mol (7.5%)
   2. BBelow 48 mmol/mol (6.5%)
   3. CBelow 64 mmol/mol (8.0%)
   4. DBelow 42 mmol/mol (6.0%)
   Show answer and explanation▾

   Answer: B. Below 48 mmol/mol (6.5%)

   NICE advises women with diabetes planning pregnancy to aim for an HbA1c below 48 mmol/mol (6.5%) if this can be achieved safely, because good periconceptional control reduces the risk of miscarriage and congenital anomalies. A stricter target of 42 mmol/mol is not recommended because it increases the risk of severe hypoglycaemia. Pregnancy is strongly advised against when HbA1c is above 86 mmol/mol (10%).

2. Question 2Pre-pregnancy, Preconception & Family Planningmedium

   A 25-year-old woman requests emergency contraception 4 days (96 hours) after a single episode of unprotected intercourse. She has no contraindications to any method. Which option is most effective?

   1. ALevonorgestrel 1.5 mg orally
   2. BUlipristal acetate 30 mg orally
   3. CCombined oral contraceptive regimen
   4. DCopper intrauterine device
   Show answer and explanation▾

   Answer: D. Copper intrauterine device

   The copper IUD is the most effective emergency contraception and can be inserted up to 5 days after intercourse, with a failure rate well below 1%. Ulipristal is licensed up to 120 hours and is the most effective oral option, but it is less effective than the copper IUD. Levonorgestrel is licensed only up to 72 hours.

3. Question 3Pre-pregnancy, Preconception & Family Planningeasy

   A woman who is exclusively breastfeeding requests hormonal contraception at 3 weeks postpartum. Which method is most suitable to start now?

   1. AProgestogen-only pill
   2. BCombined oral contraceptive pill
   3. CCombined contraceptive vaginal ring
   4. DCombined transdermal patch
   Show answer and explanation▾

   Answer: A. Progestogen-only pill

   Progestogen-only methods can be started at any time after birth and do not affect breastfeeding. Combined hormonal methods are not recommended in breastfeeding women under 6 weeks postpartum because of the raised venous thromboembolism risk in the puerperium and possible effects on milk supply.

4. Question 4Antenatal Care & Pregnancy (Low and High Risk)hard

   A woman has a 75 g oral glucose tolerance test at 26 weeks. Fasting plasma glucose is 5.8 mmol/L and the 2-hour value is 7.2 mmol/L. Using NICE criteria, how should this be interpreted?

   1. ANormal, because the 2-hour value is below 7.8 mmol/L
   2. BImpaired fasting glucose only, requiring a repeat test at 32 weeks
   3. CGestational diabetes, because the fasting value is 5.6 mmol/L or above
   4. DGestational diabetes only if a repeat fasting value is also raised
   Show answer and explanation▾

   Answer: C. Gestational diabetes, because the fasting value is 5.6 mmol/L or above

   NICE diagnoses gestational diabetes if fasting plasma glucose is 5.6 mmol/L or above, or the 2-hour value is 7.8 mmol/L or above; either value alone is sufficient. The tempting error is to treat the normal 2-hour value as reassuring, but a single abnormal fasting value meets the diagnostic threshold.

5. Question 5Antenatal Care & Pregnancy (Low and High Risk)medium

   A woman at 32 weeks' gestation reports that her baby has moved less than usual since yesterday. What is the most appropriate first step?

   1. AAdvise her to lie on her left side and count kicks for two hours at home
   2. BBook a growth ultrasound scan within the next two weeks
   3. CAuscultate the fetal heart with a handheld Doppler, then perform a CTG
   4. DReassure her that movements normally reduce in the third trimester
   Show answer and explanation▾

   Answer: C. Auscultate the fetal heart with a handheld Doppler, then perform a CTG

   Reduced fetal movements require prompt assessment: the fetal heart is first confirmed with a handheld Doppler, followed by CTG to assess wellbeing, with further investigation depending on risk factors. Asking her to count kicks at home delays assessment, and fetal movements do not normally decrease in late pregnancy, so reassurance alone is unsafe.

6. Question 6Antenatal Care & Pregnancy (Low and High Risk)hard

   A woman with chronic kidney disease books at 9 weeks. She is at high risk of pre-eclampsia. Which advice about aspirin is in line with NICE guidance?

   1. ATake aspirin 75-150 mg daily from 12 weeks until the birth
   2. BTake aspirin 300 mg daily from 20 weeks until 36 weeks
   3. CTake aspirin 75 mg daily only if proteinuria develops
   4. DTake aspirin 75-150 mg daily from booking until 28 weeks
   Show answer and explanation▾

   Answer: A. Take aspirin 75-150 mg daily from 12 weeks until the birth

   NICE recommends aspirin 75-150 mg daily from 12 weeks until birth for women with one high-risk factor, such as chronic kidney disease, chronic hypertension, autoimmune disease, diabetes or previous hypertensive disease in pregnancy. Starting late at 20 weeks or stopping at 28 weeks reduces the protective benefit, and waiting for proteinuria means pre-eclampsia may already be established.

7. Question 7Labour, Delivery & Obstetric Emergencies (Intrapartum)medium

   Shortly after spontaneous rupture of membranes at 8 cm dilatation, a loop of umbilical cord is felt in the vagina and the fetal heart rate falls to 90 bpm. While help is summoned, what should the midwife do?

   1. AReplace the cord into the uterus and ask the woman to push
   2. BApply firm traction to the cord to assess its pulsation
   3. CEncourage the woman to walk to help the head descend
   4. DElevate the presenting part and adopt the knee-chest position
   Show answer and explanation▾

   Answer: D. Elevate the presenting part and adopt the knee-chest position

   Cord prolapse is managed by relieving compression: manually elevating the presenting part and using knee-chest or exaggerated left lateral position with head down, while arranging the quickest safe birth. Attempting to replace the cord or handling it excessively causes vasospasm and worsens fetal hypoxia. Walking increases pressure on the cord.

8. Question 8Labour, Delivery & Obstetric Emergencies (Intrapartum)hard

   At 39 weeks a woman in early labour has artificial rupture of membranes. Immediately afterwards there is fresh painless vaginal bleeding and the fetal heart drops to a sustained bradycardia, while the mother's pulse and blood pressure are normal. Which diagnosis is most likely?

   1. APlacental abruption
   2. BRuptured vasa praevia
   3. CUterine rupture
   4. DPlacenta praevia
   Show answer and explanation▾

   Answer: B. Ruptured vasa praevia

   Vasa praevia involves unprotected fetal vessels crossing the membranes near the cervix; rupture at amniotomy causes fetal haemorrhage with rapid fetal bradycardia while the mother remains stable, and requires immediate delivery. Abruption usually causes painful, tense uterus and maternal signs, and placenta praevia causes maternal bleeding before labour rather than acute fetal compromise after amniotomy.

9. Question 9Labour, Delivery & Obstetric Emergencies (Intrapartum)medium

   A woman on an oxytocin infusion for induction has 6 contractions in 10 minutes and the CTG shows new late decelerations. What is the most appropriate immediate action?

   1. AStop the oxytocin infusion and request an obstetric review
   2. BIncrease the oxytocin rate to complete the first stage quickly
   3. CHalve the oxytocin rate and repeat the CTG review in one hour
   4. DContinue the infusion and perform fetal blood sampling first
   Show answer and explanation▾

   Answer: A. Stop the oxytocin infusion and request an obstetric review

   More than 5 contractions in 10 minutes is uterine tachysystole, which reduces placental perfusion; combined with late decelerations, oxytocin must be stopped and urgent review arranged, with tocolysis considered. Halving the rate may be acceptable for tachysystole with a normal CTG, but with a pathological trace it delays correcting the cause.

10. Question 10Postpartum & Newborn Careeasy

    A term baby is noted to be visibly jaundiced at 18 hours of age. What is the most appropriate action?

    1. AReassure the parents that this is physiological jaundice
    2. BAdvise more frequent feeds and review at day 3
    3. CMeasure the serum bilirubin urgently, within 2 hours
    4. DPlace the baby by a window for indirect sunlight
    Show answer and explanation▾

    Answer: C. Measure the serum bilirubin urgently, within 2 hours

    Jaundice appearing in the first 24 hours of life is always considered pathological, often from haemolysis, and NICE advises measuring serum bilirubin urgently within 2 hours. Physiological jaundice typically appears after 24 hours, so reassurance at 18 hours is unsafe. Sunlight exposure is not an accepted treatment.

11. Question 11Postpartum & Newborn Caremedium

    On day 5 after birth, a woman with no psychiatric history is restless, sleeping very little, confused and says she hears voices telling her the baby is evil. What is the most appropriate action?

    1. AExplain that baby blues are common and review her at the 6-week postnatal check
    2. BArrange same-day psychiatric assessment and do not leave her alone with the baby
    3. CRefer her for routine community counselling within the next month
    4. DAdvise rest, offer a sleep aid and arrange a midwife review in 48 hours
    Show answer and explanation▾

    Answer: B. Arrange same-day psychiatric assessment and do not leave her alone with the baby

    Rapid-onset confusion, hallucinations and delusions in the early puerperium suggest postpartum psychosis, a psychiatric emergency with risk to mother and baby that needs same-day specialist assessment. Baby blues cause tearfulness and low mood around days 3-5 but no psychotic features, so reassurance would miss a dangerous condition.

12. Question 12Gynecology & Women's Healtheasy

    A 24-year-old woman has irregular cycles every 45-60 days and acne. Using the Rotterdam criteria, how many of the three criteria are needed to diagnose polycystic ovary syndrome after excluding other causes?

    1. AOne of three
    2. BAll three
    3. CTwo, one of which must be ultrasound findings
    4. DTwo of three
    Show answer and explanation▾

    Answer: D. Two of three

    The Rotterdam criteria require any two of oligo- or anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology, after excluding other causes such as thyroid disease or hyperprolactinaemia. Ultrasound is not mandatory: irregular cycles plus hyperandrogenism are enough for diagnosis.

13. Question 13Pharmacology in Midwiferymedium

    A woman with severe pre-eclampsia receiving intravenous magnesium sulphate has absent patellar reflexes and a respiratory rate of 10/min. After stopping the infusion, which drug should be given?

    1. ANaloxone 400 micrograms intravenously
    2. BSodium bicarbonate 8.4% 50 mL intravenously
    3. CPotassium chloride 20 mmol intravenously
    4. DCalcium gluconate 10% 10 mL intravenously
    Show answer and explanation▾

    Answer: D. Calcium gluconate 10% 10 mL intravenously

    Loss of tendon reflexes and respiratory depression indicate magnesium toxicity; the infusion is stopped and 10 mL of 10% calcium gluconate is given slowly IV as the antidote, with respiratory support. Naloxone reverses opioids, which is a tempting choice for respiratory depression, but it has no effect on magnesium-induced neuromuscular blockade.

14. Question 14Pharmacology in Midwiferyhard

    A woman with severe pre-eclampsia and well-controlled asthma has an atonic postpartum haemorrhage that continues despite an oxytocin infusion and uterine massage. Which uterotonic is most appropriate next?

    1. AMisoprostol
    2. BErgometrine
    3. CCarboprost
    4. DOxytocin by additional rapid bolus
    Show answer and explanation▾

    Answer: A. Misoprostol

    Ergometrine causes vasoconstriction and is contraindicated in hypertension and pre-eclampsia, and carboprost, a prostaglandin F2-alpha analogue, can cause bronchospasm and should be avoided in asthma, leaving misoprostol as the appropriate uterotonic. Repeated rapid oxytocin boluses can cause hypotension and add little once an infusion is running. Tranexamic acid should also be given, but it is not a uterotonic.

15. Question 15Professionalism, Ethics, Patient Safety, Counselling & Educationeasy

    A woman who speaks little of the local language attends for her booking appointment with her husband, who offers to interpret. What is the most appropriate approach?

    1. ALet the husband interpret as he knows her history best
    2. BUse a professional interpreter in person or by telephone
    3. CUse translation software on a personal phone for the whole visit
    4. DPostpone booking until she brings an adult relative
    Show answer and explanation▾

    Answer: B. Use a professional interpreter in person or by telephone

    A trained professional interpreter protects accuracy and confidentiality and allows the woman to disclose sensitive information, including domestic abuse, which is routinely asked at booking. Family members may filter information or be the source of coercion. Postponing booking delays essential antenatal screening.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.