Scientific Schedule

Note: Schedule subject to change without notice.

ALARM COURSE DAY 1

TIME SESSION CONTENT

07:30-07:55 Continental Breakfast

08:00-08:10 Welcome and Course  Course organization

Description

08:10-08:25 Introduction

08:25-09:00 Management of Labour  Definitions of labour and dystocia

 Reducing dystocia

 Analgesia

09:00-09:40 Induction of Labour  Indications

 Methods

09:40-10:00 Health Break

10:00-11:15 Workshop: Management of Labour

11:15-12:00 Fetal Well Being During  Asphyxia and Cerebral Palsy
Labour
 Methods of fetal surveillance (IA and
EFM)

 Non-reassuring surveillance

 Management

12:00-12:40 Lunch

12:40-13:00 Management of an Imminent Birth "Optional"

13:00-14:20 Workshop - Fetal Health Surveillance

14:20-14:50 Assisted Vaginal  Vacuum

Delivery
 Forceps

14:50-15:05 Health Break

15:05-16:20 Workshop - Assisted Vaginal Delivery

16:20-16:35 Twins

16:35-16:50 VBAC

16:50-17:00 Questions

ALARM COURSE DAY 2

TIME SESSION CONTENT

07:30-07:55 Continental Breakfast

07:55-08:00 Welcome / Housekeeping

08:00-08:15 Shoulder Dystocia

08:15-08:45 Breech Presentation and  ECV

Delivery
 Recommendations for delivery

08:45-09:05 Postpartum  Prevention

Haemorrhage
 Management

09:05-10:25 Workshops  Breech, Pudendal Block

 Shoulder Dystocia, Postpartum

Haemorrhage

10:25-10:40 Health Break

10:40-11:10 Hypertensive Disorders  Definitions

of Pregnancy
 Diagnosis

 Management

11:10-11:40 Preterm Labour and  Diagnosis

Preterm Birth
 Management

11:40-11:55 PROM  Term

 Preterm
 11:55-12:05 Group B Streptococcus  Screening

 Intrapartum management

12:05-12:25 Antepartum  Abruption

Haemorrhage
 Previa

12:25-13:00 Lunch with Faculty Members

13:00-14:20 Workshop – Case based discussion

14:20-14:45 Question Period in Plenary Room

14:45-17:00 Evaluation for Written Exam and Skills Assessment Stations

Registrants

Overview of the Exam Process

The ALARM Course offers a comprehensive examination of knowledge and skills about
intrapartum care. Successful completion of this examination is necessary to receive the
certificate of completion. The examination takes all of the last afternoon of the course for the
candidates (and longer for the faculty!) It consists of:

 A written examination with 100 multiple choice questions, is limited to a maximum of

2 hours.

 A two-station skills test with simulation of clinical situations. Each takes nine
minutes. Allowing for movement between stations, this test takes 20 minutes.

Standards for the Exam

An ALARM certificate will be awarded only to those who attend the course in its entirety and
who pass both the written examination and each of the OSCE stations. A score of 70% is
required to pass the written examination and each OSCE station. Candidates who are not
successful on one or more component of the examination will receive a certificate of
attendance (for credits) but will not receive an ALARM certificate.

NOTE: RNs are evaluated in the same manner as physicians, midwives and residents.
Expectations for passing, however, will be consistent with the RN’s scope of practice.
Please select the correct answer

1) Which of the following statements about immediate postpartum hemorrhage is correct?

a) The most common cause is retained tissue.
b) Hysterectomy is never required.
c) Coagulation problems are commonly encountered.
d) Pregnant women compensate well for blood loss.
e) Postpartum hemorrhage is a rare cause of maternal morbidity and mortality.
2) Which of the following statements regarding placenta previa is true:
a) The incidence is approximately 3% at term.
b) When assessing APH, a digital examination should not be done until placenta previa has
been ruled out.
c) Bleeding is usually accompanied by pain.
d) The fetal heart is often abnormal or absent.
e) Malpresentation is less common than in abruptio placenta.
3) Which of the following statements about vacuum delivery is correct?
a) It can be used when a rim of cervix is left.
b) A skilled operator is a pre-requisite for vacuum delivery.
c) In contrast to forceps, the fetal head does not have to be engaged.
d) Emptying the bladder before a vacuum delivery predisposes to urinary tract infection
and should be discouraged.
e) Vacuum delivery should not be done without first inserting a pudendal block.
4) Which of the following may indicate scar rupture in a trial of labour?
a) Sudden elevation of the presenting part.
b) Scar pain.
c) Atypical / abnormal FHR patterns and/or cessation of contractions.
d) Ease of palpation of fetal parts.
e) All of the above.
5) Which of the following laboratory investigations are recommended in the initial work-up
of a woman presenting with gestational hypertension and proteinuria?
a) AST, ALT, LDH, platelets and a 24 hour urine collection for protein.
b) Serum ammonia, electrolytes, albumin and hemoglobin.
c) Serum bilirubin, amylase and blood glucose.
d) Electrolytes, serum magnesium and calcium levels.
e) None of the above.
6) Which of the following statements regarding pre-labour rupture of membranes (PROM) is
correct?
a) The latent period is the interval between the rupture of the membranes and delivery.
b) The incidence of preterm PROM is more frequent than term PROM.
c) Abruptio placenta is a major cause of PROM.
d) Sterile speculum examination assists with the diagnosis.
 e) Digital exam assists with the diagnosis.
7) ECV is ideally carried out at 37 wks because:
a) The fetus is easier to turn at that gestational age.
b) The woman is likely to go into labour immediately after an ECV.
c) Spontaneous return to breech after version is less likely.
d) The risk of emergency c-section is high.
e) Cord prolapse is likely in frank breech.
8) Which of the following situations is an indication for induction of labour?
a) Primigravida, 40 +6 wks - cervix long and closed.
b) Primigravida, 40 wks, uterine height 39 cm, estimated fetal weight 4 kg, cervix 2 cm,
effacement 50%.
c) Multigravida, 37 wks, uterine height 34cm, oligohydramnios, estimated fetal weight on
ultrasound 2.2 kg, cervix long and closed.
d) Multigravida, 36 wks, insulin-dependent diabetes, uterine height 39 cm, estimated fetal
weight on ultrasound 3.9kg.
e) Placenta previa with fetal demise.
9) What criteria must be satisfied in order to establish the diagnosis of gestational
hypertension with proteinuria?
a) Any blood pressure with diastolic ≥90, sustained over 4 hours with urine protein
≥300mg on 24 hour urine collection.
b) A sustained rise in maternal BP of ≥30/15 over patient’s known pre-pregnant or early
pregnancy BP , with ≥2+ protein.
c) BP ≥140/85, with urine protein ≥2+ on dipstick or ≥300 mg on 24 hour urine collection.
d) Pre-existing high blood pressure with a rise of 50 systolic.
e) Pre-existing high blood pressure with a postpartum decrease of 50 systolic.
10) You have done a fetal scalp pH because of atypical / abnormal fetal heart monitoring.
What value would require a repeat fetal scalp pH sampling at 30 minutes?
a) pH = 7.38.
b) pH = 7.12.
c) pH = 7.18.
d) pH = 7.23.
e) pH = 7.00.
11) Which of the following is a contraindication to tocolysis:
a) Gestational hypertension with proteinuria with a mature fetus.
b) Breech presentation.
c) Lack of operative delivery capability.
d) PROM ≤32 wks.
e) Fetal macrosomia.
12) Which of the following manoeuvers should not be performed with a vacuum?
a) Traction.
b) Extension.
 c) Rotation.
d) Flexion.
e) Deflexion.
13) Which of the following are indications for Group B Strep chemoprophylaxis?
a) Preterm labour in patients with unknown Group B Streptococcus status.
b) Documented Group B Streptococcus bacteriuria in this pregnancy.
c) Previous Group B Streptococcus affected infant.
d) All of the above.
e) None of the above.
14) Which of the following is an absolute contraindication to a planned VBAC?
a) Two previous LSCS (Low segment c-section).
b) Previous C/S for suspected CPD, large baby in this pregnancy.
c) Twins in this pregnancy.
d) Inverted “T” incision in uterus.
e) Gestational hypertension with proteinuria.
15) Which criteria must be satisfied in order to link cerebral palsy to intrapartum asphyxia?
a) Late decelerations and meconium in the amniotic fluid.
b) pH < 7.00 and base deficit ≥ 12 mmol/L, neonatal encephalopathy, cerebral palsy of the
spastic quadriplegic or dyskinetic type, exclusion of other etiologies.
c) Abnormal FH patterns, with depressed neonatal response requiring vigorous
resuscitation.
d) Documented opinion of the pediatrician who attended the baby.
e) All of the above.
16) In the active management of the third stage of labour, which of the following statements
about prevention of postpartum hemorrhage is correct?
a) No intervention has been shown to be effective.
b) Giving oxytocin with the anterior shoulder increases the incidence of retained placenta.
c) Oxytocin must be given IV.
d) Delivering the placenta quickly is the priority.
e) Prophylactic oxytocin should be offered at all deliveries.
17) In the initial management of the patient with significant antepartum hemorrhage the
following statement is most accurate:
a) Large bore IV access is recommended.
b) Initial lab work usually is for x-match only.
c) Oxygen administration is of no benefit.
d) D5W is used initially in resuscitation.
e) Fetal well-being assessment is not a priority.
18) Which of the following is not an indication for induction of labour?
a) Severe IUGR.
b) Intrauterine fetal demise in a previous pregnancy.
 c) Suspected fetal macrosomia with previous large baby.
d) Alloimmune disease at or near term.
e) Pregnancy at 41+ wks gestation.
19) Antenatal steroid administration has been shown to reduce the incidence of RDS. Which
of the following statements is true regarding antenatal steroids?
a) The usual gestational age limits are 22 to 32 wks.
b) PROM at 28 wks is a contraindication to its use.
c) Not required for women using oral prednisone for other reasons.
d) One of the preferred agents is Betamethasone 12 mg IM q24h x 2.
e) Antenatal steroids increase the incidence of perinatal infection.
20) Which of the following is a contraindication to an ECV:
a) Any contraindication to labour itself.
b) Footling breech presentation.
c) Anterior placenta.
d) Polyhydramnios.
e) All of the above.
21) A primigravida at 36 wks gestation whose BP is 150/95, with 3+ urine protein, is
admitted to hospital. Over the next 24 hours, her BP remains 150/95, she complains of a
headache and spots in front of her eyes and her reflexes are 3+. What is the recommended
treatment?
a) IV MgSO4, symptomatic treatment for headache (e.g.: Tylenol), bed rest in a darkened
room.
b) IV MgSO4 , antihypertensive therapy, strict bed rest.
c) IV MgSO4, betamethasone IM X 2 doses.
d) IV MgSO4, induction of labour.
e) Stat C/S.
22) Which of the following is not a part of the risk management process?
a) Risk assessment.
b) Actions to manage the risk.
c) Avoiding disclosure to the patient.
d) Evaluation of the risk management activities.
e) Risk identification.
23) Which of the following statements about the management of labour with a previous low
transverse uterine scar is true?
a) IV access is required.
b) Oxytocin agents must be avoided.
c) Epidurals should be avoided because they might mask the symptoms of scar rupture.
d) Continuous EFM is recommended.
e) The only reliable sign of uterine rupture is pain.
24) Evidence based practice recommends that induction of labour with an unfavorable cervix
is best achieved by:
 a) “Stripping” or “sweeping” the membranes.
b) Oxytocin alone.
c) Intracervical foley or vaginal PGE2 followed by oxytocin.
d) ARM, followed by oxytocin.
e) All of the above.
25) The indication for assisted vaginal delivery may include all of the following except:
a) Severe maternal cardiac decompensation.
b) Atypical / abnormal fetal heart rate pattern.
c) 1 hour of pushing in a multipara with an epidural.
d) Failure of descent despite maximal maternal effort.
e) Second stage length greater than 3 hours.
26) An anxious 29 year-old nullipara at 40 +3 wks has been having “labour pains” for 8
hours. She presents at 2400 hours and is found to be 2 cms dilated with the cervix 2 cm long
at station -1. Which of the following is the most appropriate?
a) Reassurance and discharge home.
b) Analgesia and oxytocin augmentation.
c) Analgesia, ARM and oxytocin augmentation.
d) Comfort measures and admission to labour ward and start partogram.
e) Admission to labour ward and offer epidural analgesia.
27) The woman, in the preceding question, 6 hours later is found to be 4 cm dilated with
cervix 0.5 cm long at station -1. Which of the following is the correct diagnosis and good
plan of action?
a) Dystocia, advise section.
b) Dystocia, ARM and oxytocin.
c) Active labour, consider starting partogram.
d) Latent phase labour, send home.
e) Active labour, encourage bed rest.
28) Which of the following statements regarding diagnostic procedures in the assessment of
significant antepartum hemorrhage is true?
a) A gentle pelvic examination is not recommended to check for cervical dilation unless
placental localization is known.
b) Ultrasound should show a retroplacental clot in the case of placental abruption.
c) Electronic fetal monitoring is only important if abruptio placenta is suspected.
d) A careful history and physical examination will reveal the etiology of most antepartum
hemorrhages.
e) Speculum exam is contraindicated.
29) Which of the following statements regarding preterm labour is true?
a) The incidence is approximately 15%.
b) Morbidity and mortality of infants born between 34-36 wks gestation is higher than
those at term.
c) Newer approaches to management have decreased the rate of preterm delivery.
 d) Long-term neonatal sequelae do not include CNS complications and cerebral palsy.
e) The diagnosis is easily made at the first assessment.
30) Which of the following statements regarding the use of oxytocin for augmentation of
labour is most accurate?
a) The cervix must be favorable before oxytocin is commenced.
b) A dosage of between 8-12 mu/min is usually insufficient to produce effective uterine
contractions.
c) The ADH effect of oxytocin is a significant problem at low doses.
d) EFM is recommended when oxytocin is used.
e) An ARM must be done before oxytocin is used.
31) What is the safe maximum pressure when using vacuum extraction?
a) 200-300 mmHg (0.27-0.41 kg/cm2).
b) 400 mmHg (0.54kg/cm2).
c) 600 mmHg (0.82kg/cm2).
d) 800 mmHg (1.08kg/cm2).
e) 1000mm Hg (1.30kg/cm2).
32) If Group B Strep (GBS) status is unknown in a patient in labour, which of the following
is an indication for intrapartum chemoprophylaxis?
a) ROM < 6 hours.
b) Maternal temperature of 37.5 C.
c) ROM > 18 hours.
d) GBS positive in a previous pregnancy.
e) None of the above.
33) Antenatal maternal steroids are indicated in the management of PROM in which one of
the following situations:
a) Chorioamnionitis.
b) Pregnancies between viability and 32 wks.
c) Limited to singleton pregnancies under 32 wks.
d) Only when tocolytics are being used.
e) Only when ultrasound confirms the absence of amniotic fluid.
34) Which antihypertensive agent should not be used in pregnancy:
a) Hydralazine.
b) ACE inhibitors.
c) Calcium channel blockers.
d) Beta - blocking agents.
e) Methlydopa.
35) Informed consent should include all of the following except:
a) Nature of treatment.
b) Benefits, risks and side effects of the treatment.
c) Evidence obtained from at least one randomized controlled trial.
 d) Alternative courses of action.
e) Likely consequences of not having the treatment.
36) The strongest evidence comes from which of the following study designs?
a) Non-randomized trial.
b) Prospective randomized trial.
c) Cohort study.
d) Retrospective case-control study.
e) Qualitative study.
37) Which of the following positions of twins is most common at term?
a) Breech/Breech.
b) Breech/Cephalic.
c) Cephalic/Breech.
d) Cephalic/Cephalic.
e) Cephalic/Transverse.
38) A woman has just experienced a pregnancy loss at 12 wks gestation. As her caregiver,
you have just come to her room and found her teary and distressed. An important
consideration for you would be to:
a) Let her know that it was an early loss and she will get over it quickly.
b) Refer to her loss as tissue or products of conception.
c) Inform her that grief is normal and offer support.
d) Suggest she try to become pregnant soon, as it will help her forget this loss.
e) Suggest she returns to work as soon as possible.
39) Which of the following is a risk factor for cord prolapse?
a) Oligohydramnios.
b) Face presentation.
c) 2 vessel cord.
d) Pre-eclampsia.
e) Multiple gestation.
40) Brachial plexus injury may result from all of the following except:
a) Excessive traction used during manoeuvers.
b) Prenatal causes.
c) Failure to do an episiotomy.
d) Maternal/uterine forces.
e) Excessive twisting used at delivery.