Self-Assessment Questions (SAQs) for Study Session 8

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 8.1 (tests Learning Outcomes 8.1, 8.2 and 8.4)

Which of the following definitions are true and which are false? Write down the correct definition for any which you think are false.

A  Fundus — the ‘rounded top’ and widest cavity of the uterus.

B  Complete breech — where the legs are bent at both hips and knee joints and are folded underneath the baby.

C  Frank breech — where the breech is so difficult to treat that you have to be very frank and open with the mother about the difficulties she will face in the birth.

D  Footling breech — when one or both legs are extended so that the baby presents ‘foot first’.

E  Hypoxia — the baby gets too much oxygen.

F  Multiple pregnancy — when a mother has had many babies previously.

G  Monozygotic twins — develop from a single fertilised ovum (the zygote). They can be different sexes but they share the same placenta.

H  Dizygotic twins — develop from two zygotes. They have separate placentas, and can be of the same sex or different sexes.


A is true.  The fundus is the ‘rounded top’ and widest cavity of the uterus.

B is true.  Complete breech is where the legs are bent at both hips and knee joints and are folded underneath the baby.

C is false. A frank breech is the most common type of breech presentation and is when the baby’s legs point straight upwards (see Figure 8.4).

D is true.   A footling breech is when one or both legs are extended so that the baby presents ‘foot first’.

E is false.  Hypoxia is when the baby is deprived of oxygen and risks permanent brain damage or death.

F is false.  Multiple pregnancy is when there is more than one fetus in the uterus.

G is false.  Monozygotic twins develop from a single fertilised ovum (the zygote), and they are always the same sex, as well as sharing the same placenta.

H is true.  Dizygotic twins develop from two zygotes, have separate placentas, and can be of the same or different sexes.

SAQ 8.2 (tests Learning Outcomes 8.1 and 8.2)

What are the main differences between normal and abnormal fetal presentations? Use the correct medical terms in bold in your explanation.


In a normal presentation, the vertex (the highest part of the fetal head) arrives first at the mother’s pelvic brim, with the occiput (the back of the baby’s skull) pointing towards the front of the mother’s pelvis (the pubic symphysis).

Abnormal presentations are when there is either a vertex malposition (the occiput of the fetal skull points towards the mother’s back instead towards of the pubic symphysis), or a malpresentation (when anything other than the vertex is presenting): e.g. breech presentation (buttocks first); face presentation (face first); brow presentation (forehead first); and shoulder presentation (transverse fetal).

SAQ 8.3 (tests Learning Outcomes 8.3 and 8.5)

  • a.List the common complications of malpresentations or malposition of the fetus at full term.
  • b.What action should you take if you identify that the fetus is presenting abnormally and labour has not yet begun?
  • c.What should you not attempt to do?


  • a.The common complications of malpresentation or malposition of the fetus at full term include: premature rupture of membranes, premature labour, prolonged/obstructed labour; ruptured uterus; postpartum haemorrhage; fetal and maternal distress which may lead to death.
  • b.You should refer the mother to a higher health facility – she may need emergency obstetric care.
  • c.You should not attempt to turn the baby by hand. This should only be attempted by a specially trained doctor or midwife and should only be done at a health facility.

SAQ 8.4 (tests Learning Outcomes 8.4 and 8.5)

A pregnant woman moves into your village who is already at 37 weeks gestation. You haven’t seen her before. She tells you that she gave birth to twins three years ago and wants to know if she is having twins again this time.

  • a.How would you check this?
  • b.If you diagnose twins, what would you do to reduce the risks during labour and delivery?


  • a.How to check if this pregnancy is twins:
    • Is the uterus larger than expected for the period of gestation?
    • What is its shape – is it round (indicative of twins) or heart-shaped (as in a singleton pregnancy)?
    • Can you feel more than one head?
    • Can you hear two fetal heartbeats (two people listening at the same time) with at least 10 beats difference?
    • If there is access to a higher health facility, and you are still not sure, try and get the woman to it for an ultrasound scan.
  • b.How do you reduce the risks during delivery of twins:
    • Be extra careful to check that the mother is not anaemic.
    • Encourage her to rest and put her feet up to reduce the risk of increased blood pressure or swelling in her legs and feet.
    • Be alert to the increased risk of pre-eclampsia.
    • Expect her to go into labour before term, and be ready to get her to the health facility before she goes into labour, going with her if at all possible.
    • Get in early touch with that health facility to warn them to expect a referral from you.
    • Make sure that transport is ready to take her to a health facility when needed.

Summary of Study Session 8