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Intrapartum Fetal Monitoring MCQs (NICE Guidelines)

Total questions: 10

Worksheet time: 5mins

Name
Class
Date
1.

A 31-year-old G1P0 at 40 weeks' gestation is in active labor. Her cervical exam is 5 cm. The CTG shows a baseline heart rate of 165 bpm, moderate variability (15 bpm), and no decelerations. Accelerations are present. According to the NICE guidelines, how should this CTG be classified?

a)

Normal

b)

Suspicious

c)

Pathological

d)

Abnormal

e)

Indeterminate

2.

A 28-year-old at 39 weeks' gestation has a CTG displaying a baseline of 140 bpm and variability of <5 bpm that has persisted for 45 minutes. No decelerations are noted. What is the correct classification for this specific feature of variability?

a)

Stable

b)

Non-reassuring

c)

Abnormal

d)

Normal

e)

Sinusoidal

3.

A G2P1 at 41 weeks' gestation is undergoing oxytocin augmentation. The CTG shows a baseline of 150 bpm, variability of 10 bpm, and late decelerations occurring with over 50% of contractions for the last 35 minutes. What is the most appropriate immediate management step?

a)

Perform immediate Cesarean delivery

b)

Discontinue the oxytocin infusion

c)

Perform fetal blood sampling (FBS)

d)

Increase maternal IV fluid rate

e)

Apply a fetal scalp electrode

4.

A resident is reviewing the CTG of a patient at 33 weeks' gestation with suspected placental abruption. The CTG is pathological with recurrent late decelerations and reduced variability. Which of the following is an absolute contraindication to performing fetal blood sampling in this patient?

a)

Maternal BMI >35

b)

Gestation less than 34 weeks

c)

Previous Cesarean section

d)

Cervical dilatation of 3 cm

e)

Maternal pyrexia

5.

Fetal blood sampling is performed for a pathological CTG in a woman at 39 weeks' gestation. The result shows a scalp blood lactate of 4.5 mmol/L. According to NICE, what is the most appropriate next step?

a)

Perform an immediate Cesarean delivery

b)

Repeat the FBS in 30–60 minutes

c)

Inform the patient that the result is normal

d)

Perform fetal scalp stimulation

e)

Discontinue all monitoring

6.

A CTG demonstrates variable decelerations. Which of the following characteristics would lead to these decelerations being classified as having "concerns" according to the NICE criteria?

a)

Duration of 30 seconds

b)

Reduced variability within the deceleration

c)

Rapid return to the baseline heart rate

d)

Presence of 'shoulders' (accelerations before and after)

e)

Uniform V-shaped appearance

7.

During the second stage of labor, a patient's CTG becomes pathological with a prolonged deceleration lasting 4 minutes. The fetal head is at station +2, and the mother is fully dilated. What is the most appropriate management?

a)

Perform fetal blood sampling

b)

Proceed with immediate operative vaginal delivery

c)

Perform an emergency Cesarean section

d)

Ask the mother to stop pushing and reassess

e)

Wait for 5 more minutes to see if the heart rate recovers

8.

A CTG shows a smooth, sine-wave-like undulating pattern with a frequency of 3–5 cycles per minute and an amplitude of 10 bpm, persisting for over 25 minutes. How should this be categorized according to NICE?

a)

Normal

b)

Suspicious

c)

Pathological

d)

Benign

e)

Early Deceleration

9.

Which physiological mechanism is primarily responsible for the development of late decelerations in the presence of uteroplacental insufficiency?

a)

Vagal stimulation via fetal head compression

b)

Baroreceptor response to umbilical cord occlusion

c)

Chemoreceptor response to fetal hypoxemia

d)

Direct myocardial depression from severe acidemia

e)

Increased intracranial pressure causing a Cushing reflex

10.

A woman at 40 weeks' gestation has a suspicious CTG with a baseline of 165 bpm. There are 6 contractions in 10 minutes. What is the most appropriate first-line action?

a)

Perform a Cesarean section

b)

Reduce or stop oxytocin and reassess

c)

Administer IV oxytocin bolus

d)

Start an IV infusion of magnesium sulfate

e)

Perform fetal blood sampling