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 questions that follow Case Study 8.1. 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.

Case Study 8.1  Is Mrs X pregnant?

Mrs X is 39 years old and has been married for 15 years. She has one child who was born 10 years ago and she is hoping very much that at last she is pregnant again. Mrs X says she and her husband have not used contraception and she doesn’t think she has had any miscarriages in that time. She hasn’t had her monthly bleeding for the past nine weeks. When you ask her about any changes in her body since her last menstrual period, she says she hasn’t noticed anything, but she has been feeling nauseous when she first gets up in the morning and she is more tired than usual. Mrs X tells you that her first baby was born after a labour of 30 hours and he weighed 4 kilograms. She also remembers that she was given iron tablets to take, but she doesn’t know why.

SAQ 8.1 (tests Learning Outcomes 8.1, 8.2 and 8.4)

  • a.What is wrong with asking Mrs X ‘In your previous pregnancy, did you have pre-eclampsia’?
  • b.How could asking the question in those words damage her trust in you?
  • c.Rewrite this question to avoid causing the problems you identified.


  • a.Someone who is not a health professional is unlikely to know what ‘pre-eclampsia’ means, so she won’t understand the question. She might say ‘no’ because she doesn’t want you to think she is ignorant. You could miss learning vital information about her risk factors if your questions are not accessible.
  • b.She may worry that you will think she is stupid because she doesn’t know this medical term. This may make her uncomfortable about sharing personal information with you.
  • c.We don’t know exactly how you rewrote the question (there are various equally good ways of saying it), but you might have used words like this:

‘In your previous pregnancy, did a health professional ever tell you that your blood pressure was high, or that you had protein in your urine? Did you ever experience bad headaches, nausea or vomiting, and swelling of your feet, hands or face?’

SAQ 8.2 (tests Learning Outcome 8.3)

  • a.What are the possible symptoms of pregnancy in Mrs X’s case study?
  • b.Is there anything in her history that suggests she may not be pregnant?
  • c.How could she find out quickly whether she probably is pregnant?


  • a.Mrs X reports three possible symptoms of pregnancy: amenorrhoea (no period for nine weeks); nausea in the mornings; and abnormal tiredness during the day.
  • b.She has wanted another baby for the past ten years, but despite not using contraception she has not conceived, so she may not be pregnant now.
  • c.The quickest way to find out if she is pregnant would be to go to the nearest health facility, where they could do a pregnancy test on her urine to see if it contains the hormone HCG, which is produced by the embryo and placenta. This test is not conclusive, but it is a probable sign of pregnancy.

SAQ 8.3 (tests Learning Outcome 8.5)

If Mrs X’s pregnancy is confirmed, do any of the features of her history suggest that she should be advised to give birth in a health facility this time? Explain why or why not.


If Mrs X is pregnant, she should be advised to give birth in a health facility this time, because of her age (she is an older mother at 39 years); she had a long first labour (over 24 hours); and her first baby was large (4 kg). All three risk factors make it more likely that she will have difficulties in delivering her second baby.

SAQ 8.4 (tests Learning Outcomes 8.1 and 8.5)

Explain why Mrs X was given iron tablets during her previous pregnancy. Is this a sign that she had a serious risk factor at that time?


Mrs X was given iron tablets during her first pregnancy as a routine precaution against her developing anaemia (shortage of red blood cells). Iron boosts the supply of red blood cells to carry oxygen around her body and that of the growing baby. All pregnant women should ideally be given iron tablets, so this is not a sign of a serious risk factor in Mrs X’s case.

SAQ 8.5 (tests Learning Outcome 8.4)

What questions did you write in your Study Diary when you completed Activity 8.1? Did you take care to use language that women in your community can understand?


We can’t predict exactly what questions you wrote in your Study Diary, or what words you used, so your questions could be a bit different from ours (below), and still be equally good. The important point is that the language you used should be understandable by the women in your community. You should ask questions such as the following:

  • When was your last monthly bleeding? Have you missed a month yet?
  • Have your breasts got any larger recently, or do they feel tender?
  • Have you felt sick, especially in the mornings when you wake up?
  • Have you felt unusually tired or sleepy during the day?
  • Have you needed to pee (pass water) more than usual?
  • Have you felt any light movements in your belly?
  • Has your belly got any bigger lately?

Summary of Study Session 8