Self-Assessment Questions (SAQs) for Study Session 13
Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.
SAQ 13.1 (tests Learning Outcomes 13.1, 13.2 and 13.4)
Which of the following statements is false? In each case, explain what is incorrect.
A Focused antenatal care focuses on the pregnant woman alone.
B Women in the basic component receive only 4 FANC visits, unless warning signs or symptoms are detected at any stage.
C Pregnant women do not need to prepare any equipment for labour and delivery.
D The birth plan in FANC is essentially the same for every woman and she is told about it at the fourth visit.
E Prophylaxis in FANC focuses on prevention of sexually transmitted infections, including mother to child transmission of HIV, malaria, nutritional deficiencies, anaemia and tetanus.
Answer
A is false. Focused antenatal care does not focus on the pregnant woman alone (this used to happen in the traditional approach). FANC includes the woman’s partner and if possible the whole family in caring for her during pregnancy, watching for danger symptoms, and preparing for the birth, complication readiness and emergency planning.
B is true. Women in the basic component receive only 4 FANC visits, unless warning signs or symptoms are detected at any stage.
C is false. A pregnant woman should prepare for labour and delivery by assembling very clean cloths, a new razor blade, very clean new string, soap and a scrubbing brush, clean water for washing and drinking, buckets and bowls, supplies for making drinks, and a flashlight.
D is false. The birth plan in FANC is individualised for every woman and her partner and respects her wishes and preferences. It is discussed at the third visit and revised if necessary at the fourth visit.
E is true. Prophylaxis in FANC focuses on prevention of sexually transmitted infections, including mother to child transmission of HIV, malaria, nutritional deficiencies, anaemia, urinary tract infections and tetanus.
SAQ 13.2 (tests Learning Outcomes 13.3 and 13.5)
Suppose a 27-year-old pregnant woman called Aster comes to see you. She tells you that this is her first pregnancy and the last time she saw her menstrual period was 25 weeks ago. What actions do you take during this first visit? When would you normally see her for the next visit?
Answer
As Aster is already 25 weeks pregnant, you should cover all the services of the first and the second FANC visits. Give close attention to investigating her medical and obstetric history and do a complete physical examination, including blood pressure, pulse, temperature, respiration rate, abdominal examination to measure fundal height, listen to the fetal heart beat, check for presentation and lie of the fetus, and check the results of urine tests. The purpose is to determine Aster’s eligibility to follow the basic component of FANC. Also advise her on nutrition, hygiene and rest.
If she is healthy and the pregnancy appears to be progressing normally, tell her that the next visit should be at 30-32 weeks of pregnancy - but she must seek help at once if she experiences any of the danger symptoms such as bleeding or foul smelling discharge from her vagina, fever, blurred vision, or feeling dizzy and confused.
SAQ 13.3 (tests Learning Outcomes 13.3 and 13.5)
Suppose Aster comes to you at 32 weeks of her pregnancy. You discover that her blood pressure is 120/60 mmHg, she has mildly pale conjunctiva and the fundal height is measured as the 38 week size. What do these signs suggest and what actions would you take?
Answer
Pale conjunctiva suggests that Aster may be anaemic, so ask her about her nutrition - what does she eat and how much food does she get each day? Perform a multiple dipstick test on a sample of her urine to see if it contains excess sugar or protein. If her urine test is normal, counsel her on improving her nutrition and provide her with iron and folate tablets.
As the fundal height is much more than you would normally expect at 32 weeks, it may indicate twins or a pathological condition and Aster should be referred for evaluation at a higher level of care. Therefore you should write a referral note and advise her to go to the nearest health centre or hospital. She may need help in arranging transportation or money for the trip. Advise her about birth preparedness, complication readiness and emergency planning.
Summary of Study Session 13