SCFHS Midwifery Complete Review Guide 2026–2027

4. Anaemia in pregnancy: haemoglobin below 11 g/dL. WHO recommends 30–60 mg elemental iron daily with folic acid 400 micrograms.
5. Booking tests: ABO and RhD group with antibody screen, haemoglobin, HBsAg, syphilis, HIV and urine for asymptomatic bacteriuria (treated with antibiotics).
6. Anti-D: routine prophylaxis at 28 weeks for RhD-negative women, then within 72 hours of birth if the baby is RhD-positive or after any sensitising event. The Kleihauer–Betke test quantifies fetomaternal haemorrhage to adjust the dose.
7. First-trimester combined screening for Down syndrome uses nuchal translucency (NT), β-hCG and PAPP-A. Diagnostic tests are chorionic villus sampling (CVS) and amniocentesis. The detailed anomaly scan is at 18–22 weeks.
8. Tdap vaccine in every pregnancy (ideally 27–36 weeks) protects the newborn from pertussis. Group B streptococcus (GBS) carriers receive IV penicillin in labour.
9. Hypertension is 140/90 or more; severe is 160/110 or more. Pre-eclampsia is new hypertension after 20 weeks with proteinuria (protein:creatinine ratio 30 mg/mmol or more) or organ dysfunction. Eclampsia is seizures in pre-eclampsia with no other cause.
10. Low-dose aspirin (75–150 mg daily) from 12 weeks until birth for women with a high-risk factor: chronic hypertension, previous pre-eclampsia, diabetes, renal disease or autoimmune disease.
11. First-line oral antihypertensive in pregnancy is labetalol; alternatives are nifedipine and methyldopa. Delivery is the definitive treatment of pre-eclampsia.
12. Magnesium sulfate: 4 g IV loading over 5–20 minutes then a maintenance infusion. Monitor patellar reflex, respiratory rate (below 12/min means stop) and urine output. Antidote: calcium gluconate 10%, 10 mL IV.
13. HELLP syndrome: haemolysis, elevated liver enzymes, low platelets. Right upper quadrant or epigastric pain in pre-eclampsia suggests liver involvement. Postnatal BP often peaks on days 3–6.
14. GDM test: 75 g OGTT at 24–28 weeks. WHO 2013 criteria: fasting 5.1–6.9, 1 hour 10.0 or more, 2 hours 8.5–11.0 mmol/L. First-line management is diet and exercise, then metformin or insulin.
15. Fetal effects of diabetes: macrosomia, shoulder dystocia, polyhydramnios and neonatal hypoglycaemia. Women with GDM are tested 6–13 weeks postpartum. Women with pre-existing diabetes take folic acid 5 mg.
16. Antepartum haemorrhage (APH) is vaginal bleeding after 24 weeks. Placenta praevia: painless, bright red. Abruption: pain and a woody uterus; risks include hypertension, trauma and smoking; complications include DIC and Couvelaire uterus. No digital vaginal examination until praevia is excluded.
17. Preterm birth is before 37 completed weeks. Betamethasone 12 mg IM twice 24 hours apart; magnesium sulfate before 30–32 weeks for neuroprotection. Preterm prelabour rupture of membranes (PPROM) is treated with erythromycin. Chorioamnionitis signs: maternal fever, fetal tachycardia and uterine tenderness.
18. Ectopic pregnancy: amenorrhoea, abdominal pain and vaginal bleeding; the commonest site is the ampulla of the fallopian tube. Methotrexate suits stable, unruptured cases. Molar pregnancy: very high hCG, uterus large for dates and a snowstorm scan.
19. Small for gestational age (SGA): estimated weight below the 10th centile. Absent end-diastolic flow in the umbilical artery means severe placental insufficiency. Post-term is beyond 42 weeks; induction is offered at 41+0 to 42+0 weeks.
20. Obstetric cholestasis: itching of palms and soles without rash with raised bile acids. Breech at 36 weeks: offer external cephalic version (ECV) if no contraindication; a transverse lie at term in labour needs caesarean. Rubella causes congenital cataract, deafness and heart defects.

Common mistakes in this chapter

• ✕ Post-term means beyond 42 completed weeks, while induction is offered from 41+0 to 42+0 weeks; do not mix the two figures.
• ✕ Pre-eclampsia appears after 20 weeks; chronic hypertension predates pregnancy or appears before 20 weeks; gestational hypertension has no proteinuria or organ dysfunction.
• ✕ The first sign of magnesium toxicity is loss of the patellar reflex, then respiratory rate below 12/min; stop the infusion then, without waiting for respiratory arrest.
• ✕ ACE inhibitors are contraindicated in pregnancy; labetalol, nifedipine and methyldopa are acceptable, with labetalol the usual first-line oral choice.
• ✕ Anti-D is for non-sensitised RhD-negative women, within 72 hours of a sensitising event or birth; it does not help a woman who already has anti-D antibodies.
• ✕ Praevia bleeds painlessly; abruption bleeds with pain and a woody uterus, and the bleeding may be concealed so the mother looks worse than the visible loss suggests.
• ✕ Steroids are for fetal lung maturity; magnesium sulfate before very preterm birth (under 30–32 weeks) is for fetal neuroprotection, not to stop labour.
• ✕ Shoulder-tip pain with suspected ectopic pregnancy means blood irritating the diaphragm (intraperitoneal bleeding), a dangerous sign, not a shoulder problem.