CEMONC KNOWLEDGE QUESTIONNAIRE

INSTRUCTIONS: True and False Questionnaire

1. Up to 50% of neonatal deaths occur during the first 24 hours after birth.

2. All instruments used in a delivery should be decontaminated with 0.5% chlorine for 30
minutes.

3. Good interpersonal and communication skills assist in developing the woman’s

confidence in the provider.

4. Birth preparedness and complication readiness includes information on danger signs in

pregnancy and labour.

5. The presenting signs and symptoms of pre- eclampsia include convulsions, diastolic
blood pressure of 90 mm Hg or more after 20 weeks gestation and proteinuria of 2+ or
more.

6. One of the indications of Caesarean Section is repaired Vesico Vaginal Fistula

7. The best fluid to manage primary PPH is Colloids

8. The management of pre-eclampsia should include sedatives and tranquilizers.

9. Cervical dilation plotted to the right of the alert line on the partograph indicates
unsatisfactory progress of labour.

10. Continuous supportive care from a caring health provider or a relative improves birth
outcomes.

11. Active Management of the Third Stage of Labour should only be conducted on women
who have a history of postpartum haemorrhage.

12. The uterotonic drug of choice for Active Management of The Third Stage of Labour is
ergometrine 0.5mg.

13. Vaginal bleeding in excess of 500 mL after birth is defined as postpartum haemorrhage

14. Quick check and rapid initial assessment should be carried out on all pregnant women
presenting in labor room.

15. The immediate management of ectopic pregnancy involves observing the woman for
signs of improvement.

16. Lower abdominal pain and uterine tenderness, together with foul-smelling lochia, are
characteristic of puerperal sepsis.
17. Perinatal death is often regarded as an indicator of poor quality of obstetric care.

18. The three main causes of newborn mortality in Tanzania are birth asphyxia, prematurity
and infection.

19. Haemorrhage, eclampsia or obstructed labour are examples of indirect causes of

maternal deaths.

20 Maintaining privacy and confidentiality is not necessary in the labour ward.

21 Crystalloid fluids contains similar concentration of sodium in plasma.

22 Indicators of bad behavioral include good care for the client.

23 Identification of the provider to assist birth is one component of Individualized birth

plan

24 The treatment of puerperal sepsis should include a combination of oral broad spectrum
antibiotics.

25 Ringers Lactate is an example of Colloid solution.

26 .Detention in a facility is one category of non-respective maternity care.

27 Checking the woman’s Temperature before blood transfusion is mandatory.

28 Abortion is defined as termination of pregnancy before 28 weeks of gestation.

29 Obstetric haemorrhage is leading indirect cause of maternal mortality.

30 The partogram is defined as a graph used in labour to monitor the parameters of

progress of labour, maternal and foetal wellbeing, and drugs/treatment given during
labour.

31 .Management of PPH due to uterine atony is to pack the uterus with the sterile gauze
in order to control bleeding.

32 .Coagulopathy due to abruption placenta is an indication for transfusing Fresh Frozen

Plasma (FFP).

33 While performing manual removal of placenta you should hold the umbilical cord
firmly with examining hand.

34 The anaesthetic technique of choice during C/S due to cord propapse is spinal
anaesthesia .

35 When performing laparotomy for ruptured Ectopic pregnancy evidence shows that
there is no need to inspect the contralateral fallopian tube and ovary.
36 If a woman is admitted during the active phase of labor, cervical dilatation is plotted
on the partograph on the alert line.

37 Regarding management of ruptured Ectopic pregnancy you should give 3 Units of

blood transfusion before surgery.

38 If a woman is hypersensitive to Sulphur she should be given Amodiaquine for

IPTp.

39 Vertical sub umbilical incision is a preferred incision when performing laparotomy for
ruptured Ectopic pregnancy.

40 In preparing woman for possible Postpartum Hysterectomy shaving the woman pubic
hair is necessary.

41 Before draining a pelvic abscess post Subtotal Hysterectomy a combination of I.V

Antibiotics should be given.

42 During Subtotal abdominal Hysterectomy due to ruptured uterus immediately ligate

round ligament, fallopian tubes and ovarian ligaments before ligating the Uterine
Arteries.

43 Clearing the airway before beginning resuscitation of the newborn involves suctioning
the nose and then the mouth.

44 Keeping the dressing on the wound for the first three days after caesarean section Is
recommended as a good post operative care.

45 Bleeding during Caesarean Section caused by lateral extension of the uterine Incision
can be controlled by uterine compression sutures.

46 When performing caesarean section in a deeply engaged fetus ,an assistant may be
needed to push the baby from below.

47 Dextrose 5% should be administered to a woman with prolonged obstructed labour

and hypoglycaemia.

48 When giving blood transfusion to a woman with severe primary PPH Intravenous
Frusemide 40mg should be given 30 mins before.

49 The loading dose of magnesium sulfate is given by IV over 20 minutes, followed by

deep IM injection to each buttock.

50 Labour is considered normal when it begins spontaneously at term (38 – 42 weeks),

the fetus is presenting by vertex and it is spontaneously completed within 12 hours
with no complications to mother or baby.
CEmONC POST-KNOWLEDGE ASSESSMENT

INSTRUCTIONS: Circle the MOST CORRECT response from the following question

1.Considering newborn deaths the following is TRUE;

a) About 75% of newborn deaths occur during the first two weeks of life
b) Up to 50% of neonatal deaths occur during the first 24 hours after birth.
c) Congenital anomalies contribute about ¼ of all newborn deaths
d) Newborn deaths are related to the quality of obstetric care

1. When processing used equipment in a CEmONC facility the following are TRUE
EXCEPT;
a) Sterilization can be achieved by hot air oven
b) Plastic materials can be sterilized by chemicals
c) Wrapped sterilized packs can be stored up to 7 days
d) All instruments used in a delivery should be decontaminated with 0.5% chlorine for
30 minutes.

2. Considering good interpersonal communication skills, the following is NOT TRUE;

a) The source of the message needs to be clear
b) They assist in developing the woman’s confidence to the provider
c) Use of closed questions encourages promotion of the skills
d) Use of encouragers improve the communication

3. The following should be discussed when preparing a birth preparedness plan;

a) The name of the care giver during delivery
b) Identifying potential blood donors
c) Discussing on danger signs in pregnancy and labour
d) The need for the couple to screen against Hepatitis B

4. Considering hypertensive disorders in Pregnancy, all of the following are TRUE

EXCEPT;
a) The presenting signs of pre- eclampsia include convulsions, diastolic blood pressure
of 90 mm Hg or more after 20 weeks gestation and proteinuria of 2+ or more
b) Hyperreflexia indicates poor prognosis
c) Injectable Hydralazine is indicated when the diastolic BP of more than 110mmHg
d) When the woman is at term, Bishop’s score should be done

6. The following is among indications of Caesarian section;

a) Previous repaired VVF
b) Maternal distress
c) Foetal distress in the second stage of labour
d) Premature labour

7. In hydration and rehydration in obstetrics, the following is True;

a) Crystalloids are among the best fluids to a woman with obstructed labour
b) The best fluids to manage primary PPH are Colloids
c) IV R/L should be given to a woman with severe anaemia and hypotension
d) About 30% of human body is made up of water
8. When managing a woman with pre-eclampsia the following is NOT TRUE;
a) Bed rest alone may be enough in mild-moderate cases
b) In some women with mild to moderate conditions hospitalization may not be needed
c) The management of pre-eclampsia should include sedatives and tranquilizers
d) Methyl dopa is the first line antihypertensive drug of choice

9. When monitoring the progress of labour using the partograph;

a) Cervical dilation plotted to the right of the alert line on the partograph indicates
unsatisfactory progress of labour
b) The rate of cervical dilatation during the latent phase of labour is 1cm/hr
c) In neglected obstructed labour the cervical plotting will be on the left side of the
action line
d) The latent phase usually lasts for 4 hours

10. The following improve birth outcome EXCEPT;

a) Continuous supportive care from a caring health provider
b) Competency and professionalism of the health care provider
c) Use of provider centered care in service provision
d) Flexibility and respect during service provision

11. When managing the third stage of labour, all are TRUE EXCEPT;
a) Active Management of the Third Stage of Labour (AMTSL) should only be
conducted on women who have a history of postpartum haemorrhage.
b) Counter traction during cord traction is needed to prevent uterine prolapse
c) Misoprostol is contraindicated to be used for AMTSL in severely anaemic women
d) Injection Ergometrine is contraindicated to be used for AMTSL in eclamptic women

12. When conducting AMTSL, the following is TRUE;

a) The uterotonic drug of choice for AMTSL is injection Ergometrine 0.5mg
b) Injection Oxytocin should be given after delivery of the anterior shoulder
c) Injection ergometrine is contraindicated in a woman previous uterine scar
d) Uterine massage is one of its components

13. When considering Obstetrical haemorrhages;

a) Abruptio placenta is an important cause of early Obstetric haemorrhages
b) Vaginal bleeding in excess of 500 mL after birth is defined as postpartum
Haemorrhage
c) Incomplete abortion is not among its causes
d) Worldwide they are responsible for about 10% of all maternal deaths

14. When admitting a woman in the labour room;

a) Quick check and rapid initial assessment should be carried out on all women.
b) There is no need to give the woman as much information and explanation as she
desires
c) Restriction of food and fluids during labour should be emphasized
d) Prim gravidas should routinely be given IV infusion

15. When managing a woman with ectopic pregnancy, the following is TRUE;
a) Ultra-sonographic diagnosis is a must
b) The immediate management involves observing the woman for signs of improvement.
c) Initial haemoglobin levels may not be very useful in determining the amount during
acute blood loss
d) The anaesthetic technique of choice is spinal anaesthesia

16. In puerperal sepsis the following is NOT TRUE;

a) Lower abdominal pain and uterine tenderness, together with foul-smelling lochia, are
characteristic features
b) Early rupture of membranes is one of its predisposing factor
c) Tachycardia is one of its presenting sign
d) Observing asepsis is one of its predisposing factor

17. In measuring the quality of obstetric care the following is TRUE;

a) Perinatal death is often regarded as an indicator of poor quality of obstetric care
b) The accepted case fatality rate in Obstetric complications is about 5%
c) The accepted Caesarean section rate is 20%
d) The higher the post-operative sepsis the poor the quality of care

18. The following is the LEAST important cause of newborn mortality in Tanzania;
a) Birth asphyxia
b) Congenital anomalies
c) Complications of prematurity
d) Infections

19. The following are examples of direct causes of maternal mortality EXCEPT;
a) Severe anaemia in Pregnancy
b) Obstetric haemorrhages
c) Eclampsia
d) Obstructed labour

20. In Johari windows the following is NOT TRUE;

a) Open window is when the behavior is known by self and others
b) Blind window in Johari windows is when the behavior is known by self but not
known by others
c) Unknown window is when the behavior is not known by self and others
d) Hidden window is when the behavior is known self and not known by others

21. In administration of fluids in Obstetrics the following is NOT TRUE

a) Crystalloid fluids contains similar concentration of sodium in plasma----True
b) Colloids tend to pass from the intra-vascular compartment to the extra vascular
compartment
c) Colloid solutions are composed of a suspension of particles that are larger than
Crystalloids
d) In order to restore circulating blood volume, infuse Crystalloids in a volume at least
three times the volume of lost blood

22. When assisting birth in shoulder dystocia the following is NOT TRUE
a) An assistant should be present to assist the birth by doing fundal pressure.
b) Majority of the women are delivered by McRoberts Manoeuvre
 c) Rubin Cork screw manoeuvre is one of vaginal approach techniques
d) Mazzanti manoeuvre is one of abdominal approach techniques

23. The following is NOT an indication of post-partum hysterectomy;

a) Abnormal implantation of the placenta with heavy PV bleeding
b) Two previous C/S with transverse lie is an indication of post-partum hysterectomy
c) Posterior uterine rupture
d) Uterine atony with persistent PV bleeding

24. When managing puerperal pyrexia the following is FALSE

a) The treatment of puerperal sepsis should include a combination of oral broad
spectrum antibiotics
b) Breast engorgement may one of its cause
c) Chronic pelvic pain may be one of its late complications
d) Presence of generalized peritonitis requires urgent laparotomy

25. The following is not an indication of upper classical uterine incision during C/S;
a) Pregnancy with Carcinoma of the cervix
b) PROM with premature labour may be may be an indication of upper Classical
incision during Caesarian section
c) Large fibroids in the lower uterine segment
d) Inaccessible lower segment due to adhesions

26. The following is NOT a category of non Respective Maternity Care;

a) Abandonment or denial of care
b) Detention in a facility
c) Physical abuse
c) Consented care

27. Considering indications of blood of transfusion in obstetrics the following is NOT

TRUE;
a) Haemoglobin of 6.5g/dl at any gestation is an indication of Blood transfusion
b) Acute blood loss with circulatory failure regardless of Hb level
c) Anaemia with Congestive Cardiac Failure
d) Chronic anaemia with Hb less than 5g/dl regardless of the gestation age

28. When managing incomplete abortion with an MVA;

a) MVA can be used to evacuate the uterus in incomplete abortion up to 14
weeks…False
b) MVA should not be used in cases of septic abortion
c) Post procedure the client need not to be counseled on family planning
d) In cases of septic abortion evacuation should be done 24 hours after initiating
antibiotics

29. The indications of Vacuum extraction include all of the following EXCEPT;
a) Uterine atony
b) Eclampsia in second stage of labour
c) Heart diseases in the second stage of labour
 d) Acute asthmatic attack in the 2nd stage of labour

30. One of the following statements defines a partograph

A. A graph used to monitor fetal heart rate during labour
B. A graph used to plot descent of fetal head
C. A graph used to chart dilatation of the cervix
D. A graph used in labour to monitor the parameters of progress of labour, maternal
and foetal wellbeing, and drugs/treatment given during labour

30. Evidence shows that all of the following interventions are used to combat Postpartum
haemorrhage except
A. Using oxytocin as one of the components of active management of third stage of
labour
B. Packing the uterus with sterile gauze in order to control bleeding
C. Aortic compression
D. Internal bimanual compression of the uterus

31. In abruption Placentae:

A. Coagulopathy is an indication for transfusing Fresh Frozen Plasma (FFP)
B. The abdomen feels very soft
C. Fetal parts are easily palpable
D. If bleeding is concealed the patient has good prognosis

32. While performing manual removal of placenta all are true except
A. You should hold the umbilical cord firmly with examining hand
B. Infection prevention should be practiced
C. The patient should be sedated by using Diazepam 10mg intravenously
D. Antibiotics are given after the procedure

33. One of the following is not indicated in the management of cord prolapse
A. The anaesthetic technique of choice during C/S due to cord propapse is spinal
anaesthesia
B. Vacuum extraction is indicated if the woman is in the second stage and the cord is
pulsating
C. If the fetus is dead there is no need of section doing caesarean
D. Immediate caesarean section is indicated if the cervix is not fully dilated

34. Regarding laparotomy for ruptured ectopic pregnancy one of the statements below is
not true:
A. General Anesthesia should always be used
B. Evidence shows that there is no need to inspect the contralateral fallopian tube and
ovary
C. Sub umbilical mid line incision is the incision of choice
D. There is no advantage of inserting an abdominal drain after the procedure

35. If a woman is admitted during the active phase of labor,

A. Fetal heart rate should be auscultated after every two hours
B. There is no need of palpating the contractions since they can be predicted by the
woman’s cries
C. She should be catheterized as a routine
 D. Cervical dilatation is plotted on the partograph on the alert line

36. All are true regarding management of ruptured Ectopic pregnancy except
A. The patient should be resuscitated to correct shock before being taken to theatre
B. You should give 3 Units of blood transfusion before surgery
C. The patient should be informed of her condition and what is going to be done
D. On entering the abdominal cavity the bleeding tube should immediately be
identified and ligated

37. Which statement is not true?

A. SP is still used for IPTp
B. There is no need of IPTp if a patient is using Cotrimoxazole prophylaxis for
pneumocystis carina pneumonia
C. If a woman is hypersensitive to Sulphur she should be given Amodiaquine for
IPTp
D. IPTp is initiated after the first trimester

38. One of the following is a preferred incision when performing laparotomy for ruptured
Ectopic pregnancy
A. Pfannenstiel incision
B. Joel Cohen incision
C. Grid iron incision
D. Vertical Sub umbilical mid line incision

39. In preparing a woman for possible Postpartum Hysterectomy all of the following are
true except
A. Her consent for the procedure should be sought
B. Shaving the woman pubic hair is necessary
C. Blood should be drawn for Hb, grouping and cross matching

40. IV line and urethral catheter should be inserted in preparing woman for possible
Postpartum Hysterectomy the following is not true:

A: shaving the woman pubic hair is necessary

B: Prophylaxis is used only for patients who are not already on antibiotics
C Ensure blood is available
D: None of the above

41. Pelvic abscess post Subtotal Hysterectomy the following is not applicable:

A: Giving IV Antibiotics is not necessary.

B: Colpotomy (drainage through vagina vault) is treatment of choice.
C: Abscess developing under the abdominal closure, open and drain the wound do not
remove fascia sutures
D: A and B

42. Regarding Subtotal abdominal Hysterectomy, the following statement is true:

 A: Anybody performing C/S should be prepared for the potential need to perform
this procedure as an emergency
B: Uterine atony with persistent bleeding and uterine rupture are common indications
C: Abnormal implantation of the placenta with hemorrhages is not an indication.
D: A and B

43. In Neonatal Resuscitation the following statements. Are true

A Clear the mouth then the nose with a clean suction device.
B Suctioning the nose first may cause gasping and inhaling of secretions.
C Insert the suction tube 1 to 2 cm into each nostril and apply suction while
withdrawing the tube.
D: All of the above

44. Choose correct statement:

A .Keeping the dressing on the wound for the first three days after caesarean section Is
recommended as a good post-operative care.
Ensure hemostasis throughout the caesarian section procedure in order reduce the risk of
wound infection and keep blood loss to a minimum.
C. In presence of wound infection keep the sutures until 10th post-operative day
D. None of the above

45. The following are causes of bleeding during Caesarean Section.

A. Lateral extension of the uterine Incision.

B .Uterine atony
C. disseminated intravascular coagulation
D. All of the above

46. When performing caesarean section the following is not true

A. in a deeply engaged fetus ,an assistant may be needed to push the baby from
below
B. Umbilical cord prolapse is common maternal indication for caesarian section.
C. Sub umbilical median incision is recommended
D. A, B, & C.

47. The following statement is/are false regarding Fluid therapy

A: Dextrose 5% should not be administered to a woman with prolonged
obstructed labor and hypoglycemia
Composition of crystalloids is similar to plasma
C. Thrombophlebitis is not a complication of fluid therapy
D.All of the above

48. The following is true regarding Blood transfusion

 A Woman with severe primary PPH Intravenous Frusemide 40mg should be given 30
min before
Severe anaemia at term is an indication for Blood transfusion
C. Hepatitis is transmissible through Blood transfusion
D. B and C

49 Regarding the loading dose of magnesium sulfate, the following statement is TRUE’
A .Given by IV slowly, followed by deep IM injection to each buttock
B. concentration of Mgso4 given deep IM is 20%
C.1 ml of 2% lignocaine is added to10 mls syringe for IV injection.
D. Total loading dose Of MgSO4 is 10 gms

50 The following are characteristic of normal labour EXCEPT

A. When it begins spontaneously at term (38 – 42 weeks),
B. The fetus is presenting by vertex and it is spontaneously completed
Within 12 hours.
C .Induction of labor due postdates successfully achieved within 8 hours
D No complications to mother or baby.