Commonly used approaches to measure perinatal depression in large research studies in LMICs include which of the following?

• a)
  

  Edinburgh Postnatal Depression Scale

  
  
• b)
  

  Patient Health Questionnaire

  
  
• c)
  

  Psychiatrists’ diagnosis

  
  
• d)
  

  General Health Questionnaire

  
  
• e)
  

  Depression Scale for Low Income Women

Risk factors for perinatal depression in low- and middle-income settings include which of the following?

• a)
  

  There are no known risk factors

  
  
• b)
  

  Exposure to intimate partner violence

  
  
• c)
  

  High family income

  
  
• d)
  

  Previous history of depression

  
  
• e)
  

  Poor family relationships

There is research suggesting that the following is/are associated with perinatal depression?

• a)
  

  Infant low birthweight

  
  
• b)
  

  Preterm infant birth

  
  
• c)
  

  Decrease in breastfeeding initiation

  
  
• d)
  

  Child stunting

  
  
• e)
  

  Practices and behaviors compromising child development

The following statement(s) is/are true regarding interventions to reduce perinatal depression?

• a)
  

  Employing non-specialist health workers is considered a feasible strategy to address maternal depression

  
  
• b)
  

  Cognitive behavioral therapy is not effective at reducing maternal depression

  
  
• c)
  

  Health promotion is as effective as psychological intervention

  
  
• d)
  

  Involving other family members is a key a feature of effective interventions

  
  
• e)
  

  Interventions cannot target upstream factors such as empowerment

Regarding global mortality rates related only to labour and delivery which of the following is/are true?

• a)
  

  There are over one million maternal deaths annually

  
  
• b)
  

  The most frequent clinical cause of maternal death is obstetric haemorrhage

  
  
• c)
  

  Annual numbers of maternal deaths increased between 1990 and 2010

  
  
• d)
  

  The most frequent cause of stillbirth is traumatic breech birth

  
  
• e)
  

  In Africa, annual numbers of neonatal deaths increased between 2000 and 2010

Caesarean delivery has the potential to save lives but safety remains an issue. Ways to achieve this include which of the following?

• a)
  

  Reducing the caesarean section rate to about 5% in low-resource settings

  
  
• b)
  

  General rather than spinal anaesthesia is the technique of choice

  
  
• c)
  

  Non-physician providers such as clinical officers or surgical technicians can undertake these procedures

  
  
• d)
  

  Antibiotic prophylaxis must be routinely given at all caesarean sections, irrespective of whether they are emergency and elective procedures

  
  
• e)
  

  Iatrogenic fistula following caesarean section is a random event that may occur even after procedures undertaken by experienced surgeons

Principles of high dependency unit (HDU) care for very sick obstetric patients include which of the following:

• a)
  

  This model of care is appropriate for patients requiring ventilation or inotropic support

  
  
• b)
  

  Newborn babies should not be allowed into the unit

  
  
• c)
  

  Key minimum equipment for an effective HDU include pulse oximetry, a sphygmomanometer, access to oxygen and ability to measure urine output

  
  
• d)
  

  Patient flow should be managed so that discharge from the HDU is to home rather than to a postnatal ward

  
  
• e)
  

  This model of care cannot be feasibly offered in low-resource settings

In best practice resuscitation of term newborns who have a bradycardia or are not breathing normally at birth which of the following is/are true?

• a)
  

  Start positive pressure ventilation using 100% oxygen

  
  
• b)
  

  Give chest compressions using the two-thumb method rather than the two-finger method

  
  
• c)
  

  Give chest compressions at a ratio of 15 compressions to 2 ventilations

  
  
• d)
  

  Use the umbilical vein for giving fluid and medication if needed

  
  
• e)
  

  Discontinue life-saving efforts if there is no detectable heart rate after 10 minutes of resuscitation

In limited resource settings WHO recommendations for prevention of MTCT of HIV include which of the following?

• a)
  

  Maternal treatment with a single dose of nevirapine at the time of labour

  
  
• b)
  

  Caesarean section for all women with HIV/AIDS

  
  
• c)
  

  Initiation of lifelong ART in pregnant and breastfeeding women

  
  
• d)
  

  Avoidance of breastfeeding

  
  
• e)
  

  Neonatal treatment with single dose of nevirapine within 24 hours of birth

Which of the following is/are true statements concerning malaria prevention?

• a)
  

  Insecticide-treated bednets (ITNs) have been associated with a decrease in low birth weight, stillbirth and spontaneous abortion in malaria-endemic countries

  
  
• b)
  

  IPT can suppress or clear existing asymptomatic infections, and provide prophylaxis against new infections (T)

  
  
• c)
  

  IPT should be given once each trimester

  
  
• d)
  

  HIV+ve women taking co-trimoxazole should also receive IPT for malaria prevention

  
  
• e)
  

  Artemisinin-based combination therapies (ACT) should be used in the first trimester for IPT

Which of the following statements is/are true regarding congenital syphilis?

• a)
  

  The risk of congenital syphilis is greatest earlier in gestation

  
  
• b)
  

  Severity of fetal infections is greatest later in gestation

  
  
• c)
  

  Congenital syphilis can be prevented if maternal syphilis is diagnosed before the third trimester and effective treatment given at least 30 days before delivery

  
  
• d)
  

  Congenital syphilis is associated with increased risk of stillbirth and preterm delivery, but does not usually increase risk of long-term sequelae if the baby survives

  
  
• e)
  

  Long term sequelae in the infant/child include deafness, blindness, and seizures

The following is/are true regarding key recommendations made following the Confidential Enquiries into Maternal deaths in South Africa for 2011 to 2013 which noted that Obstetric haemorrhage was the second most common cause of maternal death.

• a)
  

  All women with blood loss in excess of 1000mls need to be immediately assessed by a doctor

  
  
• b)
  

  Foley catheter use for induction of labour should be discouraged as misoprostol is the safer option

  
  
• c)
  

  Training community health workers to educate pregnant women about obstetric haemorrhage and promote transport plans was recommended.

  
  
• d)
  

  Patients following CS and manual removal of placenta require routine monitoring and can be transferred straight to the wards from theatre

  
  
• e)
  

  Misoprostol should be used as second line treatment for uterine atony in preference to, Syntometrine or ergometrine and to be considered for prophylaxis at CS.

Misoprostol is used extensively for prevention and treatment of Post-Partum Haemorrhage. Which of the following statement regarding Misoprostol is/are correct?

• a)
  

  One large trial conducted by WHO showed that oral misoprostol 600mcg was found to be much less effective than oxytocin for prevention of PPH (blood loss >1000ml).

  
  
• b)
  

  There is a statistically significant difference in maternal mortality for misoprostol compared with misoprostol versus placebo or for misoprostol versus other uterotonics

  
  
• c)
  

  Advance distribution of misoprostol to pregnant women with instructions to be taken after birth has been rolled out in many countries as there is robust evidence of its effectiveness.

  
  
• d)
  

  Misoprostol is not the optimum choice in the prevention of PPH but is an effective and cost-saving choice where oxytocin is not or cannot be used due to a lack of skilled birth attendants, inadequate transport and storage facilities or where a quality assured oxytocin product is not available.

  
  
• e)
  

  600mcgs of sublingual Misoprostol in addition to standard injectable uterotonics for the treatment of post-partum haemorrhage is effective and is recommended

Antepartum Haemorrhage occurs due to various causes. With regards to use of strategies to achieve reduction in maternal mortality and morbidity which of the following statements is/are correct?

• a)
  

  Folate supplementation before pregnancy reduces the risk of placental abruption.

  
  
• b)
  

  Placenta praevia occurs in about 10 per 1000 pregnancies.

  
  
• c)
  

  In case of abruption placentae vaginal route of delivery is usually safest, though caesarean may be undertaken at times for fetal distress.

  
  
• d)
  

  During the antenatal period birth planning and complication readiness/emergency preparedness is encouraged.

  
  
• e)
  

  It is important to avoid unnecessary Caesarean sections as they also increase the risk of death from haemorrhage in future pregnancies due to placenta accreta, ruptured uterus or the need for repeat Caesarean section

The three delays model has been used to explain non-proximate causes of maternal deaths. Which of the following is/are included in the three delays?

• a)
  

  Delay in becoming pregnant

  
  
• b)
  

  Delay in identifying pregnant women

  
  
• c)
  

  Delay in recognising severe illness, in the decision of seeking care and receiving care upon arrival at the health facility.

  
  
• d)
  

  Delay in the woman in finding transport and seeking care

  
  
• e)
  

  Delay in presenting at the health care facility when complications appear

Reducing stillbirths has not received much attention in the past and causes has been difficult to establish. Which of the following is/are the main difficulties?

• a)
  

  There is not a universal definition and classification system for stillbirths

  
  
• b)
  

  The burden of stillbirths is not that large and therefore other things are more important

  
  
• c)
  

  Maternal and newborn deaths are a higher priority on the global agenda.

  
  
• d)
  

  Stillbirths are usually not counted in national statistics.

  
  
• e)
  

  For a significant proportion of stillbirths the cause is difficult to establish

Which of the following is/are one of the three main causes of neonatal deaths globally?

• a)
  

  Diarrhoea

  
  
• b)
  

  Malaria

  
  
• c)
  

  Preterm birth

  
  
• d)
  

  Intrapartum related complications Preterm birth, diarrhoea and tetanus

  
  
• e)
  

  Sepsis/meningitis

Which of the following statements is/are true regarding SDGs?

• a)
  

  The SDG’s follow along with MDGs 4 and 5 setting targets of a 75% reduction in MMR globally and a 66% reduction in under five mortality.

  
  
• b)
  

  Under SDG 3, which states that the goal is to “ensure healthy lives and promote wellbeing for all ages”, is the goal to reduce child mortality to no more than 25 per 1000 live births.

  
  
• c)
  

  The SDG’s also include goals to reduce the number of stillbirths

  
  
• d)
  

  The global strategy has set targets for maternal and perinatal wellbeing setting the target that all individual countries have an MMR less than 140/100,000 live births by 2030

  
  
• e)
  

  The global strategy has set targets for maternal and perinatal wellbeing setting the target that all individual countries have a stillbirth rate of no more than 12/1000 live births, by 2030

Which of the following is/are true regarding collection of data?

• a)
  

  Surveys and censuses provide “real time” birth and death data at all levels including local, district and national.

  
  
• b)
  

  Surveys do not generally provide disaggregated data that can address the disparities in populations geographically and ethnically.

  
  
• c)
  

  Surveys do not generally provide disaggregated data that can address the disparities in populations economically.

  
  
• d)
  

  All of the countdown priority countries now have functioning civil registration systems.

  
  
• e)
  

  Death certificates can reliably collect information about maternal deaths as most death certificates ask for information regarding whether or not the woman was pregnant or recently pregnant at the time of death.

Which of these statements is/are true?

• a)
  

  Assessment of “near misses” provide critical information about the quality of care provided at facilities

  
  
• b)
  

  Assessment of “near misses” can be used to improve clinical outcomes.

  
  
• c)
  

  The “near miss” approach, which offers a way to assess the implementation of polices and interventions, is particularly effective where the number of maternal deaths is high.

  
  
• d)
  

  Clinical audits have been proven to result in substantial improvements in the care provided and in clinical outcomes, when applied to maternal death review.

  
  
• e)
  

  Social autopsies, when used to assess maternal and perinatal deaths, examine the process of seeking care and what influences this, including household, community and health system factors.

2030 global targets for ending preventable deaths in women, newborns and stillbirths include which of the following?

• a)
  

  Attaining a global average of maternal mortality ratio of <70 maternal deaths per 100,000 live births

  
  
• b)
  

  Every country attaining a neonatal mortality rate of ≤21 per 1000 live births

  
  
• c)
  

  Eliminating all deaths during pregnancy and childbirths

  
  
• d)
  

  Every country attaining a stillbirth rate of ≤12 per 1000 total births

  
  
• e)
  

  Every country reducing its maternal mortality ratio by at least two thirds from the 2010 baseline, and no country having a rate higher than 140 deaths per 100,000 live births

The leading causes of maternal deaths worldwide in 2015 include which of the following?

• a)
  

  Complications of abortion

  
  
• b)
  

  Post-partum haemorrhage

  
  
• c)
  

  Hypertensive disorders of pregnancy

  
  
• d)
  

  Sepsis

  
  
• e)
  

  Malaria

The top three leading causes of neonatal deaths worldwide in 2015 include which of the following?

• a)
  

  Complications of preterm birth

  
  
• b)
  

  Congenital malformations

  
  
• c)
  

  HIV and syphilis

  
  
• d)
  

  Intrapartum related complications

  
  
• e)
  

  Neonatal sepsis and pneumonia

The following is/are true regarding neonatal deaths and still births

• a)
  

  Complications of preterm birth is the leading cause neonatal deaths.

  
  
• b)
  

  Complications of preterm birth is the leading cause of total under 5 child deaths.

  
  
• c)
  

  Reducing HIV has the greatest effect on infant deaths

  
  
• d)
  

  Reducing syphilis has largest impact on stillbirths

  
  
• e)
  

  Intrapartum related complications are the second leading cause of neonatal death worldwide.

The majority of maternal, stillbirth and newborn deaths occur around the time of labour and the day of birth. Adverse outcomes at this time include which of the following?

• a)
  

  An estimated 43% of all maternal deaths

  
  
• b)
  

  An estimated 50% of stillbirths

  
  
• c)
  

  An estimated 73% of all neonatal deaths

  
  
• d)
  

  Three million stillbirths and newborn deaths

  
  
• e)
  

  Severe maternal and newborn morbidity and disability

Which of the following is/are true regarding severe adverse outcomes?

• a)
  

  Maternal mortality from direct obstetric causes is highest on the first and second days after birth

  
  
• b)
  

  Approximately 1.3 million stillbirths occur during labour

  
  
• c)
  

  In the case of newborns, approximately one third die on their day of birth

  
  
• d)
  

  Approximately three quarters of all neonatal deaths occurring during the first week of life

  
  
• e)
  

  Babies born preterm (<37 weeks) are at the highest risk of mortality

Which of the following is/are true regarding termination of pregnancy?

• a)
  

  Measures to prevent access to abortion, do not prevent women from seeking an abortion

  
  
• b)
  

  Abortion rates are significantly lower in countries with restrictive laws than countries with more liberal laws

  
  
• c)
  

  If access to safe abortion is not available women will turn to less safe options

  
  
• d)
  

  Treatment of complications for unsafe abortion does help to prevent mortality from unsafe abortion

  
  
• e)
  

  Access to safe abortion is the most effective method of preventing recourse to unsafe abortion.

Which of the following is/are also true regarding termination of pregnancy?

• a)
  

  The risk of a woman dying following a legal safe abortion is as low as 0.7 deaths per 100,000 pregnancies

  
  
• b)
  

  The risk of a woman dying following a legal safe abortion is even lower at 0.3 per 100,000 pregnancies for procedures performed at 8 weeks or less.

  
  
• c)
  

  The risk of a woman dying following a legal safe abortion is much lower than the risk of dying from other complications of pregnancy and childbirth

  
  
• d)
  

  The risk for a safely performed abortion does increase with increasing gestation.

  
  
• e)
  

  It has been estimated that there were over approximately 50 million abortions worldwide every year in the period 2010–2014.

The Safe Motherhood concept suffered a late international recognition. When was the first International Safe Motherhood Conference?

• a)
  

  1974

  
  
• b)
  

  1981

  
  
• c)
  

  1987

  
  
• d)
  

  1990

  
  
• e)
  

  1994

The following is/are true in relation to family planning provision?

• a)
  

  A study in India concluded that increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality

  
  
• b)
  

  The reduction in maternal mortality is probably due to a decline in the proportion of births among women with higher risk of maternal death during pregnancy and childbirth.

  
  
• c)
  

  Over one million maternal deaths were averted between 1990 and 2005 because fertility rates in developing countries declined.

  
  
• d)
  

  Countries that had the fastest progress in improving modern contraceptive prevalence rate (MCPR) experienced the greatest declines in high-risk births related to short birth intervals (<24 months) and higher parity births (birth order >3).

  
  
• e)
  

  Countries that had the fastest progress in improving MCPR experienced the greatest declines in high-risk births related to both older maternal age (>35 years) and births among younger women <18 years,