Self-Assessment Questions (SAQs) for Study Session 2

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the following 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 2.1 (tests Learning Outcome 2.2)

Imagine that you are called to the home of a young woman. She is in labour. What do you immediately do?

Answer

You need to immediately undertake a rapid evaluation to decide whether there is any reason to refer the young woman for emergency care by:

  • Checking the fetal heartbeat (is it within the normal range of 120-160 beats/minute);
  • Checking her vital signs: blood pressure, pulse and temperature, to see if they are within the normal ranges (see Section 2.1.1)
  • Looking to see if there any signs of bleeding or leaking of amniotic fluid
  • Asking her (or someone with her) if she has a headache/blurred vision, difficulty breathing, convulsions, severe abdominal pain

If there are signs of fetal distress (heart rate outside the normal range), or any of the vital signs are outside the normal range, or if any of the danger symptoms are present, you should refer her immediately.

SAQ 2.2 (tests Learning Outcome 2.5)

You are using abdominal palpation as part of your physical assessment of labour for a mother in your care. Fill in the empty boxes in Table 2.1 below.

Table 2.1  Leopold’s manoeuvres.

Name of palpationArea of the abdomen to be palpated What you are checking
Fundal palpation
Hands placed flat on either side of the middle of the abdomen; first one and then the other pushes inwards
Facing the feet, with hands on the lower part of her abdomen, press inwards with your fingers just above her pubic bone
Whether the fetal head has engaged in the cervix - if you can only grip it with two finger — width above the mother’s pubic bone, the head is engaged

Answer

Table 2.1  Leopold’s manoeuvres completed.

Name of palpationArea of the abdomen to be palpatedWhat you are checking
Fundal palpationWith hands near the top of the mother’s abdomen, press your fingers around the fundus of the uterusFetal lie – whether it is lying longitudinally (normal), obliquely or transversely
Lateral palpationHands placed flat on either side of the middle of the abdomen; first one and then the other pushes inwards An initial diagnosis of how the baby is lying and whether it is ‘head down’ or breech
Deep pelvic palpationFacing the mother’s feet, with hands on the lower part of her abdomen, press inwards with your fingers just above her pubic bone Confirmation of whether the presentation is cephalic (head down) or breech (bottom down)
Pawlick’s gripFingers grip the fetal head just above the mother’s pubic boneWhether the fetal head has engaged in the cervix – if you can only grip it with two finger-widths above the mother’s pubic bone the head is engaged

SAQ 2.3 (tests Learning Outcomes 2.3 and 2.4)

Makeda has come to your Health Post. You have done your initial rapid assessment, and there is no need for instant referral. You are now taking her history. How do you go about doing this and what information do you need to check with her?

Answer

(a)  To take Makeda’s history you will need to make her feel comfortable talking to you. You do this by following the principles of woman-friendly care in how you put your questions, and by listening carefully, answering her questions and keeping what she tells you private (look again at Box 2.1 for all the details of woman-friendly care).

(b)  Information that you need from Makeda:

  • Her name, age, height, address, religion (if she is willing to tell you) and occupation (if she is employed).
  • What is her ‘presenting symptom’ (e.g. labour pains, feelings of bearing down?)
  • Whether she has had previous pregnancies and births (how many and whether there were any complications).
  • When was the first day of her last normal menstrual period?
  • Whether she has noticed any danger symptoms (e.g. vaginal bleeding, headache, abnormal vaginal discharge).

SAQ 2.4 (tests Learning Outcomes 2.6 and 2.7)

You now have Makeda’s history and are carrying out a physical examination. What do you do first and what are you looking for?

Answer

Before starting the vaginal examination remember to follow the principles of woman-friendly care and reassure Makeda about her privacy. Then wash your hands thoroughly and put on new surgical gloves. During the examination you check:

  • The extent of cervical dilation
  • The size of Makeda’s pelvis and the adequacy of the passage for the fetus
  • The extent of any moulding (overlapping) of the fetal skull bones because of pressure from the birth canal
  • Any abnormal, foul smelling discharge, any scarring, or swelling (all of these are warning signs and if you detect any refer Makeda to a health facility).

SAQ 2.5 (tests Learning Outcome 2.1)

Which of the following statements is false? In each case, say what is incorrect.

  • a.A temperature of 39°C indicates a high grade fever.
  • b.The gestational age is how old the mother is when she becomes pregnant.
  • c.Parity is the number of babies delivered alive after 28 weeks of gestation.
  • d.Gravidity is the total number of previous pregnancies regardless of the outcome.
  • e.The three points to look out for when inspecting a women’s abdomen in labour are size, shape and scars.
  • f.Fundal palpation is the drum-like beat you sometimes hear when listening to the baby’s heart with a fetoscope.
  • g.Breech presentation indicates potential complications during delivery.
  • h.Ausculation is the sound mothers in labour sometimes make.

Answer

  • a.A is True.  A high grade fever is a temperature above 38.5ºC (low grade fever is between 37.5-38.4ºC.
  • b.B is false.  The gestational age is the number of weeks the fetus has been in the uteral calculated from the date when the women’s last normal menstrual period (LNMP) began.
  • c.C is false.  Parity is the number of babies delivered either alive or dead after 28 weeks of gestation.
  • d.D is true.  Gravidity is the total number of previous pregnancies regardless of the outcome.
  • e.E is true.  An abdominal scar indicates the possibility of scarring of the uterus which increases the risk of uterine rupture.
  • f.F is false.  Fundal palpation means palpating the dome-shaped upper part of the uterus called the fundus to check the position of the fetal head.
  • g.G is false.  Breech presentation is when the buttocks are the presenting part indicating potential difficulties at delivery and the need for referral.
  • h.H is false.  Auscultation is listening to sounds inside the abdomen.

Summary of Study Session 2